Mood & HIV Risk

Better Days
A new study looks at changes in mood as they relate to risk & protection
by Chael Needle

“Happy” is not just a number-one song by Pharrell Williams. Nurturing that emotion across its day-to-day changes may be an essential part of protecting your own and your partners’ sexual health if you are a sexually active gay, bi, or same-gender-loving HIV-positive man, according to a new study.

Led by Patrick A. Wilson, PhD, associate professor of Sociomedical Sciences at the Mailman School of Public Health, Columbia University, and recently published in the journal Health Psychology, the study shows that sexual risk, defined as unprotected anal intercourse, among participants was lower when participants felt greater well-being than usual (happier) and less depression than usual. Conversely, sexual risk was higher when depression was greater than usual (sadder) and well-being lower than usual.

Wilson and his team sought to assess the mental health of HIV-positive MSM in relation to sexual risk behavior in a more dynamic way than previous studies or interventions had. Previous studies have suggested a weak association between depression/emotional wellbeing and sexual risk-taking, with some even surmising that depression may even reduce risk. For the most part, says Wilson, “we haven’t looked at how mental health plays out over time, how it changes over time, and how it changes—in somewhat quick and rapid fashion—over time.”

That is, while a static assessment of individual mental health may provide accurate information, it is information locked into that particular moment in time. It’s like one of those photos they take of you on a rollercoaster. But, instead of a single snapshot of anguish or euphoria, what if you had streaming video of that adventurous ride of good days and bad days, better weeks and worse weeks, called Life?

With this methodology, researchers were no longer restricted to looking at the relationships between typical emotional states and risk in general; they were able to trace how fluctuations in moods relate to fluctuations in sexually protective practices. So it’s not just about feeling depressed, but feeling worse; not just about feeling happy, but feeling better. Notes Wilson: “It’s not that when I’m more depressed I’m risky; it’s also when I’m happier I’m more likely to protect myself and my partners.” It’s not the mood, per se, but the change in mood that we might also attend to. Through this lens, the world is not so easily divided between those who are depressed and those who aren’t; or, those who are “safe” and those who are “risky.”

For this assessment, then, the researchers asked participants to complete a six-week Internet-based survey. (The 106 participants were HIV-positive MSM living in New York City. The sample was racially diverse: 51.9 percent of the participants African-American; 25.5 percent were Latino/Hispanic. Almost seventy percent reported an income of $20,000/year or less. Eighty-one percent reported multiple partners. A little more than forty percent had undetectable viral loads.) For each week participants reported sexual activity, they were asked about sexual behaviors, and HIV status and gender of their partner(s). During Weeks 1, 3 and 5, participants’ depression and well-being were measured according to well-established tools.

As assessments of emotions in flux within the mental health field are often tied to major life-event triggers (illness, death, the end of a relationship), the day-to-day life stressors that may be just as impactful on mental health are often glossed over. Says Wilson, the study brings to light the fact that “just as we change environments, go in and out of different social contexts, there are different influences that can tug and pull our wellbeing and mental health such that we may be really happy one day and really sad another.”

Wilson and his team sought to assess these subtleties to create a more fine-tuned portrait of mental health, in this case among HIV-positive MSM, who may experience “higher levels of those stressors than other populations.” These stressors, in turn, may be compounded by the stressors that come with lower socioeconomic status and/or navigating life as an ethnic minority, says Wilson, who hypothesizes that these factors may help explain the observed fluctuations in mental health and mood.

“I would conjecture that many of those individuals who have means, or at a higher socioeconomic status than the guys we spoke to, may not experience much in terms of mood fluctuations. I think all people have good days and bad days, right? And moments of ‘Oh I’m feeling super-stressed right now,’ but there are ways and sometimes tools that higher socioeconomic folks have to handle those that allow them to be [more even-keeled]. [There are resources] like social support or money that can help address or reduce or mitigate the impact of stressful circumstances whereas those without means are not going to be able to deploy the same kind of wide range of different tools to deal with both environmental and personal stressors that can influence and change mood and wellbeing.”

This theory needs more evidence, so Wilson and his team are planning another study that will look at the daily experiences of younger Black MSM who are HIV-positive, tracing fluctuations in mental health in ultra-nuanced contexts of acceptance and stigma, the smaller cues of support and rejection that may shape depression and well-being. Researchers will examine sexual risk and medication adherence, among other behaviors.

In terms of the bigger picture, the examinations of how fluctuations in mood may be related to risky and protective sexual practices will hopefully lead to better mental health and health outcomes for HIV-positive MSM. Considering the increasing and disproportionate rates of infection among African-American and Latino men, the urgency for finding strategies to help, and help individuals help themselves, is great.

“It sounds naive to say, ‘If we keep people happy, they won’t be risky,’ but, in some ways that is part of what we’re trying to say,” shares Wilson. Mental health interventions and treament could become more attuned to helping individuals as they experience stressors and changes in mood over time. Engagement with individuals need not only happen when they are at a peak of depression, say, but tailored to the unfolding landscape of their emotions. “Just because you see someone one day and they present with no symptoms—depression, euphoria, or they appear to be non-depressed—it doesn’t mean the following week they won’t have some experience, whether it be subtle or more significant that can trigger changes in mood and mental health. And some of what I think interventionists and clinicians can do is help their patients cope with and respond to some of the stressors that they might experience in their day-to-day lives in a way that helps them [respond in such a way that] they won’t see such a negative impact on their wellbeing.

Another part of the mental health approach might be “helping individuals seek out support and engage in responses to stress and coping behaviors that can reduce the likelihood that they’ll ultimately feel depressed or that risk could be an option,” notes Wilson.

In closing, Wilson notes: “We need to promote happiness in people’s lives, really empower people with the tools they need to create happiness in their lives, but also to seek it out in the forms of support and the forms of friendship and other interpersonal connections that can really help when you’re experiencing times of distress and that can also prop you up….”

That’s something we can clap along about.

Chael Needle wrote about a gene therapy-based cure candidate in last month’s Treatment Horizons.