Mental Health among Men Who Have Sex with Men in Cambodia: Implications for Integration of Mental Health Services within HIV Programs

BACKGROUND:

Poor mental health contributes to poor HIV prevention, treatment and care outcomes. This paper documents factors associated with psychological distress among men who have sex with men (MSM) in Cambodia and discusses potential ways in which routine mental health management could be integrated into HIV services.

METHODS:

A cross-sectional study was conducted in 2014 among 394 MSM randomly selected from two provinces using a two-stage cluster sampling method. A structured questionnaire was used to assess psychological distress, sexual behaviors, substance use, adverse childhood experiences and family dysfunction. Multivariate logistic regression analysis was performed to explore factors associated with levels of psychological distress.

RESULTS:

In total, 10.7 % of the respondents reported having suicidal thoughts and 6.6 % reported having attempted to commit suicide in the past three months, while 38.8 % had a higher level of psychological distress, which indicates poor mental health. Higher levels of psychological distress were independently associated with older age, alcohol use, illicit drug use, poor self-reported quality of life, and reduced condom use at last sex. MSM with higher levels of psychological distress were significantly more likely to report that a family member said hurtful things to them, a parent or guardian had been physically abused, and a family member had been mentally ill when they were growing up.

CONCLUSIONS:

In order to mitigate psychological distress among MSM in Cambodia, integration of mental health interventions within HIV programmes should be strengthened. To achieve optimal impact, these interventions should also address alcohol and other substance use, and low condom use among distressed MSM. In addition, training of clinical and non-clinical HIV service providers to screen for mental health symptoms, and subsequent provision of peer-based outreach and social support for MSM identified with psychological distress is required.

Comparisons of sexual behaviors and HIV/STI testing among MSM with a lower and higher level of psychological distress

Sexual behaviors in the past 3 months	Total	Total GHQ-12 score
	(n = 394)	≤3 (n = 241)	>3 (n = 153)	p-value*
Mean number of sex partners	3.9 ± 5.4	3.8 ± 5.7	4.0 ± 5.0	0.68
Used a condom in the last sex	313 (82.8)	202 (87.4)	211 (75.5)	0.003
Had sex with girlfriends	118 (29.9)	79 (32.7)	39 (15.4)	0.03
Mean number of girlfriends you had sex with	1.7 ± 1.1	1.7 ± 1.0	1.9 ± 1.2	0.26
Used a condom in last sex with girlfriends	97 (82.2)	68 (86.1)	29 (74.4)	0.12
Had sex with boyfriends	206 (86.9)	126 (85.7)	80 (88.9)	0.48
Mean number of boyfriends you had sex with	2.4 ± 3.8	2.3 ± 3.5	2.6 ± 4.3	0.53
Used a condom in last sex with boyfriends	192 (92.8)	117 (92.9)	75 (92.6)	0.94
Had anal sex with boyfriends	196 (94.2)	116 (91.3)	80 (98.8)	0.03
Used condom in last anal sex with boyfriend	187 (92.1)	114 (94.2)	73 (89.0)	0.18
Sold sex to men	67 (17.0)	42 (17.4)	25 916.3)	0.78
Used condom when selling sex last time	63 (94.0)	40 (95.2)	23 (92.0)	0.59
Tested for HIV in the past 6 months	252 (64.0)	160 (66.4)	92 (60.1)	0.21
Been diagnosed with an STI	28 (7.1)	16 (6.6)	12 (7.9)	0.63

GHQ general health questionnaire, MSM men who have sex with men, STI sexually transmitted infection

Values are number (%) for categorical variables and mean ± SD for continuous variables

*Chi-square test or Fisher’s exact test was used as appropriate for categorical variables and Student’s t-test was used for continuous variables

Full article at:   http://goo.gl/nJqgnZ

By:  Yi S1, Tuot S1, Chhoun P2, Pal K2, Choub SC2, Mburu G3,4.

• 1Research Department, KHANA, Phnom Penh, Cambodia.
• 2Programs Department, KHANA, Phnom Penh, Cambodia.
• 3Program Impact Unit, International HIV/AIDS Alliance, Brighton, UK. gmburu@aidsalliance.org.
• 4Department of Health Research, Lancaster University, Lancaster, UK. gmburu@aidsalliance.org. 

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