Opposing associations of depression with sexual behaviour: implications for epidemiological investigation among gay, bisexual and other men who have sex with men

Ada R Miltz,Sris Allan,William J Burman,Andrew N Phillips,Fiona C Lampe,Lorraine Sherr,Janey Sewell,Alison J Rodger,Simon Edwards,Anne M Johnson

doi:10.1136/sextrans-2020-054634

Abstract

ObjectiveThe aim of this report is to investigate the nature of the relationship between depression and condomless sex (CLS) among gay, bisexual and other men who have sex with men...

Highlights

A meta-analysis carried out in 1999 concluded there was little evidence for an association between depressive symptoms and sexual behaviour linked to STI/HIV transmission risk among gay, bisexual and other men who have sex with men (GBMSM) as findings across studies were inconsistent.[1]
HIV- positive GBMSM in ASTRA were excluded from analysis if they were diagnosed with HIV less than 3 months ago, given that the recall period for sexual behaviour was the past 3 months
Characteristics of HIV-positive GBMSM in the ASTRA study In total, 2170 HIV-positive GBMSM in ASTRA who had been diagnosed with HIV for at least 3 months and who had complete data were included

Summary

Introduction

A meta-analysis carried out in 1999 concluded there was little evidence for an association between depressive symptoms and sexual behaviour linked to STI/HIV transmission risk among gay, bisexual and other men who have sex with men (GBMSM) as findings across studies were inconsistent.[1]. In a number of studies that investigated this hypothesis, the highest level of depression severity was associated with increased reporting of CLS measures compared with lower but still clinically significant levels of depression.[6 8 9 14 16 17 19] Another theory suggests that there are opposing associations of depressive symptoms: depression may result in increased sexual risk behaviour in some individuals, and in others sexual inactivity due to lowered libido and loss of interest in sex, or reductions in self-confidence and self-esteem.[1] The type of coping mechanism employed may possibly determine the direction of association. Some people may cope with depression with externalising behaviours such as sexual risk taking and substance use, and others with internalising behaviours including social withdrawal and sexual inactivity.w1 It has been suggested in genetic studies that the presence of certain genes

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