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File, Sarah E (2012)
Master's Thesis (82 pages)
Committee Chair / Thesis Adviser: Sanchez, Travis
Committee Members: Sullivan, Patrick S
Research Fields: Health Sciences, Public Health
Partnering Agencies: Emory University schools, faculty or affiliated programs ; US (Federal) agency other than CDC
Keywords: stigma; MSM; men who have sex with men; depression; CES-D; HIV prevention; racism; ecological
Program: Rollins School of Public Health, Epidemiology (Global Epidemiology)
Permanent url:


Background: High rates of depression have been observed among men who have sex with men (MSM) compared to the U.S. adult male population. Depression in MSM may be associated with risk behavior that increases risk for human immunodeficiency virus (HIV). Methods: A cross-sectional analysis was conducted to examine demographic and behavioral characteristics associated with depression among HIV-negative black and white MSM in Atlanta. The data used for this analysis were collected from July 2010 through December 2011 in the Involve[men]t project. This project is investigating HIV and sexually transmitted infection prevalence and incidence differences between adult black and white MSM in Atlanta. Results: Among 393 HIV-negative MSM at baseline, the prevalence of depression was 27.0%. Factors associated with depression included being 25 years of age and older compared to 18-24 years, non-injection drug use, an alcohol problem, unprotected anal intercourse (UAI), exchange sex, often being treated as if you were "stupid" or "talked down to" because of your race/ethnic group, agreeing that 'most people in my city think less of a person who is gay', and that 'my city is a bad place for me to live as a gay man'. Race was a significant effect modifier of the association between depression and non-injection drug use. Depression prevalence was not significantly different in black versus white men, though subsequent analyses revealed racial differences in factors associated with depression. Depression was associated with exchange sex in black MSM, and with UAI and substance use in white MSM. Conclusions: The prevalence of depression among HIV-negative MSM is high compared to the general U.S. adult male population. The link between risk behavior and depression is strongest among white MSM; depression screening should be incorporated into behavioral interventions. Both racial and sexual stigma play a role in the mental health and possibly the behavior of black MSM.

Table of Contents

TABLE OF CONTENTS -- Introduction ... 1 -- Methods ... 6 -- Results ... 10 -- Discussion ...13 -- References ... 19 -- Tables -- Table 1. Characteristics of an HIV-negative population of men who have sex with men -- in Atlanta by depression status, July 2010 - December 2011 (n=393) ... 23 -- Table 2. Factors associated with depression among HIV-negative men who have sex -- with men in Atlanta, July 2010 - December 2011 (n=393) ... 26 -- Table 3. Factors associated with depression among black HIV-negative men who have -- sex with men in Atlanta, July 2010 - December 2011 (n=170) ... 31 -- Table 4. Factors associated with depression among white HIV-negative men who have -- sex with men in Atlanta, July 2010 - December 2011 (n=223) ... 33 -- Appendices -- Appendix A. Andresen Short-Form (CESD-10) of the Center for Epidemiologic -- Studies Depression (CES-D) Scale ... 35 -- Appendix B. SAS Code ... 36


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