title: Depression mediates and moderates effects of methamphetamine use on sexual risk taking among treatment-seeking gay and bisexual men.
abstract: OBJECTIVE
  Mounting evidence suggests a syndemic relation between methamphetamine use and depression to increase sexual risk taking (i.e., HIV transmission risk behavior) among men who have sex with men. This prospective analysis of longitudinal data collected from an outpatient methamphetamine abuse treatment program for gay and bisexual men assessed whether symptoms of depression mediated and/or moderated the associations between methamphetamine use and unprotected insertive/receptive anal intercourse.
  
  
  METHODS
  From November 2005 through October 2007, 167 treatment-seeking gay and bisexual men (63% HIV-positive) enrolled in and attended a 16-week methamphetamine abuse outpatient treatment program. Participants' depressive symptoms, biomarker-confirmed methamphetamine use, and self-reported sexual risk taking were assessed at baseline and follow-up evaluations. Path analysis tested the mediating and moderating effects of depression on the associations between methamphetamine use and unprotected insertive/receptive anal intercourse.
  
  
  RESULTS
  Methamphetamine use during the treatment period had a significant indirect (Coef. = -.15; 95% CI [-.23, -.06]), but no direct (Coef. = .11; ns) or total effect (Coef. = -.04; ns) on participants' sexual risk taking after accounting for the significant mediating (Coef. = .56; 95% CI [.33, .78]) and moderating (Coef. = -.03; 95% CI [-.04, -.02]) effects of depression.
  
  
  CONCLUSIONS
  Depression fully mediated and weakly moderated associations between methamphetamine use and sexual risk taking in this sample. Interventions and treatment programs to reduce sexual risk taking among gay and bisexual men should simultaneously address methamphetamine use and depression to optimize health outcomes.
authors.affiliation: Friends Research Institute, Inc.
authors.forename: Jesse B
authors.initials: JB
authors.lastname: Fletcher
authors.affiliation: Friends Research Institute, Inc.
authors.forename: Cathy J
authors.initials: CJ
authors.lastname: Reback
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000379:methods / Q000523:psychology; D019969:Amphetamine-Related Disorders / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D001727:Bisexuality / Q000523:psychology*; D003863:Depression / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D006679:HIV Seropositivity / Q000453:epidemiology / Q000523:psychology; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008297:Male; D008694:Methamphetamine; D008875:Middle Aged; D011446:Prospective Studies; D012309:Risk-Taking; D016896:Treatment Outcome; D047568:Unsafe Sex / Q000523:psychology*
chemical_list: D008694:Methamphetamine