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Depressive Symptoms, Utilization of Mental Health Care, Substance Use and Sexual Risk Among Young Men Who have Sex with Men in EXPLORE: Implications for Age-Specific Interventions

AIDS and Behavior volume 13, Article number: 811 (2009) Cite this article

Abstract

The EXPLORE study evaluated a behavioral intervention to prevent HIV infection among MSM. We examined depressive symptoms, utilization of mental health care, substance use and HIV risk taking behaviors in YMSM aged 16–25 years compared with their older counterparts. YMSM were more likely to report depressive symptoms (OR = 1.55) and less likely to report use of counseling (OR = 0.39) or medication (OR = 0.20) for psychiatric conditions. YMSM were more likely to report heavy alcohol and drug use. YMSM more often reported engaging in unprotected insertive (OR = 1.60) and receptive (OR = 2.07) anal intercourse with presumed HIV-uninfected partners, and unprotected receptive (OR = 1.72) anal intercourse with partners of unknown-HIV status. These findings suggest the need for more appropriate and accessible mental health care and substance use services for YMSM. Additionally, HIV prevention work with this population should provide comprehensive education about HIV testing and risk reduction counseling that focuses on communication about serostatus and safety in sexual situations.

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Acknowledgements

The authors would like to thank Yijian Huang, Thomas Coates, Sam Bozeman, Kent Curtis and Sean McKee for their constructive comments on this manuscript.

We gratefully acknowledge the contributions of the EXPLORE study participants and the entire EXPLORE Study Team. Protocol Co-Chairs, Sites and Principal Investigators are listed below. For a full listing of members of the EXPLORE study team please see The EXPLORE Study Team 2004.

Protocol co-chairs: Beryl Koblin, Margaret Chesney and Thomas Coates. Boston’s Fenway Community Health Center and the Latin American Health Institute: Kenneth Mayer (Site Principal Investigator) and Team. Chicago’s Howard Brown Community Health Center: David McKirnan (Site Principal Investigator) and Team. Denver Public Health: Franklyn Judson (Site Principal Investigator) and Team. New York Blood Center: Beryl Koblin (Site Principal Investigator) and Team. San Francisco Department of Public Health: Susan Buchbinder (Site Principal Investigator), Grant Colfax (Site Co-Principal Investigator), and Team. Seattle’s University of Washington: Connie Celum (Site Principal Investigator) and Team.

We are also grateful for the support we received from Abt Associates, Inc., Center for AIDS Prevention Studies, Statistical Center for HIV/AIDS Research and Prevention and the Central Laboratory.

This work was supported by the HIV Network for Prevention Trials and sponsored by the US National Institute of Allergy and Infectious Diseases and the National Institute on Alcohol Abuse and Alcoholism, of the National Institutes of Health, Department of Health and Human Services, through contract N01 AI35176 with Abt Associates Inc; contract N01 AI45200 with the Fred Hutchinson Cancer Research Center; and subcontracts with the Denver Public Health, the Fenway Community Health Center, the Howard Brown Health Center, the New York Blood Center, the Public Health Foundation Inc., and the University of Washington.

In addition, this work was supported by the HIV Prevention Trials Network and sponsored by the National Institute of Allergy and Infectious Diseases, the National Institute of Child Health and Human Development, the National Institute on Drug Abuse, the National Institute of Mental Health, and the Office of AIDS Research, of the National Institutes of Health, US Dept of Health and Human Services, through a cooperative agreement with Family Health International (cooperative agreement 5 U01 AI46749) with a subsequent subcontract to Abt Associates Inc. with subcontracts to the Howard Brown Health Center and Denver Public Health; cooperative agreement U01 AI48040 to the Fenway Community Health Center, cooperative agreement U01 AI48016 to Columbia University (including a subagreement with the New York Blood Center); and cooperative agreement U01 AI47981 to the University of Washington; and cooperative agreement U01 AI47995 to the University of California, San Francisco.

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Affiliations

  1. The Fenway Institute, Fenway Community Health, Boston, MA, USA

    Elizabeth A. Salomon, Matthew J. Mimiaga, Steven A. Safren & Kenneth H. Mayer

  2. Clinical Research Program, Massachusetts General Hospital, 185 Cambridge Street – CPZN 2.128, Boston, MA, 02114, USA

    Elizabeth A. Salomon

  3. Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA

    Matthew J. Mimiaga & Steven A. Safren

  4. Statistical Center for HIV/AIDS Research and Prevention, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Marla J. Husnik

  5. School of Public Health, Drexel University, Philadelphia, PA, USA

    Seth L. Welles

  6. College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Marc W. Manseau

  7. Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Arnel B. Montenegro

  8. New York Blood Center, New York, NY, USA

    Beryl A. Koblin

  9. Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

    Margaret A. Chesney

  10. Department of Medicine, University of California San Francisco, San Francisco, CA, USA

    Margaret A. Chesney

  11. Brown University/Miriam Hospital, Providence, RI, USA

    Kenneth H. Mayer

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  1. Elizabeth A. Salomon
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  2. Matthew J. Mimiaga
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  9. Margaret A. Chesney
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  10. Kenneth H. Mayer
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Correspondence to Elizabeth A. Salomon.

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Salomon, E.A., Mimiaga, M.J., Husnik, M.J. et al. Depressive Symptoms, Utilization of Mental Health Care, Substance Use and Sexual Risk Among Young Men Who have Sex with Men in EXPLORE: Implications for Age-Specific Interventions. AIDS Behav 13, 811 (2009). https://doi.org/10.1007/s10461-008-9439-4

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Keywords

  • MSM
  • HIV
  • Young men
  • Mental health
  • Substance use
  • Sexual behavior