The Synergistic Impact of Sexual Stigma and Psychosocial Well-Being on HIV Testing: A Mixed-Methods Study Among Nigerian Men who have Sex with Men

Abstract

Although sexual stigma has been linked to decreased HIV testing among men who have sex with men (MSM), mechanisms for this association are unclear. We evaluated the role of psychosocial well-being in connecting sexual stigma and HIV testing using an explanatory sequential mixed methods analysis of 25 qualitative and 1480 quantitative interviews with MSM enrolled in a prospective cohort study in Nigeria from March/2013-February/2016. Utilizing structural equation modeling, we found a synergistic negative association between sexual stigma and suicidal ideation on HIV testing. Qualitatively, prior stigma experiences often generated psychological distress and perceptions of feeling unsafe, which decreased willingness to seek services at general health facilities. MSM reported feeling safe at the MSM-friendly study clinic but still described a need for psychosocial support services. Addressing stigma and unmet mental health needs among Nigerian MSM has the potential to improve HIV testing uptake.

Predictors of first-line antiretroviral therapy failure among adults and adolescents living with HIV/AIDS in a large prevention and treatment program in Nigeria

“…In this study, more than 50% of participants had CD4 counts < 200 cells/mm 3 at entry into care. This may be related to patient-level factors such as lack of awareness of their HIV status or barriers to accessing care such as stigma [ 27 , 28 ], high costs or distance from clinics [ 29 ].…”

Validation of depressive symptoms, social support, and minority stress scales among Gay, Bisexual, and other men who have with men (GBMSM) in Nigeria, Africa: A Mixed Methods Approach

“…Additionally, we found the onefactor measurement of depressive symptoms to be parsimonious, providing more evidence that the CESD-R might be a reliable scale to measure depressive symptoms among Nigerian GBMSM. This is especially relevant since previous studies have found high prevalence of depressive symptoms among Nigerian GBMSM [9,10].…”

“…The minority stress model posits that the prejudice, discrimination, and stigma experienced by sexual and gender minority individuals-as a result of sexual or gender identity-contributes to higher levels of stress, which may lead to mental health problems [6] and sexual risk behaviors [7,8].Prior studies have found high levels of mental health problems (i.e. depression, anxiety, suicide ideation, and post-traumatic stress disorder (PTSD)) among Nigerian GBMSM [9,10]. Consequently, it is important to explore these topics, especially considering the vulnerable and hostile situations Nigerian GBMSM are constantly confronted with.…”

Validation of depressive symptoms, social support, and minority stress scales among gay, bisexual, and other men who have with men (GBMSM) in Nigeria, Africa: a mixed methods approach

“…We found the one-factor measurement of depressive symptoms to be parsimonious, providing more evidence that the CESD-R might be a reliable scale to measure depressive symptoms among Nigerian GBMSM. This is especially relevant since previous studies have found high prevalence of depressive symptoms among Nigerian GBMSM [9,10]. Similar to the CESD-R, the MSPSS had sound psychometric properties, which suggests its' potential to accurately measure perceived social support from three distinct sources-family, friends, and significant otheramong Nigerian GBMSM.…”

“…Prior studies have found high levels of mental health problems (i.e. depression, anxiety, suicide ideation, and post-traumatic stress disorder (PTSD)) among Nigerian GBMSM [9,10]. Consequently, it is important to explore these topics, especially considering the vulnerable and hostile situations Nigerian GBMSM are constantly confronted with.…”