Depression strongly associated with risky sex in UK gay men

HIV-negative gay men who have several symptoms of depression are more likely to report sex without a condom, according to a study presented to the British Association for Sexual Health and HIV (BASHH) conference in Glasgow yesterday.

Several past studies have shown that poor mental health is frequently experienced by gay men. Some American studies have found an association between depression and risky sex, or depression and seroconversion to HIV, but there have been few data on the issue in HIV-negative gay men in the UK.

To fill this gap, researchers analysed data from a recent survey of people attending sexual health clinics. Only untested or HIV-negative people took part. Of over 2000 participants, 1173 were men who have sex with men (MSM) who had had sex in the past three months.

The data presented here are cross-sectional – in other words, they come from a single point in time. While the data show strong associations between depression and risky sex, they cannot prove causality.

Participants’ median age was 31. The majority were white, had a university degree and were attending a clinic in London. Just under half were in an ongoing relationship.

Depressive symptoms were measured by a validated tool known as PHQ-9, which asks respondents how often they have recently been bothered by problems such as “little interest or pleasure in doing things” and “feeling that you are a failure or have let yourself down”.

Based on the answers, 12.5% of HIV-negative gay men attending sexual health clinics had depressive symptoms at the time. (This is considerably higher than in the general population but roughly half the rate seen in a comparable survey of HIV-positive people.) While for most, the symptoms were moderate, 5.5% had more severe symptoms.

Depression was more common in men who were younger, had money problems, did not have a university degree and were not in an ongoing relationship. It was also more common among regular smokers, heavy drinkers and men who used multiple recreational drugs.

Among those with depressive symptoms, 58% said that a doctor had told them they had a mental health condition and 52% were receiving treatment.

Respondents were asked about various measures of intercourse without a condom in the past three months – with anybody (reported by 63% of all men), with two or more partners (reported by 32%) and with a partner of unknown or HIV-positive status (reported by 37%).

Men with depressive symptoms were more likely to report all of these behaviours. The associations remained statistically significant after adjustment for demographic and lifestyle factors that could skew the results: age, ethnicity, education, relationship status, geography, drug use, heavy drinking and smoking.

For example, the adjusted prevalence ratio for condomless sex with multiple partners was 1.36 (1.11-1.65) and for condomless sex with partners of unknown HIV status the adjusted prevalence ratio was 1.44 (1.21-1.71).

However, men with current depression weren’t more likely to have had a sexually transmitted infection, to have multiple partners or to report group sex.

Interestingly, men who’d been depressed in the past – but not now – were more likely to report group sex. This was the only association found between past depression and current sexual behaviour.

“This study suggests the importance of identification and management of depression among men who have sex with men,” concluded Ada Miltz of University College London. Recently, Public Health England released an 'action plan' for improving the health of men who have sex with men which put mental health and substance use at the heart of its concerns.