The Synergistic Impact of Sexual Stigma and Psychosocial Well-Being on HIV Testing: A Mixed-Methods Study Among Nigerian Men who have Sex with Men

Cristina Rodriguez-Hart; Cory Bradley; Danielle German; Rashelle Musci; Ifeanyi Orazulike; Stefan Baral; Hongjie Liu; Trevor A Crowell; Man Charurat; Rebecca G Nowak; TRUST/RV368 Study Group

doi:10.1007/s10461-018-2191-5

The Synergistic Impact of Sexual Stigma and Psychosocial Well-Being on HIV Testing: A Mixed-Methods Study Among Nigerian Men who have Sex with Men

AIDS Behav. 2018 Dec;22(12):3905-3915. doi: 10.1007/s10461-018-2191-5.

Authors

Cristina Rodriguez-Hart^{1

2}, Cory Bradley³, Danielle German³, Rashelle Musci⁴, Ifeanyi Orazulike⁵, Stefan Baral⁶, Hongjie Liu⁷, Trevor A Crowell^{8

9}, Man Charurat¹⁰, Rebecca G Nowak¹⁰; TRUST/RV368 Study Group

Collaborators

TRUST/RV368 Study Group:
Cristina Rodriguez-Hart, Stefan Baral, Trevor A Crowell, Hongjie Liu, Man Charurat, Rebecca G Nowak

Affiliations

¹ Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA. crodriguezhart@health.nyc.gov.
² Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. crodriguezhart@health.nyc.gov.
³ Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁴ Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁵ International Center on Advocacy and Rights to Health, Abuja, Nigeria.
⁶ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁷ School of Public Health, University of Maryland, College Park, MD, USA.
⁸ U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
⁹ Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
¹⁰ Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.

Abstract

Although sexual stigma has been linked to decreased HIV testing among men who have sex with men (MSM), mechanisms for this association are unclear. We evaluated the role of psychosocial well-being in connecting sexual stigma and HIV testing using an explanatory sequential mixed methods analysis of 25 qualitative and 1480 quantitative interviews with MSM enrolled in a prospective cohort study in Nigeria from March/2013-February/2016. Utilizing structural equation modeling, we found a synergistic negative association between sexual stigma and suicidal ideation on HIV testing. Qualitatively, prior stigma experiences often generated psychological distress and perceptions of feeling unsafe, which decreased willingness to seek services at general health facilities. MSM reported feeling safe at the MSM-friendly study clinic but still described a need for psychosocial support services. Addressing stigma and unmet mental health needs among Nigerian MSM has the potential to improve HIV testing uptake.

Keywords: HIV testing; Latent class analysis; Men who have sex with men; Mental health; Stigma; Suicidal ideation.

Publication types

Evaluation Study

MeSH terms

Adult
Ambulatory Care Facilities
HIV Infections / diagnosis*
HIV Infections / ethnology
HIV Infections / psychology*
Homosexuality, Male / ethnology*
Homosexuality, Male / psychology
Humans
Latent Class Analysis
Male
Mass Screening / psychology*
Mental Health
Nigeria / epidemiology
Prospective Studies
Qualitative Research
Sexual and Gender Minorities
Social Stigma*
Suicidal Ideation

Abstract

Publication types

MeSH terms

Grants and funding