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Zhou T, Chen Q, Zhong X. Associations between sexual identity stigma and positive sexual identity, and depression among men who have sex with men in China: A mediation analysis using structural equation modelling. Ann Epidemiol 2024; 96:32-39. [PMID: 38830488 DOI: 10.1016/j.annepidem.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 03/20/2024] [Accepted: 05/27/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE High levels of depression are common among men who have sex with men (MSM) in China, and there is limited research on the relationship between MSM stigma and depression. Guided by the psychological mediation framework, to explore the relationship between stigma and depression among MSM and how positive sexual identity plays a role in it, we tested this model whether: 1) enacted MSM stigma, perceived MSM stigma, and positive sexual identity are associated with depression; 2) their effects on depression are mediated through resilient coping and social support; and 3) perceived MSM stigma is a mediator of the effects of enacted MSM stigma and positive sexual identity on depression. METHODS We conducted mediation analyses using structural equation modeling (SEM) on data from a cross-sectional survey conducted among 1014 MSM recruited using a non-probability sampling method in December 2022. The data passed general analyses such as normality and correlation, which allowed for modeling. The final SEM fit metrics indicated that the model was acceptable. RESULTS Structural equation modeling results showed that enacted stigma directly and positively affected depressive symptoms (β = 0.558, 95 % confidence interval = 0.457 ~ 0.644, P < 0.001). Perceived stigma had a positive effect on depressive symptoms (β = 0.114, 95 %CI = 0.036 ~ 0.200, P = 0.002). Positive identity had a positive effect on depressive symptoms (β = 0.086, 95 %CI = 0.016 ~ 0.162, P = 0.013). In addition, the results of mediation effect analysis showed that the indirect effect of enacted stigma on the effect of depression through social support was (β = 0.040, 95 %CI = 0.003 ∼ 0.017, P = 0.049); The indirect effect of perceived stigma on the effect of depression through resilient coping was (β = -0.015, 95 %CI = -0.034 ∼ -0.002, P = 0.056); The indirect effects of positive sexual identity on the effect of depression through resilient coping and social support were (β = -0.025, 95 %CI = -0.056 ∼ -0.002, P = 0.052) and (β = -0.056, 95 %CI = -0.101 ∼ -0.023, P = 0.005). CONCLUSION Resilient coping and social support mediated the relationship between stigma and depression, and both were influenced by positive identity. This study reveals that enhancing coping and social support may reduce the impact of stigma on depressive symptoms, both of which are potential targets for interventions for MSM. Guiding MSM to develop a positive sexual identity is conducive to reducing the prevalence of depressive symptoms among MSM.
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Affiliation(s)
- Tianyi Zhou
- School of Public Health, Chongqing Medical University, Chongqing 400016, China; Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
| | - Qiao Chen
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Xiaoni Zhong
- School of Public Health, Chongqing Medical University, Chongqing 400016, China.
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Wahome E, Otieno FO, Kimani J, Boyd A, Okall D, Nzioka J, Gichuru E, van der Elst E, Mehta SD, Bailey RC, Graham SM, Sanders EJ. Impact of coronavirus disease 2019-related clinic closures on HIV incidence in young adult MSM and transgender women in Kenya. AIDS 2024; 38:407-413. [PMID: 37939103 PMCID: PMC10842664 DOI: 10.1097/qad.0000000000003782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Little is known about the impact that the COVID-19 pandemic had on risk of HIV acquisition in sub-Saharan Africa. We assessed the impact of COVID-19-related clinic closures on HIV incidence in a cohort of gay, bisexual, and other men who have sex with men (MSM) and transgender women in Kenya. METHODS MSM and transgender women enrolled in a prospective, multicentre cohort study were followed quarterly for HIV testing, behaviour assessments, and risk. We estimated the HIV incidence rate and its 95% credible intervals (CrI) among participants who were HIV-negative before COVID-19-related clinic closure, comparing incidence rate and risk factors associated with HIV acquisition before vs. after clinic reopening, using a Bayesian Poisson model with weakly informative priors. RESULTS A total of 690 (87%) participants returned for follow-up after clinic reopening (total person-years 664.3 during clinic closure and 1013.3 after clinic reopening). HIV incidence rate declined from 2.05/100 person-years (95% CrI = 1.22-3.26, n = 14) during clinic closures to 0.96/100 person-years (95% CrI = 0.41-2.07, n = 10) after clinic reopening (IRR = 0.47, 95% CrI = 0.20-1.01). The proportion of participants reporting hazardous alcohol use and several sexual risk behaviours was higher during clinic closures than after clinic reopening. In multivariable analysis adjusting for study site and participant characteristics, HIV incidence was lower after clinic reopening (IRR 0.57, 95% CrI = 0.23-1.33). Independent risk factors for HIV acquisition included receptive anal intercourse (IRR 1.94, 95% CrI = 0.88-4.80) and perceived risk of HIV (IRR 3.03, 95% CRI = 1.40-6.24). CONCLUSION HIV incidence during COVID-19-related clinic closures was moderately increased and reduced after COVID-19 restrictions were eased. Ensuring access to services for key populations is important during public health emergencies.
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Affiliation(s)
| | | | - Joshua Kimani
- Sex Worker Outreach Program (SWOP), and Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Anders Boyd
- Public Health Service of Amsterdam, Department of Infectious Diseases
- Stichting HIV Monitoring
- Amsterdam UMC location University of Amsterdam, Infectious Diseases
| | - Duncan Okall
- Sex Worker Outreach Program (SWOP), and Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Joseph Nzioka
- Sex Worker Outreach Program (SWOP), and Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | | | - Elise van der Elst
- KEMRI/Wellcome Trust Research Programme, Kilifi
- Department of Global Health, University of Amsterdam, Amsterdam, Netherlands
| | | | - Robert C. Bailey
- Nyanza Reproductive Health Society, Kisumu
- University of Illinois at Chicago, IL
| | - Susan M. Graham
- KEMRI/Wellcome Trust Research Programme, Kilifi
- Nyanza Reproductive Health Society, Kisumu
- University of Washington, Seattle, WA, USA
| | - Eduard J. Sanders
- KEMRI/Wellcome Trust Research Programme, Kilifi
- Department of Global Health, University of Amsterdam, Amsterdam, Netherlands
- University of Oxford, Headington, UK
- The Aurum Institute, Johannesburg, South Africa
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Dada D, Abu-Ba'are GR, Turner D, Mashoud IW, Owusu-Dampare F, Apreku A, Ni Z, Djiadeu P, Aidoo-Frimpong G, Zigah EY, Nyhan K, Nyblade L, Nelson LE. Scoping review of HIV-related intersectional stigma among sexual and gender minorities in sub-Saharan Africa. BMJ Open 2024; 14:e078794. [PMID: 38346887 PMCID: PMC10862343 DOI: 10.1136/bmjopen-2023-078794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/09/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVES Sexual and gender minority (SGM) populations in sub-Saharan Africa (SSA) are disproportionately impacted by HIV and often face multiple HIV-related stigmas. Addressing these stigmas could reduce SGM HIV vulnerability but little is known about how the stigmas operate and intersect. Intersectional stigma offers a lens for understanding the experiences of stigmatised populations and refers to the synergistic negative health effects of various systems of oppression on individuals with multiple stigmatised identities, behaviours or conditions. This review aims to (1) assess how often and in what ways an intersectional lens is applied in HIV-related stigma research on SGM populations in SSA and (2) understand how intersectional stigma impacts HIV risk in these populations. DESIGN Scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. DATA SOURCES Public health and regional databases were searched in 2020 and 2022. ELIGIBILITY CRITERIA Articles in French and English on HIV-related stigma and HIV outcomes among men who have sex with men, women who have sex with women and/or transgender individuals in SSA. DATA EXTRACTION AND SYNTHESIS Articles were screened and extracted twice and categorised by use of an intersectional approach. Study designs and stigma types were described quantitatively and findings on intersectional stigma were thematically analysed. RESULTS Of 173 articles on HIV-related stigma among SGM in SSA included in this review, 21 articles (12%) applied an intersectional lens. The most common intersectional stigmas investigated were HIV and same-sex attraction/behaviour stigma and HIV, same-sex attraction/behaviour and gender non-conformity stigma. Intersectional stigma drivers, facilitators and manifestations were identified across individual, interpersonal, institutional and societal socioecological levels. Intersectional stigma impacts HIV vulnerability by reducing HIV prevention and treatment service uptake, worsening mental health and increasing exposure to HIV risk factors. CONCLUSION Intersectional approaches are gaining traction in stigma research among SGM in SSA. Future research should prioritise quantitative and mixed methods investigations, diverse populations and intervention evaluation.
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Affiliation(s)
- Debbie Dada
- School of Nursing, Yale University, New Haven, Connecticut, USA
- St Michael's Hospital Centre for Urban Health Solutions, Toronto, Ontario, Canada
| | - Gamji R Abu-Ba'are
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, Connecticut, USA
- Behavioral, Sexual, and Global Health Lab, University of Rochester, Rochester, New York, USA
| | | | | | | | | | - Zhao Ni
- School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Pascal Djiadeu
- St Michael's Hospital Centre for Urban Health Solutions, Toronto, Ontario, Canada
- School of Public Health, University of Toronto Dalla Lana, Toronto, Ontario, Canada
| | - Gloria Aidoo-Frimpong
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Edem Yaw Zigah
- Behavioral, Sexual, and Global Health Lab, University of Rochester, Rochester, New York, USA
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut, USA
| | - Laura Nyblade
- Research Triangle Institute, Research Triangle Park, North Carolina, USA
| | - LaRon E Nelson
- School of Nursing, Yale University, New Haven, Connecticut, USA
- St Michael's Hospital Centre for Urban Health Solutions, Toronto, Ontario, Canada
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Zhang R, Qiao S, Aggarwal A, Yuan G, Muttau N, Sharma A, Lwatula C, Ngosa L, Kabwe M, Manasyan A, Menon A, Ostermann J, Weissman S, Li X, Harper GW. Impact of enacted stigma on mental health, substance use, and HIV-related behaviors among sexual minority men in Zambia. Arch Psychiatr Nurs 2024; 48:51-58. [PMID: 38453282 DOI: 10.1016/j.apnu.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/08/2023] [Accepted: 01/03/2024] [Indexed: 03/09/2024]
Abstract
Sexual minority men (SMM) in Zambia face significant challenges including stigma, discrimination, and mental health issues, which further impact their HIV-related risk behaviors. This study aimed to investigate the associations between enacted stigma, substance abuse, HIV-related behaviors, and mental health (i.e., depression, anxiety, and post-traumatic stress disorder [PTSD] symptoms) among SMM in Zambia. SMM aged 18-35 years who reported having multiple and/or concurrent sexual partners or low and/or inconsistent condom use in the past three months were recruited from four districts in Zambia between February and November 2021. Participants completed an anonymous interviewer-administered survey. Key variables of interest were compared between participants with higher vs. lower levels of enacted stigma. Independent samples t-tests were used for continuous variables, and chi-squared tests were used for categorical variables. A total of 197 eligible SMM participated in the study (mean age = 24.41 years). Participants with a higher level of enacted stigma showed a higher level of anxiety symptoms (χ2 = 12.91, p ≤ .001), PTSD symptoms (χ2 = 7.13, p < .01), tobacco use (χ2 = 10.47, p < .01), cannabis use (χ2 = 5.90, p < .05), and a higher number of sexual partners (t = 1.99, p < .05) in the past three months. Stigma reduction interventions may help mitigate substance abuse, HIV-related behaviors, and adverse mental health outcomes among SMM in Zambia. Health care providers, especially psychiatric-mental health nurses, can incorporate strategies for recognizing and addressing stigma into their practice through training and integrate multiple resources to create an inclusive and non-judgmental environment for SMM to improve their well-being.
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Affiliation(s)
- Ran Zhang
- University of South Carolina, Columbia, South Carolina, USA
| | - Shan Qiao
- University of South Carolina, Columbia, South Carolina, USA.
| | | | - Guangzhe Yuan
- University of South Carolina, Columbia, South Carolina, USA
| | - Nobutu Muttau
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Levy Ngosa
- Dignitate Zambia Limited, Lusaka, Zambia
| | | | - Albert Manasyan
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Jan Ostermann
- University of South Carolina, Columbia, South Carolina, USA
| | | | - Xiaoming Li
- University of South Carolina, Columbia, South Carolina, USA
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Paudel K, Bhandari P, Gautam K, Wickersham JA, Ha T, Banik S, Shrestha R. Mediating role of food insecurity in the relationship between perceived MSM related stigma and depressive symptoms among men who have sex with men in Nepal. PLoS One 2024; 19:e0296097. [PMID: 38166131 PMCID: PMC10760890 DOI: 10.1371/journal.pone.0296097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/05/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Previous studies have indicated the association between stigma and depressive symptoms among frequently stigmatized groups, such as men who have sex with men (MSM). While this association has been suggested in the literature, there is a dearth of evidence that examines whether food insecurity statistically mediates the relationship between stigma and depressive symptoms. METHODS This cross-sectional study conducted between October and December 2022 among a sample of 250 MSM in Kathmandu, Nepal, recruited through respondent-driven sampling. An unadjusted model including the exposure (stigma), mediator (food insecurity), and outcome variables (depressive symptoms) and an adjusted model that controlled for sociodemographic, behavioral, and health-related confounders were used. Bootstrapping was utilized to estimate the coefficients of these effects and the corresponding 95% confidence intervals. Via bootstrap approach, we find out the mediating role of food insecurity in the association between stigma and depressive symptoms. RESULTS Depressive symptoms, stigma, and food insecurity were 19.6%, 24.4%, and 29.2%, respectively, among MSM. Food insecurity was associated with higher age (b = 0.094; 95% CI = 0.039, 0.150) and monthly income (b = -1.806; 95% CI = -2.622, -0.985). Depressive symptoms were associated with condom-less sex in past six months (b = -1.638; 95% CI = -3.041, -0.092). Stigma was associated with higher age (b = 0.196; 95% CI = 0.084, 0.323) and PrEP uptake (b = 2.905; 95% CI = 0.659. 5.248). Food insecurity statistically mediated 20.6% of the indirect effect of stigma in depressive symptoms. CONCLUSION Our findings show that food insecurity affects the relationship between stigma and depressive symptoms in this population. Reducing food insecurity and addressing the stigma surrounding sexual orientation should be a priority when addressing mental health concerns among MSM in Nepal and other resource-limited countries with similar socio-cultural settings.
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Affiliation(s)
- Kiran Paudel
- Nepal Health Frontiers, Tokha-5, Kathmandu, Nepal
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States of America
| | | | - Kamal Gautam
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States of America
| | - Jeffrey A. Wickersham
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, United States of America
| | - Toan Ha
- School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Swagata Banik
- Baldwin Wallace University, Berea, OH, United States of America
| | - Roman Shrestha
- Nepal Health Frontiers, Tokha-5, Kathmandu, Nepal
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States of America
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, United States of America
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Umar TP, Jain N, Sayad R, Tandarto K, Jain S, Reinis A. Overcoming Stigma: The Human Side of Monkeypox Virus. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1451:383-397. [PMID: 38801592 DOI: 10.1007/978-3-031-57165-7_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Monkeypox (Mpox) virus is a zoonotic disease that was recently declared a public health emergency of international concern (PHEIC) by the World Health Organization (WHO). Symptoms of Mpox include fever, headache, muscle pain, and a rash which starts on the face and spreads to the rest of the body. The stigma surrounding the Mpox virus has been one of the greatest challenges in dealing with the disease. People with Mpox have been often shunned by their communities, and many are afraid to seek medical care for fear of ostracism. For those affected by the virus, this stigma can significantly impact their mental health and quality of life. It is further fueled by misinformation and societal norms. Hence, a multifaceted approach that includes education, awareness campaigns, and community engagement is needed to overcome the stigma associated with Mpox. Effective communication strategies are critical to the dispelling of rumors and the reduction of fear. Interventional measures need to be shaped according to the needs of those affected.
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Affiliation(s)
- Tungki Pratama Umar
- Faculty of Medicine, Sriwijaya University, Dr. Mohammad Ali Street-RSMH Complex, Palembang, 30126, Indonesia.
| | - Nityanand Jain
- Faculty of Medicine, Riga Stradiņš University, Dzirciema Street 16, Riga, 1007, Latvia.
- Joint Microbiology Laboratory, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, Riga, 1002, Latvia.
| | - Reem Sayad
- Faculty of Medicine, Assiut University, Saad Zaghloul, Assiut, 71515, Egypt
| | - Kevin Tandarto
- Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Pluit Raya Street No.2, North Jakarta, Special Capital Region of Jakarta, 14440, Indonesia
| | - Shivani Jain
- Department of Oral and Maxillofacial Surgery and Oral Implantology, Genesis Institute of Dental Sciences and Research, Ferozepur - Moga Rd, Firozpur, Punjab, 152002, India
| | - Aigars Reinis
- Faculty of Medicine, Riga Stradiņš University, Dzirciema Street 16, Riga, 1007, Latvia
- Joint Microbiology Laboratory, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, Riga, 1002, Latvia
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Kiburi SK, Jaguga F, Atwoli L. Health equity in substance use disorder treatment in Kenya. Drug Alcohol Depend 2023; 253:111005. [PMID: 37931329 DOI: 10.1016/j.drugalcdep.2023.111005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 11/08/2023]
Affiliation(s)
| | - Florence Jaguga
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Lukoye Atwoli
- Medical College East Africa, and Brain and Mind Institute, The Aga Khan University, Nairobi, Kenya
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Qiao S, Garrett CM, Addo PNO, Adeagbo O, Moore DM, Muttau N, Sharma A, Lwatula C, Ngosa L, Kabwe M, Manasyan A, Menon JA, Weissman S, Li X, Harper GW. The Impacts of Stigma Against Sexual Minority Men Within and Between Various Socioecological Levels: Breaking the Vicious Cycle in Zambia. Am J Mens Health 2023; 17:15579883231209190. [PMID: 37909703 PMCID: PMC10621297 DOI: 10.1177/15579883231209190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/13/2023] [Accepted: 10/04/2023] [Indexed: 11/03/2023] Open
Abstract
Sexual minority men (SMM) face persistent stigma in Zambia. From a holistic perspective, we aim to explore its impacts within and between multiple socioecological levels, demonstrating how their interactions create a vicious cycle of barriers to the well-being of SMM. In-depth interviews were conducted with 20 purposively recruited SMM from Lusaka, Zambia. All interviews were audio-recorded, after written consent, transcribed verbatim, and iteratively coded employing inductive (i.e., data-driven) approaches for thematic analysis using NVivo. Results suggest three key themes: (1) interpersonal socially perpetuated sexual minority stigma (SMS); (2) multidirectional interactions between psychosocial well-being and risk-taking behaviors; and (3) institutionally perpetuated SMS as a barrier to seeking and receiving health care. SMS permeates across all levels of the socioecological model to negatively impact the psychosocial well-being of SMM while acting also as a barrier to accessing HIV prevention and care. Our study necessitates structural public health intervention to decrease stigma and discrimination against SMM in Zambia, in efforts to increase their psychosocial well-being as well as their access to and utilization of HIV care by breaking the vicious cycle of SMS that pervades through the intrapersonal, interpersonal, and institutional levels of the socioecological model.
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Affiliation(s)
- Shan Qiao
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Camryn M. Garrett
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Prince N. O. Addo
- Department of Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Oluwafemi Adeagbo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Community and Behavioral Health, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Darius M. Moore
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Nobutu Muttau
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Levy Ngosa
- Dignitate Zambia Limited (DZL), Lusaka, Zambia
| | | | - Albert Manasyan
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Sharon Weissman
- Department of Internal Medicine, School of Medicine Columbia, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Gary W. Harper
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Graff NR, Hong C, Guthrie B, Micheni M, Chirro O, Wahome E, van der Elst E, Sanders EJ, Simoni JM, Graham SM. The Effect of the Shikamana Peer-and-Provider Intervention on Depressive Symptoms, Alcohol Use, and Other Drug Use Among Gay, Bisexual, and Other Men Who Have Sex with Men in Kenya. AIDS Behav 2023; 27:3053-3063. [PMID: 36929320 PMCID: PMC10504414 DOI: 10.1007/s10461-023-04027-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 03/18/2023]
Abstract
Kenyan gay, bisexual, and other men who have sex with men (GBMSM) face stigma and discrimination, which may adversely impact mental health and limit antiretroviral therapy (ART) adherence among GBMSM living with HIV. We evaluated whether the Shikamana peer-and-provider intervention, which improved ART adherence among participants in a small randomized trial, was associated with changes in mental health or substance use. The intervention was associated with a significant decrease in PHQ-9 score between baseline and month 6 (estimated change - 2.7, 95% CI - 5.2 to - 0.2, p = 0.037) compared to standard care. In an exploratory analysis, each one-point increment in baseline HIV stigma score was associated with a - 0.7 point (95% CI - 1.3 to - 0.04, p = 0.037) greater decrease in PHQ-9 score over the study period in the intervention group. Additional research is required to understand factors that influence this intervention's effects on mental health outcomes.
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Affiliation(s)
- Nicholas R Graff
- Department of Epidemiology, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, USA
| | - Chenglin Hong
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Brandon Guthrie
- Department of Epidemiology, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, USA
- Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, USA
| | | | - Oscar Chirro
- KEMRI - Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Elise van der Elst
- KEMRI - Wellcome Trust Research Programme, Kilifi, Kenya
- Global Health Department, University of Amsterdam, Amsterdam, The Netherlands
| | - Eduard J Sanders
- KEMRI - Wellcome Trust Research Programme, Kilifi, Kenya
- University of Oxford, Headington, England, UK
| | - Jane M Simoni
- Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, USA
- Department of Psychology, University of Washington, Seattle, WA, USA
- Department of Gender, Women & Sexuality Studies, University of Washington, Seattle, WA, USA
| | - Susan M Graham
- Department of Epidemiology, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, USA.
- Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, USA.
- Department of Medicine, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, USA.
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Mehta SD, Otieno FO, Kimani J, Wahome E, Okal D, Roy A, van der Elst E, Graham SM, Sanders EJ, Bailey RC. Transgender women in Kenya experience greater stigma, depressive symptoms, alcohol and drug use and risky sexual practices than cis-gendered men who have sex with men. BMC Public Health 2023; 23:1493. [PMID: 37542212 PMCID: PMC10403860 DOI: 10.1186/s12889-023-16348-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 07/18/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Worldwide, sexual and gender minority individuals have disproportionate burden of HIV. There are limited quantitative data from sub-Saharan Africa on the intersection of risks experienced by transgender women (TGW) in comparison to cis-men who have sex with men (MSM). This analysis addresses this gap by comparing reported stigma, psychosocial measures of health, and sexual risk practices between TGW and cis-MSM in Kenya. METHODS We analyzed data from the baseline visit of an ongoing prospective cohort study taking place in three diverse metropolitan areas. Eligible participants were HIV-negative, assigned male at birth, ages 18-29 years, and reported anal intercourse in the past 3 months with a man or TGW. Data collected by audio computer assisted self-interview included sociodemographic measures, and sexual practices occurring in the past 3 months. Multivariable regressions assessed differences between TGW and cis-MSM in selected sexual practices, depressive symptoms, alcohol and drug use, and stigma. RESULTS From September, 2019, through May, 2021, 838 participants were enrolled: 108 (12.9%) TGW and 730 (87.1%) cis-MSM. Adjusting for sociodemographic variables, TGW were more likely than cis-MSM to report: receptive anal intercourse (RAI; adjusted prevalence ratio [aPR] = 1.59, 95% CI: 1.32 - 1.92), engaging in group sex (aPR = 1.15, 95% CI: 1.04 - 1.27), 4 or more male sex partners (aPR = 3.31, 95% CI: 2.52 - 4.35), and 3 or more paying male sex partners (aPR = 1.58, 95% CI: 1.04 - 2.39). TGW were also more likely to report moderate to severe depressive symptoms (aPR = 1.42, 95% CI: 1.01 - 1.55), and had similar alcohol and drug abuse scores as cis-MSM. In sensitivity analysis, similar to TGW, male-identifying individuals taking feminizing gender affirming therapy had an increased likelihood of reporting RAI and group sex, and greater numbers of male sex partners and paying male sex partners relative to cis-MSM. CONCLUSIONS Across three metropolitan areas in Kenya, TGW were more likely to report depressive symptoms and increased sexual risk taking. We identified a need for research that better characterizes the range of gender identities. Our analysis affirms the need for programmatic gender-affirming interventions specific to transgender populations in Kenya and elsewhere in Africa.
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Affiliation(s)
- Supriya D Mehta
- Division of Epidemiology & Biostatistics, University of Illinois Chicago School of Public Health, 1750 W. Harrison Street, Jelke 1121, Chicago, IL, 60612, USA.
- Division of Infectious Disease Medicine, Rush University College of Medicine, Chicago, USA.
| | | | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya
- University of Manitoba, Winnipeg, Canada
| | - Elizabeth Wahome
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Duncan Okal
- Nyanza Reproductive Health Society, Kisumu, Kenya
| | - Abhishikta Roy
- Division of Epidemiology & Biostatistics, University of Illinois Chicago School of Public Health, 1750 W. Harrison Street, Jelke 1121, Chicago, IL, 60612, USA
| | - Elise van der Elst
- Global Health Department, University of Amsterdam, Amsterdam, The Netherlands
| | - Susan M Graham
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, School of Medicine, Seattle, WA, USA
| | - Eduard J Sanders
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Global Health Department, University of Amsterdam, Amsterdam, The Netherlands
- University of Oxford, Oxford, UK
- Aurum Institute, Johannesburg, South Africa
| | - Robert C Bailey
- Division of Epidemiology & Biostatistics, University of Illinois Chicago School of Public Health, 1750 W. Harrison Street, Jelke 1121, Chicago, IL, 60612, USA
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11
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Liu C, Yuan GF, Li X, Fung HW, Wong MYC, Zhao J, Feng X. Associations among internalized and perceived stigma, state mindfulness, self-efficacy, and depression symptoms among men who have sex with men in China: A serial mediation model. Arch Psychiatr Nurs 2023; 45:81-88. [PMID: 37544707 DOI: 10.1016/j.apnu.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/23/2023] [Accepted: 06/01/2023] [Indexed: 08/08/2023]
Abstract
Previous research has demonstrated that stigma is strongly related to depressive symptoms among men who have sex with men (MSM). However, data are limited regarding the associations between stigma, state mindfulness, self-efficacy, and depression symptoms. The current study aimed to analyze state mindfulness and self-efficacy as possible mediators between internalized and perceived stigma and depression symptoms. A sample of 2610 Chinese MSM (Mage = 23.99, SD = 6.09, age range: 18-68 years) was recruited from an online survey platform and completed the HIV and Homosexuality Related Stigma Scale, Patient Health Questionnaire-9, the short version of Five Facet Mindfulness Questionnaire, and the Chinese General Self-Efficacy Scale. Results indicated that state mindfulness significantly mediated the linkage between internalized and perceived stigma and depressive symptoms, and self-efficacy significantly mediated the relation between state mindfulness and depression symptoms. Furthermore, internalized and perceived stigma were associated with depression symptoms through a serial mediation of state mindfulness and self-efficacy. This study highlights that state mindfulness and self-efficacy might play important roles in the psychological response of MSM to stigmatization and psychopathology symptoms.
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Affiliation(s)
- Caimeng Liu
- College of Teacher Education, Institute of Education Science, Leshan Normal University, Leshan, China
| | - Guangzhe Frank Yuan
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA.
| | - Xiaoming Li
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA
| | - Hong Wang Fung
- Department of Social Work, Faculty of Social Sciences, The Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Ming Yu Claudia Wong
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong
| | - Jingjing Zhao
- Department of Psychology, Beijing Forestry University, Beijing, China
| | - Xueyou Feng
- Center for Mental Health Education and Counseling, Guangzhou College of Commerce, Guangzhou, China
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12
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Bernard C, Font H, Ziadeh S, Tine JM, Diaw A, Ndiaye I, Samba O, Bottai T, Jacquesy L, Verdeli H, Ngom NF, Dabis F, Seydi M, de Rekeneire N. Management of depression in people living with HIV/AIDS in Senegal: Acceptability, feasibility and benefits of group interpersonal therapy. Glob Ment Health (Camb) 2023; 10:e36. [PMID: 37854409 PMCID: PMC10579691 DOI: 10.1017/gmh.2023.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/19/2023] [Accepted: 06/20/2023] [Indexed: 10/20/2023] Open
Abstract
Depression is highly prevalent in people living with HIV (PLWH) and has negative consequences for daily life and care. We evaluated for the first time the acceptability, feasibility and benefits of group interpersonal therapy (IPT), combined with a task-shifting approach, to treat depression in PLWH in Senegal. PLWH with depression received group IPT following the World Health Organization protocol. Acceptability and feasibility criteria were defined from the literature data. The PHQ-9, the WHODAS, and the 12-item-stigma scale were used, pre- and post-treatment, including a 3-month follow-up, to assess depressive symptom severity, functioning and stigma, respectively. General linear mixed models were used to describe changes in outcomes over time. Of 69 participants, 60 completed group IPT. Refusal to enroll and dropout rates were 6.6 and 12.7%, respectively. Ninety-seven percent of participants attended at least seven out of eight sessions. Patients and facilitators endorsed group IPT, with willingness to recommend it. Depressive symptoms and disability improved drastically and sustainably. We showed that group IPT is well accepted and feasible in Senegal as treatment for depression in PLWH. Combined with a task-shifting approach, it can narrow the gap in mental health treatment. Implementation may be enhanced by refining patient identification procedures and increasing treatment accessibility.
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Affiliation(s)
- Charlotte Bernard
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Hélène Font
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Salaheddine Ziadeh
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, USA
- Faculté de Santé Publique, Université Libanaise, Sidon, Lebanon
| | - Judicaël M. Tine
- Service des Maladies Infectieuses et Tropicales, CHNU de Fann, Dakar, Senegal
| | - Abibatou Diaw
- Centre de Traitement Ambulatoire, CHNU de Fann, Dakar, Senegal
| | | | - Oumar Samba
- Service de Psychiatrie, CHNU de Fann, Dakar, Senegal
| | | | | | - Helena Verdeli
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, USA
| | - Ndeye F. Ngom
- Centre de Traitement Ambulatoire, CHNU de Fann, Dakar, Senegal
| | - François Dabis
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Moussa Seydi
- Service des Maladies Infectieuses et Tropicales, CHNU de Fann, Dakar, Senegal
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Sariola S. Mistrust: Community engagement in global health research in coastal Kenya. SOCIAL STUDIES OF SCIENCE 2023; 53:449-471. [PMID: 37002697 PMCID: PMC10240637 DOI: 10.1177/03063127231162082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article explores a case of mistrust in global health research and community engagement. It uses ethnographic material collected in 2014 and 2016 in Kenya, concerning community engagement by a HIV vaccine research group working with men who have sex with men and transgender women. In 2010, the research group was attacked by members of the wider community. Following the attack, the research group set up an engagement program to reduce mistrust and re-build relationships. Analysis focusing on mistrust shows the dynamics underlying the conflict: Norms around gender and sexuality, political support for LGBTIQ+ rights, and resources disparities were all at stake for those embroiled in the conflict, including researchers, study participants, religious leaders, and LGBTIQ+ activists in the region. Rather than a normative good with liberatory potential, community engagement in this paper is discussed as a relational tool with which mistrust was managed, highlighting the fragility of participation.
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14
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Morgan E, Dyar C, Feinstein B, Hudson H, D’Aquila R, McDade TW, Mustanski B. Inflammation Assessed by Latent Profiling is Associated with Stress and Suicidality but not Depression: Findings from the RADAR Cohort Study. ANNALS OF LGBTQ PUBLIC AND POPULATION HEALTH 2023; 4:1-13. [PMID: 37599862 PMCID: PMC10437120 DOI: 10.1891/lgbtq-2021-0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Past research has suggested that sexual and gender minorities experience elevated levels of systemic inflammation which in turn has been linked to worse mental health outcomes. Therefore, the goals of this work are to develop a better understanding of the relationship between mental health variables and inflammation among this high-risk population. Data were collected among a sample of young men who have sex with men and transgender women (YMSM/TGW, N=685) aged 16-20 at the time of enrollment. Multiplex plasma cytokine and inflammatory biomarkers were quantified. Mental health variables were self-reported and included perceived stress, depression, and suicidal ideation. Latent profile analyses (i.e., latent class analyses intended for continuous variables) were utilized to identify four unique profiles of individuals with similar inflammatory markers followed by adjusted multinomial logistic regression to estimate the association between inflammatory profiles and mental health variables. Participants experienced moderate levels of perceived stress, normal levels of depression and ten percent reported suicidal ideation in the past six months. Multinomial regression models indicated that being in the highest inflammation profile, compared to the lowest inflammation profile, was significantly associated only with increased perceived stress and suicidal ideation. In sum, we observed significant relationships between inflammation and both perceived stress and suicidal ideation, but not between inflammation and depression. Future research should continue to assess these relationships using longitudinal data as they are intricate and likely bidirectional and may be key to reducing health disparities among this population.
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Affiliation(s)
- Ethan Morgan
- College of Nursing, Infectious Disease Institute, The Ohio State University, Columbus, OH
| | - Christina Dyar
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
| | - Brian Feinstein
- Department of Psychology, Rosalind Franklin University, North Chicago, IL
| | - Hannah Hudson
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Richard D’Aquila
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Thomas W. McDade
- Department of Anthropology and Institute for Policy Research, Northwestern University, Evanston, IL
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
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15
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Lewis KA, Jadwin-Cakmak L, Walimbwa J, Ogunbajo A, Jauregui JC, Onyango DP, Moore DM, Johnson GL, Odero W, Harper GW. "You'll Be Chased Away": Sources, Experiences, and Effects of Violence and Stigma among Gay and Bisexual Men in Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2825. [PMID: 36833522 PMCID: PMC9956866 DOI: 10.3390/ijerph20042825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
Gay and bisexual men in Kenya face extreme socio-political stigma which manifests in widespread violence and discrimination across socio-ecological levels. We conducted individual in-depth interviews with 60 gay and bisexual men in western and central Kenya. Interview transcripts were thematically analyzed using an inductive, phenomenological approach to qualitatively examine experiences of stigma and violence at the interpersonal and institutional levels. A total of seven primary themes and four sub-themes emerged from the data. At the interpersonal level, participants described stigma and violence from family, friends, and romantic/sexual partners with sub-themes for gay-baiting violence, blackmail, intimate partner violence, and commitment phobia. At the institutional level, participants described stigma and violence from religious, employment, educational, and healthcare institutions. This stigma and violence severely impacted the lives of participants including their mental health, physical health, sexual health, socioeconomic status, and ability to access health-promoting services. These data identify sources of stigma and describe how this stigma manifests in the everyday lives of gay and bisexual men in Kenya. Study findings and quotes from participants highlight the severity of violence, stigma, and discrimination faced by this community and emphasize the need for decriminalization of same-sex sexualities as well as interventions to support health and wellbeing.
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Affiliation(s)
- Katherine A. Lewis
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Laura Jadwin-Cakmak
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48108, USA
| | | | | | - Juan C. Jauregui
- Luskin School of Public Affairs, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Daniel Peter Onyango
- Let Good Be Told In Us, Nyanza, Rift Valley, and Western Kenya (NYARWEK) LGBTI Coalition, Kisumu 40100, Kenya
| | - Darius M. Moore
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48108, USA
| | - Gabriel Lee Johnson
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48108, USA
| | - Wilson Odero
- School of Medicine and School of Public Health, Maseno University, Kisumu 40100, Kenya
| | - Gary W. Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48108, USA
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16
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ADEBAJO SB, ADEBIYI R, CHAMA J, BELLO S, ONONAKU U, AKA A, LAI S, BARAL SD, DYER TV, CROWELL TA, NOWAK RG, CHARURAT M. Depression and Sexual Stigma Are Associated With Cardiometabolic Risk Among Sexual and Gender Minorities Living With HIV in Nigeria. J Acquir Immune Defic Syndr 2023; 92:50-58. [PMID: 36150037 PMCID: PMC9742173 DOI: 10.1097/qai.0000000000003096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 09/06/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND People living with HIV are vulnerable to cardiometabolic diseases. We assessed the prevalence of cardiometabolic risk factors (CMRF) and associations with sexual stigma and depression among sexual and gender minorities (SGM) in Abuja and Lagos, Nigeria. METHODS The TRUST/RV368 study enrolled SGM between March 2013 and February 2020. Participants were assessed for depression, sexual stigma, and CMRF. Robust multinomial logistic regression was used to estimate adjusted odds ratio (aORs) and 95% confidence intervals (CIs) for associations of depression, sexual stigma, and other factors with increasing numbers of CMRF. RESULTS Among 761 SGM, the mean age was 25.0 ± 6.0 years; 580 (76%) identified as cisgender men, 641 (84%) had ≥1 CMRF, 355 (47%) had mild-severe depression, and 405 (53%) reported moderate-high sexual stigma. Compared with individuals without depression, those with mild (aOR 8.28; 95% CI: 4.18 to 16.40) or moderate-severe depression (aOR 41.69; 95% CI: 9.60 to 181.04) were more likely to have 3-5 CMRF. Individuals with medium (aOR 3.17; 95% CI: 1.79 to 5.61) and high sexual stigma (aOR 14.42; 95% CI: 2.88 to 72.29) compared with those with low sexual stigma were more likely to have 3-5 CMRF. Participants age 25-34 years were less likely to have 3-5 CMRF (aOR 0.41; 95% CI: 0.23 to 0.73) compared with participants age younger than 25 years. CONCLUSION CMRF increased with severity of depression and sexual stigma, potentially predisposing SGM living with HIV to cardiometabolic diseases. Integrating interventions that address depression and sexual stigma in HIV care programs for SGM may improve cardiometabolic outcomes.
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Affiliation(s)
- Sylvia B ADEBAJO
- Center for International Health Education Biosecurity – University of Maryland Baltimore, Abuja, Nigeria
| | - Ruxton ADEBIYI
- Center for International Health Education Biosecurity – University of Maryland Baltimore, Abuja, Nigeria
| | - John CHAMA
- Center for International Health Education Biosecurity – University of Maryland Baltimore, Abuja, Nigeria
| | - Segun BELLO
- Center for International Health Education Biosecurity – University of Maryland Baltimore, Abuja, Nigeria
| | | | - Abayomi AKA
- International Centre for Advocacy on Right to Health - ICARH, Abuja, Nigeria
| | - Shenghan LAI
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stefan D. BARAL
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Typhanye V. DYER
- University of Maryland School of Public Health, College Park, MD, USA
| | - Trevor A. CROWELL
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Rebecca G. NOWAK
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Man CHARURAT
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Center for International Health Education Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
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17
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Manirambona E, Shomuyiwa DO, Musa SS, Lucero-Prisno DE. Monkeypox among men who have sex with men in Africa: The need for testing and vaccination beyond stigma. J Med Virol 2023; 95:e28121. [PMID: 36056579 DOI: 10.1002/jmv.28121] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Emery Manirambona
- College of Medicine and Health Sciences, University of Rwanda, Kigali City, Rwanda
| | | | | | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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18
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Folayan MO, Oginni O, Ibigbami OI, Philip U, Mfam NN, Mbam C, Ganyam A, Salem AA, Osuji C, Bradley C, Lusher J, Sam-Agudu NA. Associations between mental health and HIV status among sexual minority and heterosexual adolescents in Nigeria. BMJ Glob Health 2022; 7:bmjgh-2022-010231. [PMID: 36564086 PMCID: PMC9791420 DOI: 10.1136/bmjgh-2022-010231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/03/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We aimed to determine associations between the mental health status of adolescents by self-reported sexual identity; and to determine associations between the mental health status of sexual minority adolescents living with and without HIV. METHODS This cross-sectional study collected data from Nigerians aged 13-19 years old using an online survey. We collected information on dependent (sexual identity) and independent (presence of depressive symptoms, generalised anxiety disorder, suicidal attempt/ideation, HIV status) study variables. A multivariate regression model determined associations between the dependent and independent variables. A second multivariate regression model was developed to establish associations between HIV status among sexual minority individuals and the dependent variables. All models were adjusted for age, sex assigned at birth and education level. RESULTS Among 1247 respondents living in Nigeria, 497 (39.9%) identified as sexual minority individuals. Compared with their heterosexual peers, sexual minority adolescents had significantly higher odds of reporting depressive symptoms (adjusted OR (AOR): 5.54; 95% CI: 4.10 to 7.47; p<0.001), high general anxiety (AOR: 3.56; 95% CI: 2.64 to 4.79; p<0.001) and history of suicidal attempt/ideation (AOR: 2.95; 95% CI: 2.20 to 3.94; p<0.001). Sexual minority adolescents living with HIV had significantly higher odds of high general anxiety (AOR: 2.42; 95% CI: 1.21 to 4.84; p=0.013), while those with unknown HIV status had significantly higher odds of depressive symptoms (AOR: 3.82, 95% CI: 2.78 to 5.27; p<0.001), high general anxiety (AOR: 3.09; 95% CI: 2.29 to 4.17; p<0.001) and suicidal attempt/ideation (AOR: 1.65; 95% CI: 1.22 to 2.24; p=0.001). CONCLUSION Sexual minority adolescents reported poorer mental health status than heterosexual adolescents. Although there was no significant difference in the mental health status of sexual minority adolescents living and not living with HIV, sexual minority adolescents with unknown HIV status reported worse mental health than their HIV-negative peers. Sexual minority adolescents in Nigeria need comprehensive rights-based care that improves access to mental health services, and those with unknown HIV status may need both HIV and mental health screening and care.
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Affiliation(s)
| | - Olakunle Oginni
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Uma Philip
- Total Health Empowerment and Development Initiative (THEDI), Makurdi, Nigeria
| | - Nserd Ntonoba Mfam
- Department of Epidemiology and Community Medicine, Federal University of Lafia, Lafia, Nigeria
| | - Chinedu Mbam
- Total Health Empowerment and Development Initiative (THEDI), Makurdi, Nigeria
| | - Amos Ganyam
- Total Health Empowerment and Development Initiative (THEDI), Makurdi, Nigeria
| | - Agada A Salem
- Total Health Empowerment and Development Initiative (THEDI), Makurdi, Nigeria
| | - Christopher Osuji
- Total Health Empowerment and Development Initiative (THEDI), Makurdi, Nigeria
| | - Cory Bradley
- Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | | | - Nadia Adjoa Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria,University of Maryland School of Medicine, Institute of Human Virology, Baltimore, Maryland, USA,Department of Paediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
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19
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Okonkwo N, Rwema JOT, Lyons C, Liestman B, Nyombayire J, Olawore O, Nsanzimana S, Mugwaneza P, Kagaba A, Sullivan P, Allen S, Karita E, Baral S. The Relationship Between Sexual Behavior Stigma and Depression Among Men Who have Sex with Men and Transgender Women in Kigali, Rwanda: a Cross-sectional Study. Int J Ment Health Addict 2022; 20:3228-3243. [PMID: 36532817 PMCID: PMC9754158 DOI: 10.1007/s11469-021-00699-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 11/27/2022] Open
Abstract
To evaluate the role of sexual behavior stigma as a determinant of depressive symptoms among men who have sex with men (MSM) and transgender women (TGW) in Kigali, Rwanda. MSM/TGW aged ≥18 years were recruited using respondent-driven sampling (RDS) between March-August, 2018. Mental health was assessed using the Patient Health Questionnaire (PHQ-9). Sexual behavior stigma from friends and family, healthcare workers, and community members was assessed using a validated instrument. Multinomial logistic regression models were used to determine the association between sexual behavior stigma and depressive symptoms and depression. Secondary analyses further compared depression and depressive symptoms among MSM and TGW. Among the 736 participants included, 14% (106/736) identified as TGW. Depression 8.9% (RDS-adjusted, 7.6%; 95% CI, 4.6-10.6) and mild/moderate symptoms of depression 26.4% (RDS-adjusted, 24.1%; 95% CI, 19.4-28.7) were common and higher among TGW compared to MSM (p < 0.001). Anticipated (41%), perceived (36%), and enacted (45%) stigmas were highly prevalent, and were also significantly higher among TGW (p < 0.001). In multivariable RDS-adjusted analysis, anticipated (relative risk ratio (RRR), 1.88; 95% CI, 1.11-3.19) and perceived (RRR, 2.06; 95% CI, 1.12-3.79) stigmas were associated with a higher prevalence of depressive symptoms. Anticipated (RRR, 4.78; 95% CI, 1.74-13.13) and enacted (RRR, 3.09; 95% CI, 1.61-5.93) stigmas were also associated with a higher prevalence of depression. In secondary analyses, the significant differences between MSM and TGW were lost after adjusting for stigma. These data demonstrate a high burden of depressive symptoms and depression among MSM/TGW in Kigali. Conceptually, stigma is a likely antecedent of mental health stress among MSM and TGW suggesting the potential utility of scaling up stigma mitigation interventions to improve the quality of life and mental health outcomes among sexual and gender minority communities in Rwanda.
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Affiliation(s)
- N. Okonkwo
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jean Olivier Twahirwa Rwema
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133 Baltimore, MD, 21205, USA
| | - C. Lyons
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133 Baltimore, MD, 21205, USA
| | - B. Liestman
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133 Baltimore, MD, 21205, USA
| | | | - O. Olawore
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133 Baltimore, MD, 21205, USA
| | - S. Nsanzimana
- Rwanda Biomedical Center, HIV and AIDS Division, Kigali, Rwanda
| | - P. Mugwaneza
- Rwanda Biomedical Center, HIV and AIDS Division, Kigali, Rwanda
| | - A. Kagaba
- Health Development Initiative, Kigali, Rwanda
| | - P. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - S. Allen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - E. Karita
- Projet San Francisco, Kigali, Rwanda
| | - S. Baral
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133 Baltimore, MD, 21205, USA
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20
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Nouri E, Moradi Y, Moradi G. What is the global prevalence of depression among men who have sex with men? A systematic review and meta-analysis. Ann Gen Psychiatry 2022; 21:38. [PMID: 36096814 PMCID: PMC9465955 DOI: 10.1186/s12991-022-00414-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 09/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression due to stigma resulting from their sexual identity, isolation, social exclusion, and insufficient access to care and counseling services has become a health problem among men who have sex with men (MSM). OBJECTIVES This study aimed to determine the global prevalence of depression among MSM as a systematic review and meta-analysis. METHODS This study was a systematic review and meta-analysis performed in five steps of search strategy, screening and selecting articles, data extraction, evaluation of the risk of bias, and meta-analysis. In this study, the determined keywords were searched in the databases of PubMed, Scopus, Embase, and Web of Science from January 1913 to July 2021 to find the initial articles, from which data were extracted according to the set checklist in the data extraction stage. Finally, the studies were included in the present meta-analysis according to the inclusion and exclusion criteria, to be evaluated using the Newcastle Ottawa scale checklist. I Square and Q Cochrane were also used to assess the degree of heterogeneity. The analyses were performed using the random-effects model in STATA 16. RESULTS The results showed the quality score of the majority of cross-sectional studies included in the meta-analysis (62 studies) was equal to six or seven (moderate), and five ones had a high-quality score. After combining these studies, the pooled prevalence of depression among MSM in the world was 35% (95% CI 31%-39%, I square; 98.95%, P-value < 0.001). Population subgroup analysis showed the pooled prevalence of depression among MSM living with HIV was 47% (95% CI 39%-55%, I square; 95.76%, P-value < 0.001). Continent subgroup analysis showed the highest pooled prevalence of depression among Asian MSM at 37% (95% CI 31%-43%, I square; 99.07%, P-value < 0.001). Also, in the subgroup analysis of the sampling method, the pooled prevalence in the studies which used the respondent-driven sampling method was equal to 34% (95% CI 25%-43%, I square; 99.32%, P-value < 0.001). Sensitivity analysis revealed the pooled prevalence of depression in studies included in the meta-analysis was near or around the pooled estimate. CONCLUSION The pooled prevalence of depression among MSM was almost three times higher than the general male population. Therefore, particular and therapeutic interventions such as screening, and harm reduction programs for mental disorders, especially depression, are suggested to be considered in service packages.
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Affiliation(s)
- Elham Nouri
- Social Determinant of the Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.,Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Yousef Moradi
- Social Determinant of the Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.,Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ghobad Moradi
- Social Determinant of the Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran. .,Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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21
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Wahome E, Boyd A, Thiong’o AN, Mohamed K, Oduor T, Gichuru E, Mwambi J, van der Elst E, Graham SM, Prins M, Sanders EJ. Stopping and restarting PrEP and loss to follow-up among PrEP-taking men who have sex with men and transgender women at risk of HIV-1 participating in a prospective cohort study in Kenya. HIV Med 2022; 23:750-763. [PMID: 35088511 PMCID: PMC9276557 DOI: 10.1111/hiv.13237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/20/2021] [Accepted: 01/04/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess frequency and predictors of switching between being on and off PrEP and being lost to follow-up (LTFU) among men who have sex with men (MSM) and transgender women (TGW) with access to PrEP services in Sub-Saharan Africa. METHODS This was a prospective cohort study of MSM and TGW from coastal Kenya who initiated daily oral PrEP from June 2017 to June 2019. Participants were followed monthly for HIV-1 testing, PrEP refill, risk assessment and risk reduction counselling. Follow-up was censored at the last visit before 30 June 2019, or the last HIV-1-negative visit (for those with HIV-1 seroconversion), whichever occurred first. We estimated transition intensities (TI) and predictors of switching: (i) between being off and on PrEP; and (ii) from either PrEP state and being LTFU (i.e. not returning to the clinic for > 90 days) using a multi-state Markov model. RESULTS In all, 134 participants starting PrEP were followed for a median of 20.3 months [interquartile range (IQR): 7.7-22.1]. A total of 49 (36.6%) people stopped PrEP 73 times [TI = 0.6/person-year (PY), 95% confidence interval (CI): 0.5-0.7] and, of these, 25 (51.0%) restarted PrEP 38 times (TI = 1.2/PY, 95% CI: 0.9-1.7). In multivariable analysis, stopping PrEP was related to anal sex ≤ 3 months, substance-use disorder and travelling. Restarting PrEP was related to non-Christian or non-Muslim religion and travelling. A total of 54 participants were LTFU: on PrEP (n = 47, TI = 0.3/PY, 95% CI: 0.3-0.5) and off PrEP (n = 7, TI = 0.2/PY, 95% CI: 0.1-0.4). In multivariable analysis, becoming LTFU while on PrEP was associated with secondary education or higher, living in the area for ≤ 1 year, residence outside the immediate clinic area and alcohol-use disorder. CONCLUSIONS Switching between being on and off PrEP or becoming LTFU while on PrEP was frequent among individuals at risk of HIV-1 acquisition. Alternative PrEP options (e.g. event-driven PrEP) may need to be considered for MSM and TGW with PrEP-taking challenges, while improved engagement with care is needed for all MSM and TGW regardless of PrEP regimen.
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Affiliation(s)
- Elizabeth Wahome
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research–CoastKilifiKenya
| | - Anders Boyd
- Public Health Service of AmsterdamDepartment of Infectious DiseasesAmsterdamThe Netherlands
- Stichting HIV MonitoringAmsterdamThe Netherlands
| | - Alexander N. Thiong’o
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research–CoastKilifiKenya
| | - Khamisi Mohamed
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research–CoastKilifiKenya
| | - Tony Oduor
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research–CoastKilifiKenya
| | - Evans Gichuru
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research–CoastKilifiKenya
| | - John Mwambi
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research–CoastKilifiKenya
| | - Elise van der Elst
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research–CoastKilifiKenya
- Department of Global HealthUniversity of AmsterdamAmsterdamThe Netherlands
| | - Susan M. Graham
- Departments of Global Health, Medicine, and EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Maria Prins
- Public Health Service of AmsterdamDepartment of Infectious DiseasesAmsterdamThe Netherlands
- Amsterdam UMCDepartment of Infectious DiseasesAmsterdam Institute for Infection and Immunity (AII)University of AmsterdamAmsterdamThe Netherlands
| | - Eduard J. Sanders
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research–CoastKilifiKenya
- Department of Global HealthUniversity of AmsterdamAmsterdamThe Netherlands
- Nuffield Department of MedicineUniversity of OxfordHeadingtonUK
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22
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Operario D, Sun S, Bermudez AN, Masa R, Shangani S, van der Elst E, Sanders E. Integrating HIV and mental health interventions to address a global syndemic among men who have sex with men. Lancet HIV 2022; 9:e574-e584. [PMID: 35750058 PMCID: PMC7613577 DOI: 10.1016/s2352-3018(22)00076-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/27/2022] [Accepted: 03/14/2022] [Indexed: 02/04/2023]
Abstract
In this Series paper, we review evidence on the co-occurring and synergistic epidemics (syndemic) of HIV and mental health problems worldwide among men who have sex with men (MSM). The multilevel determinants of this global syndemic include structural factors that enable stigma, systematic bias, and violence towards MSM across geographical and cultural contexts. Cumulative exposure to these factors over time results in population-level inequities in the burden of HIV infections and mental health problems among MSM. Evidence for this syndemic among MSM is strongest in the USA, Canada, western Europe, and parts of Asia and Latin America, with emerging evidence from sub-Saharan Africa. Integrated interventions are needed to address syndemics of HIV and mental health problems that challenge the wellbeing of MSM populations worldwide, and such interventions should consider various mental health conditions (eg, depression, anxiety, trauma, and suicidality) and their unique expressions and relationships with HIV outcomes depending on cultural contexts. In addition, interventions should identify and intervene with locally relevant structural factors that result in HIV and mental health vulnerabilities among MSM.
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Jaguga F, Kiburi SK, Temet E, Barasa J, Karanja S, Kinyua L, Kwobah EK. A systematic review of substance use and substance use disorder research in Kenya. PLoS One 2022; 17:e0269340. [PMID: 35679248 PMCID: PMC9186181 DOI: 10.1371/journal.pone.0269340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/18/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives The burden of substance use in Kenya is significant. The objective of this
study was to systematically summarize existing literature on substance use
in Kenya, identify research gaps, and provide directions for future
research. Methods This systematic review was conducted in line with the PRISMA guidelines. We
conducted a search of 5 bibliographic databases (PubMed, PsychINFO, Web of
Science, Cumulative Index of Nursing and Allied Professionals (CINAHL) and
Cochrane Library) from inception until 20 August 2020. In addition, we
searched all the volumes of the official journal of the National Authority
for the Campaign Against Alcohol & Drug Abuse (the African Journal of
Alcohol and Drug Abuse). The results of eligible studies have been
summarized descriptively and organized by three broad categories including:
studies evaluating the epidemiology of substance use, studies evaluating
interventions and programs, and qualitative studies exploring various themes
on substance use other than interventions. The quality of the included
studies was assessed with the Quality Assessment Tool for Studies with
Diverse Designs. Results Of the 185 studies that were eligible for inclusion, 144 investigated the
epidemiology of substance use, 23 qualitatively explored various substance
use related themes, and 18 evaluated substance use interventions and
programs. Key evidence gaps emerged. Few studies had explored the
epidemiology of hallucinogen, prescription medication, ecstasy, injecting
drug use, and emerging substance use. Vulnerable populations such as
pregnant women, and persons with physical disability had been
under-represented within the epidemiological and qualitative work. No
intervention study had been conducted among children and adolescents. Most
interventions had focused on alcohol to the exclusion of other prevalent
substances such as tobacco and cannabis. Little had been done to evaluate
digital and population-level interventions. Conclusion The results of this systematic review provide important directions for future
substance use research in Kenya. Systematic review registration PROSPERO: CRD42020203717.
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Affiliation(s)
- Florence Jaguga
- Department of Mental Health, Moi Teaching & Referral Hospital,
Eldoret, Kenya
- * E-mail:
| | | | - Eunice Temet
- Department of Mental Health & Behavioral Sciences, Moi University
School of Medicine, Eldoret, Kenya
| | - Julius Barasa
- Population Health, Academic Model Providing Access to Healthcare,
Eldoret, Kenya
| | - Serah Karanja
- Department of Mental Health, Gilgil Sub-County Hospital, Gilgil,
Kenya
| | - Lizz Kinyua
- Intensive Care Unit, Aga Khan University Hospital, Nairobi,
Kenya
| | - Edith Kamaru Kwobah
- Department of Mental Health, Moi Teaching & Referral Hospital,
Eldoret, Kenya
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24
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Stojanovski K, King EJ, Amico KR, Eisenberg MC, Geronimus AT, Baros S, Schmidt AJ. Stigmatizing Policies Interact with Mental Health and Sexual Behaviours to Structurally Induce HIV Diagnoses Among European Men Who Have Sex with Men. AIDS Behav 2022; 26:3400-3410. [PMID: 35434774 PMCID: PMC9556380 DOI: 10.1007/s10461-022-03683-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 12/18/2022]
Abstract
Structural stigma shapes men who have sex with men's (MSM's) mental health and sexual behaviours. The aim of this study was to examine how stigmatizing policies interact with downstream anxiety/depression and sexual behaviours to structurally pattern HIV disparities among European MSM. We conducted a secondary data analysis of the European Men-who-have-sex-with-men Internet Survey (EMIS) from 2017. We included a total of 98,600 participants living in 39 European countries. We used the Rainbow Index, a score given to countries based on their sexual and gender minority policies as the predictor of HIV diagnosis. We conducted adjusted random intercept and slope multi-level logistic regressions. In adjusted models, higher Rainbow Index scores was associated with lower predictive probabilities of diagnosed HIV, regardless of the number of condomless intercourse partners. The predictive probability of HIV diagnosis was also lower, regardless of severity of anxiety/depression, where the Rainbow Index score was better. Country-level policies interact with downstream sexual behaviours and anxiety/depression to structurally influence HIV diagnosis among MSM in Europe.
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Affiliation(s)
- Kristefer Stojanovski
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Elizabeth J King
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - K Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Marisa C Eisenberg
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Department of Mathematics, College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
| | - Arline T Geronimus
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Population Studies Centre, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Sladjana Baros
- Department for HIV, STI, Viral Hepatitis, and Tuberculosis, Institute of Public Health of Serbia "Dr Milan Jovanovic Batut", Belgrade, Serbia
| | - Axel J Schmidt
- Sigma Research, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
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Korhonen CJ, Flaherty BP, Wahome E, Macharia P, Musyoki H, Battacharjee P, Kimani J, Doshi M, Mathenge J, Lorway RR, Sanders EJ, Graham SM. Validity and reliability of the Neilands sexual stigma scale among Kenyan gay, bisexual, and other men who have sex with men. BMC Public Health 2022; 22:754. [PMID: 35421967 PMCID: PMC9009048 DOI: 10.1186/s12889-022-13066-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 03/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
We evaluated the validity and reliability of the Neilands sexual stigma scale administered to 871 gay, bisexual, and other men who have sex with men (GBMSM) at two research locations in Kenya.
Methods
Using cross-validation, exploratory factor analysis (EFA) was performed on a randomly selected subset of participants and validated using confirmatory factor analysis (CFA) on the remaining participants. Associations of the initial and final stigma scale factors with depressive symptoms, alcohol use, and other substance use were examined for the entire dataset.
Results
EFA produced a two-factor scale of perceived and enacted stigma. The CFA model fit to the two-factor scale was improved after removing three cross-loaded items and adding correlated errors (chi-squared = 26.5, df 17, p = 0.07). Perceived stigma was associated with depressive symptoms (beta = 0.34, 95% CI 0.24, 0.45), alcohol use (beta = 0.14, 95% CI 0.03, 0.25) and other substance use (beta = 0.19, 95% CI 0.07, 0.31), while enacted stigma was associated with alcohol use (beta = 0.17, 95% CI 0.06, 0.27).
Conclusions
Our findings suggest enacted and perceived sexual stigma are distinct yet closely related constructs among GBMSM in Kenya and are associated with poor mental health and substance use.
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Ndione AG, Procureur F, Senne JN, Cornaglia F, Gueye K, Ndour CT, Lépine A. Sexuality-Based Stigma and Access to Care: Intersecting Perspectives Between Health Care Providers and Men Who Have Sex With Men in HIV Care Centres in Senegal. Health Policy Plan 2022; 37:587-596. [PMID: 35147679 PMCID: PMC9113117 DOI: 10.1093/heapol/czac010] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 01/18/2022] [Accepted: 02/10/2022] [Indexed: 11/23/2022] Open
Abstract
Men who have sex with men (MSM) in Senegal face a challenging socio-legal context, marked by homophobia and the illegality of homosexuality. In addition, human immunodeficiency virus (HIV) prevalence among MSM is 27.6%, 46 times greater than the one in the general population (0.5%). Nevertheless, access to healthcare by MSM may be hampered by stigmatizing attitudes from health facility staff (medical and non-medical). This article describes the health facility staff/MSM relationship and analyses its effects on access to healthcare by MSM. The data used were collected through a field survey based on observations and qualitative interviews conducted in 2019 and 2020 with 16 MSM, 1 non-governmental organization (NGO) staff and 9 healthcare providers in Dakar (the capital city) and Mbour (secondary city on the West Coast) hospitals. The data were subject to a thematic analysis assisted by the ATLAS software. The relationship between MSM and healthcare providers is ambiguous. On the one hand, healthcare providers are torn between their professional duty to treat MSM and the cost of being stigmatized by other colleagues. Therefore, they often limit their empathy with MSM within the hospital context. On the other hand, MSM, trusting in the confidentiality of healthcare providers, feel safe in the care pathway. However, we identify the following stigmatizing factors limiting access to care include (1) fear of meeting a relative, (2) difficult relationships with non-medical support staff (mainly security guards), (3) HIV status disclosure and (4) potential conflicts with other MSM. This study is unique as it includes non-medical staff in its respondents. It shows that hospitals are divided into several areas, based on the stigma perceived by MSM. It is important to map out MSM’s care trajectories and spaces and to identify all types of staff working within them, including non-medical staff, and enrol them in stigma reduction interventions.
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Affiliation(s)
| | | | | | | | - Khady Gueye
- Ministry of Health and Social Action of Senegal
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27
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Jadwin-Cakmak L, Lauber K, Odhiambo EO, Collins B, Gumbe E, Norwitz GA, Aloo T, Lewis KA, Okutah F, Amico KR, Olango K, Odero W, Graham SM, Harper GW. "When you talk it out … you will feel like the burden has somehow gone down, you will feel light": Social Support Received by Gay, Bisexual, and Other Men Who Have Sex with Men in Western Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1667. [PMID: 35162690 PMCID: PMC8835588 DOI: 10.3390/ijerph19031667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 01/29/2023]
Abstract
Gay and bisexual men and other men who have sex with men (GBMSM) experience many sexual orientation-related stressors that negatively influence physical and mental health, making it imperative to understand their experiences of resilience-promoting resources such as social support. We utilized qualitative and participatory methodologies to examine sources of social support and types of social support received by GBMSM in Western Kenya through in-depth interviews with 60 GBMSM, including both peer educators and community members. GBMSM received emotional, informational, and instrumental support from six different relationship types: friends and peer groups, family of origin, sexual and romantic partners, healthcare providers, peer educators, and other people including work colleagues and police officers. A key finding from this study is the centrality of sexuality-specific support across all sources and types of support. Implications for clinics and LGBTQ organizations, policy, and future research are discussed.
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Affiliation(s)
- Laura Jadwin-Cakmak
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA; (K.L.); (B.C.); (K.R.A.); (G.W.H.)
| | - Kendall Lauber
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA; (K.L.); (B.C.); (K.R.A.); (G.W.H.)
| | | | - Ben Collins
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA; (K.L.); (B.C.); (K.R.A.); (G.W.H.)
| | - Edwin Gumbe
- Nyanza Reproductive Health Society, Kisumu 40100, Kenya; (E.O.O.); (E.G.); (T.A.); (F.O.)
- Nafasi Innovations, Tom Mboya, Kisumu 40100, Kenya
| | - Gabriella A. Norwitz
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA;
| | - Teddy Aloo
- Nyanza Reproductive Health Society, Kisumu 40100, Kenya; (E.O.O.); (E.G.); (T.A.); (F.O.)
| | - Katherine A. Lewis
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA;
| | - Felix Okutah
- Nyanza Reproductive Health Society, Kisumu 40100, Kenya; (E.O.O.); (E.G.); (T.A.); (F.O.)
| | - K Rivet Amico
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA; (K.L.); (B.C.); (K.R.A.); (G.W.H.)
| | - Kennedy Olango
- Men Against AIDS Youth Group (MAAYGO), Kisumu 40100, Kenya;
| | - Wilson Odero
- School of Public Health and School of Medicine, Maseno University, Kisumu 40100, Kenya;
| | - Susan M. Graham
- Global Health, Medicine, and Epidemiology, School of Medicine, University of Washington, Seattle, WA 98104, USA;
| | - Gary W. Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA; (K.L.); (B.C.); (K.R.A.); (G.W.H.)
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Armstrong R, Silumbwe A, Zulu JM. Mental health, coping and resilience among young men who have sex with men in Zambia. CULTURE, HEALTH & SEXUALITY 2021; 23:1626-1640. [PMID: 32924794 DOI: 10.1080/13691058.2020.1788726] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 06/24/2020] [Indexed: 06/11/2023]
Abstract
Current law in Zambia criminalises same-sex sexual contact while strong socio-cultural values drive a profoundly negative view of the moral status of gender and sexual minorities. Despite this, Zambia's national HIV programme has recently identified the predominantly young population of men who have sex with men as a priority group for HIV and other sexual health programming. Research in other African settings has shown how the sexual health of these young men is affected by mental health. This mixed-methods study, which drew on the minority stress model as an analytical framework, sought to explore mental health as an initial step towards understanding its influence on other health domains. Findings describe the tension, and its psychological effects, surrounding the trajectory of discovering and affirming same-sex sexuality in an environment replete with social, physical and emotional risks, but one in which young men must nevertheless seek to create and maintain a meaningful, if precarious, social existence. To achieve this, in the absence of supportive mental health services or other programmatic responses, they adopt numerous risk-mitigation or coping strategies to attempt to build resiliency and to preserve their psychological and emotional well-being.
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Affiliation(s)
- Russell Armstrong
- Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Adam Silumbwe
- School of Public Health, Health Promotion and Education Department, University of Zambia, Lusaka, Zambia
| | - Joseph Mumba Zulu
- School of Public Health, Health Promotion and Education Department, University of Zambia, Lusaka, Zambia
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Elsayed H, O'Connor C, Leyritana K, Salvana E, Cox SE. Depression, Nutrition, and Adherence to Antiretroviral Therapy in Men Who Have Sex With Men in Manila, Philippines. Front Public Health 2021; 9:644438. [PMID: 34621715 PMCID: PMC8490818 DOI: 10.3389/fpubh.2021.644438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 08/19/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: Depression is the most frequently observed psychiatric disorder among HIV patients. The effect of depression on adherence among men who have sex with men (MSM) HIV patients has not been well studied in the Philippines. Depression is commonly undiagnosed and consequently untreated, which leads to a negative influence on antiretroviral therapy (ART) adherence. Other risk factors such as HIV-related stigma, self-body image satisfaction, and nutritional status are recognized as potential barriers to access HIV prevention and treatment services issues and poor adherence. Methods: Hospital anxiety and depression scale (HADS) was used to screen depressive symptoms during scheduled clinic visits. ART adherence was self-reported using a visual analog scale questionnaire covering the last 30 days. Structured questionnaires were used for measuring risk factors and socio-demographic data. Anthropometry was conducted and body composition was assessed using bioelectrical impedance analysis. Results: One-hundred and ninety-three participants were recruited from the SHIP clinic between 7th March and 30th September 2018, of whom, 42 (21.8%) screened positive for depression (HADS score ≥ 8) and 24 (12.4%) were non-adherent to ART (<95% of medication taken as prescribed). The most common reported reason for non-adherence was simply forgotten (18 out of 42, 42.9%). Increasing depressive symptoms were associated with non-adherence [crude odds ratio (OR) = 1.13; 95% CI: 1.02–1.26]. Social family support (SFS) and body image (BI) scores were also associated with non-adherence, but were not statistically significant in multivariable models. Factors significantly associated with depressive symptoms (but not non-adherence) included the following: using intravenous drugs, being in a relationship, anxiety, self-esteem, and stigma scores. Conclusions: Increased depression symptoms, low social family support, and body image dissatisfaction may be interconnected risk factors for ART non-adherence among Filipino MSM HIV patients. Comprehensive mental health services beyond regular post-HIV testing counseling may increase adherence to ART and improve HIV treatment outcomes. Further prospective studies are needed to address the causal/reverse causal pathway between depression and non-adherence.
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Affiliation(s)
- Hend Elsayed
- Department of Tropical Medicine and Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Cara O'Connor
- Sustained Health Initiatives of the Philippines (SHIP), Mandaluyong, Philippines.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Katerina Leyritana
- Sustained Health Initiatives of the Philippines (SHIP), Mandaluyong, Philippines
| | - Edsel Salvana
- Institute of Molecular Biology and Biotechnology, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Sharon E Cox
- Department of Tropical Medicine and Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Institute of Tropical Medicine, (NEKKEN), Nagasaki University, Nagasaki, Japan
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Storm S, Deuba K, Shrestha R, Pandey LR, Dahal D, Shrestha MK, Pokhrel TN, Marrone G. Social and structural factors associated with depression and suicidality among men who have sex with men and transgender women in Nepal. BMC Psychiatry 2021; 21:476. [PMID: 34587934 PMCID: PMC8479926 DOI: 10.1186/s12888-021-03477-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 09/13/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The prevalence of depression and suicidality is high among men who have sex with men (MSM) and transgender women (TGW) worldwide. Stigma and discrimination are likely contributing factors. More research is needed in low-income, non-English speaking countries to assess the effects of social and structural factors on depression and suicidality among MSM and TGW. METHODS Nepalese MSM and TGW (n = 340) were recruited using a respondent-driven sampling design and filled out a survey questionnaire. The outcomes were depression and suicidality. Data was analyzed using bivariate and multivariable logistic regression. RESULTS More than half of the participants (59%) suffered from depression. Severe depression was more common among TGW compared to MSM (41 and 20%, respectively). When it comes to suicidality, TGW had higher lifetime prevalence of suicidal thoughts compared to MSM (32 and 5%, respectively). Depression was positively associated with sex work both for MSM (AOR: 7.9; 95% CI 3.4-18.2) and TGW (AOR: 6.5; 95% CI: 2.3-18.2). MSM who were evicted by family had high odds of suicidal thoughts (AOR: 6.2; 95% CI: 1.3-28.8). For TGW, suicidality was associated with being cheated and threatened (AOR: 3.9; 95% CI: 1.2-12.5) and having forced to marry a female (AOR: 2.2; 95% CI 1.1-5.1). CONCLUSIONS Nepalese MSM and TGW suffer from a high degree of mental and psychosocial health issues. Future studies should focus on intervention research and on collecting data from a larger variety of gender and sexual minorities.
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Affiliation(s)
- Sanna Storm
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Keshab Deuba
- National Centre for AIDS and STD Control/Global Fund Programs, Kathmandu, Nepal.
| | | | - Lok Raj Pandey
- grid.500537.4National Centre for AIDS and STD Control, Ministry of Health and Population, Kathmandu, Nepal
| | - Deepak Dahal
- grid.500537.4National Centre for AIDS and STD Control, Ministry of Health and Population, Kathmandu, Nepal
| | - Madan Kumar Shrestha
- grid.500537.4National Centre for AIDS and STD Control, Ministry of Health and Population, Kathmandu, Nepal
| | - Tara Nath Pokhrel
- grid.500537.4Family Welfare Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Gaetano Marrone
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Jauregui JC, Mwochi CR, Crawford J, Jadwin-Cakmak L, Okoth C, Onyango DP, Harper GW. Experiences of Violence and Mental Health Concerns Among Sexual and Gender Minority Adults in Western Kenya. LGBT Health 2021; 8:494-501. [PMID: 34463158 DOI: 10.1089/lgbt.2020.0495] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose: Sexual and gender minority (SGM) populations throughout Kenya as well as other sub-Saharan African countries face systemic discrimination and substantial human rights violations, yet scant literature documents the potentially harmful mental health effects of these experiences. This study sought to understand the relationship among experiences of violence, social support, and mental health among SGM adults in Kenya. Methods: Members of a local LGBT community-based organization collected survey data in Western Kenya from October 2017 to April 2018, recruiting 527 SGM participants through an array of community outreach methods. Respondents in this cross-sectional study completed a survey regarding their mental health and other psychosocial factors. Multiple linear regression analyses were conducted to assess associations between experiences of violence (SGM violence and intimate partner violence [IPV]) and mental health outcomes (depressive symptoms and post-traumatic stress symptoms [PTSSs]) and to examine the potential moderating effect of social support on these relationships. Results: Relative to those who had never faced violence, participants who experienced IPV and/or violence based on their sexual orientation, gender identity, or gender expression (SGM violence) reported significantly higher levels of depressive symptoms and PTSSs. Emotional support was associated with lower levels of PTSSs. Social support did not moderate the relationship between SGM violence and mental health symptoms. Conclusions: These findings suggest that there may be a relationship between experiences of violence and poor mental health among SGM Kenyans. More studies are needed to better understand SGM-specific risk factors for poor mental well-being among SGM people in Kenya and the types of interventions that may help mitigate these challenges.
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Affiliation(s)
- Juan C Jauregui
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Caroline R Mwochi
- Nyanza, Rift Valley and Western Kenya (NYARWEK) LGBTI Coalition, Kisumu, Kenya.,Western Kenya LBQT Feminist Forum, Kisumu, Kenya
| | - Jessica Crawford
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Laura Jadwin-Cakmak
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Cecil Okoth
- Nyanza, Rift Valley and Western Kenya (NYARWEK) LGBTI Coalition, Kisumu, Kenya
| | | | - Gary W Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Liu M, Jia J, Fan F, Sun P, Wu Z, Jiang Y, He D, Liu B, Yang Y, Zhang Y. Association of depressive symptoms with the progression of carotid intima-media thickness in a community-based cohort in Beijing, China. BMJ Open 2021; 11:e050254. [PMID: 34404713 PMCID: PMC8372881 DOI: 10.1136/bmjopen-2021-050254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/03/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To determine the relationship between depressive symptoms and progression of carotid intima-media thickness (cIMT) in a Beijing community-based population. DESIGN Prospective cohort study between 2014 and 2018. SETTING Dwellers without cardiovascular disease, hypertension or diabetes from a Beijing community. PARTICIPANTS 3849 Chinese community-dwelling individuals who underwent baseline screening for depressive symptoms were invited to participate in the study in 2014 and follow-up visit in 2018. Among them, 2124 participants completed carotid ultrasound examination both at baseline and a follow-up visit. After further excluding patients with a history of stroke, myocardial infarction or lower extremity arterial stenosis and those with a diagnosis of hypertension or diabetes and ankle-brachial index ≤0.9 at baseline, 1011 eligible participants were finally included. PRIMARY OUTCOME MEASURE The rate of mean cIMT change. RESULTS Over a median follow-up period of 4.40 years, the overall rate of mean cIMT change was 2.23% (-5.64% to 9.51%). After adjustment for 13 covariates, there was an increase of 2.36% (β=2.36, 95% CI: 0.37 to 4.36, p=0.020) for the rates of mean cIMT change in the depressive group compared with the control group. Furthermore, this association was modified by drinking status (β=3.22, 95% CI: 1.25 to 5.19, P-interaction=0.006). CONCLUSION Depressive symptoms were independently associated with progression of mean cIMT in a community-based cohort in Beijing, China. Furthermore, this relationship was modified by drinking status.
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Affiliation(s)
- Mengyuan Liu
- Department of cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Jia Jia
- Department of cardiology, Peking University First Hospital, Beijing, China
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Fangfang Fan
- Department of cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Pengfei Sun
- Department of cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Zhongli Wu
- Department of cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Yimeng Jiang
- Department of cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Danmei He
- Department of cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Bo Liu
- Department of cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Ying Yang
- Department of cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Yan Zhang
- Department of cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
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Harper GW, Lewis KA, Norwitz GA, Odhiambo EO, Jadwin-Cakmak L, Okutah F, Lauber K, Aloo T, Collins B, Gumbe E, Amico KR, Olango K, Odero W, Graham SM. “God Didn’t Make a Mistake in Creating Me”: Intrapersonal Resilience Processes among Gay and Bisexual Male Youth in Kenya. ADOLESCENTS 2021; 1:267-282. [PMID: 35665057 PMCID: PMC9161601 DOI: 10.3390/adolescents1030020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gay and bisexual male youth in Kenya experience human rights violations, including pervasive stigma and discrimination, and these oppressive forces are associated with elevated rates of mental health concerns. Despite these challenges, many gay and bisexual male youth in Kenya are thriving during this critical developmental period. This study explored intrapersonal processes that gay and bisexual male youth in Kisumu, Kenya, highlight as important to developing, and demonstrating resilience in the face of adversity. We conducted qualitative in-depth interviews (IDIs) with 40 gay and bisexual male youth, ages 20–30 (mean = 26.4), and an additional 20 IDIs with gay and bisexual men, ages 22–45 (mean = 26.6), who were working as peer educators (total n = 60), all in Kisumu, Kenya. A total of nine primary themes emerged which describe various intrapersonal resilience processes enacted by gay and bisexual male youth, including sexual identity acceptance, self-confidence, self-love, religious/spiritual affirmation, adaptive coping, successful navigation, legal rights awareness, economic stability, and advocacy satisfaction. These data demonstrate the range of positive personal processes that promote mental health and wellbeing among gay and bisexual male youth in Kenya. We discuss implications of these findings for community-based interventions, and call for a research paradigm shift away from deficits and toward resilience.
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Affiliation(s)
- Gary W. Harper
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, SPH I, Ann Arbor, MI 48109, USA
- Correspondence:
| | - Katherine A. Lewis
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, SPH I, Ann Arbor, MI 48109, USA
| | - Gabriella A. Norwitz
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St., New York, NY 10032, USA
| | | | - Laura Jadwin-Cakmak
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, SPH I, Ann Arbor, MI 48109, USA
| | - Felix Okutah
- Anza Mapema Tom Mboya Center, Nyanza Reproductive Health Society, Kisumu 40100, Kenya
| | - Kendall Lauber
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, SPH I, Ann Arbor, MI 48109, USA
| | - Teddy Aloo
- Anza Mapema Tom Mboya Center, Nyanza Reproductive Health Society, Kisumu 40100, Kenya
| | - Ben Collins
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, SPH I, Ann Arbor, MI 48109, USA
| | - Edwin Gumbe
- Anza Mapema Tom Mboya Center, Nyanza Reproductive Health Society, Kisumu 40100, Kenya
| | - K Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, SPH I, Ann Arbor, MI 48109, USA
| | - Kennedy Olango
- Men Against AIDS Youth Group (MAAYGO), Milimani Box 1174, Kisumu 40100, Kenya
| | - Wilson Odero
- Department of Family Medicine and Community Health, School of Medicine, Maseno University, Private Bag, Maseno 40105, Kenya
| | - Susan M. Graham
- Departments of Global Health and Medicine, University of Washington, Box 359909, 325 Ninth Avenue, Seattle, WA 98104, USA
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Mulqueeny DM, Nkabini SM, Pokiya MH. Mapping evidence of depression in HIV-seropositive MSM in sub-Saharan Africa: a scoping review protocol. Syst Rev 2021; 10:50. [PMID: 33546768 PMCID: PMC7866456 DOI: 10.1186/s13643-021-01604-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is one of the most prevalent mental disorders among an estimated 25.6 million people living with HIV (PLHIV) in sub-Saharan Africa (SSA). The depression rate is higher in HIV-seropositive men who have sex with men (MSM) regardless of their sexual orientation, identity or romantic attraction. This is due to various types of stigma including HIV-related stigma, social stigma, self-stigma and mental health stigma. Opportunistic infections, unemployment, poverty and food insecurity also predispose HIV-seropositive MSM to depression. Moreover, depression in heterosexual and sexual minority groups challenges and additionally burdens SSA health care systems due to inadequate economic developments, lack of mental health professionals who specialise in the treatment of depression, few MSM-centred facilities, inadequate mental health infrastructure (hospitals and clinics) and complimentary resources. Although studies have highlighted links between mental health disorder, an HIV diagnosis and sexual minority groups, there is limited research that focusses on depression and its causal factors in MSM living with HIV in SSA. Hence, the relevance of conducting this scoping review. METHODS A scoping review guided by Arksey and O'Malley's framework, the enhancements and recommendations of Levac, Colquhoun and O'Brien, Daudt and associates and the 2015 Johanna Briggs Institute's guidelines will be conducted. Systematic electronic searches of databases and search engines such as Google, Google Scholar, CINAHL (EBSCOhost), MEDLINE (Ovid), and PsycInfo (Ovid) will be conducted to attain published peer-reviewed articles of all study designs. Grey literature will be sourced from media and conference abstracts and reports, governmental reports and unpublished dissertations and theses. Additionally, websites of humanitarian organisations and other relevant departmental websites will also be searched. Literature published between 2010 and 2020 that meets the review's inclusion criteria, research question and sub-question will be included in this review. All the retrieved literature will be exported to an Endnote X9.2 library after duplicates have been removed. DISCUSSION We anticipate mapping relevant literature on depression and the causal factors in HIV-seropositive MSM living in SSA. Once analysed and summarised, the data will be useful in identifying literature gaps, informing systematic reviews and future research. The findings could also assist in depression and sexuality dialogues, and awareness campaigns that address mental health issues, stigma and discrimination among this key population living in SSA.
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Affiliation(s)
- Delarise M. Mulqueeny
- Department of Social Work, Faculty of Arts, University of Zululand, Private Bag X1001, KwaDlangezwa, 3886 South Africa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001 South Africa
| | - Senzelokuhle M. Nkabini
- Department of Social Science, Gender and Education, School of Education, University of KwaZulu-Natal, Room 01-032, 121 Marianhill Rd, Pinetown, 3605 South Africa
| | - Manduleli H. Pokiya
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001 South Africa
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Harper GW, Crawford J, Lewis K, Mwochi CR, Johnson G, Okoth C, Jadwin-Cakmak L, Onyango DP, Kumar M, Wilson BD. Mental Health Challenges and Needs among Sexual and Gender Minority People in Western Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031311. [PMID: 33535647 PMCID: PMC7908383 DOI: 10.3390/ijerph18031311] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 02/07/2023]
Abstract
Background: Sexual and gender minority (SGM) people in Kenya face pervasive socio-cultural and structural discrimination. Persistent stress stemming from anti-SGM stigma and prejudice may place SGM individuals at increased risk for negative mental health outcomes. This study explored experiences with violence (intimate partner violence and SGM-based violence), mental health outcomes (psychological distress, PTSD symptoms, and depressive symptoms), alcohol and other substance use, and prioritization of community needs among SGM adults in Western Kenya. Methods: This study was conducted by members of a collaborative research partnership between a U.S. academic institution and a Kenyan LGBTQ civil society organization (CSO). A convenience sample of 527 SGM adults (92.7% ages 18-34) was recruited from community venues to complete a cross-sectional survey either on paper or through an online secure platform. Results: For comparative analytic purposes, three sexual orientation and gender identity (SOGI) groups were created: (1) cisgender sexual minority women (SMW; 24.9%), (2) cisgender sexual minority men (SMM; 63.8%), and (3) gender minority individuals (GMI; 11.4%). Overall, 11.7% of participants reported clinically significant levels of psychological distress, 53.2% reported clinically significant levels of post-traumatic stress disorder (PTSD) symptoms, and 26.1% reported clinically significant levels of depressive symptoms. No statistically significant differences in clinical levels of these mental health concerns were detected across SOGI groups. Overall, 76.2% of participants reported ever using alcohol, 45.6% home brew, 43.5% tobacco, 39.1% marijuana, and 27.7% miraa or khat. Statistically significant SOGI group differences on potentially problematic substance use revealed that GMI participants were less likely to use alcohol and tobacco daily; and SMM participants were more likely to use marijuana daily. Lifetime intimate partner violence (IPV) was reported by 42.5% of participants, and lifetime SGM-based violence (SGMV) was reported by 43.4%. GMI participants were more likely than other SOGI groups to have experienced both IPV and SGMV. Participants who experienced SGMV had significantly higher rates of clinically significant depressive and PTSD symptoms. Conclusions: Despite current resilience demonstrated by SGM adults in Kenya, there is an urgent need to develop and deliver culturally appropriate mental health services for this population. Given the pervasiveness of anti-SGM violence, services should be provided using trauma-informed principles, and be sensitive to the lived experiences of SGM adults in Kenya. Community and policy levels interventions are needed to decrease SGM-based stigma and violence, increase SGM visibility and acceptance, and create safe and affirming venues for mental health care. Political prioritization of SGM mental health is needed for sustainable change.
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Affiliation(s)
- Gary W. Harper
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (J.C.); (K.L.); (G.J.); (L.J.-C.)
- Correspondence:
| | - Jessica Crawford
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (J.C.); (K.L.); (G.J.); (L.J.-C.)
| | - Katherine Lewis
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (J.C.); (K.L.); (G.J.); (L.J.-C.)
| | | | - Gabriel Johnson
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (J.C.); (K.L.); (G.J.); (L.J.-C.)
| | - Cecil Okoth
- Nyanza Rift Valley and Western Kenya (NYARWEK) LGBTI Coalition, Kisumu 40100, Kenya; (C.O.); (D.P.O.)
| | - Laura Jadwin-Cakmak
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (J.C.); (K.L.); (G.J.); (L.J.-C.)
| | - Daniel Peter Onyango
- Nyanza Rift Valley and Western Kenya (NYARWEK) LGBTI Coalition, Kisumu 40100, Kenya; (C.O.); (D.P.O.)
| | - Manasi Kumar
- Department of Psychiatry, School of Medicine, University of Nairobi, Nairobi 00100, Kenya;
| | - Bianca D.M. Wilson
- The Williams Institute, School of Law, University of California Los Angeles, Los Angeles, CA 90095, USA;
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Passaro RC, Chávez-Gomez S, Castañeda-Huaripata A, Gonzales-Saavedra W, Beymer MR, Segura ER, Nanclares F, Dilley J, Cabello R, Clark JL. Personalized Cognitive Counseling Reduces Drinking Expectancy Among Men Who Have Sex with Men and Transgender Women in Lima, Peru: A Pilot Randomized Controlled Trial. AIDS Behav 2020; 24:3205-3214. [PMID: 32418164 PMCID: PMC8112108 DOI: 10.1007/s10461-020-02882-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Personalized cognitive counseling (PCC) is an evidence-based intervention designed to modify HIV-related risk behavior. We assessed the impact of PCC on sexual behavior, drinking expectancy, and incidence of sexually transmitted infections (STIs) in a 6-month randomized controlled trial among 153 HIV-uninfected men who have sex with men (MSM) and transgender women (TW) in Peru. Study retention was ≥ 90%, with three HIV infections (3 Control) and 19 cases of GC/CT (10 Control, 9 PCC) at 6 months. There was a decline in condomless receptive anal intercourse in the Control (0.74, 95% CI 0.60-0.91; p < 0.01) and PCC arms (0.72, 0.55-0.94; p = 0.02) at 6-month follow-up. There was a decrease in drinking expectancy at 6 months among participants endorsing alcohol use in the PCC arm (0.89, 0.83-0.96; p < 0.01), versus no change in the Control arm (0.98, 0.92-1.04; p = 0.54). PCC was efficacious in reducing drinking expectancy and HIV risk among MSM and TW in Peru.
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Affiliation(s)
- R Colby Passaro
- Department of Emergency Medicine, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA.
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
- Division of Infectious Diseases, Department of Medicine, UCLA SAPHIR Program C/O UCLA, 10833 Le Conte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.
| | | | | | | | - Matthew R Beymer
- Department of Community Health Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Eddy R Segura
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Francisco Nanclares
- Alliance Health Project, University of California San Francisco, San Francisco, CA, USA
| | - James Dilley
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Jesse L Clark
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Wahome EW, Graham SM, Thiong’o AN, Mohamed K, Oduor T, Gichuru E, Mwambi J, van der Elst EM, Sanders EJ. Risk factors for loss to follow-up among at-risk HIV negative men who have sex with men participating in a research cohort with access to pre-exposure prophylaxis in coastal Kenya. J Int AIDS Soc 2020; 23 Suppl 6:e25593. [PMID: 33000889 PMCID: PMC7527770 DOI: 10.1002/jia2.25593] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Retention in preventive care among at-risk men who have sex with men (MSM) is critical for successful prevention of HIV acquisition in Africa. We assessed loss to follow-up (LTFU) rates and factors associated with LTFU in an HIV vaccine feasibility cohort study following MSM with access to pre-exposure prophylaxis (PrEP) in coastal Kenya. METHODS Between June 2017 and June 2019, MSM cohort participants attending a research clinic 20 km north of Mombasa were offered daily PrEP and followed monthly for risk assessment, risk reduction counselling and HIV testing. Participants were defined as LTFU if they were late by >90 days for their scheduled appointment. Participants who acquired HIV were censored at diagnosis. Cox proportional hazards models were used to estimate adjusted Hazard Ratio (aHR) of risk factors for LTFU. RESULTS AND DISCUSSION A total of 179 participants with a median age of 25.0 years (interquartile range [IQR]: 23.0 to 30.0) contributed a median follow-up time of 21.2 months (IQR: 6.5 to 22.1). Of these, 143 (79.9%) participants started PrEP and 76 (42.5%) MSM were LTFU, for an incidence rate of 33.7 (95% confidence interval [CI], 26.9 to 42.2) per 100 person-years. Disordered alcohol use (aHR: 2.3, 95% CI, 1.5 to 3.7), residence outside the immediate clinic catchment area (aHR: 2.5, 95% CI, 1.3 to 4.6 for Mombasa Island; aHR: 1.8, 95% CI, 1.0 to 3.3 for south coast), tertiary education level or higher (aHR: 2.3, 95% CI, 1.1 to 4.8) and less lead-in time in the cohort prior to 19 June 2017 (aHR: 3.1, 95% CI, 1.8 to 5.6 for zero to three months; aHR: 2.4, 95% CI, 1.2 to 4.7 for four to six months) were independent predictors of LTFU. PrEP use did not differ by LTFU status (HR: 1.0, 95% CI, 0.6 to 1.5). Psychosocial support for men reporting disordered alcohol use, strengthened engagement of recently enrolled participants and focusing recruitment on areas close to the research clinic may improve retention in HIV prevention studies involving MSM in coastal Kenya. CONCLUSIONS About one in three participants became LTFU after one year of follow-up, irrespective of PrEP use. Research preparedness involving MSM should be strengthened for HIV prevention intervention evaluations in coastal Kenya.
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Affiliation(s)
- Elizabeth W Wahome
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research–CoastKilifiKenya
| | - Susan M Graham
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research–CoastKilifiKenya
- Departments of Medicine, Epidemiology and Global HealthUniversity of WashingtonSeattleWAUSA
| | - Alexander N Thiong’o
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research–CoastKilifiKenya
| | - Khamisi Mohamed
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research–CoastKilifiKenya
| | - Tony Oduor
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research–CoastKilifiKenya
| | - Evans Gichuru
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research–CoastKilifiKenya
| | - John Mwambi
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research–CoastKilifiKenya
| | - Elise M van der Elst
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research–CoastKilifiKenya
- Department of Global HealthUniversity of AmsterdamAmsterdamthe Netherlands
| | - Eduard J Sanders
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research–CoastKilifiKenya
- Department of Global HealthUniversity of AmsterdamAmsterdamthe Netherlands
- Nuffield Department of MedicineUniversity of OxfordHeadingtonUnited Kingdom
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Fearon E, Bourne A, Tenza S, Palanee‐Phillips T, Kabuti R, Weatherburn P, Nutland W, Kimani J, Smith AD. Online socializing among men who have sex with men and transgender people in Nairobi and Johannesburg and implications for public health-related research and health promotion: an analysis of qualitative and respondent-driven sampling survey data. J Int AIDS Soc 2020; 23 Suppl 6:e25603. [PMID: 33000904 PMCID: PMC7527758 DOI: 10.1002/jia2.25603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 07/09/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION There is little published literature about gay, bisexual and other men who have sex with men and transgender individuals (MSM and TG)'s use of social media in sub-Saharan Africa, despite repressive social and/or criminalizing contexts that limit access to physical HIV prevention. We sought to describe MSM and TG's online socializing in Nairobi and Johannesburg, identifying the characteristics of those socializing online and those not, in order to inform the development of research and health promotion in online environments. METHODS Respondent-driven sampling surveys were conducted in 2017 in Nairobi (n = 618) and Johannesburg (n = 301) with those reporting current male gender identity or male sex assigned at birth and sex with a man in the last 12 months. Online socializing patterns, sociodemographic, sexual behaviour and HIV-testing data were collected. We examined associations between social media use and sociodemographic characteristics and sexual behaviours among all, and only those HIV-uninfected, using logistic regression. Analyses were RDS-II weighted. Thirty qualitative interviews were conducted with MSM and TG in each city, which examined the broader context of and motivations for social media use. RESULTS Most MSM and TG had used social media to socialize with MSM in the last month (60% Johannesburg, 71% Nairobi), mostly using generic platforms (e.g. Facebook), but also gay-specific (e.g. Grindr). HIV-uninfected MSM and TG reporting riskier recent sexual behaviours had raised odds of social media use in Nairobi, including receptive anal intercourse (adjusted OR = 2.15, p = 0.006), buying (aOR = 2.24, p = 0.015) and selling sex with men (aOR = 2.17, p = 0.004). Evidence for these associations was weaker in Johannesburg, though socializing online was associated with condomless anal intercourse (aOR = 3.67, p = 0.003) and active syphilis (aOR = 13.50, p = 0.016). Qualitative findings indicated that while online socializing can limit risk of harm inherent in face-to-face interactions, novel challenges were introduced, including context collapse and a fear of blackmail. CONCLUSIONS Most MSM and TG in these cities socialize online regularly. Users reported HIV acquisition risk behaviours, yet this space is not fully utilized for sexual health promotion and research engagement. Effective, safe and acceptable means of using online channels to engage with MSM/TG that account for MSM and TG's strategies and concerns for managing online security should now be explored, as complements or alternatives to existing outreach.
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Affiliation(s)
- Elizabeth Fearon
- Department of Global Health & DevelopmentLondon School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | - Adam Bourne
- Australian Research Centre in Sex, Health & SocietyLa Trobe UniversityMelbourneAustralia
| | - Siyanda Tenza
- Wits Reproductive Health and HIV InstituteSchool of Clinical MedicineUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Thesla Palanee‐Phillips
- Wits Reproductive Health and HIV InstituteSchool of Clinical MedicineUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | - Peter Weatherburn
- Sigma ResearchDepartment of Public Health, Environments and SocietyLondon School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | - Will Nutland
- Sigma ResearchDepartment of Public Health, Environments and SocietyLondon School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | - Joshua Kimani
- Partners for Health and DevelopmentNairobiKenya
- Department of Community Health SciencesUniversity of Manitoba (UoM)WinnipegCanada
| | - Adrian D Smith
- Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
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Oginni OA, Mapayi BM, Afolabi OT, Obiajunwa C, Oloniniyi IO. Internalized Homophobia, Coping, and Quality of Life Among Nigerian Gay and Bisexual Men. JOURNAL OF HOMOSEXUALITY 2020; 67:1447-1470. [PMID: 30977714 DOI: 10.1080/00918369.2019.1600899] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Despite high levels of homophobia in Nigeria, no studies have investigated the quality of life (QOL) of Nigerian gay and bisexual (GB) men. The associations between QOL and minority stress may differ from those reported in developed countries and may indicate alternative interventions. This study investigated internalized homophobia (IH) and coping strategies among gay and bisexual men in Nigeria and the relationships with overall QOL. Eighty-nine GB men were recruited with a snowball sampling technique. QOL (outcome), IH (predictor) and coping strategies (covariates) were assessed using standardized questionnaires. Relationships were investigated using linear regression analyses. Participants used adaptive more frequently than maladaptive coping strategies. The relationship between IH and QOL was nonlinear (β = -0.27, 95% CI = -0.48, -0.06), and the positive component was attenuated by adaptive coping strategies. Adaptive strategies can be reinforced as a therapeutic intervention to improve wellbeing among gay and bisexual men in Nigeria.
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Affiliation(s)
- Olakunle A Oginni
- Departmental of Mental Health, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University , Ile-Ife, Nigeria
- Mental Health Unit, Obafemi Awolowo University Teaching Hospitals Complex , Ile-Ife, Osun, Nigeria
| | - Boladale M Mapayi
- Departmental of Mental Health, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University , Ile-Ife, Nigeria
- Mental Health Unit, Obafemi Awolowo University Teaching Hospitals Complex , Ile-Ife, Osun, Nigeria
| | - Olusegun T Afolabi
- Departmental of Community Health, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University , Ile-Ife, Nigeria
| | - Chukwubueze Obiajunwa
- Departmental of Mental Health, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University , Ile-Ife, Nigeria
| | - Ibidunni O Oloniniyi
- Departmental of Mental Health, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University , Ile-Ife, Nigeria
- Mental Health Unit, Obafemi Awolowo University Teaching Hospitals Complex , Ile-Ife, Osun, Nigeria
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Graham SM, Micheni M, Chirro O, Nzioka J, Secor AM, Mugo PM, Kombo B, van der Elst EM, Operario D, Amico KR, Sanders EJ, Simoni JM. A Randomized Controlled Trial of the Shikamana Intervention to Promote Antiretroviral Therapy Adherence Among Gay, Bisexual, and Other Men Who Have Sex with Men in Kenya: Feasibility, Acceptability, Safety and Initial Effect Size. AIDS Behav 2020; 24:2206-2219. [PMID: 31965432 DOI: 10.1007/s10461-020-02786-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Gay, bisexual, and other men who have sex with men (GBMSM) living with HIV in rights-constrained settings need support for antiretroviral therapy (ART) adherence due to barriers including stigma. The Shikamana intervention combined modified Next Step Counseling by providers with support from trained peers to improve adherence among GBMSM living with HIV in Kenya. A randomized controlled trial with 6-month follow-up was used to determine feasibility, acceptability, safety, and initial intervention effects. Generalized estimating equations examined differences in self-reported adherence and virologic suppression. Sixty men enrolled, with 27 randomly assigned to the intervention and 33 to standard care. Retention did not differ by arm, and no adverse events occurred. Feedback on feasibility and acceptability was positive based on exit interviews. After adjustment for baseline viral suppression and confounding, the intervention group had a sixfold increased odds of viral suppression during follow-up. A larger trial of a scaled-up intervention is needed.
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Affiliation(s)
- Susan M Graham
- Departments of Medicine, Global Health, and Epidemiology, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, USA.
- Clinical Research, Kenya Medical Research Institute - Wellcome Trust Programme, Kilifi, Kenya.
| | - Murugi Micheni
- Clinical Research, Kenya Medical Research Institute - Wellcome Trust Programme, Kilifi, Kenya
| | - Oscar Chirro
- Clinical Research, Kenya Medical Research Institute - Wellcome Trust Programme, Kilifi, Kenya
| | - Joseph Nzioka
- Clinical Research, Kenya Medical Research Institute - Wellcome Trust Programme, Kilifi, Kenya
| | - Andrew M Secor
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Peter M Mugo
- Clinical Research, Kenya Medical Research Institute - Wellcome Trust Programme, Kilifi, Kenya
| | | | - Elise M van der Elst
- Clinical Research, Kenya Medical Research Institute - Wellcome Trust Programme, Kilifi, Kenya
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - K Rivet Amico
- Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
| | - Eduard J Sanders
- Clinical Research, Kenya Medical Research Institute - Wellcome Trust Programme, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Headington, Oxford, OX3 7BN, UK
| | - Jane M Simoni
- Departments of Psychology; Global Health; and Gender, Women, and Sexuality Studies, University of Washington, Seattle, WA, USA
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Doshi M, Macharia P, Mathenge J, Musyoki H, Amico KR, Battacharjee P, Blanchard J, Reza-Paul S, McKinnon LR, Kimani J, Lorway RR. Beyond biomedical and comorbidity approaches: Exploring associations between affinity group membership, health and health seeking behaviour among MSM/MSW in Nairobi, Kenya. Glob Public Health 2020; 15:968-984. [PMID: 32172670 DOI: 10.1080/17441692.2020.1739729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We explored general health and psychosocial characteristics among male sex workers and other men who have sex with men in Nairobi, Kenya. A total of 595 MSM/MSW were recruited into the study. We assessed group differences among those who self-reported HIV positive (SR-HIVP) and those who self-reported HIV negative (SR-HIVN) and by affinity group membership. Quality of life among SR-HIVP participants was significantly worse compared to SR-HIVN participants. Independent of HIV status and affinity group membership, participants reported high levels of hazardous alcohol use, harmful substance use, recent trauma and childhood abuse. The overall sample exhibited higher prevalence of moderate to severe depressive symptoms compared to the general population. Quality of life among participants who did not report affinity group membership (AGN) was significantly worse compared to participants who reported affinity group membership (AGP). AGN participants also reported significantly lower levels of social support. Membership in affinity groups was found to influence health seeking behaviour. Our findings suggest that we need to expand the mainstay biomedical and comorbidity focused research currently associated with MSM/MSW. Moreover, there are benefits to being part of MSM/MSW organisations and these organisations can potentially play a vital role in the health and well-being of MSM/MSW.
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Affiliation(s)
- Monika Doshi
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Pascal Macharia
- Health Options for Young Men on HIV/AIDS/STI (HOYMAS), Nairobi, Kenya
| | - John Mathenge
- Health Options for Young Men on HIV/AIDS/STI (HOYMAS), Nairobi, Kenya
| | - Helgar Musyoki
- National AIDS and STI Control Programme, Ministry of Health, Government of Kenya, Nairobi, Kenya
| | - K Rivet Amico
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Parinita Battacharjee
- The Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James Blanchard
- The Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Sushena Reza-Paul
- The Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lyle R McKinnon
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.,Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Joshua Kimani
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada.,Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Robert R Lorway
- The Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
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Liu J, Zhong X, Lu Z, Peng B, Zhang Y, Liang H, Dai J, Zhang J, Huang A. Anxiety and Depression Associated with Anal Sexual Practices among HIV-Negative Men Who Have Sex with Men in Western China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020464. [PMID: 31936800 PMCID: PMC7014070 DOI: 10.3390/ijerph17020464] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/13/2022]
Abstract
This study aimed to explore the prevalence and influencing factors of anxiety and depression among human immunodeficiency virus negative (HIV-negative) men who have sex with men (MSM) based on anal sex roles, so as to provide a scientific basis for the management of mental health conditions. Data were obtained from the baseline in a cohort study with a two-year follow-up period in western China. The Self-Rating Anxiety Scale and Center for Epidemiological Studies Depression Scale were used to assess anxiety and depression symptoms, respectively. The prevalence of anxiety and depression in 1771 MSM was 26.03% and 37.83%. Among them, 182 anal sex role “0” MSM who only had receptive anal sex with men reported the highest prevalence of anxiety and depression (31.32% and 46.15%), 467 anal sex role “1” MSM who only had insertive anal sex with men (22.27% and 32.76%), and 1122 anal sex role “0.5” MSM who engaged equally in both insertive and receptive anal sex intercourse with men (26.74% and 38.59%), respectively. Logistic regression analysis revealed that the influencing factors of anxiety include anal sex role “0”/”0.5”, low educational level, female sexual partners, frequently searching partners on the Internet, sexually transmitted diseases (STD) diagnosed by doctors, and no HIV counseling. Anal sex role “0”/”0.5”, rural area, casual male partners, female partners, STD diagnosed by doctors, frequently searching partners on the Internet, no HIV counseling, no condom use, and daily alcohol use were found to be associated with depression. In conclusion, early identification and intervention of anxiety and depression symptoms in HIV-negative MSM should be carried out, especially for anal sex role “0” MSM. Furthermore, key intervention and psychological counseling should be taken into consideration for MSM with a low education level, high-risk behaviors, and high-risk perceptions.
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Affiliation(s)
- Jiaxiu Liu
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - Xiaoni Zhong
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
- Correspondence:
| | - Zhuo Lu
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - Bin Peng
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - Yan Zhang
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - Hao Liang
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangxi Medical University, Nanning 520021, China
| | - Jianghong Dai
- Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Xinjiang 830011, China
| | - Juying Zhang
- Department of Epidemiology and Medical Statistics, School of Public Health, Sichuan University, Chengdu 610041, China
| | - Ailong Huang
- Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing 400016, China
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Hu J, Tan L, Huang G, Yu W. Disparity in depressive symptoms between heterosexual and sexual minority men in China: The role of social support. PLoS One 2020; 15:e0226178. [PMID: 31905216 PMCID: PMC6944333 DOI: 10.1371/journal.pone.0226178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/21/2019] [Indexed: 11/19/2022] Open
Abstract
Accumulating evidence suggests that sexual minorities experience elevated levels of depressive symptoms compared to heterosexuals in Western countries. Still, little is known about whether there is any difference in depressive symptoms between sexual minority men and heterosexual men in China. This study investigated the differences in depressive symptoms and social support between 302 Chinese sexual minority men and 249 heterosexual men. The association between depressive symptoms, social support and sexual orientation was also explored. Our results indicated that Chinese sexual minority men have more depressive symptoms and perceived lower social support than heterosexual men. Overall, sexual orientation and social support both predicted depressive symptoms. Different from previous Western studies, in our results, social support fully mediates but does not moderate the relationship between sexual orientation and depressive symptoms in Chinese men. The current findings suggest that social support has a significant impact on depressive symptoms among Chinese sexual minority men, highlighting the unique role of social support in understanding depressive symptoms among Chinese sexual minority men. Providing more social support, as well as promoting accepting and positive environments, may lead to better adjustment in this population in China.
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Affiliation(s)
- Jingchu Hu
- Department of Anxiety Disorders, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Ling Tan
- School of Management, Guangdong University of Technology, Guangzhou, Guangdong, China
- * E-mail: (LT); (WY)
| | - Gang Huang
- Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
- Normal College, Shenzhen University, Shenzhen, Guangdong, China
| | - Wenjun Yu
- College of Education, JingGangShan University, Ji’An, Jiangxi, China
- * E-mail: (LT); (WY)
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Sexual Minority Stigma, Sexual Orientation Concealment, Social Support and Depressive Symptoms Among Men Who have Sex with Men in China: A Moderated Mediation Modeling Analysis. AIDS Behav 2020; 24:8-17. [PMID: 31664571 DOI: 10.1007/s10461-019-02713-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Men who have sex with men (MSM) often experience depressive symptoms. However, the potential mechanisms resulting in depressive symptoms are not fully understood. Here, we explore possible mechanisms behind the associations between sexual minority stigma (SMS), sexual orientation concealment (SOC), and social support (SS) with depressive symptoms among MSM. Data (N = 715) used in the study were from the baseline survey of a 3-year cohort study in China. Computer-assisted self-interview was used to collect data. Mediation and moderated mediation modeling analysis were employed to address the question. It was found that SOC partially mediated the association between SMS and depressive symptoms (indirect effect = 0.11, 95% CI 0.05-0.17). SS moderated the mediation model by buffering the path from SMS to SOC (β = 0.17, t = 3.18, P = 0.002). These findings suggested that SS might strengthen the association between SMS and depressive symptoms by moderating the pathway between SMS and SOC.
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The Prevalence of Depression Associated with the Infection Status and Sexual Behaviors among Men Who Have Sex with Men in Shenzhen, China: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010127. [PMID: 31878079 PMCID: PMC6982042 DOI: 10.3390/ijerph17010127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 12/11/2019] [Accepted: 12/20/2019] [Indexed: 11/23/2022]
Abstract
Objective: To study the prevalence of depression and related factors among men who have sex with men (MSM) in Shenzhen China. Methods: Using a cross-sectional design, convenient sampling was applied to recruit participants at the AIDS(Acquired Immune Deficiency Syndrome)voluntary counseling and testing (VCT) clinic and gay clubs in 2015, thereby collecting data on sociodemographics, serological information, sexual behaviotablers, and depression. Descriptive analyses were conducted to determine the distribution of the measured variables. A chi-square test was applied to test the association between different levels of factors and depression status, alongside a binary logistic regression for multivariate analysis of depression. Results: A total of 334 MSM completed the survey. Their mean age was 29.88 ± 7.56, and 35.6% had at least college education; 44.9% considered themselves to be homosexual, and 43.4% considered themselves bisexual. The median score of depression was 12, with 116 people (34.7%) depressed. A total of 267 took the serological test. Of these 267, 60 (22.5%) were reported HIV(Human Immunodeficiency Virus) positive, 33 (12.4%) were syphilis positive, and none were hepatitis C positive. The multiple logistic regression analysis showed that a lack of awareness of AIDS knowledge (OR(Odds Ratio): 2.636, 95% CI(confidence interval): 1.384–5.020), peer education (OR: 1.752, 95% CI: 1.055–2.190), and lack of heterosexuality (OR: 1.805, 95% CI: 1.080–3.018) increased the odds of depression. Conclusion: Raising awareness of AIDS and strengthening peer education can improve depression among men who have sex with men.
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Wagner GJ, Ghosh-Dastidar B, El Khoury C, Abi Ghanem C, Balan E, Kegeles S, Mutchler MG, Mokhbat J. Major Depression Among Young Men Who Have Sex with Men in Beirut, and Its Association with Structural and Sexual Minority-Related Stressors, and Social Support. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2019; 16:513-520. [PMID: 32051694 PMCID: PMC7013382 DOI: 10.1007/s13178-018-0352-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Guided by the minority stress model, we assessed depression and its relationship to structural and sexual minority-related stressors and social support in a sample of 226 young (age 18-29 years) men who have sex with men in Beirut, Lebanon. The sample was recruited with long-chain peer referrals and administered a survey that included the PHQ-9 measure of depression. 16% had current major depression based on our PHQ-9 criteria, and 33% reported any lifetime history of suicidal ideation (including 8% who had made an attempt); 69% had experienced any sexual minority-related discrimination in the past year. In bivariate analysis, structural (unemployment, no legal resident status) and sexual minority-related (greater number of types of discrimination experienced, greater discomfort with one's sexual orientation) stressors were associated with major depression, as was lower social support. Discomfort with one's sexual orientation was the only correlate of major depression when controlling for other stressors, social support and socio-demographics. These findings highlight a high level of depression, and the potential for community building and social solidarity for mitigating the effects of stressors based in personal security, internalized stigma and discrimination.
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Affiliation(s)
| | | | | | | | - Elie Balan
- Arab Foundation for Freedom and Equality, Beirut, Lebanon
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Granderson RM, Harper GW, Wade R, Odero W, Onyango Olwango DP, Fields EL. Gender Role Strain and the Precarious Manhood of Sexual Minority Kenyan Men. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2019; 6:420-432. [PMID: 33620336 PMCID: PMC7897423 DOI: 10.1037/sgd0000340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Examining the impact of precarious manhood on the mental health of sexual minority men living in Kenya, we hypothesized that (a) men who have sex with men exclusively (MSME) and men who have sex with men and women (MSMW) would display differential patterns of conformity to norms of masculinity; (b) these differences would result in distinct patterns of association between masculine conformity and symptoms of psychological distress for MSME and MSMW; and (c) conformity to norms of masculinity would be bidirectionally associated with symptoms of depression and anxiety. Using data collected from 391 young men who participated in a community-based, cross-sectional study of HIV-related risk and resilience among young sexual minority men in western Kenya, we ran a multivariate analysis of variance (MANOVA) to assess differences in conformity to masculine norms and four hierarchical linear regression models to examine the associations between conformity to masculine norms and symptoms of anxiety and depression for MSME and MSMW. MANOVA results revealed no significant differences between MSME and MSMW in overall conformity to masculinity, although MSMW were significantly more likely to conform to the masculine norm of power over women. Regression results revealed that conformity to norms of masculinity was bidirectionally associated with psychological distress and that these patterns of association were distinct for MSME and MSMW. The discussion explores possible explanations for revealed differences between MSME and MSMW using existing research. Clinical implications, limitations, and opportunities for future research are also discussed.
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Affiliation(s)
| | | | - Ryan Wade
- University of Illinois at Urbana-Champaign
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Nyongesa MK, Mwangi P, Wanjala SW, Mutua AM, Newton CRJC, Abubakar A. Prevalence and correlates of depressive symptoms among adults living with HIV in rural Kilifi, Kenya. BMC Psychiatry 2019; 19:333. [PMID: 31675938 PMCID: PMC6825356 DOI: 10.1186/s12888-019-2339-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 10/23/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Published research on depression among people living with HIV/AIDS (PLWHA) from Africa is increasing, but data from Kenya remains scarce. This cross-sectional study measured the prevalence and correlates of depressive symptoms among PLWHA in rural Kilifi, on the Kenyan coast. METHODS Between February and April 2018, we consecutively recruited and interviewed 450 adults living with HIV and on combination antiretroviral therapy (cART). Depressive symptoms were assessed with the 9-item Patient Health Questionnaire (PHQ-9), with a positive depression screen defined as PHQ-9 score ≥ 10. Measures of psychosocial, health, and treatment characteristics were also administered. RESULTS The overall prevalence of depressive symptoms was 13.8% (95% Confidence Interval (95%CI): 10.9, 17.3). Multivariable logistic regression analysis identified current comorbid chronic illness (adjusted Odds Ratio (aOR) 5.72, 95% CI: 2.28, 14.34; p < 0.001), cART regimen (aOR 6.93, 95%CI: 2.34, 20.49; p < 0.001), perceived HIV-related stigma (aOR 1.10, 95%CI: 1.05, 1.14, p < 0.001) and difficulties accessing HIV care and treatment services (aOR 2.37, 95%CI: 1.14, 4.91; p = 0.02) as correlates of depressive symptoms. CONCLUSION The prevalence of depressive symptoms among adults living with HIV on the Kenyan coast is high. Those at high risk for elevated depressive symptoms (e.g., with comorbid chronic illnesses, on second-line cART, experiencing perceived HIV-stigma or with problems accessing HIV care) may benefit from early identification, treatment or referral, which requires integration of mental health programmes into HIV primary care.
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Affiliation(s)
- Moses K. Nyongesa
- 0000 0001 0155 5938grid.33058.3dCentre for Geographic Medicine Research-Coast, KEMRI, Box 230, Kilifi, Kenya
| | - Paul Mwangi
- 0000 0001 0155 5938grid.33058.3dCentre for Geographic Medicine Research-Coast, KEMRI, Box 230, Kilifi, Kenya
| | - Stanley W. Wanjala
- grid.449370.dDepartment of Social Sciences, Pwani University, Kilifi, Kenya
| | - Agnes M. Mutua
- 0000 0001 0155 5938grid.33058.3dCentre for Geographic Medicine Research-Coast, KEMRI, Box 230, Kilifi, Kenya
| | - Charles R. J. C. Newton
- 0000 0001 0155 5938grid.33058.3dCentre for Geographic Medicine Research-Coast, KEMRI, Box 230, Kilifi, Kenya ,grid.449370.dDepartment of Public Health, Pwani University, Kilifi, Kenya ,0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amina Abubakar
- 0000 0001 0155 5938grid.33058.3dCentre for Geographic Medicine Research-Coast, KEMRI, Box 230, Kilifi, Kenya ,grid.449370.dDepartment of Public Health, Pwani University, Kilifi, Kenya ,0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Oxford, UK ,grid.470490.eInstitute for Human Development, Aga Khan University, Nairobi, Kenya
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Romo ML, George G, Mantell JE, Mwai E, Nyaga E, Strauss M, Odhiambo JO, Govender K, Kelvin EA. Depression and sexual risk behavior among long-distance truck drivers at roadside wellness clinics in Kenya. PeerJ 2019; 7:e7253. [PMID: 31355055 PMCID: PMC6642802 DOI: 10.7717/peerj.7253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/05/2019] [Indexed: 11/20/2022] Open
Abstract
Background Truck drivers in sub-Saharan Africa are at high risk for both mental health disorders and sexually transmitted infections. We sought to determine the prevalence of depression among a sample of long-distance truck drivers seeking services at roadside wellness clinics in Kenya and explore the relationship between depression and sexual risk behavior. Methods We used data from an interviewer-administered questionnaire from 284 truck drivers in Kenya who participated in a randomized controlled trial evaluating whether offering oral HIV self-testing could increase HIV test uptake. Depression was categorized based on the Patient Health Questionnaire-9 score, with a score ≥10 indicative of probable major depressive disorder (MDD). Sexual risk behavior was operationalized as the number of condomless sex partners in the past 6 months. Results The mean participant age was 36.9 years, 83.0% were married, and 37.0% had a secondary school education or higher. Overall, 24% of participants had probable MDD, and 58.2% reported having one condomless sex partner in the past 6 months, whereas 27.3% reported having had two or more. In a multivariable Poisson regression model adjusted for demographic and other relevant variables, including number of sex partners, MDD was significantly associated with a greater number of condomless sex partners (adjusted prevalence ratio 1.63, 95% confidence interval [1.25–2.12], p < 0.001). General self-efficacy significantly mediated the association between MDD and number of condomless sex partners. Conclusions The high prevalence of depression highlights the need to test the feasibility and acceptability of mental healthcare interventions for this population, possibly integrated with HIV prevention services. Future research is needed to better understand the association between depression and sexual risk behavior, as well as the role of self-efficacy.
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Affiliation(s)
- Matthew L Romo
- Department of Epidemiology and Biostatistics & Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA.,School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Gavin George
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute & Columbia University Medical Center, New York, NY, USA
| | - Eva Mwai
- North Star Alliance, Nairobi, Kenya
| | | | - Michael Strauss
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | | | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Elizabeth A Kelvin
- Department of Epidemiology and Biostatistics & Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
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Experienced HIV-Related Stigma and Psychological Distress in Peruvian Sexual and Gender Minorities: A Longitudinal Study to Explore Mediating Roles of Internalized HIV-Related Stigma and Coping Styles. AIDS Behav 2019; 23:661-674. [PMID: 30506474 DOI: 10.1007/s10461-018-2348-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Experiencing HIV-related stigma has important impacts on the mental health of people living with HIV, which has implications for treatment adherence, disease progression, and health outcomes. The impacts of stigma are particularly important to consider among sexual and gender minorities, who often face a disproportionate burden of HIV. To address the implications of stigma in these key populations, we leveraged a longitudinal study conducted among Peruvian sexual and gender minorities to compare the relative effects of multiple mediators affecting the relationship between experienced HIV-related stigma and psychological distress: internalized HIV-related stigma, adaptive coping, and maladaptive coping. HIV-related stigma, coping, and distress were measured, respectively, at 24 weeks, 36 weeks, and 48 weeks post-diagnosis for 145 participants from the Sabes Study. HIV-related maladaptive coping largely mediated the relationship between experienced HIV-related stigma and distress. Our findings suggest interventions targeting maladaptive coping may alleviate the mental health consequences of experiencing HIV-related stigma.
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