Substance use and social problems predict HIV infection in American gay men

Roger Pebody
Original Article:

American gay men reporting depression, childhood sexual abuse, stimulant use, other substance use and heavy alcohol use are nine times more likely than men without any of these issues to subsequently acquire HIV, according to the findings of a large study conducted over four years reported in the Journal of Acquired Immune Deficiency Syndromes.

The more of these problems a man had, the more likely he was to later report risky sex or to become HIV positive. The study suggests that these problems are inter-connected and work together to heighten men’s vulnerability.

Numerous studies have shown that gay men and other men who have sex with men are more likely to report substance use, mental health problems, sexual abuse and other issues than other men.

Rather than seeing them as separate problems, some researchers have paid attention to how these issues, sexual risk taking and HIV infection link together. The term ‘syndemic’ is used to describe the co-occurrence of several diseases and social problems which combine together to have an especially negative impact on health. Some research on ‘syndemics’ draws attention to poverty and social marginalisation as underlying causes, with work on men who have sex with men sometimes suggesting that early experiences of homophobia, social rejection and concealment can have a lifelong impact.

Studies have already shown that gay men often report more than one psychosocial health problem and that having several health problems is significantly associated with both high-risk sexual behaviour and having HIV. But these studies have been cross-sectional – with data only collected at one point in time. They have been unable to show that interlinked psychosocial health problems occurred before sexual risk behaviour and HIV infection.

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