Stress increases HIV risk for gay men

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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.

Glossary

risky behaviour

In HIV, refers to any behaviour or action that increases an individual’s probability of acquiring or transmitting HIV, such as having unprotected sex, having multiple partners or sharing drug injection equipment.

receptive

Receptive anal intercourse refers to the act of being penetrated during anal intercourse. The receptive partner is the ‘bottom’.

retrospective study

A type of longitudinal study in which information is collected on what has previously happened to people - for example, by reviewing their medical notes or by interviewing them about past events. 

statistical significance

Statistical tests are used to judge whether the results of a study could be due to chance and would not be confirmed if the study was repeated. If result is probably not due to chance, the results are ‘statistically significant’. 

seroconversion

The transition period from infection with HIV to the detectable presence of HIV antibodies in the blood. When seroconversion occurs (usually within a few weeks of infection), the result of an HIV antibody test changes from HIV negative to HIV positive. Seroconversion may be accompanied with flu-like symptoms.

 

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.”

References

Burchell AN et al. Stress and increased HIV infection risk among gay and bisexual men. AIDS, advance online publication: DOI: 10: 1097/QAD.ob013e32833af7c9, 2010.