Internet-based intervention effective in the treatment of depression in people living with HIV

From aidsmap.com

An online self-help intervention is effective in the treatment of mild to moderate depressive symptoms in people with HIV, according to a randomized clinical trial conducted in the Netherlands and published in the September issue of The Lancet HIV.

The trial compared the outcomes in a group who received the online self-help intervention and a control group. The internet-based intervention, available in Dutch and English, consisted of a cognitive behavioral therapy program called “Living Positive with HIV” and developed from a self-help booklet that had previously proved effective in decreasing depressive symptoms. Participants also received minimal telephone coaching by a Masters student in psychology. The control group received the telephone coaching and could access the online intervention after the trial was completed.

Sanne van Leunen and colleagues randomly assigned 188 eligible participants to the intervention (97) or the control group (91) in 2015. Depression was assessed at baseline, Month 2, Month 5 and Month 8 (the control group did not take the last assessment).

As detailed below, results show that more participants in the intervention group than in the control group demonstrated significant change in their symptoms and that this effect was maintained for six months. Anxiety symptoms were also decreased. No adverse events were reported, the rate of satisfaction with the intervention was high, and most participants reported that they would recommend “Living Positive with HIV” to others.

Stop blaming PrEP for the increase in STI rates

From LGBTQ Nation

In an interview with the Los Angeles Blade about the new study, lead author Phillip Hammack, a professor at the University of California, Santa Cruz, debunked the notion.

“Our data don’t support the idea that we can attribute the rise in STIs to PrEP use, at least not in a direct manner. I personally don’t think that’s what’s happening,” said Hammack.

Instead, Hammack points at the rise of dating apps like Grindr, and a decrease in fear towards contracting HIV, as more likely causes.

“I would speculate it has more to do with a culture shift about sex,” said Hammack. “More people are having sex today. We’re in sort of a quiet sexual revolution when it comes to new identities, new labels, and sexual behavior.”

On the down side, the study also showed that only 4% of men who have sex with men are using PrEP. What’s more, many gay and bisexual men aged 18-25 aren’t getting annual HIV tests. 25% of men who have sex with men in that age range have never gotten an HIV test.

“I worry especially about younger men who didn’t grow up with the concerns of HIV that men of older generations did,” said Hammack in the William Institute press release on the study. “The low rate of HIV testing probably reflects a degree of complacency and cultural amnesia about AIDS.”

Read the full article.

Gay teens at least twice as likely to use illegal drugs, study suggests

From NBC News online

Lesbian, gay, bisexual and questioning (LGBQ) teens are at least twice as likely as their heterosexual peers to use illegal drugs like cocaine, ecstasy, heroin and methamphetamines, a U.S. study suggests. Previous research suggests that stressors related to being closeted or coming out and being rejected by family or friends could contribute to an increased risk of substance use among sexual minority teens, senior study author John Ayers of San Diego State University in California said.

For the new study, researchers looked at data from roughly 14,703 high school students who had been surveyed about their lifetime and prior-month use of 15 different substances, including illegal drugs as well as tobacco, alcohol and prescription drugs that weren’t given to them by a physician.

LGBQ youth were more than three times more likely to try heroin or methamphetamines at least once, and more than twice as likely to try ecstasy or cocaine, the study also found.

Stressors faced by LGBQ teens, such as stigma and isolation, “may make drugs foolishly appear attractive as a coping mechanism,” Ayers said by email. “Even experimentation with these harder drugs can derail a teen’s future,” he said.

The vast majority of teens didn’t use illegal drugs, regardless of sexual orientation, researchers report in the American Journal of Public Health.

Read the full article on NBC News.

Why STDs are on the rise in America

From the Economist online

Much of the increase in STDs has come from gay and bisexual men. Although a relatively small share of the population, they accounted for 81% of male syphilis cases in 2016, according to the Centres for Disease Control. As with heterosexuals, this seems to be because sex is now seen as less risky. That is due to the advent of PrEP, a prophylactic drug cocktail which gay men can take to nearly inoculate themselves from HIV. The reduced chances of catching HIV—along with the fact that a positive diagnosis is no longer a death sentence—seems to encourage men to drop their guard. A recent study of gay and bisexual men, published in the Lancet, a medical journal, found that as more began taking PrEP, rates of consistent condom usage dropped from 46% to 31%. Recent studies have shown that uptake of PrEP is strongly associated with increased rates of STD infection.

All this shows that changing sexual mores, and a reduced fear of the risks of unprotected sex, seem to be at fault—especially since the problem is not just limited to America. England experienced a 20% increase in syphilis diagnoses in 2017 and a 22% increase in those of gonorrhoea. Other countries in western Europe have seen ever worse outbreaks, sometimes exceeding 50%. Dwindling public spending on STD prevention—which in America has fallen by 40% in real terms since 2003—is not helping matters. Yet the chief methods of prevention, abstinence and condoms, are tried and true. Should these options seem too chaste or chaffing, then prospective partners ought to get an STD test (especially since most infections can be cleared up with a simple course of antibiotics). Verified testing is vital since verbal assurances, especially on the cusp of a liaison, can be misleading.

Read the full article.

High numbers of HIV-positive MSM not being tested for syphilis

From healio.com

Nearly one-third of sexually active HIV-positive men who have sex with men are not tested for syphilis at least annually, researchers reported in a recent study, calling the finding “concerning.”

Alex de Voux, PhDan Epidemiologist in the CDC’s Division of STD Prevention, and colleagues sought to examine the proportion of sexually active HIV-positive men who have sex with men (MSM) currently in care who were tested for syphilis in the past 3, 6 and 12 months by their HIV care provider.

A 2017 study showed that MSM accounted for more than 60% of syphilis cases nationwide in 2015. In that study, researchers determined that the rate of primary and secondary syphilis in the United States among MSM was 106 times that of men who have sex with women only.

In the current study, the authors noted that guidelines recommend that sexually active MSM, including HIV-positive MSM, be tested at least annually for syphilis, with testing every 3 to 6 months for MSM at elevated risk, and used this timeline to evaluate the group.

De Voux and colleagues used the most recent medical record and interview data collected by the Medical Monitoring Project, a population-based HIV surveillance system, from 2013 to 2014. The data showed that 71% of all sexually active HIV-positive MSM had at least one test for syphilis in the past 12 months. In the past 6 months, only 43% had been tested, and the number dropped to 22% in the past 3 months.

Researchers also examined the frequency of testing in MSM who reported risk factors, including having condomless sex and having sex with two or more partners.

Read the full article.

To find free syphilis testing near you, search by zip code on the CDC testing Website: gettested.cdc.gov

For more information about syphilis, its symptoms and treatment, click here.

Bisexual men have higher risk of heart disease

From Medical Daily

The research team analyzed data on 7,731 male participants between the ages of 20 to 59. They were divided into four groups based on their sexual identities: gay men, heterosexual men, bisexual men, and heterosexual men who have sex with men.

The two objectives of the study were to examine heart disease diagnoses among men of different sexual orientations and also measure their modifiable risk factors for heart disease.

While no correlation was found between sexual identities and heart disease diagnoses, bisexual men were found to have higher rates of several risk factors for heart disease compared to heterosexual men. These included mental distress, obesity, elevated blood pressure, etc.

The other three groups were found to have similar heart disease risk. The only difference observed in health behavior was that gay men reported lower binge drinking than straight men.

“Our findings highlight the impact of sexual orientation, specifically sexual identity, on the cardiovascular health of men and suggest clinicians and public health practitioners should develop tailored screening and prevention to reduce heart disease risk in bisexual men,” said lead author Billy Caceres, an adjunct faculty member at Rory Meyers College of Nursing, New York University.

Read the full article.

Gay men experience more depression and suicide

From Psychology Today

It’s well known to the point of stereotype that gay men experience higher rates of HIV, substance abuse, and suicide. But it’s less known, and hardly talked about, that we also have much higher rates of depression, especially those of us living with HIV, despite the causal relationship of depression and self-medicating and self-harming behavior.

You might call depression the big gray elephant in the room staring us in the face as we do our best to ignore it.

The 2013 fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual  (DSM) defines depression clinically as a depressive mood or loss of interest or pleasure in nearly all activities over a two-week period, along with four of these symptoms: “changes in appetite or weight, sleep, and psychomotor activity; decreased energy; feelings of worthlessness or guilt; difficulty thinking, concentrating, or making decisions; or recurrent thoughts of death or suicidal ideation or suicide plans or attempts.”

Although depression affects both men and women, men kill themselves at rates four times higher than women. Of the 41,149 suicides in the U.S. in 2013, nearly 80 percent were men.

[…]

An American study of gay men found that those who perceived increased homophobia and danger were more likely to report depressive symptoms. Feeling unaccepted and rejected by the gay community—as do too many gay and bisexual men of color and those living with HIV—were also found to increase the risk for depression.

Read the full article.