Role of depression as a mediator between homelessness or housing instability and sex under the influence of drugs and alcohol among men who have sex with men in a southern U.S. state

Sex under the influence of drugs is associated with condomless sex and increased HIV risk among men who have sex with men (MSM). Homelessness/housing instability has also been linked to depressive symptoms, but little is known about the mediational role of depressive symptoms between homelessness/housing instability and sex under the influence. Data were collected from adult MSM living in Georgia from June to December 2020 (N = 232). We conducted a path analysis to assess the mediational role of depressive symptoms between homelessness/housing instability and sex under the influence. After adjusting for sociodemographic characteristics, homelessness/housing instability was positively associated with depressive symptoms (Adjusted β = 0.18, p = 0.005), and depressive symptoms were positively associated with sex under the influence (Adjusted β = 0.26; p = <0.001). Homelessness/housing instability was not associated with sex under the influence (Adjusted β = 0.12; p = 0.055). The indirect effect of depressive symptoms on the relationship between homelessness/housing instability and sex under the influence was statistically significant (Adjusted β = 0.05, p = 0.023). Results suggest that depressive symptoms may help explain the observed relationship between homelessness/housing instability and sex under the influence of drugs among MSM. For MSM having housing instability, alleviating depressive symptoms may reduce rates of sex under the influence.