The relationship between depression and sexual health service utilization among men who have sex with men (MSM) in Côte d'Ivoire, West Africa 11 Medical and Health Sciences 1117 Public Health and Health Services Stefan Baral, Benjamin Mason Meier, Joseph Tucker

Mark B. Ulanja, Carrie Lyons, Sosthenes Ketende, Shauna Stahlman, Daouda Diouf, Abo Kouamé, Rebecca Ezouatchi, Amara Bamba, Fatou Drame, Ben Liestman, Stefan Baral

Research output: Contribution to journalArticle

Abstract

Background: In Cote D'Ivoire, there has been limited coverage of evidence-based sexual health services specifically supporting men who have sex with men (MSM). To date, there has been limited study of the determinants of engagement in these services including multiple intersecting stigmas and depression. Methods: 1301 MSM aged 18 years and older, were recruited using respondent-driven sampling in Abidjan, Yamoussoukro, Gagnoa and Bouake, Cote d'Ivoire from January 2015 to October 2015. Inclusion criteria included anal sex with another man in the past 12 months were to complete a structured questionnaire including the Patient Health Questionnaire (PHQ)-9 to screen for depression. Chi-Square tests were used to test difference in healthcare utilization across variables, and multiple logistic regression was used to test the association between depression and health care utilization represented by HIV and sexually transmittable infection testing and treatment. Results: Depression (aOR:1.40, 95% CI: 1.07-1.84), being aged 25-29 years (aOR:1.84, 95% CI: 1.11-3.03),unemployed (aOR:0.64, 95% CI: 0.42-0.98), being a student (aOR:0.67, 95% CI: 0.48-0.96), being identified as male (aOR:0.44, 95% CI: 0.29-0.67), and identifying as homosexual (aOR:0.74, 95% CI:0.56-0.99) were significantly associated with utilization of sexual health care services in the final multivariable model. Healthcare enacted stigma (aOR: 1.55, 95% CI: 1.03-2.33) was associated with utilizing sexual health care services, but perceived healthcare stigma, social stigma and family stigma were not. Conclusion: Given higher levels of depressive symptomatology among those engaging in sexual health care services, this engagement represents an opportunity for service integration which may have synergistic benefits for both sexual and mental health. Moreover, MSM in Cote D'Ivoire who had engaged in sexual health services were more likely to report having experienced health-care enacted stigma. Taken together, these results reinforce the need for stigma mitigation interventions to support sustained engagement in HIV prevention, treatment and care services as a means of reducing health disparities among MSM in Cote d'Ivoire.

Original languageEnglish (US)
Article number11
JournalBMC International Health and Human Rights
Volume19
Issue number1
DOIs
StatePublished - Mar 5 2019

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Western Africa
Reproductive Health
Health Services
Public Health
Depression
Delivery of Health Care
Health
Cote d'Ivoire
Patient Acceptance of Health Care
HIV
Social Stigma
Chi-Square Distribution
Sexual Behavior
Mental Health
Logistic Models
Students
Therapeutics
Infection
Surveys and Questionnaires

Keywords

  • Cote D'Ivoire
  • Depression
  • Epidemiology
  • Gender
  • HIV
  • Men who have sex with men
  • Sexual health services

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

The relationship between depression and sexual health service utilization among men who have sex with men (MSM) in Côte d'Ivoire, West Africa 11 Medical and Health Sciences 1117 Public Health and Health Services Stefan Baral, Benjamin Mason Meier, Joseph Tucker. / Ulanja, Mark B.; Lyons, Carrie; Ketende, Sosthenes; Stahlman, Shauna; Diouf, Daouda; Kouamé, Abo; Ezouatchi, Rebecca; Bamba, Amara; Drame, Fatou; Liestman, Ben; Baral, Stefan.

In: BMC International Health and Human Rights, Vol. 19, No. 1, 11, 05.03.2019.

Research output: Contribution to journalArticle

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abstract = "Background: In Cote D'Ivoire, there has been limited coverage of evidence-based sexual health services specifically supporting men who have sex with men (MSM). To date, there has been limited study of the determinants of engagement in these services including multiple intersecting stigmas and depression. Methods: 1301 MSM aged 18 years and older, were recruited using respondent-driven sampling in Abidjan, Yamoussoukro, Gagnoa and Bouake, Cote d'Ivoire from January 2015 to October 2015. Inclusion criteria included anal sex with another man in the past 12 months were to complete a structured questionnaire including the Patient Health Questionnaire (PHQ)-9 to screen for depression. Chi-Square tests were used to test difference in healthcare utilization across variables, and multiple logistic regression was used to test the association between depression and health care utilization represented by HIV and sexually transmittable infection testing and treatment. Results: Depression (aOR:1.40, 95{\%} CI: 1.07-1.84), being aged 25-29 years (aOR:1.84, 95{\%} CI: 1.11-3.03),unemployed (aOR:0.64, 95{\%} CI: 0.42-0.98), being a student (aOR:0.67, 95{\%} CI: 0.48-0.96), being identified as male (aOR:0.44, 95{\%} CI: 0.29-0.67), and identifying as homosexual (aOR:0.74, 95{\%} CI:0.56-0.99) were significantly associated with utilization of sexual health care services in the final multivariable model. Healthcare enacted stigma (aOR: 1.55, 95{\%} CI: 1.03-2.33) was associated with utilizing sexual health care services, but perceived healthcare stigma, social stigma and family stigma were not. Conclusion: Given higher levels of depressive symptomatology among those engaging in sexual health care services, this engagement represents an opportunity for service integration which may have synergistic benefits for both sexual and mental health. Moreover, MSM in Cote D'Ivoire who had engaged in sexual health services were more likely to report having experienced health-care enacted stigma. Taken together, these results reinforce the need for stigma mitigation interventions to support sustained engagement in HIV prevention, treatment and care services as a means of reducing health disparities among MSM in Cote d'Ivoire.",
keywords = "Cote D'Ivoire, Depression, Epidemiology, Gender, HIV, Men who have sex with men, Sexual health services",
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AU - Ulanja, Mark B.

AU - Lyons, Carrie

AU - Ketende, Sosthenes

AU - Stahlman, Shauna

AU - Diouf, Daouda

AU - Kouamé, Abo

AU - Ezouatchi, Rebecca

AU - Bamba, Amara

AU - Drame, Fatou

AU - Liestman, Ben

AU - Baral, Stefan

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KW - Depression

KW - Epidemiology

KW - Gender

KW - HIV

KW - Men who have sex with men

KW - Sexual health services

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