Depressive symptoms and substance use as mediators of stigma affecting men who have sex with men in Lesotho: a structural equation modeling approach

Da Wendi, Shauna Stahlman, Ashley Grosso, Stephanie Sweitzer, Sosthenes Ketende, Noah Taruberekera, John Nkonyana, Tampose Mothopeng, Stefan Baral

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)551-556
Number of pages6
JournalAnnals of epidemiology
Volume26
Issue number8
DOIs
StatePublished - Aug 1 2016

Keywords

  • Depressive symptoms
  • HIV-related risk practices
  • MSM
  • SEM
  • Stigma
  • Substance use

ASJC Scopus subject areas

  • Epidemiology

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