Abstract
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.
Highlights
In 2017, there were 4363 new HIV diagnoses in the UK of which 53% were reported among gay, bisexual, and other men who have sex with men (GBMSM) [1]
Of the 2630 individuals who participated in the AURAH Study, 1484 were classified as GBMSM
The current analysis is based on 1340 GBMSM who reported sex in the past 3 months
Summary
In 2017, there were 4363 new HIV diagnoses in the UK of which 53% were reported among gay, bisexual, and other men who have sex with men (GBMSM) [1]. 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
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