Pathways from sexual stigma to incident HIV and sexually transmitted infections among Nigerian MSM

Abstract

Objectives Sexual stigma affecting men who have sex with men (MSM) in Nigeria may be an important driver of HIV and other sexually transmitted infections (STIs), but potential mechanisms through which this occurs are not well understood. This study assessed the contributions of suicidal ideation and sexual risk behaviors to causal pathways between stigma and HIV/STIs. Design Data were collected from the TRUST/RV368 Study, a prospective cohort of 1,480 MSM from Abuja and Lagos, Nigeria. Methods Participants enrolled from March 2013-February 2016 were classified into three stigma subgroups based on a latent class analysis of nine stigma indicators. Path analysis was used to test a model where disclosure led to stigma, then suicidal ideation, then condomless sex with casual sex partners, and finally incident HIV infection and/or newly diagnosed STIs, adjusting the model for age, education, having had female sex partners in the past 12 months, and sex position. Both direct and indirect (mediational) paths were tested for significance and analyses were clustered by city. Results As stigma increased in severity, the proportion of incident HIV/STI infections increased in a dose-response relationship (low: 10.6%, medium: 14.2%, high 19.0%, p-value=.008). All direct relationships in the model were significant and suicidal ideation and condomless sex partially mediated the association between stigma and incident HIV/STI infection. Conclusions These findings highlight the importance of the meaningful integration of stigma-mitigation strategies in conjunction with mental health services as part of a broader strategy to reduce STI and HIV acquisitions among Nigerian MSM.

The role of sex work laws and stigmas in increasing HIV risks among sex workers

“…The relationship between HIV and uniformed officers refusal to provide protection varies by legal status (MH p value < 0.01) with an increased odds in settings without legal specification (aOR: 1.64; 95% CI: 1.29-2.08; p value < 0.001) and criminalized settings (aOR: 1.38; 95% CI: 1.10-1.72; p value = 0.005) compared with partially legalized settings. Blackmail is associated with HIV in non-specified settings (aOR: 1.50; 95% CI: 1.37-1.65; p value: < 0.001) and criminalized settings (aOR: 1.35; 95% CI: 1.07-1.71; p value: 0.010) compared with partially legalized 27 (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) Median years in sex work (IQR) settings. HIV is associated with physical violence in criminalized settings versus partially legalized settings (aOR: 1.34; 95% CI: 1.11-1.62; p value = 0.002).…”

“…Understanding sex work-related stigmas, especially across different legal contexts has direct implications for the implementation and effectiveness of HIV treatment programs. Where assessed, perceived, anticipated, and enacted stigmas consistently challenge progress along the HIV treatment cascade by limiting engagement in prevention, care, and treatment services [27][28][29][30] . Moreover, intersecting stigmas have been associated with prevalent HIV infection and limited uptake of services along the HIV treatment cascade across sub-Saharan Africa [31][32][33] .…”

Attaining 95-95-95 through Implementation Science: 15 Years of Insights and Best Practices from the Walter Reed Army Institute of Research’s Implementation of the U.S. President’s Emergency Plan for AIDS Relief

“…39,40 The study also identified a substantial need for diagnosis and management of other sexually transmitted infections, and new prevention interventions. [40][41][42][43][44][45][46][47] Study findings have subsequently been incorporated directly into prevention and clinical service approaches at the community centers.…”

Seizing opportunities for intervention: Changing HIV-related knowledge among men who have sex with men and transgender women attending trusted community centers in Nigeria

“…Globally, men who have sex with men (MSM) and transgender women (TGW) bear a disproportionate burden of HIV as compared to the general population [1][2][3]. In Nigeria, like many other parts of the world where same-sex sexual practices are criminalized, issues of discrimination, stigma, and fear create barriers to care and impede implementation of HIV preventive strategies [4][5][6][7][8][9], contributing to a disproportionate burden of HIV and other sexually transmitted infections [10][11][12]. The 2017 UNAIDS Databook noted an HIV prevalence of 23% among MSM in Nigeria and we have previously reported HIV prevalence as high as 66% among MSM and TGW in Lagos [13,14].…”