Investigating the association between depression and high-risk sexual behavior in gay, bisexual, and other men who have sex with men in Houston, Texas

Cristina Espinosa da Silva, The University of Texas School of Public Health

Abstract

Background. Over the past three decades, the growing HIV epidemic has touched every corner of the globe and, in 2009, over 33 million people throughout the world were living with HIV (UNAIDS, 2013). Gay, bisexual, and other men who have sex with men (MSM) are disproportionately impacted by the HIV epidemic. MSM represent the only risk group where cases of diagnosed HIV infection continue to increase (Centers for Disease Control and Prevention, 2013). In addition to higher rates of HIV infection, MSM also have increased risk of mental health problems compared to men who do not have sex with men (non-MSM) and investigating the relationship between depression and high-risk sexual behavior may provide insight for future HIV prevention programs (Alvy, 2010; Cochran, 2008).^ Specific Aim. The specific aim of this thesis was to evaluate whether depression was associated with high-risk sexual behavior among adult MSM residing in Houston, Texas from NHBS surveillance data. The first hypothesis tested in this study was that depression level is associated with high-risk sexual behavior among sexually active MSM. The second hypothesis tested was that depression is positively associated with the number of unprotected anal intercourse (UAI) partners among MSM whom already engage in high-risk sexual behavior.^ Methods. Data from the fourth round of the CDC’s National HIV Behavioral Surveillance System MSM cycle in Houston was used to evaluate the association between depression and high-risk sexual behavior. Depression was analyzed as both a continuous and categorical variable. As a categorical variable, the summed score from the CES-D scale was used to identify participants with no depressive symptoms (CES-D score = 0-9), moderate depressive symptoms (CES-D score = 10-14), and severe depressive symptoms (CES-D score ≥ 15). High-risk sexual behavior was measured based on the number of partners with whom the participant reported engaging in unprotected anal intercourse within the past 12 months. Logistic regression, linear regression, and correlation analyses were conducted in order to better understand the relationship between mental health and sexual risk-taking.^ Results. Findings from the logistic regression suggested that MSM with mild depression were 2.6 times more likely to engage in UAI with sex partners than MSM that are not depressed (p-value = 0.006). MSM with severe depression were 3.8 times more likely to engage in UAI with sex partners than MSM that are not depressed (p-value= 0.003). When evaluating depression as a continuous variable in the linear regression analysis, results indicated that UAI increased by 2% for every one unit increase in the CES-D scale, after adjusting for other variables. Results also indicated that UAI increased by 5% for every one unit increase in anal sex partners, after adjusting for other variables. Considering depression as a categorical variable in the linear regression, the number of unprotected anal sex partners increased by 30% among those with moderate depressive symptoms compared to those with no depressive symptoms, after adjusting for other variables. Findings from a correlation analysis indicated that UAI was significantly correlated with depression (p-value=0.05), income (p-value <0.0001) and total number of male anal sex partners (p-value <0.0001).^ Conclusion. Findings from both the logistic and linear regressions indicated that depression is a significant predictor of number of UAI partners among MSM in Houston. These findings suggest that targeting depression in HIV prevention interventions could help reduce high-risk sexual behavior among MSM from similar communities.^

Subject Area

LGBTQ studies|Health sciences|Behavioral sciences

Recommended Citation

Espinosa da Silva, Cristina, "Investigating the association between depression and high-risk sexual behavior in gay, bisexual, and other men who have sex with men in Houston, Texas" (2016). Texas Medical Center Dissertations (via ProQuest). AAI10183284.
http://digitalcommons.library.tmc.edu/dissertations/AAI10183284

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