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Depression Symptoms and Sexual HIV Risk Behavior Among Serodiscordant Couples

From the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York City, New York.

Address correspondence and reprint requests to Mark V. Bradley, HIV Center for Clinical and Behavioral Studies, Unit #15, New York State Psychiatric Institute and Columbia University, Unit 15, 1051 Riverside Drive, New York NY 10032. E-mail: mb2032{at}columbia.edu

Objectives: To examine data for human immunodeficiency virus (HIV)-positive patients in serodiscordant relationships to determine a) if depressive symptoms were associated with sexual risk behavior and b) if these relationships could be explained by changes in partner satisfaction. The relationship between depression symptoms and sexual risk behaviors within mixed HIV status couples is unknown.

Methods: HIV-positive and HIV-negative members of 197 serodiscordant couples (159 male/female, 38 male/male) were assessed using instruments measuring depressive symptoms, sexual risk, and couple satisfaction.

Results: HIV-positive partners with higher depression scores were less likely to be part of couples reporting unprotected sex, and HIV-positive partners' higher depression scores were associated with less unprotected intradyadic sex acts. This decrease in intradyadic sexual risk behavior was partially explained by a decrease in any sexual behavior within the couple. On the other hand, HIV-positive subjects with moderate or higher depression were more likely to have outside partners. Adding the partner satisfaction measure to the models was able to account for the relationship between the HIV-positive subjects' depression scores and outside partners, but not for that between higher depression score and reduced intradyadic sexual risk.

Conclusions: HIV-positive individuals with more depressive symptoms may be less likely to engage in high-risk sexual behavior with their partners than those with less depressive symptoms, but more likely to have sexual partners outside the relationship. These findings suggest that the relationship between depressive symptoms and sexual risk behavior in this population may be mixed and complex, and suggest that clinicians should assess sexual risk behavior across the range of depression symptom severity.

Key Words: depression • HIV • serodiscordant couples • risk behavior • partner satisfaction

Abbreviations: HIV = human immunodeficiency virus; BDI—II = Beck Depression Inventory, Second Edition; BASR = Brief Assessment of Sexual Risk; DAS = Dyadic Adjustment Scale; AIDS = acquired immunodeficiency syndrome.