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Depression and Social Stigma Among MSM in Lesotho: Implications for HIV and Sexually Transmitted Infection Prevention

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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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Acknowledgments

We would like to acknowledge and thank the Lesotho LGBT community for their participation and effective mobilization to disseminate messages about this study. We also wish to thank the study staff and interviewers who worked on this project at personal risk, including disclosure of sexual orientation to their families or communities. The Lesotho Ministry of Health was instrumental in the oversight, direction, and supervision of the study, and we are grateful for the incredible government engagement and ownership of this work. We would especially like to thank Dr. Limpho Maile, Dr. Mosilinyane Letsie, Tsietso Mot’soane, David Mothabeng, Puleng Ramphalla-Phatela, and Dr. Kyaw Thin for their invaluable support and input. This study was funded by the U.S. Agency for International Development (USAID, AID-674-A-00-00001), and implemented by Population Services International/Lesotho (PSI). From PSI, we would like to thank Dwan Dixon, Pierre Loup-Lesage, and Brian Pedersen who provided invaluable support and guidance. Finally, from USAID, we thank David Brown, Todd Koppenhaver, and Diana Acosta who provided oversight and technical assistance for the project. Additional support was provided by Johns Hopkins University Center for AIDS Research (P30AI094189) and the American Foundation for AIDS Research.

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Authors and Affiliations

  1. 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

    Shauna Stahlman, Ashley Grosso, Sosthenes Ketende, Stephanie Sweitzer & Stefan Baral

  2. Matrix Support Group, Maseru, Lesotho

    Tampose Mothopeng

  3. Population Services International, Johannesburg, South Africa

    Noah Taruberekera

  4. Ministry of Health, Maseru, Lesotho

    John Nkonyana

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  1. Shauna Stahlman
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  8. Stefan Baral
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Correspondence to Shauna Stahlman.

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Stahlman, S., Grosso, A., Ketende, S. et al. Depression and Social Stigma Among MSM in Lesotho: Implications for HIV and Sexually Transmitted Infection Prevention. AIDS Behav 19, 1460–1469 (2015). https://doi.org/10.1007/s10461-015-1094-y

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