Psychosocial and behavioral correlates of STD and HIV risk behavior among Massachusetts men who have sex with men (MSM) with Posttraumatic stress disorder (PTSD)

Background:
Previous studies have documented a consistent relationship between history of trauma and behaviors that place MSM at greater risk for STDs/HIV.

Objective:
The current study assessed psychosocial and behavioral associations of STD and HIV risk behavior among Massachusetts MSM with and without PTSD.

Method:
The study used a convenience sample of STD clinic patients (n=63) and a modified respondent-driven sampling method (n=126) to reach a diverse sample of MSM. All participants completed a quantitative survey between March 2006 and May 2007.

Result:
Sixty percent (n=113) of MSM screened positive for PTSD (SPAN screening instrument); 60% of MSM with traumatic symptoms were HIV-infected and 55% had a prior history of one or more STDs (syphilis, gonorrhea or chlamydia). MSM with PTSD, compared to those without, were more likely to have severe depression (CES-D, score 27+; OR=4.46; P<0.01) and social anxiety (SPIN; OR=2.98; P<0.01); they also had higher average scores of alcoholism (CAGE; P < 0.01), indicating more severe psychopathology. With respect to sexual risk taking, MSM with PTSD were almost twice as likely to report engaging in receptive (OR=1.94; P<0.05) and insertive (OR=1.85; P<0.05) anal sex without a condom in the previous 12-months. MSM with PTSD also had a significantly higher average number of HIV-infected partners with whom they had receptive anal sex without a condom in the past 12-months (p<0.05).

Conclusion:
Findings suggest that MSM with PTSD have high levels of psychological distress and are likely to engage in behaviors that place them at increased risk for STDs and HIV.

Implications:
Given the high prevalence of trauma and its role in potentiating sexual risk taking behavior, both STD and HIV prevention programs and intervention studies for this group of at risk MSM should incorporate counseling and skills building addressing past trauma and coping strategies.