The extent to which MSM experience dangerous psychosocial
health problems has often been measured by AIDS researchers as a
means of explaining the distribution and consequences of HIV
infection. In the current study, researchers measured the extent
to which a set of psychosocial health problems has an additive
effect on increasing HIV risk among MSM.
Random-digit-dialing was used to sample households in four
large U.S. cities (Los Angeles, San Francisco, Chicago, New York)
identified as being relatively rich in MSM residents. Telephone
interviews were conducted from November 15, 1996, through March
1, 1998. Men age 18 or older who had sex with a man since age 14
or who defined themselves as gay or bisexual were eligible for
interviewing. Of eligible households, 2,881 interviews (78
percent) were completed. HIV status was confirmed for a subsample
High-risk sex was defined as unprotected anal intercourse
with a partner of known discordant or unknown status, on the
basis of respondent's answers to questions about their four most
recent sex partners. Polydrug use was measured as three or more
recreational drugs (e.g., marijuana, cocaine, crack cocaine,
heroin, hallucinogens, inhalants, amphetamines, methamphetamines,
MDMA ["ecstasy"], barbiturates or tranquilizers, painkillers).
Partner violence was measured as the experience of any form of
violence -- symbolic (e.g., "verbally threatened you," "stalked
you"), physical (e.g., "hit you," "kicked you"), or sexual
("forced you to have sex") -- in the past five years with a primary
partner. Childhood sexual abuse was defined as the experience of
being "forced or frightened by someone into doing something
sexually" with a partner more than 10 years older than the
respondent when the respondent was age 16 or younger.
The sample was predominantly European American, although
with substantial participation of men of color (21 percent), a
wide range of ages (16 percent were older than age 50 years), and
a wide income distribution (42 percent earned less than $40,000
per year). The majority (84 percent) identified themselves as
Each of the psychosocial health conditions appears as an
independent positive correlate of the others in the multivariate
models. For example, childhood sexual abuse is independently
associated with depression, polydrug use, and partner violence;
polydrug use is independently associated with depression and
partner violence; and partner violence is independently
associated with childhood sexual abuse, depression, and polydrug
use. Of the six possible associations, only the association
between childhood sexual abuse and multiple drug use failed to
achieve statistical significance at the multivariate level. That
relation was positive at the bivariate level.
Using HIV infection and high-risk sexual behavior as
independent variables, both polydrug use and partner violence
were significantly associated with HIV seropositivity, whereas
depression and childhood sexual abuse had positive but
nonsignificant associations with HIV seropositivity. Using the
same approach, polydrug use, partner violence, and childhood
sexual abuse were significantly associated with high-risk sexual
behavior, with depression having a positive but nonsignificant
association with such behavior. The relationship between high-risk sex and HIV seropositivity remained significant after
adjustment for each of the health and demographic variables.
Compared with the group of men reporting no psychosocial
health problems, greater numbers of health problems were
significantly and positively associated with HIV infection (1
problem=1.8 OR; 2 problems=2.7 OR; 3 and 4 problems=2.2 OR) and
current high-risk sexual practices (1 problem=1.6 OR; 2
problems=2.4 OR; 3 and 4 problems=3.5 OR). The same findings
occurred when controlling for demographic variables in a
multivariate logistic regression model.
"AIDS prevention among MSM has overwhelmingly focused on
sexual risk alone," the authors wrote. "Other health problems
among MSM not only are important in their own right, but also may
interact to increase HIV risk. HIV prevention might become more
effective by addressing the broader health concerns of MSM while
also focusing on sexual risks," they concluded.
Back to other CDC news for June 24, 2003
This article was provided by CDC National Prevention Information Network.
It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.