Skip to main content

Advertisement

SpringerLink
Log in

Does Effective Depression Treatment Alone Reduce Secondary HIV Transmission Risk? Equivocal Findings from a Randomized Controlled Trial

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Depressed mood has been associated with HIV transmission risk behavior. To determine whether effective depression treatment could reduce the frequency of sexual risk behavior, we analyzed secondary outcome data from a 36-week, two-arm, parallel-design, randomized controlled trial, in which homeless and marginally housed, HIV-infected persons with comorbid depressive disorders were randomized to receive either: (a) directly observed treatment with the antidepressant medication fluoxetine, or (b) referral to a local public mental health clinic. Self-reported sexual risk outcomes, which were measured at 3, 6, and 9 months, included: total number of sexual partners, unprotected sexual intercourse, unprotected sexual intercourse with an HIV-uninfected partner or a partner of unknown serostatus, and transactional sex. Estimates from generalized estimating equations regression models did not suggest consistent reductions in sexual risk behaviors resulting from treatment. Mental health interventions may need to combine depression treatment with specific skills training in order to achieve durable impacts on HIV prevention outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr. 2005;39:446–53.

    Article  PubMed  Google Scholar 

  2. Crepaz N, Marks G, Liau A, Mullins MM, Aupont LW, Marshall KJ, et al. Prevalence of unprotected anal intercourse among HIV-diagnosed MSM in the United States: a meta-analysis. AIDS. 2009;23:1617–29.

    Article  PubMed  Google Scholar 

  3. Bing EG, Burnam MA, Longshore D, Fleishman JA, Sherbourne CD, London AS, et al. Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry. 2001;58:721–8.

    Article  PubMed  CAS  Google Scholar 

  4. Whetten K, Reif S, Whetten R, Murphy-McMillan LK. Trauma, mental health, distrust, and stigma among HIV-positive persons: implications for effective care. Psychosom Med. 2008;70:531–8.

    Article  PubMed  Google Scholar 

  5. Sandfort TGM, Clement U, Knobel J, Keet R, de Vroome EMM. Sexualization in the coping process of HIV-infected gay men. Clin Psychol Psychother. 1995;2:220–6.

    Article  Google Scholar 

  6. Tallis F. Cognitive behavioural strategies for HIV sexual risk reduction. Clin Psychol Psychother. 1995;2:267–77.

    Article  Google Scholar 

  7. McKirnan DJ, Ostrow DG, Hope B. Sex, drugs and escape: a psychological model of HIV-risk sexual behaviours. AIDS Care. 1996;8:655–69.

    Article  PubMed  CAS  Google Scholar 

  8. Herbst JH, Beeker C, Mathew A, McNally T, Passin WF, Kay LS, et al. The effectiveness of individual-, group-, and community-level HIV behavioral risk-reduction interventions for adult men who have sex with men: a systematic review. Am J Prev Med. 2007;32:S38–67.

    Article  PubMed  Google Scholar 

  9. Kalichman SC. Co-occurrence of treatment nonadherence and continued HIV transmission risk behaviors: implications for positive prevention interventions. Psychosom Med. 2008;70:593–7.

    Article  PubMed  Google Scholar 

  10. Safren SA, Traeger L, Skeer MR, O’Cleirigh C, Meade CS, Covahey C, et al. Testing a social-cognitive model of HIV transmission risk behaviors in HIV-infected MSM with and without depression. Health Psychol. 2010;29:215–21.

    Article  PubMed  Google Scholar 

  11. Joe GW, Knezek L, Watson D, Simpson DD. Depression and decision-making among intravenous drug users. Psychol Rep. 1991;68:339–47.

    Article  PubMed  CAS  Google Scholar 

  12. Kennedy CA, Skurnick J, Wan JY, Quattrone G, Sheffet A, Quinones M, et al. Psychological distress, drug and alcohol use as correlates of condom use in HIV-serodiscordant heterosexual couples. AIDS. 1993;7:1493–9.

    Article  PubMed  CAS  Google Scholar 

  13. Kelly JA, Murphy DA, Bahr GR, Koob JJ, Morgan MG, Kalichman SC, et al. Factors associated with severity of depression and high-risk sexual behavior among persons diagnosed with human immunodeficiency virus (HIV) infection. Health Psychol. 1993;12:215–9.

    Article  PubMed  CAS  Google Scholar 

  14. Stein MD, Solomon DA, Herman DS, Anderson BJ, Miller I. Depression severity and drug injection HIV risk behaviors. Am J Psychiatry. 2003;160:1659–62.

    Article  PubMed  Google Scholar 

  15. Hutton HE, Lyketsos CG, Zenilman JM, Thompson RE, Erbelding EJ. Depression and HIV risk behaviors among patients in a sexually transmitted disease clinic. Am J Psychiatry. 2004;161:912–4.

    Article  PubMed  Google Scholar 

  16. Sikkema KJ, Watt MH, Drabkin AS, Meade CS, Hansen NB, Pence BW. Mental health treatment to reduce HIV transmission risk behavior: a positive prevention model. AIDS Behav. 2010;14:252–62.

    Article  PubMed  Google Scholar 

  17. Safren SA, O’Cleirigh C, Tan JY, Raminani SR, Reilly LC, Otto MW, et al. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals. Health Psychol. 2009;28:1–10.

    Article  PubMed  Google Scholar 

  18. Tsai AC, Weiser SD, Petersen ML, Ragland K, Kushel MB, Bangsberg DR. A marginal structural model to estimate the causal effect of antidepressant medication treatment on viral suppression among homeless and marginally housed persons with HIV. Arch Gen Psychiatry. 2010;67:1282–90.

    Article  PubMed  Google Scholar 

  19. Pyne JM, Fortney JC, Curran GM, Tripathi S, Atkinson JH, Kilbourne AM, et al. Effectiveness of collaborative care for depression in human immunodeficiency virus clinics. Arch Intern Med. 2011;171:23–31.

    PubMed  Google Scholar 

  20. Tsai AC, Karasic DH, Hammer GP, Charlebois ED, Ragland K, Moss AR, et al. Directly observed antidepressant medication treatment and HIV outcomes among homeless and marginally housed HIV-positive adults: a randomized controlled trial. Am J Public Health. 2013;103:308–15.

    Article  PubMed  Google Scholar 

  21. Lennon CA, Huedo-Medina TB, Gerwien DP, Johnson BT. A role for depression in sexual risk reduction for women? A meta-analysis of HIV prevention trials with depression outcomes. Soc Sci Med. 2012;75:688–98.

    Article  PubMed  Google Scholar 

  22. Grossman CI, Gordon CM. Mental health considerations in secondary HIV prevention. AIDS Behav. 2010;14:263–71.

    Article  PubMed  Google Scholar 

  23. Zolopa AR, Hahn JA, Gorter R, Miranda J, Wlodarczyk D, Peterson J, et al. HIV and tuberculosis infection in San Francisco’s homeless adults. Prevalence and risk factors in a representative sample. JAMA. 1994;272:455–61.

    Article  PubMed  CAS  Google Scholar 

  24. Robertson MJ, Clark RA, Charlebois ED, Tulsky J, Long HL, Bangsberg DR, et al. HIV seroprevalence among homeless and marginally housed adults in San Francisco. Am J Public Health. 2004;94:1207–17.

    Article  PubMed  Google Scholar 

  25. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured clinical interview for DSM-IV-TR axis I disorders, research version, patient edition (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute; 2002.

    Google Scholar 

  26. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62.

    Article  PubMed  CAS  Google Scholar 

  27. Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159:702–6.

    Article  PubMed  Google Scholar 

  28. Yelland LN, Salter AB, Ryan P. Performance of the modified Poisson regression approach for estimating relative risks from clustered prospective data. Am J Epidemiol. 2011;174:984–92.

    Article  PubMed  Google Scholar 

  29. Khan A, Brodhead AE, Schwartz KA, Kolts RL, Brown WA. Sex differences in antidepressant response in recent antidepressant clinical trials. J Clin Psychopharmacol. 2005;25:318–24.

    Article  PubMed  Google Scholar 

  30. Gorman JM. Gender differences in depression and response to psychotropic medication. Gend Med. 2006;3:93–109.

    Article  PubMed  Google Scholar 

  31. Khan A, Kolts RL, Thase ME, Krishnan KR, Brown W. Research design features and patient characteristics associated with the outcome of antidepressant clinical trials. Am J Psychiatry. 2004;161:2045–9.

    Article  PubMed  Google Scholar 

  32. Khan A, Brodhead AE, Kolts RL, Brown WA. Severity of depressive symptoms and response to antidepressants and placebo in antidepressant trials. J Psychiatr Res. 2005;39:145–50.

    Article  PubMed  Google Scholar 

  33. Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the food and drug administration. PLoS Med. 2008;5:e45.

    Article  PubMed  Google Scholar 

  34. Cochran SD. Emerging issues in research on lesbians’ and gay men’s mental health: does sexual orientation really matter? Am Psychol. 2001;56:931–47.

    Article  PubMed  CAS  Google Scholar 

  35. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129:674–97.

    Article  PubMed  Google Scholar 

  36. Herek GM. Sexual stigma and sexual prejudice in the United States: a conceptual framework. In: Hope DA, editor. Contemporary perspectives on lesbian, gay, and bisexual identities. Nebraska symposium on motivation. New York: Springer; 2009. p. 65–112.

    Chapter  Google Scholar 

  37. Crepaz N, Marks G. Are negative affective states associated with HIV sexual risk behaviors? a meta-analytic review. Health Psychol. 2001;20:291–9.

    Article  PubMed  CAS  Google Scholar 

  38. Crepaz N, Marks G. Towards an understanding of sexual risk behavior in people living with HIV: a review of social, psychological, and medical findings. AIDS. 2002;16:135–49.

    Article  PubMed  Google Scholar 

  39. O’Cleirigh C, Newcomb ME, Mayer KH, Skeer M, Traeger L, Safren SA. Moderate levels of depression predict sexual transmission risk in HIV-infected MSM: a longitudinal analysis of data from six sites involved in a “prevention for positives” study. AIDS Behav. 2013;17:1764–9.

    Article  PubMed  Google Scholar 

  40. Pence BW, Gaynes BN, Williams Q, Modi R, Adams J, Quinlivan EB, et al. Assessing the effect of measurement-based care depression treatment on HIV medication adherence and health outcomes: rationale and design of the SLAM DUNC study. Contemp Clin Trials. 2012;33:828–38.

    Article  PubMed  Google Scholar 

  41. Katon WJ, Von Korff M, Lin EH, Simon G, Ludman E, Russo J, et al. The pathways study: a randomized trial of collaborative care in patients with diabetes and depression. Arch Gen Psychiatry. 2004;61:1042–9.

    Article  PubMed  Google Scholar 

  42. Weiser SD, Bangsberg DR, Kegeles S, Ragland K, Kushel MB, Frongillo EA. Food insecurity among homeless and marginally housed individuals living with HIV/AIDS in San Francisco. AIDS Behav. 2009;13:841–8.

    Article  PubMed  Google Scholar 

  43. Vogenthaler NS, Kushel MB, Hadley C, Frongillo EA, Riley ED, Bangsberg DR, et al. Food insecurity and risky sexual behaviors among homeless and marginally housed HIV-infected individuals in San Francisco. AIDS Behav. 2013;17:1688–93.

    Article  PubMed  Google Scholar 

  44. Riley ED, Moore K, Sorensen JL, Tulsky JP, Bangsberg DR, Neilands TB. Basic subsistence needs and overall health among human immunodeficiency virus-infected homeless and unstably housed women. Am J Epidemiol. 2011;174:515–22.

    Article  PubMed  Google Scholar 

  45. Riley ED, Neilands TB, Moore K, Cohen J, Bangsberg DR, Havlir D. Social, structural and behavioral determinants of overall health status in a cohort of homeless and unstably housed HIV-infected men. PLoS ONE. 2012;7:e35207.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank Judith Rabkin for critical input on the design of the study and the interpretation of the findings, and Kathleen Ragland for assistance with data management. This study was funded by U.S. National Institutes of Health (NIH) R01MH063011 and R01MH054907. The authors also acknowledge K24MH087227 and K23MH096620 for salary support, and the helpful comments provided by participants at a seminar sponsored by the Harvard University Center for AIDS Research (P30AI060354). Roche donated HIV RNA kits. Study doses of Prozac weekly were donated by Eli Lilly from 2002 through 2005.

Author information

Authors and Affiliations

  1. Chester M. Pierce, MD Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Alexander C. Tsai

  2. Center for Global Health, Massachusetts General Hospital, Room 1529-E3, 100 Cambridge Street, 15th Floor, Boston, MA, 02114, USA

    Alexander C. Tsai & David R. Bangsberg

  3. Harvard Medical School, Boston, MA, USA

    Alexander C. Tsai, Matthew J. Mimiaga, Steven A. Safren & David R. Bangsberg

  4. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    Matthew J. Mimiaga

  5. Department of Psychiatry, San Francisco General Hospital at the University of California at San Francisco, San Francisco, CA, USA

    James W. Dilley, Dan H. Karasic & James L. Sorensen

  6. Alliance Health Project, San Francisco, CA, USA

    James W. Dilley

  7. Communicable Disease Emergency Response Branch, California Department of Public Health, Sacramento, CA, USA

    Gwendolyn P. Hammer

  8. Center for AIDS Prevention Studies, Department of Medicine, University of California at San Francisco, San Francisco, CA, USA

    Edwin D. Charlebois

  9. Fenway Health, Boston, MA, USA

    Steven A. Safren

  10. Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Steven A. Safren

  11. Mbarara University of Science and Technology, Mbarara, Uganda

    David R. Bangsberg

Authors
  1. Alexander C. Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthew J. Mimiaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James W. Dilley
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gwendolyn P. Hammer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dan H. Karasic
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Edwin D. Charlebois
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. James L. Sorensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Steven A. Safren
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. David R. Bangsberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexander C. Tsai.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tsai, A.C., Mimiaga, M.J., Dilley, J.W. et al. Does Effective Depression Treatment Alone Reduce Secondary HIV Transmission Risk? Equivocal Findings from a Randomized Controlled Trial. AIDS Behav 17, 2765–2772 (2013). https://doi.org/10.1007/s10461-013-0600-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-013-0600-3

Keywords

Search

Navigation