Risky Sexual Behaviors as Correlates of Depression and Suicidal Ideation Among Male HIV Test-Seekers at a Voluntary Counseling and Testing Facility in Taiwan

Risky sexual behavior and self-rated mental health among young adults in Skåne, Sweden - a cross-sectional study

BACKGROUND

Risky sexual behavior is a public health challenge that significantly affects young people's health and well-being in Sweden and throughout the world. Moreover, poor mental health, anxiety and depression among adolescents and young adults have increased in recent years. However, although hypothesized, the associations between general mental health and risky sexual behavior among young adults are less established. Thus, this study aimed to examine the association between self-rated mental health and risky sexual behavior among young adults in southern Sweden.

METHODS

Population-based, cross-sectional survey data from 2968 participants aged 18-30 years old residing in southern Sweden was used (response rate 42%). The survey included questions on sexual behavior, alcohol habits, sociodemographic background, and mental health. Logistic regression was used to examine the associations between mental health, depression, anxiety, and risky sexual behavior, stratified by sex (gender). Indicators for risky sexual behavior included not using a condom, non-condom use with casual partner, and multiple (≥2) sexual partners during the last year.

RESULTS

Generally, male participants rated their depression and anxiety levels considerably lower than their female counterparts. Poor mental health, high depression, and high anxiety scores (levels) were significantly associated with having multiple sexual partners among among female participants; adjusted odds ratios (aOR) was 1.3 (95% CI 1.01 to 1.71). However, findings among males were not statistically significant. Furthermore, overall results indicated that higher depression and anxiety scores were associated with 1.4 and 1.6 higher odds, respectively, of not using condom with a casual partner in the most recent sexual encounter. Similarly, higher anxiety scores were associated with non-condom use in the latest sexual encounter, aOR 1.4 (1.1-1.7), but no significant gender-specific associations were found.

CONCLUSION

The associations found between poor mental health factors and multiple sex partners among females warrant consideration in future public health interventions. Further research to increase the understanding of the causal mechanisms that link mental health factors and risky sexual behavior, especially multiple sex partners, among young adult females is needed to support evidence-based interventions.

Syndemic Conditions, Sexual Risk Behavior, and HIV Infection Among Men Who Have Sex with Men in Taiwan

Men who have sex with men (MSM) continue to constitute the majority of HIV incidence in Taiwan. This study examined the associations between five co-occurring psychosocial health conditions (PHCs)-childhood physical abuse (CPA), childhood sexual abuse (CSA), intimate partner violence (IPV), internalized homophobia (IH), and methamphetamine use (MU), and two outcomes (HIV infection and condomless anal sex) among a community sample of 1,000 Taiwanese MSM (mean age 28.5 years). Compared to MSM who had never experienced any PHC, MSM with one or more PHCs had greater than twofold higher odds of being HIV-positive, and those with three or more PHCs had twofold higher odds of having condomless anal sex. Interactive effects on HIV infection were identified from CPA + CSA + MU and CPA + IPV + MU. An interactive effect on condomless anal sex was detected between IH and MU. In order to control the escalating HIV epidemic among MSM in Taiwan, interventions are needed to address syndemic psychosocial health conditions.

Emotional Outcomes of Casual Sexual Relationships and Experiences: A Systematic Review

Casual sexual relationships and experiences (CSREs) are common and emotionally significant occurrences. Given the uncommitted, often emotionally complicated nature of CSREs, researchers have asked whether these experiences may have positive and/or negative emotional consequences. We reviewed 71 quantitative articles examining emotional outcomes of CSREs, including subjective emotional reactions (e.g., excitement, regret) and emotional health (e.g., depression, self-esteem). Overall, people evaluated their CSREs more positively than negatively. In contrast, CSREs were associated with short-term declines in emotional health in most studies examining changes in emotional health within a year of CSRE involvement. Emotional outcomes of CSREs differed across people and situations. Women and individuals with less permissive attitudes toward CSREs experienced worse emotional outcomes of CSREs. Alcohol use prior to CSREs, not being sexually satisfied, and not knowing a partner well were also associated with worse emotional outcomes. These findings suggest directions for prevention/intervention related to CSREs. For example, skill-building related to sexual decision-making may help individuals decide whether, and under what circumstances, CSREs are likely to result in positive or negative emotional outcomes. In addition, the limitations of extant research suggest directions for future inquiry (e.g., examining whether verbal and nonverbal consent practices predict emotional outcomes of CSREs).

Factors Associated With Sexual Risk Behaviors Among People Who Use Drugs in Communities in Cambodia

In Cambodia, HIV prevalence at 4% remains high among people who use drugs (PWUD). Complex and overlapping risk behaviors may enhance sexual transmission risk beyond PWUD. This study, therefore, aims to assess the factors associated with sexual risk behaviors among PWUD. Respondent Driven Sampling was used to recruit 1626 PWUD. Univariate and multivariate logistic regression analyses were used to identify factors associated with transmission risk including that high mental disorder scores were a strong predictor of sexual risk behaviors (odds ratio [OR] ranged from 1.9 to 2.8). Factors associated with sexual risk behaviors varied by gender: for men, these included geographical regions, non-married status, and heroin use; and for women, factors were age ≤20 years (OR = 5.4), living with friends (OR = 6.4), living in Central coastal region (OR = 6.1), and heroin use (OR = 4.8).

Factors Affecting HIV Testing among Youth in Kenya

With the high prevalence of HIV among youth in sub-Saharan Africa, it is vital to better understand factors affecting HIV testing among this population; this is the first step in the HIV treatment cascade. The purpose of this study was to examine factors related to behavioral intentions regarding HIV testing using existing pre-test data from the HIV SEERs (Stigma-reduction via Education, Empowerment, and Research) Project, a community-based participatory research program targeting 13-24-year-olds in Kenya. It was hypothesized that HIV knowledge, social support, subjective well-being, and mental health (depression, anxiety, and stress) would serve as facilitators to HIV testing while projected stigma and substance use would serve as barriers to HIV testing. In partial support of our hypotheses, findings from logistic regression analyses revealed that HIV knowledge, substance use, depression, and social support were significant predictors of HIV testing intentions. However, HIV knowledge and substance use served as facilitators while depression and social support served as barriers. While projected stigma was correlated with HIV testing intentions, it was not a significant predictor in the regression analysis. Subjective well-being, anxiety, and stress were not significant predictors in the regression analysis. These findings have important implications for HIV testing initiatives designed for youth in Kenya as well as future research on HIV testing with this population.

Effects of cognitive behavioral therapy on people living with HIV and depression: A systematic review and meta-analysis

The aim of this review is to examine the efficacy of cognitive behavioral therapy (CBT) on people living with HIV (PLWH) and depression. A literature search from five electronic databases was conducted, and articles published until July 2017 were collected. The inclusion criteria included randomized controlled trials (RCTs) of CBT that were conducted among PLWH with clinically relevant depression. Comprehensive Meta-Analysis 2 was used to obtain pooled results. Seven RCTs, with a total sample size of 388 participants, met the inclusion criteria. Compared with the control group, the CBT group had statistically significant, short-term improvements in depression (g = -0.486, 95% CI [-0.969 to -0.003], P = 0.048). A significant reduction in viral load was also observed at the long-term follow-up (g = -0.306, 95% CI [-0.573 to -0.040], P = 0.024), but no improvements were found in CD4. Results of this meta-analysis showed that CBT is effective in reducing depression symptoms in PLWH with comorbid depression for a short period of time. However, the findings of this review may not be generalized in the clinical field due to the small number of involved studies and the limited study sample. Thus, more robust and adequately powered studies are needed to further explore CBT interventions in PLWH with depression.