symptoms and transmission risk among persons living with HIV.

Relationships over time between mental health symptoms and transmission risk among persons living with HIV.

Relationships between mental health symptoms (anxiety and depression) or a positive state of mind and behaviour associated with HIV transmission (substance use and risky sexual behaviour) were explored in a longitudinal study of persons living with HIV (PLH; N = 936) who were participants in a transmission-prevention trial. Bivariate longitudinal regressions were used to estimate the correlations between mental health symptoms and HIV-related transmission acts for 3 time frames: at the baseline interview, over 25 months, and from assessment to assessment. At baseline, mental health symptoms were associated with transmission acts. Elevated levels of mental health symptoms at baseline were associated with decreasing alcohol or marijuana use over 25 months. Over 25 months, an increasingly positive state of mind was associated with decreasing alcohol or marijuana use; an increasingly positive state of mind in the immediate intervention condition and increasing depressive symptoms in the lagged condition were related to increasing risky sexual behaviour. These findings suggest that mental health symptoms precede a decrease in substance use and challenge self-medication theories. Changes in mental health symptoms and sexual behaviour occur more in tandem.

This study’s findings, from one of the first longitudinal studies to examine the relationship between mental health and substance use or sexual risk in people living with HIV, suggest the need for further study to disentangle complex associations between mental health and HIV transmission risk. The study enrolled 936 HIV-positive participants who had reported unprotected vaginal or anal sex in the previous 3 months, with a sex partner whose HIV serostatus was negative or unknown, and followed them for over 2 years. Clinically relevant depressive symptoms and anxiety symptoms were found in 40% and 36% of participants, respectively. Overtime, both those who experienced increasing depression and those with an increasing positive states of mind decreased the numbers of seronegative sexual partners, consistent with previous findings that risky sex is associated with both positive and negative moods. Elevated levels of mental health symptoms at baseline were associated with elevated hard drug use and alcohol or marihuana use but substance use decreased over time in this group, as well as in those with an increasing positive state of mind. These changes appear to have occurred regardless of whether people were enroled immediately in a Healthy Living Intervention or had to wait 25 months to participate. Clearly, the field of positive health, dignity, and prevention, which combines HIV prevention and respect for the human rights of people living with HIV, has an intriguing research agenda ahead of it.