The Additive Effects of Depressive Symptoms and Polysubstance Use on HIV Risk Among Gay, Bisexual, and Other Men Who Have Sex with Men




Card, Kiffer G.
Lachowsky, Nathan J.
Armstrong, Heather L.
Cui, Zishan
Wang, Lu
Sereda, Paul
Jollimore, Jody
Patterson, Thomas L.
Corneil, Trevor
Hogg, Robert S.

Journal Title

Journal ISSN

Volume Title


Addictive Behaviors


Introduction—Among gay, bisexual, and other men who have sex with men (GBM), collinearity between polysubstance use and mental health concerns has obscured their combined effects on HIV risk with multivariable results often highlighting only one or the other. Methods—We used mediation and moderation analyses to examine the effects of polysubstance use and depressive symptoms on high-risk sex (i.e., condomless anal sex with serodiscordant/unknown status partner) in a sample of sexually-active GBM, aged >16 years, recruited in Metro Vancouver using respondent driven sampling. Hospital Anxiety and Depression Scale scores assessed mental health. Alcohol Use Disorder Identification Test scores assessed alcohol disorders. Poly-use of multiple drug types (e.g., stimulants, sedatives, opiates, hallucinogens) was assessed over the previous six months. Results—Among 719 predominantly white (68.0%), gay-identified (80.7%) GBM, alcohol use was not associated with increased prevalence of high-risk sex. Controlling for demographic factors and partner number, an interaction between polysubstance use and depressive symptoms revealed that the combined effects were additively associated with increased odds for high-risk sex. Mediation models showed that polysubstance use partially mediated the relationship between depressive symptoms and high-risk sex. Conclusion—An interaction effect between polysubstance use (defined by using 3 or more substances in the past six months) and depressive symptoms (defined by HADS scores) revealed that the combination of these factors was associated with increased risk for high-risk sex – supporting a syndemic understanding of the production of HIV risk.


The authors would like to thank the Momentum Study participants, office staff and community advisory board, as well as our community partner agencies, Health Initiative for Men, YouthCO HIV and Hep C Society, and Positive Living Society of BC.


Gay and bisexual men, Polysubstance use, Alcohol use, HIV risk, Depressive Symptoms


Card, K. G., Lachowsky, N. J., Armstrong, H. L., Cui, Z., Wang, L., Sereda, P., Jollimore, J., Patterson, T. L., Corneil, T., Hogg, R. S., Roth, E. A., & Moore, D. M. (2018). “The Additive Effects of Depressive Symptoms and Polysubstance Use on HIV Risk Among Gay, Bisexual, and Other Men Who Have Sex With Men.” Addictive Behaviors, 82, 158–165.