Intimate partner violence, depression, and sexual behaviour among gay, bisexual and other men who have sex with men in the PROUD trial

Ada R Miltz, Fiona C Lampe, Loraine J Bacchus, Sheena McCormack, David Dunn, Ellen White, Alison Rodger, Andrew N Phillips, Lorraine Sherr, Amanda Clarke, Alan McOwan, Ann Sullivan, Mitzy Gafos, Ada R Miltz, Fiona C Lampe, Loraine J Bacchus, Sheena McCormack, David Dunn, Ellen White, Alison Rodger, Andrew N Phillips, Lorraine Sherr, Amanda Clarke, Alan McOwan, Ann Sullivan, Mitzy Gafos

Abstract

Background: Little is known about the prevalence and correlates of intimate partner violence (IPV) among gay, bisexual and other men who have sex with men (GBMSM) in the UK. The aim of this study was to investigate the prevalence of IPV, associations of socio-economic and psychosocial factors with IPV, and the association of IPV with depression and sexual behaviour, among GBMSM in the PROUD trial of pre-exposure prophylaxis (PrEP).

Methods: PROUD enrolled 544 HIV-negative participants in England from 2012 to 2014; participants were randomised to immediate or deferred PrEP. This analysis included 436 GBMSM who had IPV data at month-12 and/or 24. Prevalence of IPV victimization and perpetration (lifetime, and in the past year) was assessed at these time-points. Generalized estimating equations were used to investigate associations with IPV, using pooled data from both time-points.

Results: At month-12 (N = 410), 44.9% of men reported ever being a victim of IPV, 15.6% in the last year, and 19.5% reported ever perpetrating IPV, 7.8% in the last year. At month-24 (N = 333), the corresponding prevalence was 40.2 and 14.7% for lifetime and past year IPV victimization and 18.0 and 6.9% for lifetime and past year IPV perpetration. IPV prevalence did not differ by randomised arm. Men reporting internalized homophobia and sexualized drug use were more likely to report IPV. Lifetime and last year experience of IPV victimization and perpetration were strongly associated with depressive symptoms (PHQ-9 ≥ 10) (adjusted for socio-demographics: lifetime IPV victimization PR 2.57 [95% CI: 1.71, 3.86]; past year IPV victimization PR 2.93 [95% CI: 1.96, 4.40]; lifetime IPV perpetration PR 2.87 [95% CI: 1.91, 4.32]; past year IPV perpetration PR 3.47 [95% CI: 2.13, 5.64], p < 0.001 for all); IPV was not consistently associated with measures of condomless anal sex or high partner numbers.

Conclusions: GBMSM at high-risk of HIV who are seeking/taking PrEP may experience a high burden of IPV, which may be linked to depression. Training on awareness of and enquiry for IPV among GBMSM in sexual health clinics is recommended.

Trial registration: ClinicalTrials.gov identifier: NCT02065986 . Registered 19 February 2014 (retrospectively registered).

Keywords: Depression; HIV; Intimate partner violence (IPV); Men who have sex with men (MSM); Pre-exposure prophylaxis (PrEP); STI; Sexual risk behaviour.

Conflict of interest statement

Ethics approval and consent to participate

The study was reviewed and approved by London Bridge Research Ethics Committee (12/LO/1289). Written informed consent was obtained from all participants.

Consent for publication

Not applicable.

Competing interests

The PROUD study was provided drug free of charge by Gilead Sciences plc. which also distributed it to participating clinics and provided funds for additional diagnostic tests for HCV and drug levels. AP has received payments for presentations made at meetings sponsored by Gilead in spring 2015. EW has had tuition fees and a stipend paid by Gilead. AC received advisory board fees from Gilead Sciences plc. and GSK/ViiV; speaker fees from Gilead and conferences bursaries from Gilead & Janssen. SM reports grants from the European Union H2020 scheme, EDCTP 2, the National Institute of Health Research, and Gilead Sciences; other support from Gilead Sciences, and the Population Council Microbicide Advisory Board; and is Chair of the Project Advisory Committee for USAID grant awarded to CONRAD to develop tenofovir-based products for use by women (non-financial).

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Prevalence of IPV victimization and perpetration at month-12 (N = 410)
Fig. 2
Fig. 2
Prevalence of IPV victimization and perpetration at month-24 (N = 333)
Fig. 3
Fig. 3
Adjusted associations of lifetime and past year measures of IPV victimization with sexual behaviours in the past three months among 436 men who participated in PROUD. a CAS with at least two receptive or at least two insertive CAS partners. b CAS with at least five receptive or at least five insertive CAS partners. c Not known to be on HIV treatment. d The model was fitted to include age in four categories (< 25; 25–29; 30–39; 40+), dichotomous UK born and self-reported sexual identity
Fig. 4
Fig. 4
Adjusted associations of lifetime and past year measures of IPV perpetration with sexual behaviours in the past three months among 436 men who participated in PROUD. a CAS with at least two receptive or at least two insertive CAS partners. b CAS with at least five receptive or at least five insertive CAS partners. c Not known to be on HIV treatment. d The model was fitted to include age in four categories (< 25; 25–29; 30–39; 40+), dichotomous UK born and self-reported sexual identity

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