Depressive symptoms and unprotected sex in St. Petersburg, Russia

Objective: Growing evidence indicates that emotional distress such as depression may have the potential to increase the risk for HIV and other sexually transmitted infections (STIs). This study investigated the association between depressive symptoms and unprotected sex among STI clinic patients in Russia.

Methods: We used pre-intervention data collected between 2009 and 2010 among 307 participants who were enrolled in a randomized intervention trial conducted in an STI clinic in St. Petersburg, Russia. The 10-item Center for Epidemiological Studies Depression Scale was used to identify depressive symptoms and two indicators were used to measure unprotected sex. Logistic regression models were applied for the analysis and controlled for the following potential confounders: demographic characteristics, being a commercial sex worker, history of drug injection and alcohol misuse.

Results: Of the participants, 20.2% were classified as having depressive symptoms. About 59.6% of the participants did not use a condom during the last sexual intercourse and 24.4% never used condoms in the past 3months. Depressive symptoms were significantly associated with both indicators of unprotected sex in two different models: odds ratio (OR)=2.36, 95% confidence interval (CI), 1.24-4.48 for unprotected sex in the last sexual intercourse; and OR=2.71, 95% CI, 1.43-5.11 for unprotected sex in the past 3months.

Conclusion: Depressive symptoms were common and were strongly associated with unprotected sex among study participants in St. Petersburg, Russia. Efforts to promote condom use should address lack of condom use due to depressive symptoms.