No abstract

Depressive symptoms are highly prevalent among HIV-positive men who have sex with men (MSM) and may contribute to risky health behaviors. However, research linking depressed mood to condomless sex in HIV-positive MSM has yielded mixed findings and has focused primarily on testing for a linear association. In the current study, we tested both linear and curvilinear models to assess the association of depressive symptoms to condomless anal sex for the most recent sexual episode in a sample of MSM living with HIV (N = 96, M age = 44, 57% Caucasian). Participants completed the Center for Epidemiological Studies-Depression Scale and self-reported on their sexual behaviors. Findings confirmed a curvilinear association of depressive symptoms with condomless anal sex for encounters involving non-primary partner: MSM with moderate levels of depressed mood were more likely to report non-condom use compared to those with low and high levels of depressive symptoms. Future research should test whether treatment for depression can serve to enhance the impact of sexual health promotion interventions for MSM.

Viral suppression, a critical component of HIV care, is more likely when individuals initiate antiretroviral therapy (ART) early in disease progression and maintain optimal levels of adherence to ART regimens. Although several studies have documented the negative association of depressive symptoms with ART adherence, less is known about how depressed mood relates to intentional versus unintentional lapses in adherence as well as the mechanisms underlying this association. The purpose of the current study was to examine the association of depressive symptoms with ART adherence, assessed as a multidimensional construct. Secondarily, this study conducted preliminary indirect path models to determine if medication self-efficacy could explain the depressed mood-adherence relationship. Depressive symptoms were not associated with 95% ART taken, self-reported viral load, deliberate adjustments to ART regimens or skipped ART doses. However, the indirect association of depressive symptoms via decrements in medication self-efficacy was significant for 95% ART taken, self-reported viral load and skipped ART doses, but not deliberate changes to ART regimens. In this sample of HIV-positive outpatients, there is evidence to support medication self-efficacy as a potential mechanism underlying the association between depressive symptoms and ART adherence. Additional longitudinal studies are needed to formally examine medication taking self-efficacy as a mediator.

Previous research has reported an association between depressive symptoms and sexual risk behavior. The purpose of this study was to explore whether gender moderates this association in a sample of HIV-positive African-Americans. Participants (N = 93) self-reported depressive symptoms (Center for Epidemiological Studies-Depression Scale; CES-D), and sexual risk behavior for the past 4 months. Analyses revealed that the depressive symptoms-by-gender interaction was associated with condomless sex and substance use proximal to sex. When analyses were stratified by gender, depressive symptoms were associated with condomless sex and frequency of substance use only for women. We conclude that depressive symptoms may be a more powerful sexual risk factor among women relative to men.

The original version of this article unfortunately contained a mistake in Fig. 1. The figure was incorrectly presented with the results of an additional path model for forgotten antiretroviral therapy (ART) doses that was dropped from the primary analyses.