Department of Prevention and Community Health, George Washington University, Milken Institute School of Public Health, Washington, DC.
Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT.
J Acquir Immune Defic Syndr. 2021 Jun 1;87(2):e188-e197. doi: 10.1097/QAI.0000000000002667.
Black men who have sex with men (BMSM) remain at highest risk for HIV in the United States. Internalized HIV stigma and depression contribute to substance use and condomless anal intercourse (CAI). Religion and spirituality (R/S) are associated with decreased HIV-related risk behaviors for some groups, but their impact among BMSM is uncertain. We investigated the main and moderating roles of R/S on pathways from internalized HIV stigma to CAI while under the influence of drugs.
We used baseline data from 1511 BMSM from the HIV Prevention Trials Network (HPTN) 061 study to examine the associations between internalized HIV stigma, depressive symptoms, alcohol use, and CAI while under the influence of drugs, adjusting for covariates in generalized structural equation models. We then tested whether R/S moderated the association between (1) internalized HIV stigma and depressive symptoms, (2) depressive symptoms and alcohol use, and (3) alcohol use and CAI while under the influence of drugs.
Spiritual beliefs [F(1,2) = 9.99, P < 0.001], spiritual activities [F(1,2) = 9.99, P < 0.001], and religious attendance [F(1,2) = 9.99, P < 0.001] moderated the pathway between internalized HIV stigma and depressive symptoms. As internalized HIV stigma increased, those with lower spiritual activity scores experienced significantly higher increases in depressive symptoms compared with those with higher spiritual activity scores whose depressive symptom scores remained unchanged [stigma × spiritual activities B = -0.18 (SE = 0.07), P < 0.001].
Religion and spirituality were protective against CAI among BMSM. Future intervention research should explore ways to incorporate religious and/or spiritual activities to reduce internalized HIV stigma as one way to reduce depressive symptoms among BMSM.
在美国，与男性发生性关系的黑人男性（BMSM）仍然面临最高的 HIV 风险。内化的 HIV 耻辱感和抑郁会导致药物使用和无保护的肛交（CAI）。宗教和精神信仰（R/S）与某些群体减少与 HIV 相关的风险行为有关，但它们在 BMSM 中的影响尚不确定。我们研究了 R/S 对在药物影响下从内化的 HIV 耻辱感到 CAI 的途径的主要和调节作用。
我们使用来自 HIV 预防试验网络（HPTN）061 研究的 1511 名 BMSM 的基线数据，在广义结构方程模型中调整了协变量，以检验内化的 HIV 耻辱感、抑郁症状、酒精使用和在药物影响下的 CAI 之间的关联。然后，我们测试了 R/S 是否调节了（1）内化的 HIV 耻辱感和抑郁症状之间的关联，（2）抑郁症状和酒精使用之间的关联，以及（3）酒精使用和在药物影响下的 CAI 之间的关联。
精神信仰[F(1,2) = 9.99, P < 0.001]、精神活动[F(1,2) = 9.99, P < 0.001]和宗教出席[F(1,2) = 9.99, P < 0.001]调节了内化的 HIV 耻辱感和抑郁症状之间的途径。随着内化的 HIV 耻辱感的增加，那些精神活动得分较低的人经历的抑郁症状显著增加，而那些精神活动得分较高的人的抑郁症状保持不变[耻辱感×精神活动 B = -0.18（SE = 0.07），P < 0.001]。
宗教和精神信仰对 BMSM 中的 CAI 具有保护作用。未来的干预研究应该探索将宗教和/或精神活动纳入其中的方法，以减少内化的 HIV 耻辱感，作为减少 BMSM 抑郁症状的一种方式。
