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Acharya A, Kumar N, Singh K, Byrareddy SN. "Mpox in MSM: Tackling Stigma, Minimizing Risk Factors, Exploring Pathogenesis, and Treatment Approaches". Biomed J 2024:100746. [PMID: 38734408 DOI: 10.1016/j.bj.2024.100746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/07/2024] [Accepted: 05/05/2024] [Indexed: 05/13/2024] Open
Abstract
Mpox is a zoonotic disease caused by the monkeypox virus (MPV), primarily found in Central and West African countries. The typical presentation of the disease before the 2022 mpox outbreak includes a febrile prodrome 5-13 days post-exposure, accompanied by lymphadenopathy, malaise, headache, and muscle aches. Unexpectedly, during the 2022 outbreak, several cases of atypical presentations of the disease were reported, such as the absence of prodromal symptoms and the presence of genital skin lesions suggestive of sexual transmission. As per the World Health Organization (WHO), as of March 20, 2024, 94,707 cases of mpox were reported worldwide, resulting in 181 deaths (22 in African endemic regions and 159 in non-endemic countries). The United States Centers for Disease Control and Prevention (CDC) reports a total of 32,063 cases (33.85% of total cases globally), with 58 deaths (32.04% of global deaths) due to mpox. Person-to-person transmission of mpox can occur through respiratory droplets and sustained close contact. However, during the 2022 outbreak of mpox, a high incidence of anal and perianal lesions among MSMs indicated sexual transmission of MPV as a major route of transmission. Since MSMs are disproportionately at risk for HIV transmission, this review discusses the risk factors, transmission patterns, pathogenesis, vaccine, and treatment options for mpox among MSM and people living with HIV (PLWH). Furthermore, we provide a brief perspective on the evolution of the MPV in immunocompromised people like PLWH.
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Affiliation(s)
- Arpan Acharya
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Narendra Kumar
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kamal Singh
- Department of Veterinary Pathobiology, College of Veterinary Medicine, and Bond Life Sciences Center, University of Missouri, Columbia, Missouri, USA
| | - Siddappa N Byrareddy
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA; Department of Genetics, Cell Biology and Anatomy, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA; Department of Biochemistry and Molecular Biology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
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Eubanks A, Coulibaly B, Dembélé Keita B, Anoma C, Dah TTE, Mensah E, Kaba S, Lokrou KJ, Ouedraogo FR, Badjassim AMF, Maradan G, Bourrelly M, Mora M, Riegel L, Rojas Castro D, Yaya I, Spire B, Laurent C, Sagaon-Teyssier L. Socio-behavioral correlates of pre-exposure prophylaxis use and correct adherence in men who have sex with men in West Africa. BMC Public Health 2022; 22:1832. [PMID: 36175860 PMCID: PMC9520809 DOI: 10.1186/s12889-022-14211-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple barriers compromise pre-exposure prophylaxis (PrEP) engagement (i.e., use and adherence) in men who have sex with men (MSM). In low/middle-income countries, little is known about PrEP engagement in this population. In West Africa, the CohMSM-PrEP study was one of the rare interventions providing PrEP to MSM. We estimated PrEP use and correct adherence rates in CohMSM-PrEP, together with associated factors over time. METHODS: CohMSM-PrEP recruited MSM in four community-based clinics in Mali, Côte d'Ivoire, Burkina Faso, and Togo. Quarterly follow-up included collecting socio-behavioral data, and providing a comprehensive HIV prevention package, PrEP (daily or event-driven), and peer educator (PE)-led counselling. Using repeated measures, multivariate generalized estimating equations models were used to identify factors associated with self-reported i) PrEP use and ii) correct PrEP adherence during participants' most recent anal intercourse (defined as four pills/week for daily users and 2 + 1 + 1 for event-driven users). RESULTS Five hundred twenty participants were included with a median follow-up time of 12 months (IQR 6-21). Of the 2839 intercourses declared over the follow-up period, PrEP use was self-reported for 1996 (70%), and correct PrEP adherence for 1461 (73%) of the latter. PrEP use was higher in participants who also attended participating clinics outside of scheduled visits (adjusted odds ratio (aOR) [95% Confidence Interval, CI], p-value; 1.32[1.01-1.71], 0.040), and in those who practiced condomless anal sex (1.86[1.54-2.24], < 0.001). Correct adherence was higher in those who often contacted PE outside of scheduled visits (2.16[1.01-4.64], 0.047) and in participants who adopted receptive/versatile sexual positions with stable partners (1.36[1.03-1.81], 0.030). Instead, after an interaction effect between financial situation and regimen was tested, it was lower in event-driven users with a difficult/very difficult financial situation (comfortable/just making ends meet & daily, 4.19[2.56-6.86], < 0.001; difficult/very difficult & daily, 6.47[4.05-10.30], < 0.001; comfortable/just making ends meet & event-driven, 1.63[1.22-2.17], 0.001), and in participants who felt alone (0.76[0.58-0.99], 0.042). CONCLUSIONS Community-based clinic attendance and PE contact outside of scheduled visits were both associated with higher PrEP engagement, but some socially and economically marginalized participants struggled with adherence. As scale-up continues in West Africa, we recommend implementing community-based interventions and providing extra support for vulnerable users to ensure adequate PrEP engagement.
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Affiliation(s)
- August Eubanks
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France.
| | | | | | | | - Ter Tiero Elias Dah
- Association African Solidarité, Ouagadougou, Burkina Faso.,Centre Muraz, Centre Muraz, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso
| | | | | | | | | | | | - Gwenaëlle Maradan
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France.,ORS PACA, Observatoire Régional de La Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Michel Bourrelly
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France.,Coalition Plus, Community-Based Research Laboratory, Pantin, France
| | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France
| | - Lucas Riegel
- Coalition Plus, Community-Based Research Laboratory, Pantin, France
| | - Daniela Rojas Castro
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France.,Coalition Plus, Community-Based Research Laboratory, Pantin, France
| | - Issifou Yaya
- TransVIHMI, Univ Montpellier, INSERM, Montpellier, IRD, France
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France
| | | | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France.,ARCAD Santé PLUS, Bamako, Mali
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Wiginton JM, Murray SM, Algarin AB, Baral SD, Sanchez TH, Smith LR. Metrics of sexual behavior stigma among cisgender men who have sex with men in Mexico: exploratory and confirmatory factor analyses. BMC Infect Dis 2022; 22:690. [PMID: 35964006 PMCID: PMC9375942 DOI: 10.1186/s12879-022-07672-0] [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] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/01/2022] [Indexed: 11/24/2022] Open
Abstract
Cisgender gay, bisexual, and other men who have sex with men (MSM) in Mexico experience disparities in sexual health outcomes, perhaps most notably in HIV prevalence, HIV testing and status awareness, and condom use. Sexual behavior stigma, underpinned by socio-structural factors specific to Mexico (e.g., machismo), uniquely shapes these sexual health disparities. However, few reliable, valid measures are available to document, track, and ultimately mitigate sexual behavior stigma in this context. Exploratory and confirmatory factor analyses were performed on responses to a 13-item sexual behavior stigma scale from 15,681 MSM recruited online across Mexico. Associations with extracted factors were tested to assess construct validity. Three subscales were identified in exploratory factor analysis and validated in confirmatory factor analysis: "stigma from family and friends" (α = 0.65), "anticipated healthcare stigma" (α = 0.84), and "general social stigma" (α = 0.70). External construct validity was indicated through each subscale's strong association (all p < 0.001) with perceived community intolerance of MSM and perceived community discrimination toward people living with HIV. These subscales show promise as reliable, valid measures for assessing sexual behavior stigma among MSM in Mexico, and as tools for documenting and tracking sexual behavior stigma trends, comparing regional burdens of sexual behavior stigma, and tracking the progress of stigma-mitigation interventions among MSM in Mexico. Future research is needed to understand the extent to which each subscale is differentially associated with sexual (and other) health outcomes, which can inform the development and implementation of uniquely tailored stigma-mitigation, HIV-prevention, HIV-care, and other needed interventions for MSM in Mexico.
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Affiliation(s)
- John Mark Wiginton
- School of Social Work, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA.
- Department of Medicine, University of California-San Diego, San Diego, USA.
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Angel B Algarin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, CA, San Diego, USA
| | - Stefan D Baral
- Center for Public Health & Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Travis H Sanchez
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, CA, San Diego, USA
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Trang K, Jovanovic T, Hinton DE, Sullivan P, Worthman CM, Lam LX, Chi NK, Thanh NC, Ha TV, Go V, Hoffman I, Giang LM. Elevated trauma exposure and mental health burden among men who have sex with men in Vietnam. Transcult Psychiatry 2022; 59:362-379. [PMID: 35072562 DOI: 10.1177/13634615211058348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to characterize trauma exposure and mental health burden among men who have sex with men (MSM) in Hanoi, Vietnam. Participants comprise 100 HIV-positive and 98 high-risk, HIV-negative MSM, ranging from 18 to 29 years of age. Data were collected using the Childhood Trauma Questionnaire, Traumatic Events Inventory, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and PTSD Symptom Scale. A subset of participants (n = 12) were also interviewed to evaluate community perception of the prevalence, causation, and available treatment options for mental health issues within the MSM community in Vietnam. In our sample, 23.2% reported having experienced moderate-to-severe childhood physical abuse; 18.7% physical neglect; 13.6% emotional abuse; 11.1% emotional neglect; and 26.8% sexual abuse. Such trauma exposure continued into adulthood and manifested most commonly in the form of interpersonal violence. Approximately 37.4% of the sample met the criteria for probable PTSD; 26.8% for moderate-to-severe depression; and 20.2% for moderate-to-severe anxiety. Neither exposure nor mental health burden differed by serostatus. Linear regression revealed that childhood emotional abuse was the only sub-type of trauma significantly associated with depression, anxiety, and PTSD symptoms. The majority of interviewees believed that mental health burden was higher among MSM relative to the general population and attributed this to their vulnerability to interpersonal violence and lack of available coping resources. However, few believed that these mental health issues warranted clinical attention, and only one participant was able to identify a mental health service provider. Our findings suggest that trauma exposure and mental health burden are prevalent among MSM, irrespective of serostatus, and much higher than what has been previously reported among the general population in Vietnam.
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Bui TM, Chiu R, Chiu RG, Nguyen QN, Nguyen LH, Nguyen HLT, Vu LG, Vu GT, Van Ngo T, Vu TMT, Tran BX, Latkin CA, Ho CSH, Ho RCM. Depressive symptoms are associated with immunological failure among HIV-positive patients in Vietnam. PSYCHOL HEALTH MED 2021; 28:1244-1250. [PMID: 34789031 DOI: 10.1080/13548506.2021.2005808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
As the lives of people living with HIV (PLWH) become increasingly normalized, more focus is being given to the associated comorbidities of HIV, including those related to mental health such as depression. This study aims to evaluate the correlation between depressive symptoms and HIV outcomes in Vietnam through the measurement of CD4 cell count. A mixed design was utilized, in which both a longitudinal assessment of CD4 cell counts and a cross-sectional survey of depressive symptoms were conducted on 481 patients in the Bach Mai and Ha Dong HIV clinics (Hanoi, Vietnam). CD4 cell count data was extracted from the medical records of participants, and depressive symptoms were screened using the Patient Health Questionnaire (PHQ-9). The results illustrate that the presence of moderately severe to severe depressive symptoms is associated with lower CD4 cell counts, indicating poorer HIV outcomes resulting from comorbid depression. This correlation was especially noticeable in the PHQ-9 items for psychomotor agitation/retardation (p < 0.05) and suicidal ideation (p < 0.05). Future policy and treatment options for HIV in Vietnam should consider the presence of comorbid mental health conditions in order to provide more suitable and effective treatment in the goal of providing a higher quality of life for PLWH.
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Affiliation(s)
- Thu Minh Bui
- Bach Mai Medical College, Bach Mai Hospital, Hanoi, Vietnam
| | - Richard Chiu
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Ryan G Chiu
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Quang N Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.,UFR Biosciences Department Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Long Hoang Nguyen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Huong Lan Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.,Faculty of Nursing, Duy Tan University, Da Nang, Vietnam
| | - Linh Gia Vu
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.,Faculty of Nursing, Duy Tan University, Da Nang, Vietnam
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Toan Van Ngo
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Thuc Minh Thi Vu
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MA, USA
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Institute for Health Innovation and Technology (IHealthtech), National University of Singapore, Singapore, Singapore
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Septarini NW, Hendriks J, Maycock B, Burns S. Methodologies of Stigma-Related Research Amongst Men Who Have Sex With Men (MSM) and Transgender People in Asia and the Pacific Low/Middle Income Countries (LMICs): A Scoping Review. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:688568. [PMID: 36304052 PMCID: PMC9580832 DOI: 10.3389/frph.2021.688568] [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: 03/31/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022] Open
Abstract
Much stigma-related research focuses on marginalized populations, including men who have sex with men (MSM) and transgender people. The importance of research in this area is widely recognized, however methodologies and measures vary between studies. This scoping review will collate existing information about how stigma-related research has been conducted in low/middle income countries (LMICs) within the Asia Pacific region, and will compare research designs, sampling frameworks, and measures. Strengths and limitations of these studies will inform recommendations for future stigma-related health research. A methodological framework for scoping studies was applied. Searches of Psych INFO, Scopus, ProQuest, Global Health and PubMed were used to identify articles. Stigma-related research amongst MSM and transgender communities, published between 2010 and 2019 in LMICs within the Asia Pacific region were included. A total of 129 articles based on 123 different studies were included. Of the 129 articles 51.19% (n = 66) were quantitative; 44.96% (n = 57) were qualitative and 3.88% (n = 5) were mixed methods studies. The majority of studies (n = 57; 86.36%) implemented a cross sectional survey. In-depth interviews (n = 20, 34.48%) were also common. Only 3.88% of studies utilized mixed-methods design. Non-probabilistic and probabilistic sampling methods were employed in 99.22 and 0.78% of studies respectively. The most common measures used in quantitative studies were the Center for Epidemiological Study on Depression (CES-D) (n = 18) and the Self Stigma Scale (SSS) (n = 6). Strengths and limitations proposed by researchers included in this review are summarized as lesson learnt and best practices in stigma-related research.
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Affiliation(s)
- Ni Wayan Septarini
- School of Population Health, Curtin University, Perth, WA, Australia
- Department of Community and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
- *Correspondence: Ni Wayan Septarini ;
| | - Jacqueline Hendriks
- School of Population Health, Curtin University, Perth, WA, Australia
- Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Perth, WA, Australia
| | - Bruce Maycock
- European Center for Environmental and Human Health, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Sharyn Burns
- School of Population Health, Curtin University, Perth, WA, Australia
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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: 11] [Impact Index Per Article: 3.7] [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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Hershow RB, Miller WC, Giang LM, Sripaipan T, Bhadra M, Nguyen SM, Vu VD, Bui Q, Ha TV, Go VF. Minority Stress and Experience of Sexual Violence Among Men Who Have Sex With Men in Hanoi, Vietnam: Results From a Cross-Sectional Study. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:6531-6549. [PMID: 30569781 DOI: 10.1177/0886260518819884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Men who have sex with men (MSM) are highly vulnerable to sexual violence, a known driver of HIV infection. Homosexuality stigma may be a unique risk factor for sexual violence among MSM. In this study, we examine the relationship between homosexuality stigma measures and sexual violence in the last 12 months using a minority stress framework. MSM were recruited using convenience and snowball sampling. Participants completed an interviewer-administered survey and provided blood samples for HIV testing. Bivariable associations were tested between self-reported experience of sexual violence in the last 12 months and homosexuality stigma measures using odds ratios (ORs) produced by Cochran-Mantel-Haenszel Statistics. A logistic regression model for each type of minority stress was built to conduct the multivariable analyses with independent covariates. Of 202 MSM, 29 (14.4%) participants reported experiencing sexual violence in the last 12 months. About one fourth of participants reported experiencing high enacted (55/202; 27.2%), perceived (52/202; 25.7%), and internalized (60/202; 29.7%) homosexuality stigma. In bivariable and multivariable analyses, enacted homosexuality stigma was the only variable consistently associated with experience of sexual violence in the last 12 months (aOR: 3.5; 95% confidence interval [CI]: [1.5, 8.4]). Sexual violence and homosexuality stigma are highly prevalent among MSM in Hanoi, Vietnam. MSM-targeted HIV prevention interventions in Vietnam should incorporate violence prevention and homosexuality stigma reduction activities. Longitudinal studies are needed to understand how homosexuality stigma influences sexual violence and other HIV risk behaviors among MSM.
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Affiliation(s)
| | | | | | | | | | | | | | - Quynh Bui
- The University of North Carolina at Chapel Hill, USA
| | - Tran Viet Ha
- The University of North Carolina at Chapel Hill, USA
| | - Vivian F Go
- The University of North Carolina at Chapel Hill, USA
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Feinstein BA, Swann G, Sarno EL, Moran KO, Newcomb ME, Mustanski B. Minority Stressors and Identity Affirmation as Predictors of Condomless Sex Among Self-Identified Bisexual Men: The Role of Partner Gender. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1057-1065. [PMID: 32651880 PMCID: PMC7796898 DOI: 10.1007/s10508-020-01775-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 04/15/2020] [Accepted: 06/12/2020] [Indexed: 06/11/2023]
Abstract
Bisexual men are at increased risk for HIV/STI and early pregnancy involvement compared to heterosexual men, and minority stressors (e.g., enacted and internalized stigma) are associated with sexual risk behavior in samples of gay and bisexual men. However, few studies have specifically focused on bisexual men, and little is known about the unique predictors of sexual risk behavior in this population. Further, few studies have focused on positive sexual orientation-related factors such as identity affirmation, which may be protective against sexual risk behavior. As such, the goals of the current study were to examine minority stressors and identity affirmation as predictors of condomless sex among self-identified bisexual men, and whether these associations differed as a function of partner gender. We used four waves of data spanning 24 months from a subset of self-identified bisexual men in a larger cohort of gay and bisexual men ages 16-29 years at enrollment. At each wave, participants reported on up to four partners, allowing us to examine within-person associations. We used mixed effects negative binomial models to examine the associations between our predictors (discrimination, internalized binegativity, and identity affirmation) and condomless sex acts. In addition, we tested whether partner gender moderated each of the associations by including interaction effects in each of the models. Results indicated that higher levels of internalized binegativity and lower levels of identity affirmation were associated with less condomless sex with female partners, but they were not associated with condomless sex with male partners. Discrimination was not associated with condomless sex with male or female partners. These findings suggest that predictors of condom use among self-identified bisexual men differ as a function of partner gender, and they highlight the need to identify strategies to promote sexual health while also supporting positive identity development in this population.
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Affiliation(s)
- Brian A Feinstein
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., Suite 1400, Chicago, IL, 60611, USA.
| | - Gregory Swann
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Elissa L Sarno
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kevin O Moran
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael E Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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da Silva LAV, Duarte FM, Magno L, Dourado I, Squire C. Moral barriers to HIV prevention and care for gay and bisexual men: Challenges in times of conservatism in Brazil. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:424-440. [PMID: 33432619 DOI: 10.1111/1467-9566.13230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 10/26/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
This article examines narratives about promiscuity that are emphasized by some gay and bisexual men who are themselves living with HIV. We used semi-structured interviews to assess the processes, outcomes, and meanings of HIV diagnosis among 10 young gay and bisexual men aged between 18 and 30 years old. Interviews were conducted in health service settings for the diagnosis and treatment of HIV and AIDS in Salvador, Brazil. Based on a socioculturally oriented approach, the narratives suggest that discourse about promiscuity seems to persist, or is even strengthened, in order to explain HIV infection among young gays/bisexual men and to emphasize a more restrained sexual life following HIV diagnosis. Despite the biotechnologies and biomedical advances, some difficulties and tensions also persist in the daily life of young people living with HIV. Difficulties in starting new relationships, dilemmas around responsibility for infection/transmission, fear and guilt are elements that stand out in these narratives, demonstrating that HIV discourses and practices may produce greater stigma and discrimination in current times, individualizing and blaming certain people for the infection/transmission of the virus, and marginalizing practices that do not conform to hegemonic heteronormativity.
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Affiliation(s)
- Luís Augusto Vasconcelos da Silva
- Institute of Humanities, Arts and Sciences Professor Milton Santos, Federal University of Bahia (Universidade Federal da Bahia: UFBA), Salvador, Brazil
- Institute of Collective Health, UFBA, Salvador, Brazil
| | | | - Laio Magno
- Institute of Collective Health, UFBA, Salvador, Brazil
- Department of Life Sciences, Bahia State University, Salvador, Brazil
| | - Inês Dourado
- Institute of Collective Health, UFBA, Salvador, Brazil
| | - Corinne Squire
- Centre for Narrative Research, School of Social Sciences, University of East London, London, UK
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Espinosa da Silva C, Smith LR, Patterson TL, Semple SJ, Harvey-Vera A, Nunes S, Rangel G, Pines HA. Stigma and Web-Based Sex Seeking Among Men Who Have Sex With Men and Transgender Women in Tijuana, Mexico: Cross-Sectional Study. JMIR Public Health Surveill 2020; 6:e14803. [PMID: 32031963 PMCID: PMC7055757 DOI: 10.2196/14803] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 09/20/2019] [Accepted: 11/15/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Stigma toward sexual and gender minorities is an important structural driver of HIV epidemics among men who have sex with men (MSM) and transgender women (TW) globally. Sex-seeking websites and apps are popular among MSM and TW. Interventions delivered via Web-based sex-seeking platforms may be particularly effective for engaging MSM and TW in HIV prevention and treatment services in settings with widespread stigma toward these vulnerable populations. OBJECTIVE To assess the potential utility of this approach, the objectives of our study were to determine the prevalence of Web-based sex seeking and examine the effect of factors that shape or are influenced by stigma toward sexual and gender minorities on Web-based sex seeking among MSM and TW in Tijuana, Mexico. METHODS From 2015 to 2018, 529 MSM and 32 TW were recruited through venue-based and respondent-driven sampling. Interviewer-administered surveys collected information on Web-based sex seeking (past 4 months) and factors that shape or are influenced by stigma toward sexual and gender minorities (among MSM and TW: traditional machismo, internalized stigma related to same-sex sexual behavior or gender identity, and outness related to same-sex sexual behavior or gender identity; among MSM only: sexual orientation and history of discrimination related to same-sex sexual behavior). A total of 5 separate multivariable logistic regression models were used to examine the effect of each stigma measure on Web-based sex seeking. RESULTS A total of 29.4% (165/561) of our sample reported seeking sex partners on the Web. Web-based sex seeking was negatively associated with greater endorsement of traditional machismo values (adjusted odds ratio [AOR] 0.36, 95% CI 0.19 to 0.69) and greater levels of internalized stigma (AOR 0.96, 95% CI 0.94 to 0.99). Web-based sex seeking was positively associated with identifying as gay (AOR 2.13, 95% CI 1.36 to 3.33), greater outness (AOR 1.17, 95% CI 1.06 to 1.28), and a history of discrimination (AOR 1.83, 95% CI 1.08 to 3.08). CONCLUSIONS Web-based sex-seeking is relatively common among MSM and TW in Tijuana, suggesting that it may be feasible to leverage Web-based sex-seeking platforms to engage these vulnerable populations in HIV prevention and treatment services. However, HIV interventions delivered through Web-based sex-seeking platforms may have limited reach among those most affected by stigma toward sexual and gender minorities (ie, those who express greater endorsement of traditional machismo values, greater levels of internalized stigma, lesser outness, and nongay identification), given that within our sample they were least likely to seek sex on the Web.
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Affiliation(s)
| | - Laramie R Smith
- Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Thomas L Patterson
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Shirley J Semple
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | | | - Stephanie Nunes
- Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Gudelia Rangel
- United States-Mexico Border Health Commission, Tijuana, Mexico
- El Colegio de la Frontera Norte, Tijuana, Mexico
| | - Heather A Pines
- Department of Medicine, University of California, San Diego, La Jolla, CA, United States
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Coulaud PJ, Sagaon-Teyssier L, Mimi M, M'madi Mrenda B, Maradan G, Mora M, Bourrelly M, Keita BD, Keita AA, Anoma C, Babo Yoro SA, Dah TTE, Coulibaly C, Mensah E, Agbomadji S, Bernier A, Couderc C, Laurent C, Spire B. Combined Sexual Behavioral Profiles in HIV-Seronegative Men Who have Sex with Men in West Africa (CohMSM ANRS 12324-Expertise France). ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:331-345. [PMID: 31399923 DOI: 10.1007/s10508-019-01513-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 06/10/2019] [Accepted: 07/10/2019] [Indexed: 06/10/2023]
Abstract
Understanding the dynamics of HIV infection in men who have sex with men (MSM) can help improve efficiency in existing prevention strategies. We aimed to identify and describe the sexual behaviors of MSM most at risk of HIV infection in West Africa. HIV-negative MSM were provided a quarterly preventive follow-up package in the community-based cohort CohMSM. They completed face-to-face sociobehavioral questionnaires every 6 months. This sub-study on 520 participants used a baseline, 6-, 12- and 18-month data cluster analysis to categorize two profiles (high risk [HRE] and moderate risk [MRE] of exposure to HIV) based on three risky sexual practices over the previous 6 months. HRE-MSM (61%) were more engaged in receptive practices, had a higher proportion of inconsistent condom use during anal sex, and reported more sexual partners than MRE-MSM (39%). The proportion of HIV seroconversions observed during the first 18 months of follow-up using sexual behavioral profiles (92% are HRE-MSM) was higher than using the three risky sexual practices separately. Factors associated with the HRE-MSM profile were being younger (18-21 years), reporting stigma, and having had no female partner while being attracted only to men. Our findings suggest that in order to identify MSM most at risk of HIV infection, several risky sexual practices need to be evaluated in a combined approach. Prevention programs should pay particular attention to younger MSM, and implement activities addressing questions of MSM identity and stigma in order to reduce the dynamic of HIV infection in Western African MSM.
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Affiliation(s)
- Pierre-Julien Coulaud
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France.
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France.
| | - Luis Sagaon-Teyssier
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Mohamed Mimi
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Bakridine M'madi Mrenda
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Gwenaëlle Maradan
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Marion Mora
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Michel Bourrelly
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | | | | | | | - Ter Tiero Elias Dah
- Association African Solidarité, Ouagadougou, Burkina Faso
- Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | | | | | | | | | | | | | - Bruno Spire
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
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Metheny N, Stephenson R. Political Environment and Perceptions of Social Inclusion After Nationwide Marriage Equality Among Partnered Men Who Have Sex with Men in the USA. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2019; 16:521-528. [PMID: 31798756 PMCID: PMC6889050 DOI: 10.1007/s13178-018-0357-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The aim of this paper is to examine how nationwide marriage equality and minority stressors are associated with perceptions of social inclusion using a national sample of partnered men who have sex with men (MSM)(n=498). A four-item scale measuring changes in perceived social inclusion due to the nationwide legalization of same-sex marriage was created. Respondents were categorized into four distinct political environments using results from the 2016 US Presidential election. Multilevel modeling was used to examine associations between political environment, minority stressors, and perceived social inclusion. Changes in perceived social inclusion due to marriage equality did not significantly differ between political environments. Higher levels of internalized, anticipated, and enacted stigma were all associated with fewer gains in perceived social inclusion. An interaction between political environment and external stigma was significant in the most politically conservative areas. The legalization of marriage equality has improved perceived social inclusion overall, but less so among men who experience more discrimination and live in conservative environments. Multilevel interventions to change social norms are needed to help decrease minority stressors and improve perceived social inclusion in politically conservative areas with elevated levels of discrimination.
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Affiliation(s)
- Nicholas Metheny
- University of Michigan School of Nursing, Ann Arbor, MI,
USA
- University of Michigan Center for Sexuality and Health
Disparities, Ann Arbor, MI, USA
| | - Rob Stephenson
- University of Michigan School of Nursing, Ann Arbor, MI,
USA
- University of Michigan Center for Sexuality and Health
Disparities, Ann Arbor, MI, USA
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Pathways From Sexual Stigma to Inconsistent Condom Use and Condom Breakage and Slippage Among MSM in Jamaica. J Acquir Immune Defic Syndr 2019; 78:513-521. [PMID: 29697593 DOI: 10.1097/qai.0000000000001712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV prevalence among men who have sex with men (MSM) in Jamaica, where same sex practices are criminalized, is among the Caribbean's highest. Sexual stigma, the devaluation, mistreatment, and reduced power afforded to sexual minorities, is a distal driver of HIV vulnerabilities. The mechanisms accounting for associations between sexual stigma and condom use outcomes are underexplored. We examined pathways from sexual stigma to condom use and condom breakage and/or slippage among MSM in Jamaica. METHODS We conducted a cross-sectional survey with a chain-referral sample of MSM (n = 556) in Kingston, Montego Bay, and Ocho Rios. Structural equation modeling using weighted least squares estimation methods was conducted to test the direct effects of sexual stigma on inconsistent condom use and condom breakage/slippage, and the indirect effects through depression, sexual abuse history, and condom use self-efficacy, adjusting for sociodemographic factors. RESULTS One-fifth of participants (21%; 90/422) who had engaged in anal sex reported inconsistent condom use, and 38% (155/410) reported condom breakage/slippage during the previous 4 weeks. The relationship between sexual stigma and inconsistent condom use was mediated by the combination effect of sexual abuse history, condom use self-efficacy, and depression. The relationship between sexual stigma and condom breakage and slippage was mediated by the combination effect of condom use self-efficacy and sexual abuse history. CONCLUSIONS Sexual stigma is associated with negative condom use outcomes in Jamaican MSM, mediated by psychosocial factors. Multilevel social ecological approaches to the HIV prevention cascade can inform interventions at individual, interpersonal, community, and systemic levels.
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15
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Coulaud PJ, Sagaon-Teyssier L, Mimi M, Maradan G, Mora M, Bourrelly M, Dembélé Keita B, Keita AA, Anoma C, Yoro SAB, Dah ETT, Coulibaly C, Mensah E, Agbomadji S, Palvadeau P, Bernier A, Rojas Castro D, Couderc C, Laurent C, Spire B. Changes in risky sexual behaviours among West African MSM enrolled in a quarterly HIV testing and counselling prevention programme (CohMSM ANRS 12324 - Expertise France). Sex Transm Infect 2019; 96:115-120. [PMID: 31371449 DOI: 10.1136/sextrans-2018-053892] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 06/10/2019] [Accepted: 07/09/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Whether regular HIV testing and counselling reduce risky sexual behaviours in African men who have sex with men (MSM) is still a matter for debate. We aimed to identify behavioural trajectories based on HIV risk exposure (HRE) and factors affecting their evolution. METHODS Data were collected from 621 HIV-negative West African MSM (Mali, Cote d'Ivoire, Burkina Faso and Togo) included in a community-based cohort providing quarterly HIV testing and counselling. Sociobehavioural data were collected every 6 months. HRE was defined as reporting inconsistent condom use during receptive anal sex with male partners of unknown HIV status in the previous 6 months. Using 18-month follow-up data, group-based trajectory modelling helped identify behavioural trajectories and determine the factors associated with their evolution. HIV seroconversions (n=67) were specified in each group trajectory. RESULTS Two distinct group trajectories were identified: medium-risk exposure MSM (ME-MSM) (61%, 6.4% of whom having seroconverted) and high-risk exposure MSM (HE-MSM) (39%, 17.5% of whom having seroconverted). A significant declining trend in the probability of reporting HRE over time ((95% CI)) was observed for HE-MSM (from 0.59 (0.48 to 0.70) at M0 to 0.31 (0.22 to 0.41) at M18), while it remained constant for ME-MSM (0.034 (0.0 to 0.079)). This can be explained by a progressive use of risk reduction strategies (less receptive anal sex, better knowledge of their partners' status and increasing condom use). Being younger, living in Burkina Faso, self-considering both a man and a woman and reporting a higher level of depression were all associated with HE membership. Among HE-MSM, HRE was higher in those practising transactional or group sex and those experiencing psychological harassment. CONCLUSIONS Quarterly HIV testing and counselling seem to reduce risky sexual behaviours in HIV-negative MSM at greatest risk of infection. Specific support for young MSM, focusing on identity and mental health, is needed to strengthen HIV prevention in West African MSM.
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Affiliation(s)
- Pierre-Julien Coulaud
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France .,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Mohamed Mimi
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Gwenaëlle Maradan
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Michel Bourrelly
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | | | | | | | - Elias Ter Tiero Dah
- Association African Solidarité, Ouagadougou, Burkina Faso.,Centre MURAZ, Bobo-Dioulasso, Burkina Faso
| | | | | | | | - Pamela Palvadeau
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | - Adeline Bernier
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | - Daniela Rojas Castro
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | | | | | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
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Desyani NLJ, Waluyo A, Yona S. The relationship between stigma, religiosity, and the quality of life of HIV-positive MSM in Medan, Indonesia. ENFERMERIA CLINICA 2019. [PMID: 31300297 DOI: 10.1016/j.enfcli.2019.04.077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aims to determine the relationship between stigma, religiosity, and the quality of life of HIV-positive men who have sex with men (MSM) in Medan. METHODS This is an analytical observational study with a cross-sectional approach. Data in demographics, stigma, religiosity, and quality of life were obtained directly from the participants. Data were taken from April to May 2018. There were 175 subjects who met the criteria which; (i) HIV-positive MSM; (ii) aged≥18 y.o.; and (iii) able to read and write. RESULTS Bivariate analysis found that there is a negative relationship between stigma and quality of life (p-value=0.007), and there is a positive relationship between religiosity and quality of life (p-value=0.000). CONCLUSION These findings suggest that stigma is an indicator of poor quality of life, while higher religiosity is associated with better quality of life. An interdisciplinary approach is needed in health care planning and social services, to improve the quality of life of HIV-positive MSM.
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Affiliation(s)
- Ni Luh Jayanthi Desyani
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia; Health of Polytechnic Manado, North Sulawesi, Indonesia
| | - Agung Waluyo
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia.
| | - Sri Yona
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
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A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries. BMC Med 2019; 17:17. [PMID: 30764819 PMCID: PMC6376728 DOI: 10.1186/s12916-019-1250-8] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/02/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Stigma is associated with health conditions that drive disease burden in low- and middle-income countries (LMICs), including HIV, tuberculosis, mental health problems, epilepsy, and substance use disorders. However, the literature discussing the relationship between stigma and health outcomes is largely fragmented within disease-specific siloes, thus limiting the identification of common moderators or mechanisms through which stigma potentiates adverse health outcomes as well as the development of broadly relevant stigma mitigation interventions. METHODS We conducted a scoping review to provide a critical overview of the breadth of research on stigma for each of the five aforementioned conditions in LMICs, including their methodological strengths and limitations. RESULTS Across the range of diseases and disorders studied, stigma is associated with poor health outcomes, including help- and treatment-seeking behaviors. Common methodological limitations include a lack of prospective studies, non-representative samples resulting in limited generalizability, and a dearth of data on mediators and moderators of the relationship between stigma and health outcomes. CONCLUSIONS Implementing effective stigma mitigation interventions at scale necessitates transdisciplinary longitudinal studies that examine how stigma potentiates the risk for adverse outcomes for high-burden health conditions in community-based samples in LMICs.
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Finding Sex Partners Through Social Media Among Men Who Have Sex with Men in Hanoi, Vietnam. J Community Health 2019; 43:146-156. [PMID: 28677027 DOI: 10.1007/s10900-017-0397-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Many men who have sex with men (MSM) in low and middle income countries search for male sexual partners via social media in part due to societal stigma and discrimination, yet little is known about the sexual risk profiles of MSM social media users. This cross-sectional study investigates the prevalence of social media use to find male sex partners in Hanoi, Vietnam and examines associations between social media use and sociodemographic and behavioral characteristics, including levels of internalized, perceived and enacted stigma, high-risk sexual behaviors, and HIV testing. 205 MSM were recruited from public venues where MSM congregate as well as through snowball sampling and completed an anonymous survey. MSM who found their male sexual partners using social media in the last year were more likely to have completed a university or higher degree (aOR 2.6; 95% CI 1.2-5.7), experience high levels of MSM-related perceived stigma (aOR 3.0; 95% CI 1.1-8.0), and have more than ten lifetime male sexual partners (aOR 3.2; 95% CI 1.3-7.6) compared to those who did not use social media. A niche for social media-based interventions integrating health and stigma-reduction strategies exists in HIV prevention programs for MSM.
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Nguyen VAT, Nguyen NQH, Khuat TH, Nguyen PTT, Do TT, Vu XT, Tran K, Ho MT, Nguyen HKT, Vuong TT, Vuong QH. Righting the Misperceptions of Men Having Sex with Men: A Pre-Requisite for Protecting and Understanding Gender Incongruence in Vietnam. J Clin Med 2019; 8:E105. [PMID: 30658424 PMCID: PMC6351936 DOI: 10.3390/jcm8010105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 01/16/2023] Open
Abstract
Protecting the rights of the lesbians, gays, bisexuals, transgender, intersex, and queers (LGBTIQ) population requires, first and foremost, a proper understanding of their sexual orientation and gender identity. This study highlights a severe misunderstanding and lack of knowledge among health professionals in Vietnam with regard to the men who have sex with men (MSM) and transgenders. This study uses (i) a survey based on the convenience sampling method among 150 health workers that covered 61 questions and (ii) 12 in-depth interviews in two metropolitan centres in Vietnam, Hanoi and Ho Chi Minh city. Three main topics are explored: (i) the general knowledge of healthcare workers about MSM and transgenders; (ii) their knowledge about the sexual reproductive health and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) risks of MSM and transgenders; and (iii) their attitudes and behaviors towards MSM and transgenders. One of the notable findings is how prevalent the misperceptions are across the board, namely, in staff of both sexes, in both cities, at various kinds of medical facilities, at different work positions and educational levels. Half of the respondents consider transgenders to have a curable mental problem while 45% say MSM only have sex with males. Most remarkably, 12.7% state if they have any choice, they want nothing to do with MSM and transgenders. The study finds there is a considerable percentage of health professionals who lack knowledge about the diversity of sexual orientation, gender identity, and health issues related to the sexual minorities and gender non-conforming population. To improve the clinical process for serving these at-risk groups, the study suggests the continual education for the health workers needs to be added to their formal as well as in-job training.
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Affiliation(s)
- Van Anh T Nguyen
- Institute for Social Development Studies (ISDS), Hanoi 100000, Vietnam.
| | | | - Thu Hong Khuat
- Institute for Social Development Studies (ISDS), Hanoi 100000, Vietnam.
| | | | - Thu Trang Do
- Institute for Social Development Studies (ISDS), Hanoi 100000, Vietnam.
| | - Xuan Thai Vu
- Institute for Social Development Studies (ISDS), Hanoi 100000, Vietnam.
| | - Kien Tran
- Institute for Social Development Studies (ISDS), Hanoi 100000, Vietnam.
- School of Law, Vietnam National University, Hanoi 100000, Vietnam.
| | - Manh Tung Ho
- Centre for Interdisciplinary Social Research, Phenikaa University, Yen Nghia, Ha Dong, Hanoi 100803, Vietnam.
- Faculty of Economics and Finance, Phenikaa University, Yen Nghia, Ha Dong, Hanoi 100803, Vietnam.
| | | | | | - Quan Hoang Vuong
- Centre for Interdisciplinary Social Research, Phenikaa University, Yen Nghia, Ha Dong, Hanoi 100803, Vietnam.
- Faculty of Economics and Finance, Phenikaa University, Yen Nghia, Ha Dong, Hanoi 100803, Vietnam.
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Coulaud PJ, Sagaon-Teyssier L, M'madi Mrenda B, Maradan G, Mora M, Bourrelly M, Dembélé Keita B, Keita AA, Anoma C, Babo Yoro SA, Dah TTE, Coulibaly C, Mensah E, Agbomadji S, Bernier A, Couderc C, Laurent C, Spire B. Interest in HIV pre-exposure prophylaxis in men who have sex with men in West Africa (CohMSM ANRS 12324 - Expertise France). Trop Med Int Health 2018; 23:1084-1091. [PMID: 30055043 DOI: 10.1111/tmi.13129] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore the interest in taking PrEP among Western African men who have sex with men (MSM). METHODS A cross-sectional survey was implemented at enrolment of HIV-negative MSM in a multiple centre community-based cohort study in four West African countries (Mali, Côte d'Ivoire, Burkina Faso, Togo). A standardised face-to-face questionnaire collected data on socio-demographic and behavioural characteristics over the previous 6 months. Descriptive analysis and multivariate logistic regression helped identify factors associated with the interest in taking PrEP. RESULTS Of 564 participants, 87% were interested in taking PrEP. Interest in PrEP was associated with inconsistent condom use for anal sex (adjusted odds ratio (aOR): 2.11; 95% confidence interval (CI) 1.21-3.67), transactional sex (aOR: 2.02; 95% CI 1.11-3.71), searching for male sexual partners on the Internet in the previous month (aOR: 1.86; 95% CI 1.01-3.43), having a high level of self-esteem (aOR: 1.20; 95% CI 1.06-1.36), having at least one sexually transmitted infections at enrolment (aOR: 5.08; 95% CI 1.40-18.4) and not being aware of PrEP (aOR: 2.03; 95% CI 1.04-3.96). Participants having sex with HIV-positive male partners (aOR: 0.28; 95% CI 0.11-0.74), those being more sexually attracted to women than to men (aOR: 0.20; 95% CI 0.07-0.89) and those reporting psychological and material support from close friends (aOR: 0.33; 95% CI 0.15-0.73) were less interested in taking PreP. CONCLUSIONS Western African HIV-negative MSM appear very interested in taking PrEP, especially those most at risk of HIV infection. PrEP implementation in a comprehensive prevention package should be considered urgently.
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Affiliation(s)
- Pierre-Julien Coulaud
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, SESSTIM, IRD, INSERM, Aix Marseille Université, Marseille, France.,Observatoire régional de la santé Provence-Alpes-Côte d'Azur, ORS PACA, Marseille, France
| | - Luis Sagaon-Teyssier
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, SESSTIM, IRD, INSERM, Aix Marseille Université, Marseille, France.,Observatoire régional de la santé Provence-Alpes-Côte d'Azur, ORS PACA, Marseille, France
| | - Bakridine M'madi Mrenda
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, SESSTIM, IRD, INSERM, Aix Marseille Université, Marseille, France.,Observatoire régional de la santé Provence-Alpes-Côte d'Azur, ORS PACA, Marseille, France
| | - Gwenaëlle Maradan
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, SESSTIM, IRD, INSERM, Aix Marseille Université, Marseille, France.,Observatoire régional de la santé Provence-Alpes-Côte d'Azur, ORS PACA, Marseille, France
| | - Marion Mora
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, SESSTIM, IRD, INSERM, Aix Marseille Université, Marseille, France.,Observatoire régional de la santé Provence-Alpes-Côte d'Azur, ORS PACA, Marseille, France
| | - Michel Bourrelly
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, SESSTIM, IRD, INSERM, Aix Marseille Université, Marseille, France.,Observatoire régional de la santé Provence-Alpes-Côte d'Azur, ORS PACA, Marseille, France
| | | | | | | | | | - Ter Tiero Elias Dah
- Association African Solidarité, Ouagadougou, Burkina Faso.,Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | | | | | | | | | | | | | - Bruno Spire
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, SESSTIM, IRD, INSERM, Aix Marseille Université, Marseille, France.,Observatoire régional de la santé Provence-Alpes-Côte d'Azur, ORS PACA, Marseille, France
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21
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Measurements of Sexuality-Based Stigma among Gay, Bisexual, and Other Men Who Have Sex with Men (GBMSM) in Resource-Poor Settings: A Review. AIDS Behav 2018; 22:1614-1638. [PMID: 29128941 DOI: 10.1007/s10461-017-1975-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Gay, bisexual, and other men who have sex with men (GBMSM) in resource-poor settings are disproportionately affected by the HIV/AIDS epidemic. GBMSM living in these settings may face unique barriers to HIV prevention, including legal barriers and increased sexuality-based stigma. It is therefore imperative to tailor HIV prevention and care resources to recognize the lived realities of GBMSM in these settings. Central to this is the accurate measurement of sexuality-based stigma. However, there is wide inconsistency in how sexuality-based stigma is measured among GBMSM in resource-poor settings. This paper reviews recent studies of sexuality-based stigma among GBMSM in resource-poor settings, finding great variability in measurements. The results of the review call for greater attention to the development of contextually and culturally specific measures of sexuality-based stigma for GBMSM living in resource-poor settings.
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The relation between mental health, homosexual stigma, childhood abuse, community engagement, and unprotected anal intercourse among MSM in China. Sci Rep 2018; 8:3984. [PMID: 29507341 PMCID: PMC5838107 DOI: 10.1038/s41598-018-22403-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 02/22/2018] [Indexed: 12/02/2022] Open
Abstract
The aim of the study was to explore the relation of various factors with unprotected anal intercourse (UAI) and provide some insight for HIV intervention on Chinese men who have sex with men (MSM). The current cross-sectional study recruited 365 MSM in Dalian, China. More than half of the respondents (117 respondents, 51.8% of the sample) had engaged in UAI. The multivariable logistic regression model suggested that poorer mental health (AOR: 7.16; 95% CI: 3.14–16.31), self-stigma (AOR: 1.53; 95% CI: 1.00–2.34), and experience(s) of physical abuse in childhood (AOR: 5.85; 95% CI: 1.77–19.30) were significantly and positively related to UAI. Community engagement was negatively associated with UAI (p < 0.05). It appears it is necessary to incorporate mental health services, eliminate the stigma against homosexuality, and facilitate MSM-related community engagement into intervention strategies to prevent UAI among Chinese MSM. Targeted UAI interventions in the subgroup with a history of childhood physical abuse should also be of great concern.
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23
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Lamontagne E, d’Elbée M, Ross MW, Carroll A, Plessis AD, Loures L. A socioecological measurement of homophobia for all countries and its public health impact. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Erik Lamontagne
- UNAIDS, Geneva, Switzerland
- Aix-Marseille School of Economics, Marseille cedex 2, France
| | - Marc d’Elbée
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael W Ross
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Aengus Carroll
- The International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA), Geneva, Switzerland
| | - André du Plessis
- The International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA), Geneva, Switzerland
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24
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Pathways from sexual stigma to incident HIV and sexually transmitted infections among Nigerian MSM. AIDS 2017; 31:2415-2420. [PMID: 28926403 DOI: 10.1097/qad.0000000000001637] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Sexual stigma affecting MSM in Nigeria may be an important driver of HIV and other sexually transmitted infections (STIs), but potential mechanisms through which this occurs are not well understood. This study assessed the contributions of suicidal ideation and sexual risk behaviors to causal pathways between stigma and HIV/STIs. DESIGN Data were collected from the TRUST/RV368 Study, a prospective cohort of 1480 MSM from Abuja and Lagos, Nigeria. METHODS Participants enrolled from March 2013 to February 2016 were classified into three stigma subgroups based on a latent class analysis of nine stigma indicators. Path analysis was used to test a model where disclosure led to stigma, then suicidal ideation, then condomless sex with casual sex partners, and finally incident HIV infection and/or newly diagnosed STIs, adjusting the model for age, education, having had female sex partners in the past 12 months, and sex position. Both direct and indirect (mediational) paths were tested for significance and analyses were clustered by city. RESULTS As stigma increased in severity, the proportion of incident HIV/STI infections increased in a dose-response relationship (low: 10.6%, medium: 14.2%, high 19.0%, P = 0.008). All direct relationships in the model were significant and suicidal ideation and condomless sex partially mediated the association between stigma and incident HIV/STI infection. CONCLUSION These findings highlight the importance of the meaningful integration of stigma-mitigation strategies in conjunction with mental health services as part of a broader strategy to reduce STI and HIV acquisitions among Nigerian MSM.
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25
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Vu NTT, Holt M, Phan HTT, La LT, Tran GM, Doan TT, Nguyen TNN, de Wit J. Amphetamine-Type-Stimulants (ATS) Use and Homosexuality-Related Enacted Stigma Are Associated With Depression Among Men Who Have Sex With Men (MSM) in Two Major Cities in Vietnam in 2014. Subst Use Misuse 2017; 52:1411-1419. [PMID: 28436758 DOI: 10.1080/10826084.2017.1284233] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) are disproportionately affected by mental health concerns, including depression. Amphetamine-type-stimulants (ATS) use and homosexuality-related stigma and discrimination have been found associated with depression among MSM. OBJECTIVES To assess the prevalence of depression and its associations with ATS use and homosexuality-related stigma and discrimination among MSM in Vietnam. METHODS 622 MSM were conveniently recruited in Hanoi and Ho Chi Minh city, Vietnam, from September to December 2014. We collected information on demographic characteristics, ATS, alcohol and other drug use, sexual behaviors, homosexuality-related and discrimination stigma, and sexual sensation-seeking. Depression and suicidal thoughts were assessed by the Patient Health Questionnaire (PHQ-9). We assessed associations of depression with ATS use and homosexuality-related stigma and discrimination using logistic regression. RESULTS Of 622 sampled MSM, 11.3% were classified as having major depression, 9.8% reported any suicidal thoughts in the last two weeks, 30.4% ever had used any ATS, 88.8% ever ad drank alcohol and 21.5% had ever used any other drugs. In multivariate analysis, depression was significantly associated with ATS use (Adjusted Odds Ratio [AOR: 2.20; (95% Confidence Interval (CI): 1.32-3.67], younger age of sexual debut with another man (AOR: 0.09; 95% CI: 0.02-0.50), and greater enacted homosexuality-related stigma (AOR: 1.97; 95% CI: 1.19-3.26). CONCLUSIONS We found a moderate prevalence of depression among sampled MSM, which was associated with ATS use and enacted homosexuality-related stigma. We recommend integrating assessment and interventions regarding depression and methamphetamine use into gay-friendly, culturally adapted holistic HIV prevention for MSM in Vietnam.
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Affiliation(s)
- Nga Thi Thu Vu
- a Centre for Social Research in Health, University of New South Wales , Sydney , Australia.,b Institute of Preventive Medicine and Public Health, Hanoi Medical University , Hanoi , Vietnam
| | - Martin Holt
- a Centre for Social Research in Health, University of New South Wales , Sydney , Australia
| | - Huong Thi Thu Phan
- c Vietnam Administration for HIV/AIDS Prevention and Control, Ministry of Health , Hanoi , Vietnam
| | - Lan Thi La
- d Hanoi Centre of HIV/AIDS Prevention and Control , Hanoi , Vietnam
| | - Gioi Minh Tran
- e Center for Community Health Promotion , Hanoi , Vietnam
| | | | | | - John de Wit
- a Centre for Social Research in Health, University of New South Wales , Sydney , Australia
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26
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Shame and blame and its influence on male gay (chaay rak chaay) quality of life in Bangkok Thailand: a health promotion community nursing perspective. JOURNAL OF PUBLIC MENTAL HEALTH 2017. [DOI: 10.1108/jpmh-12-2016-0054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to explore gay male informant experiences of discrimination and stigma in Bangkok from a health promotion community nursing perspective.
Design/methodology/approach
Semi-structured in-depth interviews were conducted with 30 informants and included field work observations at eight entertainment venues. Data analysis utilised an inductive thematic approach.
Findings
Key themes that emerged from the data were related to communication, particularly the use of smart phone applications; lack of privacy in health services; sexual exploitation by entertainment venues; and concerns about coming out safely to protect self-esteem and mental health.
Originality/value
Development of key mental health promotion messages based on a greater understanding and knowledge of discrimination and stigma may help to reduce negative behaviour and stigmatisation towards Thai gay men in Bangkok.
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Boggiano VL, Nguyen HLT, Nguyen LH, Tran TD, Van Nguyen H, Le HT, Le HQ, Hoang CD, Nguyen CT, Tran BX, Latkin CA, Zary N, Vu TMT. Sexual behaviors among methadone maintenance patients in a mountainous area in northern Vietnam. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:39. [PMID: 28841918 PMCID: PMC5574107 DOI: 10.1186/s13011-017-0123-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/21/2017] [Indexed: 11/10/2022]
Abstract
Background Methadone maintenance treatment (MMT) improves patients’ ability to access HIV-related services and reduces needle sharing and other risky HIV-related behaviors. However, patients may continue to engage in risky sexual practices. In this study, we evaluate sexual behaviors of MMT patients in a mountainous province in Northern Vietnam. Methods We explored the health status, MMT and substance use history, and sexual practices of 241 male MMT patients in Tuyen Quang province. Health status was investigated using the EuroQOL-5 Dimensions-5 Levels (EQ-5D-5 L). Multivariate logistic regression was employed to assess associated factors. Results Most patients (66.4%) reported having at least one sexual partner within the previous twelve months. Most of these partners were spouses or primary partners (72.6%). About 8.3% of patients had casual partners, and 5.8% had visited sex workers; of those who engaged in casual sexual relationships, 90.9% reported using condoms. Current drug use and living in a remote area were associated with an increased odd of having two or more sexual partners, while anxiety or depression was associated with lower odds. Conclusion This study highlights a low proportion of having sexual risk behaviors among MMT patients in Vietnamese mountainous settings. Integrating education about safe sexual practices into MMT services, along with providing medical care and ensuring methadone treatment adherence, is an important component in HIV risk reduction for these patients who were at risk of unsafe sexual practices.
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Affiliation(s)
- Victoria L Boggiano
- Berkeley School of Public Health, University of California, Berkeley, California, USA
| | - Huong Lan Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam.
| | - Long Hoang Nguyen
- School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Tho Dinh Tran
- Department of Hepatobiliary Surgery, Vietnam-Germany Hospital, Hanoi, Vietnam
| | - Hung Van Nguyen
- Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Huong Thi Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Hai Quan Le
- Tuyen Quang Provincial AIDS Center, Tuyen Quang, Vietnam
| | - Canh Dinh Hoang
- Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carl A Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nabil Zary
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Thuc Minh Thi Vu
- Department of Immunology and Allergy, National Otolaryngology Hospital, Hanoi, Vietnam
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28
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Chard AN, Metheny N, Stephenson R. Perceptions of HIV Seriousness, Risk, and Threat Among Online Samples of HIV-Negative Men Who Have Sex With Men in Seven Countries. JMIR Public Health Surveill 2017. [PMID: 28634155 PMCID: PMC5497068 DOI: 10.2196/publichealth.7546] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Rates of new HIV infections continue to increase worldwide among men who have sex with men (MSM). Despite effective prevention strategies such as condoms and pre-exposure prophylaxis (PrEP), low usage of both methods in many parts of the world hinder prevention efforts. An individual’s perceptions of the risk of acquiring HIV and the seriousness they afford to seroconversion are important drivers of behavioral risk-taking. Understanding the behavioral factors suppressing the uptake of HIV prevention services is a critical step in informing strategies to improve interventions to combat the ongoing HIV pandemic among MSM. Objective The study aimed to examine cross-national perceptions of HIV/AIDS seriousness, risk, and threat and the association between these perceptions and sociodemographic characteristics, relationships, and high-risk sexual behaviors among MSM. Methods Participants in Australia, Brazil, Canada, Thailand, South Africa, the United Kingdom, and the United States were recruited for a self-administered survey via Facebook (N=1908). Respondents were asked to rate their perceived seriousness from 1 (not at all serious) to 5 (very serious) of contracting HIV, their perceived risk from 1 (no risk) to 10 (very high risk) of contracting HIV based on their current behavior, and their perception of the threat of HIV—measured as their confidence in being able to stay HIV-negative throughout their lifetimes—on a scale from 1 (will not have HIV by the end of his lifetime) to 5 (will have HIV by the end of his lifetime). Covariates included sociodemographic factors, sexual behavior, HIV testing, drug use, and relationship status. Three ordered logistic regression models, one for each outcome variable, were fit for each country. Results Contracting HIV was perceived as serious (mean=4.1-4.6), but perceptions of HIV risk (mean=2.7-3.8) and threat of HIV (mean=1.7-2.2) were relatively low across countries. Older age was associated with significantly lower perceived seriousness of acquiring HIV in five countries (Australia: odds ratio, OR 0.97, 95% CI 0.94-0.99; Brazil: OR 0.95, 95% CI 0.91-0.98; Canada: OR 0.96, 95% CI 0.93-0.98; South Africa: OR 0.96, 95% CI 0.94-0.98; United Kingdom: OR 0.95, 95% CI 0.92-0.98). Being in a male-male sexual relationship was associated with significantly lower perceived risk of HIV in four countries (Australia: OR 0.47, 95% CI 0.30-0.75; Canada: OR: 0.54, 95% CI 0.35-0.86; United Kingdom: OR 0.38, 95% CI 0.24-0.60; United States: OR 0.5, 95% CI 0.31-0.82). Drug use in the previous year was associated with greater threat of contracting HIV in two countries (Canada: OR 1.81, 95% CI 1.13-2.91; United Kingdom: OR 1.7, 95% CI 1.06-2.74). Conclusions Few measures of behavioral or sexual risk-taking were significantly associated with perceived HIV seriousness, risk, or threat across countries. Overall, low levels of reported risk were identified, and results illustrate important gaps in the understanding of risk among MSM across societies that could be addressed through culturally-tailored prevention messaging.
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Affiliation(s)
- Anna N Chard
- Department of Environmental HealthRollins School of Public HealthEmory UniversityAtlanta, GAUnited States
| | - Nicholas Metheny
- Department of Health Behavior and Biological SciencesSchool of NursingUniversity of MichiganAnn Arbor, MIUnited States.,Center for Sexuality and Health DisparitiesSchool of NursingUniversity of MichiganAnn Arbor, MIUnited States
| | - Rob Stephenson
- Department of Health Behavior and Biological SciencesSchool of NursingUniversity of MichiganAnn Arbor, MIUnited States.,Center for Sexuality and Health DisparitiesSchool of NursingUniversity of MichiganAnn Arbor, MIUnited States
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29
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Stahlman S, Hargreaves JR, Sprague L, Stangl AL, Baral SD. Measuring Sexual Behavior Stigma to Inform Effective HIV Prevention and Treatment Programs for Key Populations. JMIR Public Health Surveill 2017; 3:e23. [PMID: 28446420 PMCID: PMC5425775 DOI: 10.2196/publichealth.7334] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/26/2017] [Accepted: 03/01/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The levels of coverage of human immunodeficiency virus (HIV) treatment and prevention services needed to change the trajectory of the HIV epidemic among key populations, including gay men and other men who have sex with men (MSM) and sex workers, have consistently been shown to be limited by stigma. OBJECTIVE The aim of this study was to propose an agenda for the goals and approaches of a sexual behavior stigma surveillance effort for key populations, with a focus on collecting surveillance data from 4 groups: (1) members of key population groups themselves (regardless of HIV status), (2) people living with HIV (PLHIV) who are also members of key populations, (3) members of nonkey populations, and (4) health workers. METHODS We discuss strengths and weaknesses of measuring multiple different types of stigma including perceived, anticipated, experienced, perpetrated, internalized, and intersecting stigma as measured among key populations themselves, as well as attitudes or beliefs about key populations as measured among other groups. RESULTS With the increasing recognition of the importance of stigma, consistent and validated stigma metrics for key populations are needed to monitor trends and guide immediate action. Evidence-based stigma interventions may ultimately be the key to overcoming the barriers to coverage and retention in life-saving antiretroviral-based HIV prevention and treatment programs for key populations. CONCLUSIONS Moving forward necessitates the integration of validated stigma scales in routine HIV surveillance efforts, as well as HIV epidemiologic and intervention studies focused on key populations, as a means of tracking progress toward a more efficient and impactful HIV response.
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Affiliation(s)
- Shauna Stahlman
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States
| | - James R Hargreaves
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Laurel Sprague
- HIV Justice Network, Detroit, MI, United States.,Irvin D Reid Honors College, Wayne State University, Detroit, MI, United States
| | - Anne L Stangl
- Department of Global Health, Youth and Development, International Center for Research on Women, Washington, DC, United States
| | - Stefan D Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States
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30
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The Relationship Between Methamphetamine Use, Sexual Sensation Seeking and Condomless Anal Intercourse Among Men Who Have Sex With Men in Vietnam: Results of a Community-Based, Cross-Sectional Study. AIDS Behav 2017; 21:1105-1116. [PMID: 27351193 DOI: 10.1007/s10461-016-1467-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study assessed the relationship between methamphetamine use and condomless anal intercourse (CAI) among men who have sex with men (MSM) in Hanoi and Ho Chi Minh City, Vietnam. Of 622 MSM participants, 75.7% reported any CAI in the last three months, 23.2% reported engaging in sex work in the last three months, 21.1% reported group sex in the last twelve months (21.1%) and 14.3% had used methamphetamine for sex in the last three months. CAI was associated with living in Ho Chi Minh City vs. Hanoi, being versatile during anal sex, a greater degree of sexual sensation-seeking, and more strongly agreeing that withdrawal before ejaculation is effective in preventing HIV. Effect-modification analysis showed that recent sex-related methamphetamine use was related to a higher probability of CAI for men with low sexual sensationseeking scores. Methamphetamine assessment and/or interventions should be incorporated into HIV prevention and research with Vietnam's MSM population.
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31
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Vu NTT, Holt M, Phan HTT, La LT, Tran GM, Doan TT, de Wit J. The Prevalence and Correlates of HIV and Undiagnosed Infection among Men Who Have Sex with Men in Hanoi, Vietnam: Findings from a Cross-sectional, Biobehavioral Study. Front Public Health 2016; 4:275. [PMID: 28066754 PMCID: PMC5165257 DOI: 10.3389/fpubh.2016.00275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/02/2016] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Men who have sex with men (MSM) are a key population for HIV infection in Vietnam, and the use of amphetamine type substances (ATS) is prevalent and possibly increasing in this population. The reported analysis examines the association between ATS use before or during sex and HIV infection among MSM in Hanoi, Vietnam. METHODS This cross-sectional study of 210 MSM was conducted in Hanoi, Vietnam, in late 2014. Men tested for HIV and answered questions about demographic characteristics, sexual sensation seeking, depression, belief in HIV prevention strategies, homosexuality-related stigma and discrimination, recent accessing of HIV prevention services, sexual behaviors and ATS, and other drug use behaviors. We performed logistic regression to assess correlates of HIV infection. RESULTS HIV prevalence was 6.7% (14/210), and 85.7% (12/14) of HIV-positive men were not aware of their HIV status. Of the 210 participants, 10.5, 2.9, and 3.8% of men had used methamphetamine, amphetamine, and ecstasy before or during sex in the last 3 months. In multivariable analysis, HIV infection was associated with recent sex-related methamphetamine use [adjusted odds ratio (AOR): 5.03, 95% confidence interval (CI): 1.35-18.68], engaging in recent sex work (AOR: 3.55, 95% CI: 1.07-11.75), and homosexuality-related perceived stigma (AOR: 2.32, 95% CI: 0.98-5.47). CONCLUSION Findings underscore the importance of integrating methamphetamine use interventions into HIV prevention services and scaling-up of gay-friendly, non-stigmatizing HIV testing services for MSM in Hanoi. We recommend the routine assessment of ATS use and undiagnosed infection in this population.
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Affiliation(s)
- Nga Thi Thu Vu
- Centre for Social Research in Health, UNSW Australia, Sydney, NSW, Australia; Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Martin Holt
- Centre for Social Research in Health, UNSW Australia , Sydney, NSW , Australia
| | - Huong Thi Thu Phan
- Vietnam Administration for HIV/AIDS Prevention and Control, Ministry of Health , Hanoi , Vietnam
| | - Lan Thi La
- Hanoi Centre of HIV/AIDS Prevention and Control , Hanoi , Vietnam
| | | | | | - John de Wit
- Centre for Social Research in Health, UNSW Australia, Sydney, NSW, Australia; Utrecht University, Utrecht, Netherlands
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A Randomized Control Trial for Evaluating Efficacies of Two Online Cognitive Interventions With and Without Fear-Appeal Imagery Approaches in Preventing Unprotected Anal Sex Among Chinese Men Who Have Sex with Men. AIDS Behav 2016; 20:1851-62. [PMID: 26802004 DOI: 10.1007/s10461-015-1263-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Fear appeal approach has been used in health promotion, but its effectiveness has been mixed. It has not been well applied to HIV prevention among men who have sex with men (MSM). The present study developed and evaluated the relative efficacy of three online interventions (SC: STD-related cognitive approach, SCFI: STD-related cognitive plus fear appeal imagery approach, Control: HIV-related information based approach) in reducing prevalence of unprotected anal intercourse (UAI) among 396 MSM using a randomized controlled trial design. Participants' levels of fear-related emotions immediately after watching the assigned intervention materials were also assessed. Participants were evaluated at baseline and 3 months after the intervention. Results showed that participants in the SCFI scored significantly higher in the instrument assessing fear after the watching the intervention materials. However, no statistically significant differences were found across the three groups in terms of UAI at Month 3. Some significant within-group reductions in some measures of UAI were found in three groups. Further studies are warranted to test the role of fear appeal in HIV prevention.
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Stahlman S, Grosso A, Ketende S, Pitche V, Kouanda S, Ceesay N, Ouedraogo HG, Ky-Zerbo O, Lougue M, Diouf D, Anato S, Tchalla J, Baral S. Suicidal ideation among MSM in three West African countries: Associations with stigma and social capital. Int J Soc Psychiatry 2016; 62:522-31. [PMID: 27515832 DOI: 10.1177/0020764016663969] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Suicidal ideation is understudied among men who have sex with men (MSM) across Sub-Saharan Africa. AIMS This study aimed to explore social capital and sexual behavior stigma associated with suicidal ideation among MSM in the West African nations of The Gambia, Burkina Faso and Togo. METHODS Participants were recruited using respondent-driven sampling and snowball sampling across multiple cities (n = 1555) from July 2011 to August 2013. During a single study visit, participants completed a survey. Logistic regression models were used to assess bivariate and multivariable associations with suicidal ideation. RESULTS The prevalence of lifetime suicidal ideation was 13% overall and ranged 6%-17% across study sites. After adjusting for potential confounders, MSM who reported stigma as a result of having sex with men were more likely to report suicidal ideation. Physical and sexual violence was strongly associated with suicidal ideation, including being physically harmed (adjusted odds ratio (aOR) = 2.94, 95% confidence interval (CI) = 1.91, 4.52), tortured (aOR = 3.86, 95% CI = 2.17, 6.86) and raped (aOR = 3.07, 95% CI = 2.05, 4.60). In contrast, increasing social participation with the broader community was associated with decreased report of suicidal ideation (aOR = 0.91, 95% CI = 0.85, 0.99). CONCLUSION Sexual behavior stigma should be addressed to improve mental health among MSM in Western Sub-Saharan Africa.
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Affiliation(s)
- Shauna Stahlman
- Center for Public Health and Human Rights and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ashley Grosso
- Center for Public Health and Human Rights and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sosthenes Ketende
- Center for Public Health and Human Rights and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vincent Pitche
- Conseil National de Lutte contre le SIDA-Togo (National AIDS Council), Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
| | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso Institut Africain de Santé Publique, Ouagadougou, Burkina Faso
| | | | - Henri G Ouedraogo
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Odette Ky-Zerbo
- Programme d'Appui au Monde Associatif et Communautaire (PAMAC), Ouagadougou, Burkina Faso
| | - Marcel Lougue
- Programme d'Appui au Monde Associatif et Communautaire (PAMAC), Ouagadougou, Burkina Faso
| | | | | | | | - Stefan Baral
- Center for Public Health and Human Rights and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Depressive symptoms and substance use as mediators of stigma affecting men who have sex with men in Lesotho: a structural equation modeling approach. Ann Epidemiol 2016; 26:551-556. [PMID: 27425206 DOI: 10.1016/j.annepidem.2016.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 03/30/2016] [Accepted: 06/03/2016] [Indexed: 01/25/2023]
Abstract
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.
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Nguyen TQ, Bandeen-Roche K, Bass JK, German D, Nguyen NTT, Knowlton AR. A tool for sexual minority mental health research: The Patient Health Questionnaire (PHQ-9) as a depressive symptom severity measure for sexual minority women in Viet Nam. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2016; 20:173-191. [PMID: 27642381 PMCID: PMC5019570 DOI: 10.1080/19359705.2015.1080204] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In a context with limited attention to mental health and prevalent sexual prejudice, valid measurements are a key first step to understanding the psychological suffering of sexual minority populations. We adapted the Patient Health Questionnaire as a depressive symptom severity measure for Vietnamese sexual minority women, ensuring its cultural relevance and suitability for internet-based research. Psychometric evaluation found that the scale is mostly unidimensional and has good convergent validity, good external construct validity, and excellent reliability. The sample's high endorsement of scale items emphasizes the need to study minority stress and mental health in this population.
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Affiliation(s)
- Trang Quynh Nguyen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, USA
- Institute for Studies of Society, Economy and Environment, Viet Nam
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, USA
| | - Judith K Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA
| | - Nam Thi Thu Nguyen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA
- Health Strategy and Policy Institute, Viet Nam
| | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA
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Stahlman S, Grosso A, Ketende S, Sweitzer S, Mothopeng T, Taruberekera N, Nkonyana J, Baral S. Depression and Social Stigma Among MSM in Lesotho: Implications for HIV and Sexually Transmitted Infection Prevention. AIDS Behav 2015; 19:1460-9. [PMID: 25969182 PMCID: PMC4858167 DOI: 10.1007/s10461-015-1094-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Social stigma is common among men who have sex with men (MSM) across Sub-Saharan Africa, and may influence risks for HIV and sexually transmitted infections (STIs) via its association with depression. We conducted a cross-sectional study of 530 MSM in Lesotho accrued via respondent-driven sampling. Using generalized structural equation models we examined associations between stigma, social capital, and depression with condom use and testing positive for HIV/STIs. Depression was positively associated with social stigma experienced or perceived as a result of being MSM. In contrast, increasing levels of social cohesion were negatively associated with depression. Social stigma was associated with testing positive for HIV; however, this association did not appear to be mediated by depression or condom use. These data suggest a need for integrated HIV and mental health care that addresses stigma and discrimination and facilitates positive social support for MSM.
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Affiliation(s)
- Shauna Stahlman
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, E7133, 615 N. Washington St., Baltimore, MD, 21205, USA,
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