Fletcher Jesse B, Clark Kirsty A, Reback Cathy J
Friends Research Institute, Inc., Los Angeles, CA.
Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT.
Addict Res Theory. 2021;29(3):263-270. doi: 10.1080/16066359.2020.1807960. Epub 2020 Aug 25.
Methamphetamine use is associated with disproportionate risk of HIV infection and increased risk of depression among sexual minority men. The purpose of the study was to estimate the association between clinical depression diagnoses and sexual risk-taking among cisgender men who have sex with men (MSM) who use methamphetamine.
From March 2014 through January 2016, 286 MSM who use methamphetamine but were not seeking treatment for methamphetamine use disorder were enrolled to participate in a technology-based randomized controlled trial to reduce methamphetamine use and HIV sexual risk behaviors; participants were assessed for major depressive episodes (MDE) and persistent depressive disorder (PDD) at baseline. Multivariate clustered zero-inflated negative binomial regression analyses of condomless anal intercourse (n=282; 1,248 visits) estimated the association between this baseline diagnostic result and engagement in sexual risk-taking over time.
Participants predominantly identified as non-white (80%), averaged 42 years of age, and reported a HIV prevalence rate of 46%. Engagement in sexual risk-taking consistently demonstrated a positive curvilinear relationship with clinical depression severity, such that, for example, participants without clinical depression (59% of the sample; coef.=1.16) and those with MDE (36% of the sample; coef.=1.45) both demonstrated elevated rates of condomless anal sex with anonymous partners relative to participants with PDD (5% of the sample; analytical reference category; both coef. p<0.05). Data also demonstrated a trend (p = 0.053) of reduced sexual risk-taking with main partners among participants diagnosed with MDE (coef.=-0.94).
Methamphetamine use among participants in this study inverted the functional form of the relationship between depression and sexual risk among MSM observed in prior studies. Whereas low-grade depression has been associated with increased sexual risk-taking in prior samples of MSM, methamphetamine upends this relationship, such that the greatest engagement in sexual risk-taking occurred among those diagnosed with MDE at baseline. Additional research is warranted to clarify how methamphetamine influences sexual risk-taking among MSM with/without comorbid depression.
使用甲基苯丙胺与感染艾滋病毒的风险不成比例以及男同性恋者患抑郁症的风险增加有关。本研究的目的是评估在使用甲基苯丙胺的男同性恋者（MSM）中，临床抑郁症诊断与性冒险行为之间的关联。
从2014年3月至2016年1月，招募了286名使用甲基苯丙胺但未寻求甲基苯丙胺使用障碍治疗的男同性恋者，参与一项基于技术的随机对照试验，以减少甲基苯丙胺的使用和艾滋病毒性风险行为；在基线时对参与者进行了重度抑郁发作（MDE）和持续性抑郁症（PDD）的评估。对无保护肛交（n = 282；1248次就诊）进行多变量聚类零膨胀负二项回归分析，以估计该基线诊断结果与随时间进行性冒险行为之间的关联。
参与者主要为非白人（80%），平均年龄42岁，报告的艾滋病毒感染率为46%。性冒险行为与临床抑郁症严重程度始终呈现正曲线关系，例如，没有临床抑郁症的参与者（占样本的59%；系数 = 1.16）和患有MDE的参与者（占样本的36%；系数 = 1.45）与患有PDD的参与者（占样本的5%；分析参考类别；两个系数p < 0.05）相比，与匿名伴侣进行无保护肛交的比例均有所升高。数据还显示，被诊断患有MDE的参与者与主要伴侣进行性冒险行为减少的趋势（p = 0.053）（系数 = -0.94）。
本研究中参与者使用甲基苯丙胺颠覆了先前研究中观察到的男同性恋者抑郁症与性风险之间关系的功能形式。在先前的男同性恋者样本中，低度抑郁症与性冒险行为增加有关，而甲基苯丙胺颠覆了这种关系，使得在基线时被诊断患有MDE的人中性冒险行为最为严重。有必要进行更多研究以阐明甲基苯丙胺如何影响有/无合并抑郁症的男同性恋者的性冒险行为。
