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Depression is Associated With Sexual Risk Among Men who Have Sex With Men, but is Mediated by Cognitive Escape and Self-Efficacy

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journal contribution
posted on 01.03.2012, 00:00 authored by Lisa M. Alvy, David J. McKirnan, Gordon Mansergh, Beryl Koblin, Grant D. Colfax, Stephen Flores, Sharon Hudson
Men who have sex with men (MSM) show high rates of HIV infection, and higher rates of depression than non-MSM. We examined the association between depression and sexual risk among “high risk” MSM. Evidence has been mixed regarding the link between depression and risky sex, although researchers have rarely considered the role of psychosocial vulnerabilities such as self-efficacy for sexual safety or “escape” coping styles. In a national sample (N=1,540) of HIV-positive and HIV-negative MSM who reported unprotected sex and drug use with sex partners, we found evidence that depression is related to HIV transmission risk. Self-efficacy for sexual safety and cognitive escape mediated the link between depression and risk behavior, suggesting that psychosocial vulnerability plays an important role in the association of depression with sexual risk. These findings may help us construct more accurate theories regarding depression and sexual behavior, and may inform the design of sexual safety interventions.


This research was conducted as part of Project MIX: Behavioral Intervention to Reduce Sexual Risk Behavior of Substance-Using (Non-Injection) Men Who Have Sex With Men. It was supported by the Centers for Disease Control and Prevention through cooperative agreements with the University of Illinois at Chicago and Howard Brown Health Center, New York Blood Center and the New York Academy of Medicine, the San Francisco Department of Public Health AIDS Office, the Health Research Association in Los Angeles, and the CDC Division of HIV/AIDS Prevention in Atlanta.


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Post print version of article may differ from published version. The original publication is available at; DOI: 10.1007/s10461-010-9678-z.


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