Stress increases sexual risk-taking and risk of HIV for gay men

The more stressful life events a gay man experiences, the greater the odds that he will engage in risky sexual behaviours and become infected with HIV, according to a Canadian study presented to the Sixteenth International AIDS Conference in Toronto last week. The investigators suggest that providing gay men with the skills to cope with stressful events could therefore prove a useful HIV-prevention strategy.

Investigators from the Polaris HIV seroconversion study in Ontario, Canada, hypothesised that stress could cause some gay and bisexual men to engage in risky sexual practices. They therefore conducted interviews with 124 gay or bisexual men who had recently tested HIV-positive and a control population of 234 gay or bisexual men who had recently tested HIV-negative to determine their experiences of stressful events in the six months before their HIV test.

Stressful events were divided into four broad categories:

• Health-related stress – including issues such as accident and injury, problems with drugs or alcohol, and attempted suicide.
• Financial and security-related stress – including employment problems, dropping out of college or failing a course, loss of housing due to a disaster, and moving to a worse area or city.
• Relationship-related events – including end of a romance, end of a close relationship, conflict, knowledge of affairs, and separation.
• Criminal events – including being physically attacked, sexually abused, accused or arrested for a crime, or imprisonment.

At baseline, the individuals who tested HIV-positive and HIV-negative had broadly similar characteristics. The median age for both groups was approximately 35 years, over 50% of both groups of men had completed university, and the racial profile of both groups was similar.

However, a higher percentage of HIV-positive men than HIV-negative men reported experiencing stressful life-events in the six months before their HIV test. Of note, a higher percentage (36%) of HIV-positive men reported five or more stressful life-events than HIV-negative men (21%). For each of the four broad categories examined, a higher percentage of HIV-positive men reported experiencing stress than HIV-negative men.

After adjusting for receptive unprotected anal sex, the investigators found that gay and bisexual men who reported five or more stressful had a 116% increased risk of HIV infection. They also found that gay and bisexual men under the age of 30 who reported financial or security stress were 216% more likely to become infected with HIV than men in this age group who did not have these stresses. However, as men aged, the relationship between financial and security stress and the odds of HIV infection weakened considerably.

The investigators’ findings suggested that although some other life-events increased the risk of HIV infection, they only did so marginally, suggesting that gay men may already have well-developed coping strategies for some stressful events. For example, the end of a romance was associated with a 20% increase in risk. A major financial crisis increased the risk of HIV infection by 43% and problems with drugs and alcohol by 53%. Although these increases may seem dramatic, they were not statistically significant. Interestingly, being fired or laid off actually lowered the risk of HIV infection in the investigators’ adjusted analysis.

“Results provide evidence that stressful events among gay and bisexual men are related to increased risk of HIV infection”, comment the investigators, adding “even after adjusting for receptive anal sex, experiencing five-plus stressful life events was still associated with a two-fold increase in the risk of HIV infection.” The investigators speculate that an increasing burden of stress may incline individuals to engage in risky activities. They also suggest that stress may weaken the immune system, increasing the risk of infection with HIV should exposure occur.

They suggest that future HIV prevention research should look at the provision of stress coping mechanisms to gay men.