Synergistic effects of psychosocial and substance use problems on increased sexual transmission risk among HIV-infected men who have sex with men

Published: July 22, 2010

Synergistic effects of psychosocial and substance use problems on increased sexual transmission risk among HIV-infected men who have sex with men

C. O’Cleirigh1,2, M. Mimiaga1,2, S.A. Safren1,2, R. Stall3, K.H. Mayer1,4

1The Fenway Institute, Fenway Community Health, Boston, United States, 2Harvard Medical School / Massachusetts General Hospital, Boston, United States, 3University of Pittsburgh Graduate School of Public Health, Pittsburg, United States, 4Brown Medical School, Providence, United States

Background: Among HIV-infected MSM, negative affect (e.g., anxiety/depression) and maladaptive attempts to cope with negative affect (e.g., substance/alcohol use) are associated with sexual transmission risk behaviors (TRB). These mental health and substance use issues can co-occur at high rates and may interact syndemically to increase the likelihood of TRB. The current study hypothesized that the combined effects of six syndemic indicators (childhood sexual abuse, posttraumatic stress disorder(PTSD), anxiety disorders, depression, polysubstance use, alcohol abuse) would increase the likelihood of TRB among HIV-infected MSM.
Methods: 380 HIV-infected MSM who reported unprotected anal intercourse in the past 3 months completed psychosocial, substance use, and sexual risk assessments. One syndemics variable was generated identifying for how many of six indicators each participant met diagnostic screen-in criteria. This variable was categorized to reflect three syndemic levels (no indicators; 1-3 indicators, > 4 indicators). Binary logistic regression was used to analyze the relationships with TRB (serodiscordant unprotected anal intercourse in the past 3 months).
Results: The rates at which the 380 participants met criteria for each of the indicators were childhood sexual abuse history-45%, anxiety disorders-32.6%, polysubstance use-27.9%, PTSD-27.9%, alcohol abuse-20.8%, and depression-13.6%. Twenty percent did not meet criteria for any syndemic indicator. The syndemics variable was associated with a significantly higher likelihood of TRB. For those with 1-3 indicators there was a greater than two-fold increase in the likelihood of TRB (Odds Ratio:2.31 ; 95% CI: 1.61 – 4.58; p< .01) and for those with >4 indicators there was a four fold increase (Odds Ratio:4.17 ; 95% CI: 2.01 – 8.23; p< .001) compared to those with no indicators.
Conclusions: Interrelated psychosocial problems co-occur at very high rates among HIV-infected MSM. The syndemic co-occurrence of these problems is associated with dramatic elevations in TRB. Secondary prevention interventions that also address psychosocial problems may reap additional benefit.

Download the e-Poster

Leave a Reply