Sexual Stigma Patterns Among Nigerian Men Who Have Sex with Men and Their Link to HIV and Sexually Transmitted Infection Prevalence
Sexual stigma facilitates the spread of HIV and sexually transmitted infections (STIs) but little is known about stigma affecting Nigerian men who have sex with men (MSM). We assessed patterns of sexual stigma across Nigerian MSM and their relationship to HIV and STIs. Data were collected from the TRUST/RV368 Study, a prospective cohort of 1480 Nigerian MSM enrolled from March 2013 to February 2016 using respondent driven sampling. Structural equation modeling was utilized to assess the association between stigma classes and HIV and STI prevalence, adjusting for participants’ characteristics. A dose–response association was found between stigma class and HIV prevalence (27, 40, 55%, overall χ2 p < 0.001) and STI prevalence (15, 21, 24%, overall χ2 p = 0.011). These data suggest that stigma mitigation strategies, combined with increased engagement of MSM and retention in the HIV care continuum, need to be a component of interventions focused on reducing HIV transmission risks among MSM in Nigeria.
KeywordsMen who have sex with men Stigma Latent class analysis HIV infections Sexually transmitted infections
We are very grateful to the individuals who participated in this study, despite the sexual stigma they have experienced, as well as to the study staff who have remained dedicated to the mission of TRUST/RV368 throughout.
The views expressed are those of the authors and should not be construed to represent the positions of the U.S. Army, the Department of Defense, or the Department of Health and Human Services. The investigators have adhered to the policies for protection of human subjects as prescribed in AR-70.
Compliance with Ethical Standards
Conflicts of interest
The authors declare that they have no conflict to interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Approval for the study was obtained by the Federal Capital Territory Health Research Ethics Committee, the University of Maryland Baltimore Institutional Review Board (IRB), and the Walter Reed Army Institute of Research IRB.
Informed consent was obtained from all individual participants included in the study.
- 10.Papworth E, Grosso A, Ketende S, Wirtz A, Cange C, Kennedy C, et al. Examining risk factors for HIV and access to services among female sex workers (FSW) and men who have sex with men (MSM) in Burkina Faso, Togo, and Cameroon. 2014. http://www.jhsph.edu/research/centers-and-institutes/research-to-prevention/publications/WA_FinalReport.pdf.
- 12.Sekoni AO, Ayoola OO, Somefun EO. Experiences of social oppression among men who have sex with men in a cosmopolitan city in Nigeria. HIV/AIDS-Res Palliat Care. 2015;7:21–7.Google Scholar
- 16.Nylund K. Latent transition analysis: modeling extensions and an application to peer victimization [dissertation]. Los Angeles: University of California Los Angeles; 2007. https://www.statmodel.com/download/nylunddis.pdf.
- 18.Collins LM, Lanza ST. Latent class analysis and latent transition analysis. Hoboken: Wiley; 2010.Google Scholar
- 24.Schwartz S, Nowak R, Orazulike I, Keshinro B, Ake J, Kennedy S, et al. The immediate effect of the Same-Sex Marriage Prohibition Act on stigma, discrimination, and engagement on HIV prevention and treatment services in men who have sex with men in Nigeria: analysis of prospective data from the TRUST cohort. Lancet HIV. 2015;2:e299–306.CrossRefPubMedPubMedCentralGoogle Scholar
- 28.Muthen LK, Muthen B. Mplus user’s guide. 7th ed. Los Angeles: Muthen & Muthen; 2015. https://www.statmodel.com/download/usersguide/MplususerguideVer_7_r3_web.pdf.
- 29.Stahlman S, Sanchez TH, Sullivan PS, Ketende S, Lyons C, Charurat ME, et al. The prevalence of sexual behavior stigma affecting gay men and other men who have sex with men across Sub-Saharan Africa and in the United States. J Med Internet Res Public Heal Surveill. 2016;21:1–19.Google Scholar
- 34.Asparouhov T, Muthen B. Auxiliary variables in mixture modeling: using the BCH method in Mplus to estimate a distal outcome model and an arbitrary second model. Mplus Web Notes No. 15 Version 2. 2015. https://www.statmodel.com/download/asparouhov_muthen_2014.pdf.
- 41.Sivasubramanian M, Mimiaga M, Mayer KH, Anand V, Johnson C, Prabhugate P, et al. Suicidality, clinical depression, and anxiety disorders are highly prevalent in men who have sex with men in Mumbai, India: findings from a community-recruited sample. Psycho. Health Med. 2012;16:450–62.CrossRefGoogle Scholar
- 42.Henderson AM. On the ground: programmes serving the needs of key populations; 2014. http://apps.who.int/iris/bitstream/10665/145002/1/WHO_HIV_2014.50_eng.pdf.
- 45.Ross MW, Berg RC, Schmidt AJ, Hospers HJ, Breveglieri M, Furegato M, et al. Internalised homonegativity predicts HIV-associated risk behavior in European men who have sex with men in a 38-country cross-sectional study: some public health implications of homophobia. BMJ Open. 2013;3:1–11.CrossRefGoogle Scholar
- 48.Betron M. Screening for violence against MSM and transgenders : report on a pilot project in Mexico and Thailand. Washington, DC; 2009. http://www.healthpolicyinitiative.com/Publications/Documents/1100_1_GBV_MARP_Final_Project_Report_FINAL_4_27_10_acc.pdf.
- 56.Subramanian T, Ramakrishnan L, Aridoss S, Goswami P, Kanguswami B, Shajan M, et al. Increasing condom use and declining STI prevalence in high-risk MSM and TGs: evaluation of a large-scale prevention program in Tamil Nadu, India. BMC Public Health. 2013;13:857.CrossRefPubMedPubMedCentralGoogle Scholar
- 57.UNAIDS. Fast-Track: Ending the AIDS epidemic by 2030; 2014. http://www.unaids.org/en/resources/documents/2014/JC2686_WAD2014report.