TY - JOUR
T1 - Pathways from sexual stigma to incident HIV and sexually transmitted infections among Nigerian MSM
AU - Rodriguez-Hart, Cristina
AU - Nowak, Rebecca G.
AU - Musci, Rashelle
AU - German, Danielle
AU - Orazulike, Ifeanyi
AU - Kayode, Blessing
AU - Liu, Hongjie
AU - Gureje, Oye
AU - Crowell, Trevor A.
AU - Baral, Stefan
AU - Charurat, Man
N1 - Funding Information:
The work was supported by a cooperative agreement (W81XWH-11-2-0174) between the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., and the U.S. Department of Defense (DoD). This study is also supported by funds from the US National Institutes of Health under Award No. R01MH099001 and R01AI120913 and training grant T32 A1050056-12, the US Military HIV Research Program (Grant No. W81XWH-07-2-0067), Fogarty AITRP (D43TW01041), and the President’s Emergency Plan for AIDS Relief through cooperative agreement U2G IPS000651 from the HHS/Centers for Disease Control and Prevention (CDC), Global AIDS Program with IHVN.
Publisher Copyright:
© 2017 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2017/11/13
Y1 - 2017/11/13
N2 - Objectives: Sexual stigma affecting 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 1480 MSM from Abuja and Lagos, Nigeria. Methods: Participants enrolled from March 2013 to 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=0.008). 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. Conclusion: 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.
AB - Objectives: Sexual stigma affecting 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 1480 MSM from Abuja and Lagos, Nigeria. Methods: Participants enrolled from March 2013 to 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=0.008). 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. Conclusion: 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.
KW - HIV infections
KW - MSM
KW - incidence
KW - path analysis
KW - sexually transmitted infections
KW - stigma
UR - http://www.scopus.com/inward/record.url?scp=85034114884&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85034114884&partnerID=8YFLogxK
U2 - 10.1097/QAD.0000000000001637
DO - 10.1097/QAD.0000000000001637
M3 - Article
C2 - 28926403
AN - SCOPUS:85034114884
SN - 0269-9370
VL - 31
SP - 2415
EP - 2420
JO - AIDS
JF - AIDS
IS - 17
ER -