ObjectiveTo examine the relationship between depressive disorders and unprotected anal intercourse with casual partners, among homosexually active men attending for primary care. MethodsThe first 460 homosexually active men enrolling in an Australian integrated primary care programme were screened for current depressive disorders using the Primary Care Evaluation of Mental Disorders (PRIME-MD) and completed questionnaires on their sexual behaviour in the prior 6 months. One hundred and sixty-two (35%) were HIV positive, 283 (62%) were HIV negative and 15 (3%) were untested. ResultsThe prevalence of major depressive episode (MDE), as measured by the PRIME-MD, on enrolment was 28% (129/460), while the prevalence of dysthymic disorder (DD) was 26% (121/460). These include 84 men (18%) who met the criteria for both disorders ('double depression'). Men with DD alone, however, were significantly more likely than men with neither disorder to report having had unprotected anal intercourse with a casual partner (11/38 [29%] vs. 43/292 [15%]; OR: 2.36 [95%CI: 1.09-5.10]; P 5 0.035). ConclusionsDepressive disorders were highly prevalent in this cohort and independent of HIV status. MDE was associated with reduced sexual activity. Among men without MDE, the presence of DD was independently associated with an increased likelihood of reporting unsafe anal sex with a casual partner in the prior 6 months.Keywords: homosexual men, neuropsychological, prevention of sexual transmission, psychiatry, psychosocial, risk factors, sexual behaviour Received: 30 September 2002, accepted 20 February 2003 Introduction Depressive disorders are highly prevalent in people with HIV infection [1][2][3][4][5]. Clinical wisdom is that this high prevalence results from the psychosocial stress of HIV diagnosis and disease together, perhaps, with direct neurochemical effects of the virus. A number of studies, however, identify levels of depressive disorder among uninfected members of the communities particularly affected by HIV that are similarly high [6][7][8][9][10]. Ciesla and Roberts, in a recent metaanalysis of 10 studies, concluded that HIV infection did appear to be an independent risk factor for major depression, but not for dysthymic disorder (DD) [11].The relationship between depression and HIV risk behaviour among gay men has been addressed in many studies, but the results have been conflicting. Ross [12] [20]. Dolezal in a recent study of homosexually active Latino men found a positive association between measures of selfworth and sexual risk taking [21], and Robins [22,23] found that gay men who reported unprotected anal intercourse had lower levels of psychological distress than their peers. Similarly, Rubb's group found that homosexually active men whose responses indicated depressed ideation were less likely to report having engaged in receptive or insertive unprotected anal intercourse [24].While these results appear conflicting, it seems that no previous study has differentiated between the two common patterns of depression seen c...

IntroductionThe use of anti-retroviral therapy (ART) has dramatically reduced HIV-1 associated morbidity and mortality. However, HIV-1 infected individuals have increased rates of morbidity and mortality compared to the non-HIV-1 infected population and this appears to be related to end-organ diseases collectively referred to as Serious Non-AIDS Events (SNAEs). Circulating miRNAs are reported as promising biomarkers for a number of human disease conditions including those that constitute SNAEs. Our study sought to investigate the potential of selected miRNAs in predicting mortality in HIV-1 infected ART treated individuals.Materials and MethodsA set of miRNAs was chosen based on published associations with human disease conditions that constitute SNAEs. This case: control study compared 126 cases (individuals who died whilst on therapy), and 247 matched controls (individuals who remained alive). Cases and controls were ART treated participants of two pivotal HIV-1 trials. The relative abundance of each miRNA in serum was measured, by RTqPCR. Associations with mortality (all-cause, cardiovascular and malignancy) were assessed by logistic regression analysis. Correlations between miRNAs and CD4+ T cell count, hs-CRP, IL-6 and D-dimer were also assessed.ResultsNone of the selected miRNAs was associated with all-cause, cardiovascular or malignancy mortality. The levels of three miRNAs (miRs -21, -122 and -200a) correlated with IL-6 while miR-21 also correlated with D-dimer. Additionally, the abundance of miRs -31, -150 and -223, correlated with baseline CD4+ T cell count while the same three miRNAs plus miR-145 correlated with nadir CD4+ T cell count.DiscussionNo associations with mortality were found with any circulating miRNA studied. These results cast doubt onto the effectiveness of circulating miRNA as early predictors of mortality or the major underlying diseases that contribute to mortality in participants treated for HIV-1 infection.

The Care and Prevention Programme (CPP) began in 1998. It is based on the philosophy of primary health care, and has improved health among homosexually active men, including about a third of HIV‐positive South Australians. The CPP was assessed using financial analysis and qualitative methods. Participants wanted to access care where they could feel comfortable and safe to talk about issues of sexuality and lifestyle. The CPP model is “economically” sustainable, but not “financially” sustainable within the Medicare Benefits Schedule. It is vulnerable to changes in political environment. The financing model for the CPP has been adapted by including state funding. General practitioners have adapted by lowering their personal incomes (but not quality of care). These adaptations have achieved fragile financial viability. Facilitators of sustainability for the CPP included: ➢It is part of the community that it serves; ➢The creation of deeply integrated networks of diversity‐competent service providers; and ➢“Virtuous non‐adaptability” of service providers in refusing to compromise care standards despite financial pressure to do so. Threats to sustainability included: ➢Difficulty maintaining a diversity‐competent workforce skilled in HIV medicine; ➢Marginal financial viability; and ➢Political vulnerability.