Gay, bisexual, and other men who have sex with men (MSM) living with HIV are disproportionately affected by negative mental health outcomes due to stigma, discrimination, and other social and cultural pressures. Studies suggested mental health disorders such as depression are associated with negative patient outcomes and likely affects HIV antiretroviral therapy (ART). Factors that may increase the odds of depressive symptoms are intimate partner violence (IPV) and sexual orientation disclosure. This study’s objectives are to (1) describe the prevalence of IPV, and depressive symptoms among MSM living with HIV in China, and (2) examine the associations between IPV, sexual orientation disclosure, and depressive symptoms among MSM living with HIV in China.
We analyzed data from a larger study examining HIV-HCV co-infection among MSM in China (N=1805). Recruitment occurred between 2014 and 2016 in Shanghai and Chengdu. Local community-based organizations (CBOs) assisted with participant recruitment and enrollment. Rapid HIV oral testing was conducted, and blood plasma samples were sent to the local Centers for Disease Control and Prevention (CDC) for confirmatory tests. A 7-item adapted questionnaire assessed IPV including emotional, physical, verbal, and sexual victimizations in the past 5 years; depressive symptoms were assessed using an adapted CES-D scale. Participants who are aware of their HIV-positive status were then asked if they have initiated ART. We examined bivariate associations between IPV, sexual orientation disclosure, and depressive symptoms. We then used multivariable logistic regression to determine the unique effects of IPV and sexual orientation disclosure on depressive symptoms controlling for study covariates.
Participants’ mean age was 32.7 years old (SD: 10.0). More than half (56.2%) received some college education or higher. A majority were currently single, and 20.9% disclosed their sexual orientation to their family or friends. Over fifteen percent (15.4%) reported having experienced IPV in the last five years, and 7.1% reported more than one form of IPV. Nearly one-third (32%) screened for depressive symptoms. In bivariate analysis, sexual orientation disclosure was significantly associated with IPV (OR=1.70, 95% CI [1.27-2.26]), and IPV and recent substance use were associated with depressive symptoms (OR=1.78, 95% CI [1.37-2.31]; OR=1.45, 95% CI [1.08-1.94]). Those who screened depressive symptoms were less likely to have initiated ART (OR=0.73, 95% CI [0.60-0.90]). In multivariate analyses, MSM living with HIV who experienced any form of IPV had statistically significantly higher odds of depressive symptoms (AOR=1.76, 95% CI [1.10-2.82]).
Conclusions and Implications
High percentages of MSM living with HIV in two cities in China screened positive for depressive symptoms. IPV was strongly associated with depressive symptoms. Our results suggest the need to address sexual orientation-related stigma and discrimination issues to facilitate ART treatment and improve overall HIV care. Healthcare workers may consider integrating violence victimization screening and trauma-informed approaches with standard HIV care, especially in community-based settings. Further research should focus on elucidating the extent of unmet needs for mental health care among MSM living with HIV in China. Innovative approaches and interventions are needed to provide psychological support to this population.