Contemplating suicide – an indication of poor mental health and a risk factor for committing suicide – is much more common in Nigerian men who have sex with men (MSM) than in the general population and is associated with significantly lower odds of getting tested for HIV. Furthermore, MSM who experience high levels of sexual stigma are more likely to acquire HIV or an STI.
This is according to research recently published by Dr Cristina Rodriguez-Hart of the University of Maryland from a cohort study of Nigerian MSM, exploring the links between sexual stigma, psychological wellbeing and HIV outcomes.
TRUST/RV368 is a prospective cohort study that utilises respondent driven sampling to recruit MSM into HIV prevention, treatment, and care services in Abuja and Lagos, Nigeria. A total of 1480 MSM were enrolled between March 2013 and February 2016. Participants completed questionnaires about their experiences of stigma, sexual behaviour and psychosocial wellbeing.
A mixed methods component of the study focused on the impact of stigma on HIV testing. Quantitative data was used to assess suicidal ideation as a mechanism linking sexual stigma to HIV testing in both Lagos and Abuja. The purpose of the qualitative phase was to gain a better understanding of how sexual stigma impacted health and access to HIV services. Read more via AIDS Map
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
Rodriguez-Hart, C., Bradley, C., German, D. et al. AIDS Behav (2018) 22: 3905. https://doi-org.proxy.lib.duke.edu/10.1007/s10461-018-2191-5
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.
Discussion
This study demonstrated high levels of suicidal ideation among Nigerian MSM with suicidal ideation acting as one mechanism by which sexual stigma contributed to lower levels of HIV testing. The qualitative results reinforced these findings by suggesting that sexual stigma could lead to suicidal ideation and long-lasting trauma. Lack of support following sexual stigma was especially common and exacerbated poor mental health. This study enriches the existing research by exploring how and under what conditions sexual stigma may promote less HIV testing, suggesting the potential for multiple avenues of intervention.
The levels of suicidal ideation were very high, much higher than the 3.2% previously reported for Nigerian adults [42], suggesting that suicidal ideation may be a significant health issue affecting MSM in Nigeria as has been found elsewhere in SSA [20, 28, 29]. Such high levels of suicidal ideation are alarming as such thoughts are strongly linked to suicide [42] and because it was found that suicidal ideation was associated with a significantly lower odds of having received an HIV test. Given the known benefits of HIV testing, our study findings highlight that poor mental health may drive HIV infection by reducing HIV testing [1]. Many studies have focused on assessing the impact of poor mental health on engagement with the HIV Care Continuum [43]. However, there is a need to better understand how poor mental health impacts uptake of HIV prevention and testing services among those not diagnosed with HIV. Read more via NCBI