Chronic Medical Conditions and Infectious Diseases Among Men Who Have Sex with Men: Associations with Mental Illness, Substance Abuse, and HIV Status

Background:Gay, bisexual, and other men who have sex with men (MSM), have higher rates of serious mental illnesses (SMI) and substance use disorders (SUDs) compared with men in the general population. Although these conditions are associated with higher rates of chronic medical conditions (CMCs) such as diabetes, asthma, and heart disease and infectious diseases such as tuberculosis and Hepatitis C, health research with MSM has focused on HIV and other sexually transmitted infections (STIs). Consequently, relatively little is known about the rates of CMCs and non-sexually transmitted infectious diseases for MSM. This study compared the rates of these under-investigated conditions and diseases in a sample of MSM with rates in a matched sample of men derived from a general population survey. The study further explored the associations among CMCs and SMI, SUDs, and HIV infection.

Methods: MSM 18 years and older living in the Chicago area were recruited through an Internet-based survey administered in 2008 and again in 2010. Across administrations, 640 unduplicated participants completed all questions, yielding a response rate of 69%. A comparison sample was generated using data from the 2008 and 2010 National Survey on Drug Use and Health (NSDUH), propensity score matching with calipers and the following covariates: sex, age, education race/ethnicity, and population density. This yielded 620 MSM and 620 matched male NSDUH participants. In both samples, SMI was assessed using the K6 screening scale, SUD was assessed using DSM-IV symptom questions, and HIV status was self-reported. Both surveys contained questions on the lifetime prevalence of 10 CMCs as well as tuberculosis and STIs other than HIV. Separate logistic regressions were run with each CMC or infectious condition as the DV with covariates representing: group, race/ethnicity, age, education, HIV status, SUDs, and SMI.

Results: Compared with a matched general population sample, and after controlling for demographics, HIV, SUD, and SMI, MSM had significantly (p < .01) higher odds on 9 of the conditions assessed: liver disease (OR=1.77), hypertension (OR=1.46), asthma (OR = 1.46), pneumonia (OR = 1.95), diabetes (OR = 1.96), pancreatitis (OR = 4.91), ulcers (OR = 3.19), liver disease (OR = 6.88), and STIs (OR = 7.56).  Heart disease was the only condition with a lower odds ratio for the MSM sample (OR = .47). Being HIV positive was associated with higher odds of pancreatitis (OR = 18.37), liver disease (OR = 6.11), and STI (OR = 7.35). SMI was associated with higher odds of asthma (OR = 1.67) and chronic lung disease (OR = 1.72). SUD showed few significant associations.

Implications: The findings suggest that MSM, relative to other men, are more likely to experience a range of CMCs that are not specifically attributable to HIV infection, SMI, or SUDs. The causal mechanisms for these differences are unknown but could be related to stigma and lack of adequate health care access. Social workers providing case management services to MSM clients should be aware of their higher risk for medical complexity and be prepared to facilitate access to primary health care services.