SEXUAL STIGMA AND EXPLANATORY MECHANISMS LINKING SEXUAL STIGMA TO HIV, STIS, AND HIV TESTING AMONG NIGERIAN MEN WHO HAVE SEX WITH MEN

men who have sex with men;stigma;HIV;sexually transmitted infection;HIV testing;Public Health Studies

Rodriguez-Hart, Cristina MargotBaral, Stefan ;

Johns Hopkins University

关键词: men who have sex with men;    stigma;    HIV;    sexually transmitted infection;    HIV testing;    Public Health Studies;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/60771/RODRIGUEZ-HART-DISSERTATION-2017.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Statement of ProblemAlthough studies have found that sexual stigma affecting men who have sex with men (MSM) is associated with increased sexual risk behavior and HIV infection, few studies have assessed the pathways linked to these important outcomes. Theoretically-based models assessing these pathways would provide a better understanding of points of intervention to reduce the negative effects of sexual stigma. This is especially important for countries such as Nigeria, which have a high burden of HIV among MSM and rising levels of sexual stigma.MethodsThe sample consisted of 1,480 MSM who enrolled in a prospective cohort study in Nigeria that provided HIV/STI diagnosis and treatment from March 2013 to February 2016, called the TRUST/RV368 study. Latent variable modeling techniques were utilized to develop a measure of sexual stigma and explore pathways using structural equation modeling (SEM). In aim 1, latent class analysis was used to develop stigma classes, and predictors of class and distal outcomes were subsequently added. In aim 2, path analysis was used to test a model where disclosure led to stigma, stigma led to suicidal ideation, suicidal ideation led to condomless sex, and condomless sex led to HIV and/or STI incidence, with direct and indirect (mediational) paths tested for significance. In aim 3, latent transition analysis was used to assess if suicidal ideation modified the association between sexual stigma and HIV testing.ResultsThree stigma classes of low, medium, and high emerged. Increasing sexual stigma was associated with increasing levels of HIV/ STIs in a dose-response association. All direct relationships in the path model were significant and suicidal ideation and condomless sex partially mediated the association between stigma and HIV and/or STI incidence. Suicidal ideation and sexual stigma had a synergistic negative impact on HIV testing where the interaction effects were more strongly negative than the main effects alone.ConclusionsHigher stigma among Nigerian MSM was associated with increased risk of HIV/ STIs. Strategies to improve MSM engagement with HIV services may need to integrate stigma mitigation strategies that address trauma and provide psychosocial support within MSM-friendly venues that approach sexual minority health holistically.