Stress of perceived threat: negative associations between HIV-cognitions and mental health for uninfected gay/bisexual men

Abstract

Background: Research on stress associated with illness-related cognitions traditionally focuses on patients or survivors. However, given both high rates of infection and pervasive threat messaging targeting gay/bisexual men, this study examined the prevalence, content, and correlates of HIV-related cognitions among uninfected (but at risk) individuals. Methods: 456 gay/bisexual men were asked how often they thought about HIV, both day-to-day and during sex (7-point scale, never to all the time), and were asked for open-ended responses about the content of these thoughts. Responses were coded into thematic categories (all kappas > .80). Participants also completed a series of self-report measures. Findings: 25% reported frequent daily HIV-related cognitions and 29% reported frequent cognitions during sex. Cognitions were grouped into 7 themes: fear of infection, physical impact of infection, social impact of infection, risk behavior, prevention behavior, partner mistrust, and friends living with HIV. Higher frequency of daily HIV cognitions was independent of objective risk (e.g., number of partners, condomless sex), but was associated with greater depression, anxiety, and sexual compulsivity. In regression models, the content of cognitions (threat of infection) was more important than frequency in predicting mental health. Discussion: Persistent cognitions about the threat of HIV infection are significantly associated with depression and anxiety among gay/bisexual men, independent of actual risk behavior. The stress of this perceived threat may be a critical factor to consider in prevention messaging and programs for gay/bisexual men.