Contemplating suicide – an indication of poor mental health and a risk factor for committing suicide – is much more common in Nigerian men who have sex with men (MSM) than in the general population and is associated with significantly lower odds of getting tested for HIV. Furthermore, MSM who experience high levels of sexual stigma are more likely to acquire HIV or an STI.
This is according to research recently published by Dr Cristina Rodriguez-Hart of the University of Maryland from a cohort study of Nigerian MSM, exploring the links between sexual stigma, psychological wellbeing and HIV outcomes.
TRUST/RV368 is a prospective cohort study that utilises respondent driven sampling to recruit MSM into HIV prevention, treatment, and care services in Abuja and Lagos, Nigeria. A total of 1480 MSM were enrolled between March 2013 and February 2016. Participants completed questionnaires about their experiences of stigma, sexual behaviour and psychosocial wellbeing.
A mixed methods component of the study focused on the impact of stigma on HIV testing. Quantitative data was used to assess suicidal ideation as a mechanism linking sexual stigma to HIV testing in both Lagos and Abuja. The purpose of the qualitative phase was to gain a better understanding of how sexual stigma impacted health and access to HIV services.
Quantitative data was collected for all 1480 participants. Stigma in relation to having sex with men was measured by considering answers relating to factors such as discriminatory remarks by family members, rejection from friends, refusal from police to protect them, verbal harassment, blackmail, physical violence, rape, fear of seeking health care and fear of walking in public. Participants were then assigned to one of three groups based on their stigma experiences: low, medium or high stigma. The participants were also asked whether they had contemplated suicide (suicidal ideation) and had ever been tested for HIV.
For the qualitative portion, 25 MSM from the Abuja site were interviewed using a semi-structured interview guide. Researchers oversampled participants who were either in the high or medium stigma classes to ensure that they could speak about stigma experiences. The interviews focused on five main topics: treatment of MSM by society, disclosure of same-sex practices, MSM social networks, mental health, HIV testing, and engagement with HIV care for those living with HIV.
The full study sample consisted of participants who were primarily under 25 years of age (60%) and had completed high school or less education (70%). While 82% identified their gender as male, 12% identified as female and 6% identified as both or non-conforming.