TY - JOUR
T1 - Depressive symptoms and substance use as mediators of stigma affecting men who have sex with men in Lesotho
T2 - a structural equation modeling approach
AU - Wendi, Da
AU - Stahlman, Shauna
AU - Grosso, Ashley
AU - Sweitzer, Stephanie
AU - Ketende, Sosthenes
AU - Taruberekera, Noah
AU - Nkonyana, John
AU - Mothopeng, Tampose
AU - Baral, Stefan
N1 - Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Purpose Research on the relationship between sexual orientation–related stigma and risks for HIV among men who have sex with men (MSM) is limited. This study tests a hypothesis that substance use and depressive symptoms mediate the relationship between stigma in the health care system and HIV-related risk practices among MSM in Maseru, Lesotho. Methods In 2014, we conducted a cross-sectional study among MSM in Lesotho accrued via respondent-driven sampling including a survey and biological testing for HIV. The hypothesis was tested using structural equation modeling. Results Of the 318 participants, 22.3% had experienced stigma in the health care system. Stigma in the health care system was associated with depression (β = 0.329, P =.018) and alcohol use (β = 1.417, P =.001). Noninjection illicit drug use (β = 0.837, P =.039) and alcohol use (β = 0.282, P =.000) significantly predicted number of sex partners. Stigma was directly associated with condomless anal sex (β = 0.441, P =.036), and no indirect association was found. Conclusions Alcohol use and depressive symptoms mediate the relationship between MSM stigma in the health care system and reported number of sex partners. The implications are significant with a focus on the need for comprehensive interventions addressing stigma and mental health when aiming to improve more proximal HIV-related risk practices for MSM.
AB - Purpose Research on the relationship between sexual orientation–related stigma and risks for HIV among men who have sex with men (MSM) is limited. This study tests a hypothesis that substance use and depressive symptoms mediate the relationship between stigma in the health care system and HIV-related risk practices among MSM in Maseru, Lesotho. Methods In 2014, we conducted a cross-sectional study among MSM in Lesotho accrued via respondent-driven sampling including a survey and biological testing for HIV. The hypothesis was tested using structural equation modeling. Results Of the 318 participants, 22.3% had experienced stigma in the health care system. Stigma in the health care system was associated with depression (β = 0.329, P =.018) and alcohol use (β = 1.417, P =.001). Noninjection illicit drug use (β = 0.837, P =.039) and alcohol use (β = 0.282, P =.000) significantly predicted number of sex partners. Stigma was directly associated with condomless anal sex (β = 0.441, P =.036), and no indirect association was found. Conclusions Alcohol use and depressive symptoms mediate the relationship between MSM stigma in the health care system and reported number of sex partners. The implications are significant with a focus on the need for comprehensive interventions addressing stigma and mental health when aiming to improve more proximal HIV-related risk practices for MSM.
KW - Depressive symptoms
KW - HIV-related risk practices
KW - MSM
KW - SEM
KW - Stigma
KW - Substance use
UR - http://www.scopus.com/inward/record.url?scp=84978893193&partnerID=8YFLogxK
U2 - 10.1016/j.annepidem.2016.06.005
DO - 10.1016/j.annepidem.2016.06.005
M3 - Article
C2 - 27425206
AN - SCOPUS:84978893193
SN - 1047-2797
VL - 26
SP - 551
EP - 556
JO - Annals of Epidemiology
JF - Annals of Epidemiology
IS - 8
ER -