TY - JOUR
T1 - The relationship between depression and sexual health service utilization among men who have sex with men (MSM) in Côte d'Ivoire, West Africa
AU - Ulanja, Mark B.
AU - Lyons, Carrie
AU - Ketende, Sosthenes
AU - Stahlman, Shauna
AU - Diouf, Daouda
AU - Kouamé, Abo
AU - Ezouatchi, Rebecca
AU - Bamba, Amara
AU - Drame, Fatou
AU - Liestman, Ben
AU - Baral, Stefan
N1 - Funding Information:
The Global Fund for AIDS, Tuberculosis and Malaria provided the financial support for the data collection in Cote D’Ivoire. Stefan Baral’s effort was supported by the Johns Hopkins University Center for AIDS Research, an NIH funded program (P30AI094189), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK, and OAR. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Funding Information:
The authors gratefully acknowledge the study participants. This research was conducted by the consortium Enda Santé—Johns Hopkins University (JHU) in collaboration with the Government of Côte d’Ivoire National AIDS Control Program and with the financial support of the Global Fund to fight AIDS, Tuberculosis and Malaria. The authors would like to thank the individuals who embraced this research project and chose to participate in this study. This study would not have been possible without the leadership from the community, including Blety, Espace Confiance, and Ruban Rouge. The authors would also like to thank our partners from the Programme National de Lutte contre le Sida (PNLS) and CeDRes Abidjan. Thank you to Emily Crawford and Jenny Sherwood for their dedication to study implementation.
Publisher Copyright:
© 2019 The Author(s).
PY - 2019/3/5
Y1 - 2019/3/5
N2 - Background: In Cote D'Ivoire, there has been limited coverage of evidence-based sexual health services specifically supporting men who have sex with men (MSM). To date, there has been limited study of the determinants of engagement in these services including multiple intersecting stigmas and depression. Methods: 1301 MSM aged 18 years and older, were recruited using respondent-driven sampling in Abidjan, Yamoussoukro, Gagnoa and Bouake, Cote d'Ivoire from January 2015 to October 2015. Inclusion criteria included anal sex with another man in the past 12 months were to complete a structured questionnaire including the Patient Health Questionnaire (PHQ)-9 to screen for depression. Chi-Square tests were used to test difference in healthcare utilization across variables, and multiple logistic regression was used to test the association between depression and health care utilization represented by HIV and sexually transmittable infection testing and treatment. Results: Depression (aOR:1.40, 95% CI: 1.07-1.84), being aged 25-29 years (aOR:1.84, 95% CI: 1.11-3.03),unemployed (aOR:0.64, 95% CI: 0.42-0.98), being a student (aOR:0.67, 95% CI: 0.48-0.96), being identified as male (aOR:0.44, 95% CI: 0.29-0.67), and identifying as homosexual (aOR:0.74, 95% CI:0.56-0.99) were significantly associated with utilization of sexual health care services in the final multivariable model. Healthcare enacted stigma (aOR: 1.55, 95% CI: 1.03-2.33) was associated with utilizing sexual health care services, but perceived healthcare stigma, social stigma and family stigma were not. Conclusion: Given higher levels of depressive symptomatology among those engaging in sexual health care services, this engagement represents an opportunity for service integration which may have synergistic benefits for both sexual and mental health. Moreover, MSM in Cote D'Ivoire who had engaged in sexual health services were more likely to report having experienced health-care enacted stigma. Taken together, these results reinforce the need for stigma mitigation interventions to support sustained engagement in HIV prevention, treatment and care services as a means of reducing health disparities among MSM in Cote d'Ivoire.
AB - Background: In Cote D'Ivoire, there has been limited coverage of evidence-based sexual health services specifically supporting men who have sex with men (MSM). To date, there has been limited study of the determinants of engagement in these services including multiple intersecting stigmas and depression. Methods: 1301 MSM aged 18 years and older, were recruited using respondent-driven sampling in Abidjan, Yamoussoukro, Gagnoa and Bouake, Cote d'Ivoire from January 2015 to October 2015. Inclusion criteria included anal sex with another man in the past 12 months were to complete a structured questionnaire including the Patient Health Questionnaire (PHQ)-9 to screen for depression. Chi-Square tests were used to test difference in healthcare utilization across variables, and multiple logistic regression was used to test the association between depression and health care utilization represented by HIV and sexually transmittable infection testing and treatment. Results: Depression (aOR:1.40, 95% CI: 1.07-1.84), being aged 25-29 years (aOR:1.84, 95% CI: 1.11-3.03),unemployed (aOR:0.64, 95% CI: 0.42-0.98), being a student (aOR:0.67, 95% CI: 0.48-0.96), being identified as male (aOR:0.44, 95% CI: 0.29-0.67), and identifying as homosexual (aOR:0.74, 95% CI:0.56-0.99) were significantly associated with utilization of sexual health care services in the final multivariable model. Healthcare enacted stigma (aOR: 1.55, 95% CI: 1.03-2.33) was associated with utilizing sexual health care services, but perceived healthcare stigma, social stigma and family stigma were not. Conclusion: Given higher levels of depressive symptomatology among those engaging in sexual health care services, this engagement represents an opportunity for service integration which may have synergistic benefits for both sexual and mental health. Moreover, MSM in Cote D'Ivoire who had engaged in sexual health services were more likely to report having experienced health-care enacted stigma. Taken together, these results reinforce the need for stigma mitigation interventions to support sustained engagement in HIV prevention, treatment and care services as a means of reducing health disparities among MSM in Cote d'Ivoire.
KW - Cote D'Ivoire
KW - Depression
KW - Epidemiology
KW - Gender
KW - HIV
KW - Men who have sex with men
KW - Sexual health services
UR - http://www.scopus.com/inward/record.url?scp=85062404363&partnerID=8YFLogxK
U2 - 10.1186/s12914-019-0186-6
DO - 10.1186/s12914-019-0186-6
M3 - Article
C2 - 30832673
AN - SCOPUS:85062404363
SN - 1472-698X
VL - 19
JO - BMC International Health and Human Rights
JF - BMC International Health and Human Rights
IS - 1
M1 - 11
ER -