Association of Co-Occurring Psychosocial Health Problems and Increased Vulnerability to HIV/AIDS Among Urban Men Who Have Sex With Men

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 of respondents.

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 gay.

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.

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