Association of Depressive Symptoms and Condomless Anal Sex with Main and Casual Partners among Young, Black Men who have Sex with Men in Atlanta Open Access

Chandra, Christina (Spring 2020)

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Background: Young, black men who have sex with men (MSM) in the U.S. South experience higher rates of HIV and sexually transmitted infections (STIs) compared to the general population. At the same time, prevalence of depression among black MSM is high. Previous studies have found mixed results on the association between depression and condomless anal sex (CAS), the primary mode of transmission of HIV and STIs among MSM. We assessed the association between depressive symptoms and CAS by partner type – main or casual – among young, black MSM.

Methods: We analyzed baseline data from a cohort of young, black HIV-negative MSM in Atlanta, Georgia, who completed computer-assisted self-interviews. The PHQ-8 was used to assess depressive symptoms, and we applied a cutoff of 10 or greater to classify participants with depressive symptoms. We examined two outcomes: any CAS with a main male partner and any CAS with a casual male partner, both in the last 6 months. We used bivariable and multivariable logistic models with predicted margins to estimate the prevalence ratios of CAS with main or casual partners among MSM with depressive symptoms compared to MSM without. We identified potential confounders a priori using a directed acyclic graph approach.

Results: Among 298 participants, 40 (13.4%) had depressive symptoms. Of 251 participants with data on CAS by partner type, 122 (49.6%) reported any CAS with a main partner and 101 (41.1%) reported any CAS with a casual partner in the past 6 months. After adjusting for age, housing stability, annual household income, substance use in the past 6 months, and everyday discrimination, we found a significantly higher prevalence of CAS with a casual partner among MSM with depressive symptoms compared to those without [adjusted prevalence ratio (aPR)=1.59, 95% confidence interval (CI)=1.15-2.21] and no association between CAS with a main partner and depressive symptoms (aPR=0.90, 95% CI=0.61-1.35).

Conclusion: The association between depressive symptoms and CAS varies by partner type among young, black MSM in Atlanta. These findings highlight the importance of studying specific CAS outcomes in studies of sexual risk behaviors in this priority population for HIV and STI prevention.

Table of Contents

Introduction 1

Methods 3

Results 5

Discussion 7

References 11

Tables 15

Appendix. Supplementary Material 17

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