Associations Between General Selfefficacy And Depression / Anxiety/Stigma And Sexual Behavior Among Newly HIV-diagnosed MSM

BackgroundMen who have sex with men(MSM)is one of the main populations of HIV infection in China.The HIV infection rate of MSM in China is rapidly rising.HIV-positive MSM faces AIDS and homosexuality-related stigma.In China,the lifetime prevalence of depression and anxiety in MSM is four times that of the average male.Mental health is closely related to physical health.Depression and anxiety are associated with HIV high-risk behaviors,ART compliance and HIV disease progression among the HIV-positive people.If HIV-positive people continue to have high-risk behaviors,they can easily cause second-generation transmission.It is not uncommon to have multiple partners among HIV positive MSM in China.The proportion of unprotected sex among them is high.Therefore,the AIDS prevention of MSM should not only target HIV-negative MSM,prevent HIV infection,but also conduct effective intervention with HIV-positive MSM and do a good job of positive prevention.It is of great significance to reduce the second-generation transmission of HIV.Self-efficacy is the confidence of people in their ability to perform a job.A person with high self-efficacy has strong self-confidence,will be more positive in life,and will be able to handle intellectually,optimistically and positively to meet unknown challenges.People with high self-efficacy are more likely to recover quickly from setbacks and disappointments.General Self-Efficacy is an overall self-confidence that reflects people's ability to respond to various external environmental challenges.It has been shown that General Self-Efficacy is related to a variety of specific self-efficacy,and relatively stable and has a universal characteristic relative to specific self-efficacy.The negative correlation between general self-efficacy and depression/anxiety/stigma has been reported in different cultures.There is also a correlation between self-efficacy and risk sexual behavior among floating populations,South African high school students,and heterosexual couples.However,the relationship between general self-efficacy and depression/anxiety/stigma and sexual behavior among newly diagnosed HIV-positive MSM has not been reported.How to use this relationship to improve the quality of life of HIV-positive MSM and reduce the second-generation transmission has important public health significance and deserves further discussion.Therefore,in this study,the relationship between general self-efficacy and depression,anxiety,and stigma was studied for this particular population.Changes of general self-efficacy,depression,anxiety,and stigma in randomized clinical trials which promote linkage to care and treatment were analyzed.The study will provide a new scientific basis for improving the quality of life of newly diagnosed HIV-positive MSM through regulating emotion,responding actively to psychological problems,and promoting their mental health.Using a follow-up data to analyzed the relationship between general self-efficacy and sexual partners and unprotected sexual behavior in newly diagnosed HIV-positive MSM in Beijing,provide theoretical basis and data support for reducing the number of sexual partners,unprotected sexual behavior,the risk of second-generation transmission,and controlling the spread of HIV epidemic in MSM.Objective1.Through a cross-sectional survey of newly diagnosed HIV-positive MSM in Beijing,to understand the relationship between general self-efficacy and depression,anxiety and stigma among newly diagnosed HIV-positive.Analyze the changes of general self-efficacy,depression,anxiety,and stigma in randomized controlled clinical trials for referral care and promotion of care.2.Through a one-year follow-up,repeated measure the general self-efficacy and sexual behavior(including sexual partners and unprotected sexual behavior)of newly diagnosed HIV-positive MSM of Beijing at 0,6 and12 months,to explore the relationship between general self-efficacy and sexual behavior.MethodsThe HIV testing of MSM was conducted in Beijing from March 2013 to March 2015.Newly diagnosed HIV positive MSM who meet the inclusion criteria were recruited to a randomized controlled clinical trial and randomly assigned to the intervention or control group.The control group received standard care.The intervention group was provided intervention of peer counseling combined text messages on the basis of standard care.The purpose of the intervention was to link them to HIV care and promote therapy.Both this two groups were followed for 12 months.General self-efficacy,depression,anxiety,stigma and sexual behavior were measured at 0,6 and 12 months follow-up.The relationship between general self-efficacy and depression,anxiety and stigma among newly diagnosed HIV-positive MSM was analyzed using cumulative odds ratio logistic regression and logistic regression of two-class response variables.The repeated measures ANOVA was used to analyze changes in general self-efficacy,depression,anxiety and stigma in randomized clinical trials(0 months,6 months follow-up,and 12 months follow-up).Logistic regression and generalized estimating equation(GEE)were used to analyze the relationship between general self-efficacy and sexual behavior using data from baseline(0 months),6 months follow-up,and 12 months follow-up.Results1.The relationship between general self-efficacy and depression,anxiety and stigma among newly diagnosed HIV-positive MSMA total of 3,588 subjects were tested for HIV,and 455 MSM were diagnosed as HIV positive with a positive rate of 12.7%.Of the 455 newly diagnosed HIV-positive MSMs,367(80.7%)participated in the randomized controlled clinical trials.367 newly diagnosed HIV-positive MSM participated in the randomized controlled clinical trials,184 subjects were assigned to the intervention group,and 183 were assigned to the control group.The follow-up maintenance rate in the intervention group was 93.5% at 6 months and 92.9% at 12 months.The follow-up retention rate in the control group was 86.9% at 6 months and76.5% at 12 months.The score of general self-efficacy of 367 newly diagnosed HIV-positive MSM was(31.5±6.3).Among them,70(19.1%)were classified as likely depression,53(14.4%)borderline depression,and 244(66.5%)were normal;100(27.3%)were classified as likely anxiety,69(18.8%)borderline anxiety,and 198(54.0%)were normal;191 stigma scores ? 27(52.0%)and 176 stigma scores> 27(48.0%).There were negative associations between general self-efficacy and depression among the study population.As general self-efficacy increased by one unit,the odds of borderline or suspected depression versus normal,or suspected depression versus normal and borderline depression both decreased by 12% [adjusted odds ratio(AOR):0.88,95% confidence interval(CI):0.85-0.92] after adjusted for potential confounders.Similarly,general self-efficacy was also negatively associated with anxiety(AOR: 0.89,95% CI:0.86-0.93).As general self-efficacy increased by one unit,the odds of borderline or suspected anxiety versus normal,or suspected anxiety versus normal and borderline anxiety both decreased by 11%.In the multivariate logistic regression model,there was a negative correlation between general self-efficacy and stigma(AOR: 0.96,95CI: 0.93-0.99).After adjusting for confounding factors,a one-point increase in the general self-efficacy score reduces the risk of stigma by 4%.Using the data of 12 months of follow-up,repeated measures ANOVA showed that there was no significant difference in scores of general self-efficacy,depression,anxiety and stigma between the intervention group and the control group.At baseline,6 months,and 12 months follow-up,the subjects' depression(P<0.01),anxiety(P<0.01),and stigma were decreased(P<0.01).2.The association between general self-efficacy and sexual behavior among newly diagnosed HIV-positive MSMOf the 367 HIV positive MSM in the baseline,42 were infected with syphilis(11.4%).41.4% of the participants had 10 or more male sexual partners.In the past 3 months,50.1% of them had 2 or more male partners.Previous 9.3% had HIV-positive male partners ever.In the past 3 months,5.5% had HIV-positive male partners.There were 36.0% of them had female sexual partners ever.There were 43.1% of them had casual male partners while traveling.25.7% of them had unprotected insertive anal intercourse with male partners in the past 3 months,39.5% of them had unprotected receptive anal intercourse,and 51.2% of them had unprotected active or passive anal intercourse.In the past 3 months,5.2% of them had unprotected insertive anal intercourse with HIV-positive male partners,8.5% had unprotected receptive anal intercourse with HIV-positive male partners,and 11.7% had unprotected insertive or receptive anal intercourse with HIV-positive male partners.In the last 3 months,3.0% had unprotected vaginal or anal with female partners.Multivariate logistic regression analysis of baseline data showed that after adjusting for confounding factors related to the outcome variables,the higher general self-efficacy score was the protective factor for casual partners during travel.When the general self-efficacy score increased by one point,the chance of have casual male partners while traveling decreased by 6%(OR: 0.94,95%CI: 0.91-0.98).Multivariate logistic regression analysis of baseline data showed that the general self-efficacy was negatively associated with unprotected insertive anal intercourseamong HIV-positive male partners.One point increase in the general self-efficacy score decreased the risk of unprotected insertive anal sex with HIV-positive male partners by 8%(OR: 0.92,95% CI: 0.86-0.99).For the baseline,6-month follow-up,and 12-month follow-up data,the multivariate GEE model did not reveal the ssociation between general self-efficacy and sexual partners and unprotected sexual behavior in the intervention and control groups.ConclusionThe newly diagnosed HIV-positive MSM faced with serious problems of depression,anxiety and stigma,and high levels of HIV related risk sexual behaviors.For newly diagnosed HIV-positive MSM,higher self-efficacy can help reduce symptoms of depression/ anxiety/stigma.In addition,higher self-efficacy can promote the reduction of HIV-related risk sexual behaviors in some degree,thereby reduce the second-generation transmission.Further HIV prevention studies may try to reduce depression and anxiety levels and HIV-related risk behaviors through the interventions targeted at increasing the general self-efficacy.This will provide new ideas for AIDS prevention and control.