Anxiety and Depression Associated with Anal Sexual Practices among HIV-Negative Men Who Have Sex with Men in Western China
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Procedures
2.2. Study Content and Measurements
2.2.1. Assessment of Anxiety
2.2.2. Assessment of Depression
2.2.3. Anal Sex Role Factors
2.2.4. Social Demographic Factors
2.2.5. Behavior-Related Factors
2.2.6. Risk Perception-Related Factors
2.3. Quality Control and Ethics
2.4. Statistical Analysis
3. Results
3.1. Participants’ Characteristics
3.2. The Prevalence of Anxiety and Depression in Different Anal Sex Roles of MSM
3.3. The Influencing Factors of Anxiety in HIV-Negative MSM
3.4. The Influencing Factors of Depression in HIV-Negative MSM
4. Discussion
4.1. The Prevalence of Anxiety and Depression in HIV-Negative MSM
4.2. Influencing Factors
4.3. Limitation
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Characteristics | Total n (%) | Anxiety | p Value | Depression | p Value | ||
---|---|---|---|---|---|---|---|
NO n (%) | YES n (%) | NO n (%) | YES n (%) | ||||
N | 1771 (100.00) | 1310 (73.97) | 461 (26.03) | 1101 (62.17) | 670 (37.83) | ||
Anal sex role factors | |||||||
The role of MSM in anal sex with male sexual partners | |||||||
Anal sex role “1” | 467 (26.37) | 363 (77.73) | 104 (22.27) | 0.0415 | 314 (67.24) | 153 (32.76) | 0.0047 |
Anal sex role “0.5” | 1122 (63.35) | 822 (73.26) | 300 (26.74) | 689 (61.41) | 433 (38.59) | ||
Anal sex role “0” | 182 (10.28) | 125 (68.68) | 57 (31.32) | 98 (53.85) | 84 (46.15) | ||
Social demographic factors | |||||||
Age | |||||||
18–24 | 557 (31.45) | 400 (71.81) | 157 (28.19) | 0.1633 | 321 (57.63) | 236 (42.37) | 0.0285 |
25–30 | 532 (30.04) | 389 (73.12) | 143 (26.88) | 342 (64.29) | 190 (35.71) | ||
≥31 | 682 (38.51) | 521 (76.39) | 161 (23.61) | 438 (64.22) | 244 (35.78) | ||
Area # | |||||||
Urban | 1267 (71.74) | 971 (76.64) | 296 (23.26) | <0.0001 | 829 (65.43) | 438 (34.57) | <0.0001 |
Rural | 499 (28.26) | 337 (67.54) | 162 (32.46) | 271 (54.31) | 228 (45.69) | ||
Ethnic groups # | |||||||
Han nationality | 1638 (92.54) | 1201 (73.32) | 437 (26.68) | 0.0324 | 1009 (61.60) | 629 (38.40) | 0.0944 |
Other ethnic minorities | 132 (7.46) | 108 (81.82) | 24 (18.18) | 91 (68.94) | 41 (31.06) | ||
Educational level # | |||||||
Junior high or below | 215 (12.15) | 128 (59.53) | 87 (40.47) | <0.0001 | 108 (50.23) | 107 (49.77) | <0.0001 |
Senior high | 468 (26.46) | 330 (70.51) | 138 (29.49) | 275 (58.76) | 193 (41.24) | ||
College or graduate or above | 1086 (61.39) | 850 (78.27) | 236 (21.73) | 716 (65.93) | 370 (34.07) | ||
Employment status # | |||||||
On the job | 1358 (76.81) | 1016 (74.82) | 342 (25.18) | 0.0150 | 861 (63.40) | 497 (36.60) | 0.1219 |
Students at school | 243 (13.74) | 184 (75.72) | 59 (24.28) | 144 (59.26) | 99 (40.74) | ||
Retired or unemployed | 167 (9.45) | 108 (64.67) | 59 (35.33) | 94 (56.29) | 73 (43.71) | ||
Marital status | |||||||
Unmarried | 1314 (74.20) | 986 (75.04) | 328 (24.96) | 0.0706 | 834 (63.47) | 480 (36.53) | 0.1257 |
Married | 307 (17.33) | 211 (68.73) | 96 (31.27) | 176 (57.33) | 131 (42.67) | ||
Divorce or widowhood | 150 (8.47) | 113 (75.33) | 37 (24.67) | 91 (60.67) | 59 (39.33) | ||
Personal monthly income # | |||||||
≤3000 | 927 (52.94) | 658 (70.98) | 269 (29.02) | 0.0014 | 522 (56.31) | 405 (43.69) | <0.0001 |
3001–5000 | 602 (34.38) | 454 (75.42) | 148 (24.58) | 398 (66.11) | 204 (33.89) | ||
≥5001 | 222 (12.68) | 183 (82.43) | 39 (17.57) | 168 (75.68) | 54 (24.32) | ||
Behavior-related factors | |||||||
Regular male sexual partners in the last six months # | |||||||
0 | 293 (16.80) | 217 (74.06) | 76 (25.94) | 0.2290 | 179 (61.09) | 114 (38.91) | 0.3778 |
1 | 1188 (68.12) | 892 (75.08) | 296 (24.92) | 755 (63.55) | 433 (36.45) | ||
≥2 | 263 (15.08) | 184 (69.96) | 79 (30.04) | 156 (59.32) | 107 (40.68) | ||
Casual male sexual partners in the last six months # | |||||||
0 | 705 (40.68) | 541 (76.74) | 164 (23.26) | 0.0373 | 466 (66.10) | 239 (33.90) | 0.0072 |
≥1 | 1028 (59.32) | 743 (72.28) | 285 (27.72) | 614 (59.73) | 414 (40.27) | ||
Female sexual partners in the last six months # | |||||||
0 | 1462 (84.17) | 1113 (76.13) | 349 (23.87) | <0.0001 | 944 (64.57) | 518 (35.43) | <0.0001 |
≥1 | 275 (15.83) | 172 (62.55) | 103 (37.45) | 137 (49.82) | 138 (50.18) | ||
Frequency of seeking partners on the Internet in the last 6 months # | |||||||
Often | 117 (6.62) | 69 (58.97) | 48 (41.03) | 0.0006 | 55 (47.01) | 62 (52.99) | 0.0008 |
Sometimes or occasionally | 986 (55.80) | 743 (75.35) | 243 (24.65) | 612 (62.07) | 374 (37.93) | ||
Never | 664 (37.58) | 495 (74.55) | 169 (25.45) | 434 (65.36) | 230 (34.64) | ||
Whether a commercial sexual service in the past 6 months # | |||||||
Yes | 100 (5.66) | 63 (63.00) | 37 (37.00) | 0.0095 | 54 (54.00) | 46 (46.00) | 0.0810 |
No | 1668 (94.34) | 1246 (74.70) | 422 (25.30) | 1046 (62.71) | 622 (37.29) | ||
Diagnosed with an sexually transmitted diseases (STD) in the past six months # | |||||||
Yes | 142 (8.03) | 87 (61.27) | 55 (38.73) | 0.0003 | 70 (49.30) | 72 (50.70) | 0.0009 |
No | 1626 (91.97) | 1221 (75.09) | 405 (24.91) | 1030 (63.25) | 596 (36.65) | ||
Frequency of alcohol use in the last month # | |||||||
Daily | 72 (4.07) | 45 (62.50) | 27 (37.50) | 0.0464 | 30 (41.67) | 42 (58.33) | 0.0009 |
Occasionally | 1152 (65.12) | 866 (75.17) | 286 (24.83) | 733 (63.63) | 419 (36.37) | ||
Never | 545 (30.81) | 397 (72.84) | 148 (27.16) | 336 (61.65) | 209 (38.35) | ||
Whether a use of illicit drugs in the past six months # | |||||||
No | 1695 (96.91) | 1261 (74.40) | 434 (25.60) | 0.1136 | 1058 (62.42) | 637 (37.58) | 0.8452 |
Yes | 54 (3.09) | 35 (64.81) | 19 (35.19) | 33 (61.11) | 21 (38.89) | ||
Risk perception-related factors | |||||||
Perceived severity of AIDS # | |||||||
Very serious | 1107 (62.54) | 832 (75.16) | 275 (24.84) | 0.3072 * | 679 (61.34) | 428 (38.66) | 0.5051 * |
Serious | 522 (29.49) | 379 (72.61) | 143 (27.39) | 334 (63.98) | 188 (36.02) | ||
General | 123 (6.95) | 87 (70.73) | 36 (29.27) | 77 (62.60) | 46 (37.40) | ||
Not serious | 10 (0.56) | 7 (70.00) | 3 (30.00) | 7 (70.00) | 3 (30.00) | ||
Not serious at all | 8 (0.45) | 4 (50.00) | 4 (50.00) | 3 (37.50) | 5 (62.50) | ||
Perceived prevalence of HIV among MSM in your city # | |||||||
Very high | 375 (21.23) | 258 (68.80) | 117 (31.20) | 0.0691 | 219 (58.40) | 156 (41.60) | 0.2287 |
High | 774 (43.83) | 595 (76.87) | 179 (23.13) | 502 (64.86) | 272 (35.14) | ||
General | 420 (23.78) | 308 (73.33) | 112 (26.67) | 253 (60.24) | 167 (39.76) | ||
Low | 126 (7.13) | 93 (73.81) | 33 (26.19) | 81 (64.29) | 45 (35.71) | ||
Very low | 71 (4.02) | 52 (73.24) | 19 (26.76) | 43 (60.56) | 28 (39.44) | ||
Perceived threat of HIV to yourself and your family # | |||||||
Very large | 973 (55.03) | 707 (72.66) | 266 (27.34) | 0.0994 | 587 (60.33) | 386 (39.67) | 0.0147 |
Relatively large and moderate | 639 (36.14) | 474 (74.18) | 165 (25.82) | 400 (62.60) | 239 (37.40) | ||
Very small | 156 (8.82) | 126 (80.77) | 30 (19.23) | 113 (72.44) | 43 (27.56) | ||
Frequency of condom use when having anal sex with men # | |||||||
Always | 956 (56.84) | 725 (75.84) | 231 (24.16) | 0.0051 | 616 (64.44) | 340 (35.56) | 0.0050 |
Occasionally | 562 (33.41) | 423 (75.27) | 139 (24.73) | 356 (63.35) | 206 (36.65) | ||
Never | 164 (9.75) | 105 (64.02) | 59 (35.98) | 84 (51.22) | 80 (48.78) | ||
HIV voluntary counseling # | |||||||
Yes | 1074 (60.88) | 820 (76.35) | 254 (23.65) | 0.0046 | 719 (66.95) | 355 (33.05) | <0.0001 |
No | 690 (39.12) | 485 (70.29) | 205 (29.71) | 377 (54.64) | 313 (45.36) | ||
HIV voluntary testing # | |||||||
Yes | 1362 (77.17) | 1021 (74.96) | 341 (25.04) | 0.1586 | 870 (63.88) | 492 (36.12) | 0.0133 |
No | 403 (22.83) | 288 (71.46) | 115 (28.54) | 230 (57.07) | 173 (42.93) |
Mental Health Problems | Anal Sex Role “1” (n = 467) | Anal Sex Role “0.5” (n = 1122) | Anal Sex Role “0” (n = 182) | F/χ2 | p |
---|---|---|---|---|---|
Score/N (%) | Score/N (%) | Score/N (%) | |||
Anxiety | |||||
Mean ± SD | 42.09 ± 10.20 | 42.94 ± 10.75 | 44.25 ± 11.55 | 2.80 | 0.0611 a |
Median | 42.00 | 42.00 | 42.00 | ||
Yes (≥50) | 104 (22.27) | 300 (26.74) | 57 (31.32) | 6.3652 | 0.0415 b |
No (<50) | 363 (77.73) | 822 (73.26) | 125 (68.68) | ||
Depression | |||||
Mean ± SD | 12.78 ± 8.93 | 14.02 ± 9.62 | 16.31 ± 11.71 | 8.83 | 0.0002 a |
Median | 12.00 | 12.00 | 13.50 | ||
Yes (≥16) | 153 (32.76) | 433 (38.59) | 84 (46.15) | 10.7378 | 0.0047 b |
No (<16) | 314 (67.24) | 689 (61.41) | 98 (53.85) |
Independent Variables | B | S.E. | Wald | p Value | OR | 95%CI for OR | |
---|---|---|---|---|---|---|---|
Lower | Upper | ||||||
Anal sex role | |||||||
“1” | (reference) | ||||||
“0.5” | 0.2900 | 0.1374 | 4.4534 | 0.0348 | 1.336 | 1.021 | 1.750 |
“0” | 0.5783 | 0.2073 | 7.7802 | 0.0053 | 1.783 | 1.188 | 2.677 |
Educational level | |||||||
College or graduate or above | (reference) | ||||||
Senior high | 0.3117 | 0.1322 | 5.5604 | 0.0184 | 1.366 | 1.054 | 1.770 |
Junior high or below | 0.8225 | 0.1664 | 24.4415 | <0.0001 | 2.276 | 1.643 | 3.154 |
Female sexual partners in the last six months | |||||||
0 | (reference) | ||||||
≥1 | 0.5404 | 0.1478 | 13.3661 | 0.0003 | 1.717 | 1.285 | 2.293 |
Frequency of seeking partners on the Internet in the last 6 months | |||||||
Never | (reference) | ||||||
Sometimes or occasionally | −0.0636 | 0.1221 | 0.2715 | 0.6023 | 0.938 | 0.739 | 1.192 |
Often | 0.5836 | 0.2207 | 6.9947 | 0.0082 | 1.793 | 1.163 | 2.763 |
Diagnosed with STD in the past six months | |||||||
No | (reference) | ||||||
Yes | 0.5953 | 0.1933 | 9.4873 | 0.0021 | 1.813 | 1.242 | 2.649 |
HIV voluntary counseling | |||||||
No | (reference) | ||||||
Yes | −0.2628 | 0.1159 | 5.1445 | 0.0233 | 0.769 | 0.613 | 0.965 |
Independent Variables | B | S.E. | Wald | p Value | OR | 95%CI for OR | |
---|---|---|---|---|---|---|---|
Lower | Upper | ||||||
Anal sex role | |||||||
“1” | (reference) | ||||||
“0.5” | 0.2693 | 0.1278 | 4.4395 | 0.0351 | 1.309 | 1.019 | 1.682 |
“0” | 0.5787 | 0.1971 | 8.6243 | 0.0033 | 1.784 | 1.212 | 2.625 |
Area | |||||||
Rural | (reference) | ||||||
Urban | −0.4127 | 0.1182 | 12.1885 | 0.0005 | 0.662 | 0.525 | 0.834 |
Casual sexual partners in the last six months | |||||||
0 | (reference) | ||||||
≥1 | 0.2772 | 0.1202 | 5.3133 | 0.0212 | 1.319 | 1.042 | 1.670 |
Female sexual partners in the last six months | |||||||
0 | (reference) | ||||||
≥1 | 0.5432 | 0.1467 | 13.7131 | 0.0002 | 1.721 | 1.291 | 2.295 |
Diagnosed with STD in the past six months | |||||||
No | (reference) | ||||||
Yes | 0.5144 | 0.1941 | 7.0253 | 0.0080 | 1.673 | 1.143 | 2.447 |
Frequency of seeking partners on the Internet in the last 6 months | |||||||
Never | (reference) | ||||||
Sometimes or occasionally | 0.0124 | 0.1233 | 0.0101 | 0.9198 | 1.012 | 0.795 | 1.289 |
Often | 0.6664 | 0.2287 | 8.4909 | 0.0036 | 1.947 | 1.244 | 3.048 |
Frequency of alcohol use in the last month | |||||||
Never | (reference) | ||||||
Occasionally | −0.1704 | 0.1177 | 2.0954 | 0.1477 | 0.843 | 0.670 | 1.062 |
Daily | 0.8594 | 0.2725 | 9.9499 | 0.0016 | 2.362 | 1.385 | 4.029 |
Frequency of condom use when having anal sex with men | |||||||
Never | (reference) | ||||||
Occasionally | −0.5143 | 0.1966 | 6.8456 | 0.0089 | 0.598 | 0.407 | 0.879 |
Always | −0.4524 | 0.1871 | 5.8425 | 0.0156 | 0.636 | 0.441 | 0.918 |
HIV voluntary counseling | |||||||
No | (reference) | ||||||
Yes | −0.5317 | 0.1104 | 23.1937 | <0.0001 | 0.588 | 0.473 | 0.730 |
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Liu, J.; Zhong, X.; Lu, Z.; Peng, B.; Zhang, Y.; Liang, H.; Dai, J.; Zhang, J.; Huang, A. Anxiety and Depression Associated with Anal Sexual Practices among HIV-Negative Men Who Have Sex with Men in Western China. Int. J. Environ. Res. Public Health 2020, 17, 464. https://doi.org/10.3390/ijerph17020464
Liu J, Zhong X, Lu Z, Peng B, Zhang Y, Liang H, Dai J, Zhang J, Huang A. Anxiety and Depression Associated with Anal Sexual Practices among HIV-Negative Men Who Have Sex with Men in Western China. International Journal of Environmental Research and Public Health. 2020; 17(2):464. https://doi.org/10.3390/ijerph17020464
Chicago/Turabian StyleLiu, Jiaxiu, Xiaoni Zhong, Zhuo Lu, Bin Peng, Yan Zhang, Hao Liang, Jianghong Dai, Juying Zhang, and Ailong Huang. 2020. "Anxiety and Depression Associated with Anal Sexual Practices among HIV-Negative Men Who Have Sex with Men in Western China" International Journal of Environmental Research and Public Health 17, no. 2: 464. https://doi.org/10.3390/ijerph17020464