Sexual behavior stigma and depression among transgender women and cisgender men who have sex with men in Côte d'Ivoire

Ayden Scheim, Carrie Lyons, Rebecca Ezouatchi, Benjamin Liestman, Fatou Drame, Daouda Diouf, Ibrahima Ba, Amara Bamba, Abo Kouame, Stefan Baral

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Transgender women (TGW) and cisgender men who have sex with men (cisMSM) across sub-Saharan Africa experience health inequalities relative to other adults. Recent research has also revealed health inequalities between these often-conflated groups. Among TGW and cisMSM in Côte d'Ivoire, we sought to determine whether transgender female identity was associated with probable depression, and whether sexual behavior stigma mediated this association. Methods: In 2015–2016, a cross-sectional respondent-driven sampling survey of adult TGW and cisMSM was conducted across five cities. We conducted a three-way decomposition of mediation and interaction of gender identity and sexual behavior stigma. Depression was measured by the nine-item Patient Health Questionnaire (PHQ-9). Results: Of 1301 participants, 339 (26.1%) were TGW. The prevalence of probable depression was 22.7% among TGW and 12.2% among cisMSM (P < .001). After confounder adjustment, the relative risk of depression attributable to transgender female gender identity was 1.68 (95% CI = 1.36, 2.00) with 69.9% (95% CI = 42.6, 97.1) of this effect mediated by sexual behavior stigma. The effect of stigma on depression did not differ significantly by gender. Conclusions: These data suggest that stigma mitigation interventions specifically addressing the stigma affecting transgender women may also address mental health inequalities between transgender women and cisMSM in Côte d'Ivoire.

Original languageEnglish (US)
Pages (from-to)79-83.e1
JournalAnnals of epidemiology
Volume33
DOIs
StatePublished - May 2019

Keywords

  • Depression
  • Discrimination
  • Sexual and gender minorities
  • Transgender persons

ASJC Scopus subject areas

  • Epidemiology

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