Resum
Background: Annual depression rates among men who have sex with men (MSM) from high income countries are 3- to 9-fold higher than the general population (12%-36% vs. 4%, respectively); however, little is known about depression rates in MSM in low- and middle-income countries (LMIC). Among HIV-negative MSM, depression is associated with increased alcohol/drug use and decreased condom use during sexual intercourse while for HIV-positive MSM, depression reduces accessing or adhering to medical care and is associated with worse long-term survival. The present study assessed the prevalence of depression among MSM seeking HIV/STI services in Peru, a LMIC. Methods: Between August 2017 and December 2018, MSM presenting for HIV/STI services at the community-based organization Epicentro were offered depression screening using the Peruvian-validated version of the Patient Health Questionnaire (PHQ-9). The PHQ-9, used globally, consists of 9 questions that measure the frequency of core depression symptoms on a scale ranging from “0” (not at all) to “3” (nearly every day). PHQ-9 scores = 5 are suggestive of depression with the highest score (27) corresponding to severe levels. Results: A total of 185 MSM consented to depression screening, of whom 13% tested positive for HIV and 87% tested negative; 4 participants sought other STI services and declined HIV testing. Mean participant age was 28.77 years (range, 17-58). Alcohol and/or drug use during last sexual encounter was reported by 20% of men. Depression prevalence was: 58% none/no depression (PHQ-9 = 0-4); 23% mild (PHQ-9 = 5-9); 12% moderate (PHQ-9 = 10-14); 5% moderately severe (PHQ-9 = 15-19); and 2% severe (PHQ-9 = 20-27). There was an association with depression (PHQ-9 score =5) for both having a positive HIV test result and alcohol use though not statistically significant (p=0.39 and 0.09, respectively). Conclusions: Depression was common among Peruvian MSM, with >40% scoring positive for the disorder. Most depression severity was mild- to moderate, which could be treated by brief, non-pharmacological depression interventions. Though no significant association between depression and HIV or alcohol use was observed, both are known depression risk factors meriting future research in LMIC. Finally, future research must include more diverse populations, especially transgender women.