The Impact of Mental Illness on HIV Testing Behavior in Men who Have Sex with Men (MSM) in the United States Open Access

McKinlay, Michelle (Spring 2020)

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Objective: Assess the impact of mental illness on HIV testing behavior in MSM in the United States.

Methods: We analyzed data from the 2018 American Men’s Internet Survey (AMIS), an annual online survey conducted to explore HIV risk behaviors among men who have sex with men (MSM) in the US. The Kessler 6 (K6) Psychological Distress Scale was used to assess the exposure, and a question about HIV testing in the past 12 months was used to assess the outcome. Serious mental illness (SMI), the primary exposure, was defined by a K6 scale score of 13 or higher. Univariate and bivariate analyses were conducted, with calculation of prevalence ratios for the latter. Multivariate logistic regression was used to assess the relationship between SMI and HIV testing in the past 12 months, and potential confounders included age, race/ethnicity, education, illicit substance use, sexual orientation outness, experience of discrimination by friends and/or family, experience of discrimination in a healthcare setting, and health insurance.

Results: Among 9,946 individuals included in our analysis, 5,290 (53.3%) reported receiving an HIV test in the past 12 months and 2,390 (24.03%) had SMI. 86.5% of study participants reported seeing a healthcare provider in the past year. On average, individuals who reported not receiving an HIV test in the past 12 months had a higher psychological distress score (µ = 8.50) compared to individuals who reported receiving an HIV test in the past 12 months (µ = 7.62). Logistic regression analysis showed the odds of HIV testing in the past 12 months in MSM with SMI were 0.92 times the odds of HIV testing in the past 12 months in MSM without SMI, which was not statistically significant (p-value: 0.1334).

Conclusion: The burden of SMI among our population was substantial. Although we found a null relationship between SMI and HIV testing, there was evidence of a negative association. Most MSM in our study appeared engaged in healthcare, which might have modified this relationship. Further research is needed to better understand this relationship among MSM with mental illness who are not as engaged in healthcare, because they may be at greatest risk for HIV infection.

Table of Contents

i. Background - 1

ii. Methods - 5

a. Study design and population - 5

b. Measures - 6

c. Univariate and Bivariate Statistical Analyses - 8

d. Multivariate Statistical Analyses - 9

iii. Results - 11

a. Characteristics of study sample (Table 1) - 11

b. Bivariate associations with HIV testing (Table 2) - 12

c. K6 psychological distress scale (Tables 3 and 4) - 13

d. Adjusted associations with HIV testing (Table 5) - 13

iv. Discussion - 15

a. Strengths - 20

b. Limitations - 21

c. Future Direction - 22

v. References - 25

vi. Figures and Tables - 29

a. Figure 1 - 29

b. Table 1A - 30

c. Table 1B - 32

d. Table 2 - 34

e. Table 3 - 36

f. Table 4 - 37

g. Table 5 - 39

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