DEPRESSIVE SYMPTOMS AND ALCOHOL USE AS MEDIATORS OF HIV-RELATED RISK PRACTICES AND STIGMA AFFECTING MEN WHO HAVE SEX WITH MEN IN LESOTHO: A STRUCTURAL EQUATION MODELLING APPROACH
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Date
2015-05-04
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Johns Hopkins University
Abstract
ABSTRACT
Background
Men have sex with men (MSM) in Lesotho can be exposed to sex-orientation stigma, which could result in increased engagement in sexual risk behaviors.
Methods
We investigated whether alcohol use and depressive symptoms mediate the relationship between MSM stigma in health system and HIV-related risk practices using structural equation modelling (SEM).
Results
Of the participants, the mean age was 23.6 (range 18 -56), and 94.3% (300/318) reported being homosexual or bisexual. The average PHQ-score is 5.3(SD=4.0) and the average AUDIT-C score is 4.1(SD=4.0). 22.3% (71/318) had ever experienced stigma in health system. In latent class analysis (LCA), 84.7% (260/307) were assigned to the high risk group and 15.3% (47/307) to the low risk group. Stigma in health system is significantly associated with depression (β= 0.219, p = 0.002) and alcohol use (β= 0.643, p = 0.000). Depression significantly predicted sexual risk behavior class (β= 0.569, p = 0.000). There is also a partial significant effect of alcohol use on sexual risk behavior class (β= 0.104, p = 0.072). There was no significant direct effect of stigma on sexual risk behavior (p = 0.472).
Conclusions
MSM stigma in health system is associated with increased engagement in sexual risk behavior and depressive symptoms and alcohol use mediate the association. Implications for interventions include the importance of reducing MSM stigma, as well as a focus on depression and alcohol use as two methods of reducing engagement in sexual risk practices.
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Keywords
MSM stigma, depression, alcohol use, sexual risk behavior, latent class analysis, structural equation modelling