Clinically significant depressive symptoms and sexual behaviour among men who have sex with men

Miltz, Ada; Rodger, Alison; Sewell, Janey; Speakman, Andrew; Phillips, Andrew; Sherr, Lorraine; Gilson, Richard; Asboe, David; Nwokolo, Nneka; Clarke, Amanda; Gompels, Mark; Allan, Sris; Collins, Simon; Lampe, Fiona

doi:10.1192/bjpo.bp.116.003574

Cited by 22 publications

(30 citation statements)

References 46 publications

(88 reference statements)

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“…Findings from the AURAH study were not used to inform hypothesized relationships. This includes previously published data on correlates of depression [21]. The postulated relationships are discussed in the context of the results of the model.…”

Section: Devising a Conceptual Model Of Causal Connections Between Somentioning

confidence: 94%

“…The AURAH (Attitudes to and Understanding of Risk of Acquisition of HIV) study collected data from individuals attending 20 GUM clinics in England from 2013 to 2014. Among a sub-sample of 1340 GBMSM, depressive symptoms were found to have moderate to strong associations with measures of CLS in the past 3 months, and with bacterial STI diagnosis and post-exposure prophylaxis (PEP) use in the past year [21]. Associations remained after adjusting for socio-demographic factors and additionally adjusting for smoking, higher-risk drinking, and recreational drug use [21].…”

Section: Introductionmentioning

confidence: 93%

“…Among a sub-sample of 1340 GBMSM, depressive symptoms were found to have moderate to strong associations with measures of CLS in the past 3 months, and with bacterial STI diagnosis and post-exposure prophylaxis (PEP) use in the past year [21]. Associations remained after adjusting for socio-demographic factors and additionally adjusting for smoking, higher-risk drinking, and recreational drug use [21]. Although cross-sectional studies have provided strong evidence for a link between depression and CLS, they cannot provide insight into the direction of association.…”

Section: Introductionmentioning

confidence: 97%

“…There is substantial evidence for an association between symptoms of depression and increased engagement in condomless sex (CLS), including CLS with multiple partners and partners of an unknown/sero-different HIV status [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21], and HIV acquisition [22] in studies of GBMSM. Most of these studies have been conducted in the U.S. To date, two UK cross-sectional studies have investigated the relationship between symptoms of depression and CLS.…”

Section: Introductionmentioning

confidence: 99%

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Investigating Conceptual Models for the Relationship Between Depression and Condomless Sex Among Gay, Bisexual, and Other Men Who have Sex with Men: Using Structural Equation Modelling to Assess Mediation

et al. 2019

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The aim of this study is to investigate five hypothesized mechanisms of causation between depression and condomless sex with ≥ 2 partners (CLS2+) among gay, bisexual, and other men who have sex with men (GBMSM), involving alternative roles of self-efficacy for sexual safety and recreational drug use. Data were from the AURAH cross-sectional study of 1340 GBMSM attending genitourinary medicine clinics in England (2013-2014). Structural equation modelling (SEM) was used to investigate which conceptual model was more consistent with the data. Twelve percent of men reported depression (PHQ-9 ≥ 10) and 32% reported CLS2+ in the past 3 months. AURAH data were more consistent with the model in which depression was considered to lead to CLS2+ indirectly via low self-efficacy for sexual safety (indirect Beta = 0.158; p < 0.001) as well as indirectly via higher levels of recreational drug use (indirect Beta = 0.158; p < 0.001). SEM assists in understanding the relationship between depression and CLS among GBMSM.

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Section: Devising a Conceptual Model Of Causal Connections Between Somentioning

confidence: 94%

Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Investigating Conceptual Models for the Relationship Between Depression and Condomless Sex Among Gay, Bisexual, and Other Men Who have Sex with Men: Using Structural Equation Modelling to Assess Mediation

et al. 2019

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“…50 The prevalence of CLS with two or more partners and CLS with an unknown and/or HIV-positive status partner (men who reported no CLS partners of unknown HIV status and only one HIV positive CLS partner who was a DOI: 10.3310/pgfar05180 PROGRAMME GRANTS FOR APPLIED RESEARCH 2017 VOL. 5 NO.…”

Section: The Cognitive Impairment In People With Hiv In the European mentioning

confidence: 99%

Implications for a policy of initiating antiretroviral therapy in people diagnosed with human immunodeficiency virus: the CAPRA research programme

Miltz

Phillips

Speakman

et al. 2017

Programme Grants Appl Res

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BackgroundMore than 100,000 people in the UK are living with a human immunodeficiency virus (HIV) infection. There are currently estimated to be around 4000 people newly infected in the UK per year, mostly men who have sex with men (MSM). It has become increasingly clear that antiretroviral therapy (ART) used to treat people infected with HIV also has a profound effect on infectivity. At the initiation of the programme, it was the policy in the UK to initiate ART in people when their cluster of differentiation 4 (CD4) count was approaching 350/µl.ObjectivesTo assess what would be the effectiveness and cost-effectiveness of a policy of immediate initiation of ART at diagnosis among MSM, taking into account the potential reductions in new infections.DesignWe calibrated an individual-based model of HIV transmission, progression and the effect of ART in MSM, informed by a series of studies on sexual behaviour in relation to ART use and the transmission risk in people with viral suppression on ART, and by surveillance data collected by Public Health England.Setting, participants and interventionsThe series of studies used to inform the model included (1) the Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) study, a cross-sectional self-administered questionnaire study of people diagnosed with HIV attending eight HIV outpatient clinics in the UK (2011–12); (2) the Cognitive Impairment in People with HIV in the European Region (CIPHER) study, a study of levels of neurocognitive impairment in HIV-positive ASTRA participants and people from HIV clinics in Rome, Copenhagen and Minsk; (3) the Attitudes to, and Understanding of, Risk of Acquisition of HIV (AURAH) study, a cross-sectional self-administered questionnaire study of individuals who have not been diagnosed as HIV-positive attending 20 genitourinary medicine clinics across the UK (2013–14); (4) a substudy of sexual behaviour among individuals enrolled in an open-label multicentre international randomised trial (from 2013) of immediate versus deferred ART (to CD4 cell counts of 350/µl) in people with CD4 cell counts of > 500/µl [the Strategic Timing of Antiretroviral Therapy (START) trial]; and (5) Partners of People on ART: a new Evaluation of the Risks (PARTNER), an observational multicentre longitudinal study of HIV serodifferent heterosexual and MSM couples, in which the HIV-positive partner is on ART (2010–14).Main outcome measuresThe main outcome measures were the clinical effectiveness and cost-effectiveness of a policy of immediate initiation of ART at diagnosis.ResultsBased on data from studies (i)–(v), we estimated from our modelling work that increases in condomless sex (CLS) among MSM as a whole may explain the increase in HIV infection incidence in MSM epidemics over a time when ART coverage and viral suppression increased, demonstrating the limiting effects of non-condom use on the HIV epidemic among MSM. Accordingly, an increase in the overall proportion of MSM living with HIV who are virally suppressed on ART from the current level of < 60% to 90% without increases in CLS was required to achieve a reduction in the incidence of HIV among MSM to < 1 per 1000 person-years. The incremental cost-effectiveness ratio associated with the fourfold increase in levels of HIV testing and ART at diagnosis required to provide this increase from < 60% to 90% was £20,000 if we assumed continuation of current ART prices. However, this value falls to £3500 if we assume that ART prices will fall to 20% of their current cost as a result of the introduction of generic drugs. Therefore, our evaluation suggests that ART initiation at diagnosis is likely to be highly cost-effective in MSM at a population level, particularly accounting for future lower ART costs as generic drugs are used. The impact will be much greater if levels of HIV testing can be enhanced.LimitationsIt was necessary to make some assumptions beyond the available data in order to extrapolate cost-effectiveness through modelling.ConclusionsOur findings suggest that ART initiation at diagnosis is likely to be cost-effective in MSM. Of note, after this programme of work was completed, results from the main START trial demonstrated benefit in ART initiation even in people with CD4 cell counts of > 500/µl, supporting ART initiation in people diagnosed with a HIV infection.Future workThere is a need for future research into the means of increasing the frequency with which MSM test for HIV.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Depressive symptoms, perceived social support, and anticipated HIV stigma among HIV‐negative/unknown men who have sex with men in China during the COVID‐19 pandemic: A multicenter online cross‐sectional study

Dai

et al. 2023

Brain and Behavior

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Objective To investigate the prevalence of depressive symptoms among human immunodeficiency virus (HIV)‐negative/unknown men who have sex with men (MSM) in China and explore the relationship between perceived social support, anticipated HIV stigma, and depressive symptoms. Methods Participants in this study were recruited from a gay social networking app (Blued) in China by convenience sampling from December 16, 2020 to March 1, 2021. Perceived Social Support Questionnaire, Anticipated HIV Stigma Questionnaire, and Center for Epidemiologic Studies Depression Scale were used to measure the social support, anticipated HIV stigma, and depressive symptoms of participants. Confirmatory factor analysis was performed to assess the reliability and validity of the measurement model. Structural equation modeling was employed to evaluate the association of perceived social support, anticipated HIV stigma, and depressive symptoms, as well as the mediation effects. Results Overall, 47.70% (665/1394) of the participants had depressive symptoms. Perceived social support could have both direct and indirect effects on depressive symptoms with the mediating role of anticipated HIV stigma among HIV‐negative/unknown MSM. Conclusion Tailored interventions regarding perceived social support and anticipated HIV stigma, such as group therapy, mutual support groups and mindfulness training, with the involvement of non‐governmental or governmental organizations, should be taken into account to reduce depressive symptoms and stigma among HIV‐negative/unknown MSM in China.

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Clinically significant depressive symptoms and sexual behaviour among men who have sex with men

Cited by 22 publications

References 46 publications

Investigating Conceptual Models for the Relationship Between Depression and Condomless Sex Among Gay, Bisexual, and Other Men Who have Sex with Men: Using Structural Equation Modelling to Assess Mediation

Investigating Conceptual Models for the Relationship Between Depression and Condomless Sex Among Gay, Bisexual, and Other Men Who have Sex with Men: Using Structural Equation Modelling to Assess Mediation

Implications for a policy of initiating antiretroviral therapy in people diagnosed with human immunodeficiency virus: the CAPRA research programme

Depressive symptoms, perceived social support, and anticipated HIV stigma among HIV‐negative/unknown men who have sex with men in China during the COVID‐19 pandemic: A multicenter online cross‐sectional study

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