Intimate partner violence, depression, and sexual behaviour among gay, bisexual and other men who have sex with men in the PROUD trial

Ada R Miltz,Loraine J Bacchus,Lorraine Sherr,Sheena Mccormack,Amanda Clarke,Fiona C Lampe,David Dunn,Mitzy Gafos,Andrew N Phillips,Ellen White,Alison Rodger,Ann Sullivan,Alan Mcowan

doi:10.1186/s12889-019-6757-6

Abstract

BackgroundLittle is known about the prevalence and correlates of intimate partner violence (IPV) among gay, bisexual and other men who have sex with men (GBMSM) in the UK. The aim of this study was to investigate the prevalence of IPV, associations of socio-economic and psychosocial factors with IPV, and the association of IPV with depression and sexual behaviour, among GBMSM in the PROUD trial of pre-exposure prophylaxis (PrEP).MethodsPROUD enrolled 544 HIV-negative participants in England from 2012 to 2014; participants were randomised to immediate or deferred PrEP. This analysis included 436 GBMSM who had IPV data at month-12 and/or 24. Prevalence of IPV victimization and perpetration (lifetime, and in the past year) was assessed at these time-points. Generalized estimating equations were used to investigate associations with IPV, using pooled data from both time-points.ResultsAt month-12 (N = 410), 44.9% of men reported ever being a victim of IPV, 15.6% in the last year, and 19.5% reported ever perpetrating IPV, 7.8% in the last year. At month-24 (N = 333), the corresponding prevalence was 40.2 and 14.7% for lifetime and past year IPV victimization and 18.0 and 6.9% for lifetime and past year IPV perpetration. IPV prevalence did not differ by randomised arm. Men reporting internalized homophobia and sexualized drug use were more likely to report IPV. Lifetime and last year experience of IPV victimization and perpetration were strongly associated with depressive symptoms (PHQ-9 ≥ 10) (adjusted for socio-demographics: lifetime IPV victimization PR 2.57 [95% CI: 1.71, 3.86]; past year IPV victimization PR 2.93 [95% CI: 1.96, 4.40]; lifetime IPV perpetration PR 2.87 [95% CI: 1.91, 4.32]; past year IPV perpetration PR 3.47 [95% CI: 2.13, 5.64], p < 0.001 for all); IPV was not consistently associated with measures of condomless anal sex or high partner numbers.ConclusionsGBMSM at high-risk of HIV who are seeking/taking PrEP may experience a high burden of IPV, which may be linked to depression. Training on awareness of and enquiry for IPV among GBMSM in sexual health clinics is recommended.Trial registrationClinicalTrials.gov identifier: NCT02065986. Registered 19 February 2014 (retrospectively registered).

Highlights

Little is known about the prevalence and correlates of intimate partner violence (IPV) among gay, bisexual and other men who have sex with men (GBMSM) in the UK
It has been suggested in syndemic theory that it is the synergistic interaction of two or more co-occurring psychosocial factors, such as childhood sexual abuse, Intimate partner violence (IPV), depression, and drug use that may compound the risk of HIV/STIs [11, 12]
Given that previous studies have linked depression to IPV and to sexual risk behaviour, further analyses were performed in order to examine the role of depressive symptoms on the relationship between IPV and sexual behaviour, and findings are briefly described in the text. These analyses investigated associations of: (i) depression with sexual behaviours in unadjusted and socio-demographic adjusted Generalized estimating equations (GEE) models, (ii) IPV measures with sexual behaviours adjusted for depression in GEE models, and (iii) lifetime IPV victimization with sexual behaviours among men with depression and among men without depression, via use of interaction terms in unadjusted GEE models

Summary

Introduction

Little is known about the prevalence and correlates of intimate partner violence (IPV) among gay, bisexual and other men who have sex with men (GBMSM) in the UK. There is a growing body of research on the prevalence of IPV victimization among gay, bisexual and other men who have sex with men (GBMSM) in the U.S [3,4,5], data on IPV perpetration are limited. Evidence from a recent meta-analysis of mainly U.S studies suggests that experiences of IPV are associated with depression, drug use, sexual risk behaviour, and HIV seropositivity among GBMSM [3]. It has been suggested in syndemic theory that it is the synergistic interaction of two or more co-occurring psychosocial factors, such as childhood sexual abuse, IPV, depression, and drug use that may compound the risk of HIV/STIs [11, 12]

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