Depression and HIV Risk Taking Among Men Who Have Sex with Other Men and Who Use the Internet to Find Partners for Unprotected Sex

Abstract

This study examines the prevalence of depression in a sample of men who have sex with men (MSM) who are at high risk for HIV. It examines the relationship between depressive symptomatology and involvement in HIV risk behaviors and the factors associated with greater depressive symptomatology. The data come from a national random sample of 332 MSM who used any of 16 websites to identify men with whom they could engage in unprotected sex. Data were collected via telephone interviews. Depression was more prevalent in this population (26.7%) than among men in the general population. Depression was not related directly to any of the HIV risk behaviors examined, but it was related to men's attitudes toward condom use, which was the strongest predictor of their involvement in risky behaviors. Five factors were identified as being associated with greater depression: lower educational attainment, greater discrimination based on sexual orientation, greater eroticizing of ejaculatory fluids, experiencing more substance abuse problems, and greater childhood maltreatment. The study found that depression is a consequential problem in this population. Although depression does not appear to be related directly to HIV risk practices in this population, its influence cannot be discounted because of its effects on other key predictors of risk involvement.

KEYWORDS:

• depression
• gay men
• bisexual men
• men who have sex with men (MSM)
• HIV risk practices
• Internet

ACKNOWLEDGMENTS

The author wishes to acknowledge, with gratitude, the contributions made by Thomas P. Lambing to this study's data collection and data entry/cleaning efforts.

Notes

1. Although a measure assessing the total number of times a man reported having unprotected sex during a particular time period is a direct measure of risk, the author believes that the chosen measure, which assesses the proportion of sex acts that are unprotected, is a better measure because it indicates a person's likelihood of having unprotected sex across time points. The latter indicates his “usual” practices and tendencies, whereas the former indicates his practices during a specific period that may or may not represent his “usual” sexual opportunities. The number of sexual encounters will increase or decrease during different time periods for the men in this study due to situational influences; thus, basing the risk assessment on the total number of unprotected sexual acts would miss this variation. Consequently, using the proportion of the sexual acts that were unprotected offers a better indication of this behavior when the men are engaging in their “typical” number of sexual encounters as well as for the times when their number of encounters increases or decreases.