A recent study by University College London showed that HIV-negative gay men who have several symptoms of depression are more likely to have sex without a condom. Some American studies have also found an association between depression and risky sex. 

Researchers analysed data from a survey of people attending sexual health clinics. Only untested or HIV-negative people took part. 

Based on the answers of 1,173 gay men, 12.5% of HIV-negative gay men attending sexual health clinics had depressive symptoms at the time (this is considerably higher than in the general population, but roughly half the rate seen in a comparable survey of HIV-positive people). While for most, the symptoms were moderate, 5.5% had more severe symptoms.

Depression was more common in men who were younger, had money problems, did not have a university degree and were not in an ongoing relationship. It was also more common among regular smokers, heavy drinkers and men who used multiple recreational drugs.

Among those with depressive symptoms, 58% said that a doctor had told them they had a mental health condition and 52% were receiving treatment.

The data showed strong associations between men currently experiencing depression and risky sex, but not for men who no longer experience depression - other than they were more likely to have group sex. 

This study suggests that your mental health and self-esteem has a HUGE impact on whether you take care to look after your own health, including avoiding HIV infection. 

Body image, alcohol, drugs, depression, relationship problems, work problems, loneliness... the list goes on. The battle against HIV doesn’t start and end with finding the right condom size or getting you to think condoms are the best thing since sliced bread. HIV prevention isn’t even about getting you to the clinic to test for HIV. There is a lot more to it than just that. HIV prevention activities, including FS, can only work if you care about yourself and care about your own health. 

Self-worth is the key to a happy and healthy life. This goes for everything and not just remaining HIV-negative. Self-worth brings confidence, and confidence will help you stay in control of your life.  

If you are HIV-negative and would like to remain that way, the best ways are as follows:

Condoms: Condoms are one of the most effective and reliable ways of preventing the spread of HIV (and many other STIs) when you fuck. 

We recommend the use of condoms with plenty of water-based lube to prevent the transmission of HIV, especially if you are not certain of your partner’s HIV status. If you don’t use condoms when you fuck, and you have not been diagnosed with HIV, we recommend that you test for HIV regularly. 

Partner selection: It’s estimated that one in twelve gay men in London has HIV. There are no visual signs or sexual behaviours which guarantee someone will be HIV-positive or negative. There are many reasons why someone may not want to tell you their HIV status and lots of men don’t know their HIV status, or believe it to be different from what it actually is. Around 16% of HIV-positive men don’t know that they have HIV. If you are HIV-negative you cannot safely or reliably find partners who are also negative if you have just met in a bar or through internet sites/apps.

Having condomless sex will also expose you to other sexually transmitted infections (e.g. hepatitis, syphilis, NSU, gonorrhoea and herpes) which can be harder to treat in men with a compromised immune system.

Can I have bareback sex with someone who is HIV-positive?

Gay men who are HIV-positive and are on medication are less likely to pass on HIV. This is because the medication that they are on helps to reduce the amount of HIV in their body. It’s not impossible for them to pass on HIV but it’s very unlikely if they are undetectable. 

HIV-positive? If you are HIV-positive, and on medication, the best thing to do is to keep on taking your medication. Sounds patronising, we know, but many people ‘forget’ to take their medication and a break in your cycle could mean your viral load increasing fast. The best way to remain undetectable is to make sure you keep on taking your medication. 

PEP: If you have unprotected sex with someone who you think is positive, or if you’re not sure of their status, then PEP is available from your local GUM clinic or A&E department. PEP, which is a month-long course of medication, may stop you becoming positive if you start to take it within 72 hours of exposure (the sooner the better) and keep to the medication for the whole course. 

PrEP: Pre-exposure prophylaxis (PrEP) is a promising new way of preventing HIV infections. PrEP involves HIV-negative men taking a daily dose of one or two of the drugs that are used to treat HIV. Studies suggest that this can prevent infection if the user is exposed to HIV. At present in the UK PrEP has only been available to men in a clinical trial for the PROUD study. This study is now over and groups like GMFA are campaigning to make PrEP available to all gay men who want it on the NHS. To keep up-to-date with PrEP, visit www.gmfa.org.uk/prep.

Test for HIV and STIs: Having an STI can make you more vulnerable to HIV infection. All sexually active gay men should test for STIs at least once a year. If you are having lots of sex, and especially if you are having lots of unprotected sex, then you should test more frequently. It takes roughly ten days for most STIs to show up in a test. It takes about four weeks for HIV to show up in a test.

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For more information on HIV, STIs and sexual ahead advice, visit www.gmfa.org.uk/sex

To find your nearest GUM clinic  visit www.gmfa.org.uk/clinics

For more information on depression, mental health or to find support, visit www.nhs.uk/depression

To talk to someone now about sex, sexual health or HIV call THT Direct on 0808 802 1221.