Abstract #92  -  Prevalent HIV infection as a mediator of psychiatric morbidity differences among men varying in sexual orientation
Authors:   Presenting Author:   Prof Susan Cochran - UCLA School of Public Health
Additional Authors:  Prof Vickie Mays,
Aim: Study Objectives: Previous studies in the United States, Canada, Europe and Australia (King et al., 2008) have found somewhat elevated rates of substance use and psychiatric disorders among gay and bisexual men as compared to heterosexual men. Whether this observed difference can be explained by similar differences in prevalent HIV infection (Cochran & Mays, 2007) and its associated harmful mental health effects (Whetten, Reif, Whetten, & Murphy-McMillan, 2008) is not known. We use information available in the California Quality of Life Survey to investigate the extent to which differences in prevalent HIV infection mediates the association between sexual orientation, illicit drug use, and mental health morbidity among men.
Method / Issue: Method: The 2004-2005 Cal-QOL, a population-based survey of 2272 Californians aged 18 to 72 years, oversampled for minority sexual orientation interviewed 1102 men including 753 exclusively heterosexual men and 349 sexual minority men (e.g., gay, bisexual, and homosexually experienced heterosexual men). Of the latter group, 61 reported that they were currently living with HIV infection. The fully-structured CATI-based interview also assessed past year illicit drug use, current levels of psychological distress (Andrews & Slade, 2001), as well as demographic characteristics. We use a mediational analysis approach (Gelfand, Mensinger, & Tenhave, 2009) to evaluate the extent to which HIV infection mediates anticipated associations between sexual orientation and mental health markers.
Results / Comments: Results: Sexual minority men reported significantly higher rates of both past year illicit drug use (42% vs. 18%) and current psychological distress ( = 6.5 vs. 4.8) than did exclusively heterosexual men, after adjusting for demographic confounding due to age, race/ethnicity, education, and foreign birth. Among sexual minority men, those who reported prevalent HIV infection were also more likely to report illicit drug use (57% vs. 40%) and higher levels of psychological distress ( = 9.8 vs. 5.8). Mediational analyses indicate that although prevalent HIV infection does account for some of the observed increased risk for illicit drug use and higher psychological distress, it does not completely attenuate the sexual orientation differences.
Discussion: Discussion: Our findings suggest, as expected, that HIV infection is associated with higher rates of illicit drug use and general psychological distress among sexual minority men. But the differences are not enough to account for the overall differences in drug use and distress observed between heterosexual and sexual minority men. Elsewhere both the harmful effects of anti-gay stigma and cultural norms that encourage illicit drug use have been implicated as similar correlates of psychological morbidity (Cochran, 2001) suggesting that this mental health disadvantage experienced by sexual minority men may have multiple contributory causes.
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