@article{8a9a569ae26c4dec907b35bf57837aae,
title = "Depressive symptoms and substance use as mediators of stigma affecting men who have sex with men in Lesotho: a structural equation modeling approach",
abstract = "Purpose Research on the relationship between sexual orientation–related stigma and risks for HIV among men who have sex with men (MSM) is limited. This study tests a hypothesis that substance use and depressive symptoms mediate the relationship between stigma in the health care system and HIV-related risk practices among MSM in Maseru, Lesotho. Methods In 2014, we conducted a cross-sectional study among MSM in Lesotho accrued via respondent-driven sampling including a survey and biological testing for HIV. The hypothesis was tested using structural equation modeling. Results Of the 318 participants, 22.3% had experienced stigma in the health care system. Stigma in the health care system was associated with depression (β = 0.329, P =.018) and alcohol use (β = 1.417, P =.001). Noninjection illicit drug use (β = 0.837, P =.039) and alcohol use (β = 0.282, P =.000) significantly predicted number of sex partners. Stigma was directly associated with condomless anal sex (β = 0.441, P =.036), and no indirect association was found. Conclusions Alcohol use and depressive symptoms mediate the relationship between MSM stigma in the health care system and reported number of sex partners. The implications are significant with a focus on the need for comprehensive interventions addressing stigma and mental health when aiming to improve more proximal HIV-related risk practices for MSM.",
keywords = "Depressive symptoms, HIV-related risk practices, MSM, SEM, Stigma, Substance use",
author = "Da Wendi and Shauna Stahlman and Ashley Grosso and Stephanie Sweitzer and Sosthenes Ketende and Noah Taruberekera and John Nkonyana and Tampose Mothopeng and Stefan Baral",
note = "Funding Information: We would like to acknowledge and thank the Lesotho LGBT community for their participation and effective mobilization to disseminate messages about this study. We also wish to thank the study staff and interviewers who worked on this project at personal risk, including disclosure of sexual orientation to their families or communities. The Lesotho Ministry of Health was instrumental in the oversight, direction, and supervision of the study, and we are grateful for the incredible government engagement and ownership of this work. We would especially like to thank Dr. Limpho Maile, Dr. Mosilinyane Letsie, Tsietso Mot'soane, David Mothabeng, Puleng Ramphalla-Phatela, and Dr. Kyaw Thin for their invaluable support and input. This study was funded by the U.S. Agency for International Development (USAID, AID-674-A-00-00001 ) and implemented by Population Services International/Lesotho (PSI). From PSI, we would like to thank Dwan Dixon, Pierre Loup-Lesage, and Brian Pedersen who provided invaluable support and guidance. Finally, from USAID, we thank David Brown, Todd Koppenhaver, and Diana Acosta who provided oversight and technical assistance for the project. Additional support was provided by Johns Hopkins University Center for AIDS Research ( P30AI094189 ) and the American Foundation for AIDS Research. Publisher Copyright: {\textcopyright} 2016 Elsevier Inc.",
year = "2016",
month = aug,
day = "1",
doi = "10.1016/j.annepidem.2016.06.005",
language = "English (US)",
volume = "26",
pages = "551--556",
journal = "Annals of epidemiology",
issn = "1047-2797",
publisher = "Elsevier Inc.",
number = "8",
}