Background Some HIV-infected MSM are at risk for acquisition and transmission of STDs because of ongoing high risk sexual behaviours. HIV-infected MSM also can experience psychosocial stressors and related mental health issues. We assessed the association between STD risk behaviours and the desire to discuss mental health issues, as reported by HIV-infected MSM currently receiving care in HIV clinics.

Methods In 2007, 426 HIV-infected MSM receiving care in eight urban HIV clinics were randomly selected to complete a survey that queried them about risk behaviours and health concerns. We estimated the percentages who answered that they wanted to discuss their mental health with their clinicians, by sexual behaviour and substance use in the past year. Differences in percentages of patients were considered statistically significant if the two tailed p value was ≤0.05 using a χ² test.

Results 90% of patients had initiated care for their HIV infection more than a year ago. In the year preceding the survey, 74% had multiple sexual partners, 75% engaged in anal intercourse, 48% had at least one HIV-uninfected partner, and 82% used illegal psychoactive drugs. Among those who reported anal intercourse, 39% did not use a condom during the most recent episode. Among patients, 70% wanted to talk with their clinicians about how they felt mentally or emotionally. Patients who engaged in unprotected receptive anal sex were more likely to want such a conversation than those who did not engage in unprotected receptive anal sex (80% vs 62%, p<0.01); those who engaged in unprotected insertive anal sex were also more likely to want a discussion (81% vs 63%, p<0.01).

Conclusions Although the vast majority of these patients had been in treatment for more than a year, a large percentage of patients engaged in substance abuse and sexual behaviours that increase their risk of HIV transmission, and STD transmission and acquisition. Such patients were more likely to want to discuss their mental health concerns than those who did not engage in these behaviours. These findings underscore the importance of interventions to decrease risky sexual behaviour and to promote clinical assessment of mental health needs for this patient population. A mental health assessment can identify patients who might need greater psychosocial support or referral for treatment of substance abuse and underlying mental illness.