Stress increases HIV risk for gay men

Stressful life events appear to increase the risk of HIV infection for gay men, Canadian researchers report in the online edition of AIDS.

Men testing HIV-positive were more likely than those who tested HIV-negative to report five or more recent stressful events.

“We observed that gay and bisexual men … who reported stressful life events were at increased risk of HIV infection, and there was evidence that this effect was at least partially mediated by sexual risk behaviour,” comment the investigators.

Stress has been associated with an increased risk of sexually transmitted infections amongst heterosexuals. However, the impact of stress on HIV risk for gay men is little understood.

Therefore, investigators from the Polaris HIV Seroconversion Study group in Ontario, Canada, undertook a retrospective case-controlled analysis to determine the impact of stress on the risk of infection with HIV.

Gay and bisexual men testing HIV-positive (123) were matched with gay and bisexual men who tested negative (240). All 363 individuals completed a questionnaire asking about their recent experience of 35 stressful life events, which were related to health, relationships, bereavements, finances and employment, and crime.

Information was also gathered on sexual risk behaviour.

The men diagnosed with HIV reported a higher median number of stressful life events than those who were HIV-negative (3 vs 2, p = 0.002).

Stress related to health (p = 0.005); relationships (p = 0.02); because of bereavement (p = 0.01); due to finances or employment (p = 0.005); and because of crime (p = 0.02); were all reported significantly more often by men testing HIV-positive.

Experiencing a greater number of stressful events was associated with an increased likelihood of reporting unprotected receptive anal intercourse with an HIV-positive partner, or a partner of unknown HIV status. This association fell just short of statistical significance (p = 0.06).

Moreover, a higher proportion of HIV-positive men reported five or more recent stressful events (33 vs 20%).

The investigators’ first set of statistical analyses showed that experiencing five or more stressful events significantly increased the risk of infection with HIV (odds ratio, 2.5; 95% CI, 1.3 to 4.7).

However, the relationship between stress and infection with HIV was weakened and was no longer significant when the investigators took into account sexual risk behaviour. The relationship was further attenuated when they took into account reported unprotected receptive sex with a partner who was HIV-positive or of unknown status.

Three possible reasons why stress could increase the risk of HIV are proposed by the investigators.

First, they suggest that stress can damage mental health. Interviews with 30 men recently infected with HIV found that they were in a poor emotional condition.

Second, they propose that stress could lead to engagement with sexual networks where there is a higher prevalence of HIV. For example, men who reported that they were stressed were more likely to say that they met sex partners at dance or sex clubs.

Finally, they posit that stress could damage the immune system. Separate research has shown that individuals who are stressed are more likely to be infected with the viruses such as the common cold.

“If stressful life events do increase HIV infection risk, this has implications for prevention,” comment the investigators.

Prevention campaigns could promote effective coping strategies, they suggest.

Furthermore, the investigators “advise clinicians informing patients of an HIV-positive test result to be aware that patients may be simultaneously under stress from other life events and to provide counselling supports as needed.”