Background: Psychological and physical symptoms are prevalent among MSM with diagnosed HIV, but their relationship with sexual behaviour is unclear. Methods: We assessed the associations of depression, anxiety, and physical symptom distress, with sexual behaviour among 2097 HIV-diagnosed MSM in ASTRA, a questionnaire study of UK HIV outpatients in 2011/12. Depression and anxiety were classiﬁed, respectively, by PHQ-9 and GAD-7 scores (0-4 minimal; 5-9 mild; 10-14 moderate; ≥ 15 severe).Physical symptom score (PSS) was the sum of distress scores from 10 common symptoms (0-1 minimal; 2-6 low; 7-9: moderate; ≥ 10 high). Sexual activity in the past 3 months was classiﬁed as: not sexually active; condom-protected sex or HIV-positive partner(s) only; condom-less sex with HIV-negative/status-unknown partner(s) (CLS-D).
Results: Of 2097 MSM, 37% were not sexually active; 48% reported condom-protected sex or HIV-positive partner(s) only; 16% reported CLS-D. Prevalence of depression (PHQ-9 ≥ 10), anxiety (GAD-7 ≥ 10), and moderate/high physical symptom distress (PSS ≥ 7) varied across sexual activity groups, being highest among MSM who were not sexually active, and lowest among MSM who reported condom-protected sex or HIV-positive partner(s) only.
Among 1322 sexually active MSM, each symptom measure was associated with CLS-D. Using separate logistic models, adjusted odds ratios (95% CI) of CLS-D were: 1.3 (0.9–1.8), 1.4 (1.0–2.2) and 1.5 (1.0–2.3) for mild, moderate, severe depression versus minimal [p = 0.020 trend]; 1.5 (1.1–2.1), 1.3 (0.8– 2.0), 2.1 (1.3–3.4) for mild, moderate, severe anxiety versus minimal [p=0.002 trend]; 1.4 (1.0–1.9), 1.7 (1.1–2.6), 1.9 (1.3–2.9) for low, moderate, high physical symptom distress versus minimal [p < 0.001 trend]. Models were adjusted for presence/HIV-status of stable partner; alcohol consumption; recent recreational drug use; ART/viral load group.
Conclusions: Among HIV-diagnosed MSM, depression, anxiety and physical symptoms have a complex association with sexual behaviour, being linked both with lack of sexual activity and, among those who are sexually active, with CLS-D. In addition to clinical importance, symptom management may be one important component of prevention strategies among HIV-diagnosed MSM.
|Number of pages||1|
|Publication status||Published - 3 Apr 2013|