1. Depressive symptoms and substance use as mediators of stigma affecting men who have sex with men in Lesotho: a structural equation modeling approach.
- Author
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Wendi D, Stahlman S, Grosso A, Sweitzer S, Ketende S, Taruberekera N, Nkonyana J, Mothopeng T, and Baral S
- Subjects
- Adult, Age Factors, Cross-Sectional Studies, Developing Countries, HIV Infections epidemiology, HIV Infections prevention & control, Homosexuality, Male statistics & numerical data, Humans, Incidence, Lesotho, Male, Middle Aged, Risk Assessment, Risk-Taking, Substance-Related Disorders psychology, Young Adult, HIV Infections psychology, Homosexuality, Male psychology, Sexual Partners psychology, Social Stigma, Substance-Related Disorders epidemiology
- 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., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2016
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