Abstract

Background

Methamphetamine use is associated with disproportionate risk of HIV infection and increased risk of depression among sexual minority men. The purpose of the study was to estimate the association between clinical depression diagnoses and sexual risk-taking among cisgender men who have sex with men (MSM) who use methamphetamine.

Method

From March 2014 through January 2016, 286 MSM who use methamphetamine but were not seeking treatment for methamphetamine use disorder were enrolled to participate in a technology-based randomized controlled trial to reduce methamphetamine use and HIV sexual risk behaviors; participants were assessed for major depressive episodes (MDE) and persistent depressive disorder (PDD) at baseline. Multivariate clustered zero-inflated negative binomial regression analyses of condomless anal intercourse (n = 282; 1,248 visits) estimated the association between this baseline diagnostic result and engagement in sexual risk-taking over time.

Results

Participants predominantly identified as nonwhite (80%), averaged 42 years of age, and reported a HIV prevalence rate of 46%. Engagement in sexual risk-taking consistently demonstrated a positive curvilinear relationship with clinical depression severity, such that, for example, participants without clinical depression (59% of the sample; coef. = 1.16) and those with MDE (36% of the sample; coef. = 1.45) both demonstrated elevated rates of condomless anal sex with anonymous partners relative to participants with PDD (5% of the sample; analytical reference category; both coef. p < 0.05). Data also demonstrated a trend (p = 0.053) of reduced sexual risk-taking with main partners among participants diagnosed with MDE (coef. = −0.94).

Conclusions

Methamphetamine use among participants in this study inverted the functional form of the relationship between depression and sexual risk among MSM observed in prior studies. Whereas low-grade depression has been associated with increased sexual risk-taking in prior samples of MSM, methamphetamine upends this relationship, such that the greatest engagement in sexual risk-taking occurred among those diagnosed with MDE at baseline. Additional research is warranted to clarify how methamphetamine influences sexual risk-taking among MSM with/without comorbid depression.

中文翻译：

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男男性行为者使用甲基苯丙胺的抑郁症和艾滋病毒传播风险

摘要

背景

甲基苯丙胺的使用与性少数男性感染艾滋病毒的不成比例的风险和抑郁症的风险增加有关。该研究的目的是评估使用甲基苯丙胺的男男性行为者 (MSM) 的临床抑郁症诊断与性风险之间的关联。

方法

从 2014 年 3 月到 2016 年 1 月，286 名使用甲基苯丙胺但未寻求甲基苯丙胺使用障碍治疗的 MSM 参加了一项基于技术的随机对照试验，以减少甲基苯丙胺的使用和 HIV 性危险行为；参与者在基线时接受了重度抑郁发作 (MDE) 和持续性抑郁症 (PDD) 评估。对无安全套肛交（n  = 282；1,248 次就诊）的多变量聚集零膨胀负二项式回归分析估计了该基线诊断结果与随着时间的推移参与性冒险之间的关联。

结果

参与者主要被认定为非白人（80%），平均年龄为 42 岁，报告的 HIV 感染率为 46%。参与性冒险行为始终表现出与临床抑郁症严重程度呈正曲线关系，例如，没有临床抑郁症的参与者（样本的 59%；系数 = 1.16）和患有 MDE 的参与者（样本的 36%； coef. = 1.45）均显示与 PDD 参与者相比，与匿名伴侣的无安全套肛交发生率升高（样本的 5%；分析参考类别；两者 coef. p  < 0.05）。 数据还表明，在被诊断为 MDE 的参与者中，与主要伴侣的性冒险行为减少的趋势 ( p = 0.053) (coef. = -0.94)。

结论

本研究参与者中甲基苯丙胺的使用颠倒了先前研究中观察到的 MSM 中抑郁与性风险之间关系的功能形式。虽然在之前的 MSM 样本中，低度抑郁症与性冒险行为增加有关，但甲基苯丙胺颠覆了这种关系，因此在基线时诊断为 MDE 的人中，性冒险行为的参与度最高。有必要进行进一步的研究来阐明甲基苯丙胺如何影响有/没有共病抑郁症的 MSM 中的性冒险行为。