Abstract
Much research has examined the relationship between depressive symptoms and unprotected sex among men who have sex with men (MSM), but little is known about how depression is related to the sexual behavior of men who intentionally engage in unprotected anal intercourse, or bareback sex. In this study, we explored the extent to which depressive symptoms were associated with rates of unprotected sex among barebackers, and whether this relationship was dependent upon HIV serostatus. Using a sample of 120 MSM who engage in intentional condomless sex, we found that for HIV-negative participants, depressive symptoms were associated with the overall frequency of unprotected anal intercourse as well as unprotected anal intercourse with a serodiscordant partner. For HIV-positive participants, depressive symptoms were not associated unprotected intercourse. Additional research is needed to better understand depression among men who bareback and how interventions could be designed to address depression and reduce sexual risk behaviors.
Resumen
A pesar de la amplia investigación de la relación entre los síntomas depresivos y el sexo desprotegido entre hombres que tienen sexo con hombres (HSH), se sabe poco sobre cómo la depresión se relaciona con la conducta de los hombres que practican el sexo “bareback”, es decir, el coito anal intencionalmente desprotegido. En este estudio, exploramos si los síntomas depresivos estaban asociados a las tasas de sexo desprotegido entre un grupo de 120 hombres con episodios recientes de sexo “bareback” y si esta asociación dependía del estatus serológico por VIH. Encontramos que entre participantes VIH-negativos, los síntomas depresivos se asociaban tanto con la frecuencia global del coito anal desprotegido, como también con el coito anal desprotegido con una pareja serodiscordante. En cambio, para los participantes VIH-positivos, no hubo relación entre los síntomas depresivos y el coito anal desprotegido. Se requiere investigación adicional para comprender mejor el rol de la depresión entre hombres que practican el sexo “bareback” y para determinar cómo elaborar intervenciones que podrían enfocarse en la depresión y reducir conductas sexuales de riesgo.
Similar content being viewed by others
References
Alvy LM, McKirnan DJ, Mansergh G, et al. Depression is associated with sexual risk among men who have sex with men, but is mediated by cognitive escape and self-efficacy. AIDS Behav. 2001;15(6):1171–9.
Beck A, McNally I, Petrak J. Psychosocial predictors of HIV/STI risk behaviours in a sample of homosexual men. Sex Transm Infect. 2003;79(2):142–6.
Bradley MV, Remien RH, Dolezal C. Depression symptoms and sexual HIV risk behavior among serodiscordant couples. Psychosom Med. 2008;70(2):186–91.
Koblin BA, Husnik MJ, Colfax G, Huang Y, Madison M, Mayer K. Risk factors for HIV infection among men who have sex with men. AIDS. 2006;20:731–9.
Parsons JT, Halkitis PN, Wolitski RJ, Gomez CA. Correlates of sexual risk behaviors among HIV-positive men who have sex with men. AIDS Educ Prev. 2003;15(5):383–400.
Perdue T, Hagan H, Thiede H, Valleroy L. Depression and HIV risk behavior among seattle-area injection drug users and young men who have sex with men. AIDS Educ Prev. 2003;15(1):81–92.
Rogers G, Curry M, Oddy J, Pratt N, Beilby J, Wilkinson D. Depressive disorders and unprotected casual anal sex among Australian homosexually active men in primary care. HIV Med. 2003;4(3):271–5.
Stall R, Mills TC, Williamson J, Hart T, Greenwood G, Paul J, et al. Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. Am J Public Health. 2003;93(6):939–42.
Yi H, Sandfort TGM, Shidlo A. Effects of disengagement coping with HIV risk on unprotected sex among HIV-negative gay men in New York City. Health Psychol. 2010;29(2):205–14.
Carballo-Diéguez A, Ventuneac A, Bauermeister J, Dowsett GW, Dolezal C, Remien RH, et al. Is ‘bareback’ a useful construct in primary HIV-prevention? Definitions, identity, and research. Cult Health Sex. 2009;11(1):51–65.
Carballo-Diéguez A, Bauermeister J. “Barebacking”: intentional condomless anal sex in HIV-risk contexts. Reasons for and against it. J Homosex. 2004;47(1):1–16.
McKirnan DJ, Tolou-Shams M, Courtenay-Quirk C. The treatment advocacy program: a randomized controlled trial of a peer-led safer sex intervention for HIV-infected men who have sex with men. J Consult Clin Psychol. 2010;78(6):952–63.
Stein MD, Anderson BJ, Solomon DA, Herman DS, Ramsey SE, Brown RA, et al. Reductions in HIV risk behaviors among depressed drug injectors. Am J Drug Alcohol Abuse. 2005;31(3):417–32.
Hampton MC, Halkitis PN, Mattis JS. Coping, drug use, and religiosity/spirituality in relation to HIV serostatus among gay and bisexual men. AIDS Educ Prev. 2010;22(5):417–29.
Dolezal C, Carballo-Diéguez A, Nieves-Rosa L, Diaz F. Substance use and sexual risk behavior: understanding their association among four ethnic groups of Latino men who have sex with men. J Subst Abuse. 2000;11(4):323–36.
Levounis P, Galanter M, Dermatis H, Hamowy A, De Leon G. Correlates of HIV transmission risk factors and considerations for interventions in homeless, chemically addicted and mentally ill patients. J Addict Disord. 2002;21(3):61–72.
Kennedy SH, Dickens SE, Eisfeld BS, Bagby RM. Sexual dysfunction before antidepressant therapy in major depression. J Affect Disord. 1999;56(2–3):201–8.
Akena DH, Musisi S, Kinyanda E. A comparison of the clinical features of depression in HIV-positive and HIV-negative patients in Uganda. Afr J Psychiatry (Johannesbg). 2010;13(1):43–51.
Newcomb ME, Mustanski B. Internalized homophobia and internalizing mental health problems: a meta-analytic review. Clin Psychol Rev. 2010;30(8):1019–29.
Meyer I. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97.
Bancroft J, Janssen E, Strong D, Carnes L, Vukadinovic Z, Long JS. The relation between mood and sexuality in heterosexual men. Arch Sex Behav. 2003;32(3):217–30.
Bancroft J, Janssen E, Strong D, Vukadinovic Z. The relation between mood and sexuality in gay men. Arch Sex Behav. 2003;32(3):231–42.
Bancroft J, Janssen E. The dual control model of male sexual response: a theoretical approach to centrally mediated erectile dysfunction. Neurosci Biobehav Rev. 2000;24(5):571–9.
Carballo-Diéguez A, Dowsett G, Ventuneac A, Remien R, Balan I, Dolezal C, et al. Cybercartography of popular Internet sites used by New York City men who have sex with men interested in bareback sex. AIDS Educ Prev. 2006;18(6):475–89.
Couper M, Rowe B. Evaluation of a computer-assisted self-interview component in a computer-assisted interview survey. Public Opin Q. 1996;60(1):89–105.
Carballo-Diéguez A, Remien RH, Dolezal C, Wagner G. Reliability of sexual behavior self-reports in male couples of discordant HIV-status. J Sex Res. 1999;38(2):152–8.
Beck A, Steer R, Brown G. The Beck Depressive Inventory—Second Edition Manual. San Antonio: The Psychological Corporation; 1996.
SPSS Inc. PASW 18.0 for Windows, Release 18.0. Chicago: SPSS Inc., 1996.
John U, Meyer C, Rumpf HJ, Hapke U. Self-efficacy to refrain from smoking predicted by major depression and nicotine dependence. Addict Behav. 2004;29(5):857–66.
Lin EH, Katon W, Von Korff M, Rutter C, Simon GE, Oliver M, et al. Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care. 2004;27(9):2154–60.
Odegard PS, Capoccia K. Medication taking and diabetes: a systematic review of the literature. Diabetes Educ. 2007;33(6):1014–29.
Allgöwer A, Wardle J, Steptoe A. Depressive symptoms, social support, and personal health behaviors in young men and women. Health Psychol. 2001;20(3):223–7.
Carballo-Diéguez A, Ventuneac A, Dowsett GW, Balan I, Bauermeister J, Remien RH, et al. Sexual pleasure and intimacy among men who engage in “bareback sex”. AIDS Behav. 2011;15(Suppl 1):S57–65.
Acknowledgments
Dr. Houston is supported by a training grant from the National Institute of Mental Health (T32 MH019139; Behavioral Sciences Research in HIV Infection; Principal Investigator, Theodorus Sandfort, Ph.D.). This research was supported by Grant R01 MH69333 from the NIMH to the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University (Alex Carballo-Diéguez, Ph.D., Principal Investigator). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIMH or the NIH. The authors would like to thank Theresa Exner, Timothy Frasca, Rebecca Giguere, Susie Hoffman, Marina Mabragaña, John Markowitz, Tsitsi Masvaure, Judith Rabkin, and Ray Smith for their assistance and support in completing this report.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Houston, E., Sandfort, T., Dolezal, C. et al. Depressive Symptoms Among MSM Who Engage in Bareback Sex: Does Mood Matter?. AIDS Behav 16, 2209–2215 (2012). https://doi.org/10.1007/s10461-012-0156-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-012-0156-7