Original Paper

AIDS and Behavior

, Volume 17, Issue 8, pp 2765-2772

Does Effective Depression Treatment Alone Reduce Secondary HIV Transmission Risk? Equivocal Findings from a Randomized Controlled Trial

  • Alexander C. TsaiAffiliated withChester M. Pierce, MD Division of Global Psychiatry, Department of Psychiatry, Massachusetts General HospitalCenter for Global Health, Massachusetts General HospitalHarvard Medical School Email author 
  • , Matthew J. MimiagaAffiliated withHarvard Medical SchoolDepartment of Epidemiology, Harvard School of Public Health
  • , James W. DilleyAffiliated withDepartment of Psychiatry, San Francisco General Hospital at the University of California at San FranciscoAlliance Health Project
  • , Gwendolyn P. HammerAffiliated withCommunicable Disease Emergency Response Branch, California Department of Public Health
  • , Dan H. KarasicAffiliated withDepartment of Psychiatry, San Francisco General Hospital at the University of California at San Francisco
  • , Edwin D. CharleboisAffiliated withCenter for AIDS Prevention Studies, Department of Medicine, University of California at San Francisco
  • , James L. SorensenAffiliated withDepartment of Psychiatry, San Francisco General Hospital at the University of California at San Francisco
  • , Steven A. SafrenAffiliated withChester M. Pierce, MD Division of Global Psychiatry, Department of Psychiatry, Massachusetts General HospitalHarvard Medical SchoolFenway HealthBehavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital
  • , David R. BangsbergAffiliated withChester M. Pierce, MD Division of Global Psychiatry, Department of Psychiatry, Massachusetts General HospitalCenter for Global Health, Massachusetts General HospitalHarvard Medical SchoolMbarara University of Science and Technology

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Abstract

Depressed mood has been associated with HIV transmission risk behavior. To determine whether effective depression treatment could reduce the frequency of sexual risk behavior, we analyzed secondary outcome data from a 36-week, two-arm, parallel-design, randomized controlled trial, in which homeless and marginally housed, HIV-infected persons with comorbid depressive disorders were randomized to receive either: (a) directly observed treatment with the antidepressant medication fluoxetine, or (b) referral to a local public mental health clinic. Self-reported sexual risk outcomes, which were measured at 3, 6, and 9 months, included: total number of sexual partners, unprotected sexual intercourse, unprotected sexual intercourse with an HIV-uninfected partner or a partner of unknown serostatus, and transactional sex. Estimates from generalized estimating equations regression models did not suggest consistent reductions in sexual risk behaviors resulting from treatment. Mental health interventions may need to combine depression treatment with specific skills training in order to achieve durable impacts on HIV prevention outcomes.

Keywords

HIV Depression Antidepressive agents Sexual behavior Protected sex Homeless persons