AIDS and Behavior

, Volume 22, Issue 12, pp 3905–3915 | Cite as

The Synergistic Impact of Sexual Stigma and Psychosocial Well-Being on HIV Testing: A Mixed-Methods Study Among Nigerian Men who have Sex with Men

  • Cristina Rodriguez-HartEmail author
  • Cory Bradley
  • Danielle German
  • Rashelle Musci
  • Ifeanyi Orazulike
  • Stefan Baral
  • Hongjie Liu
  • Trevor A. Crowell
  • Man Charurat
  • Rebecca G. Nowak
  • the TRUST/RV368 Study Group
Original Paper


Although sexual stigma has been linked to decreased HIV testing among men who have sex with men (MSM), mechanisms for this association are unclear. We evaluated the role of psychosocial well-being in connecting sexual stigma and HIV testing using an explanatory sequential mixed methods analysis of 25 qualitative and 1480 quantitative interviews with MSM enrolled in a prospective cohort study in Nigeria from March/2013–February/2016. Utilizing structural equation modeling, we found a synergistic negative association between sexual stigma and suicidal ideation on HIV testing. Qualitatively, prior stigma experiences often generated psychological distress and perceptions of feeling unsafe, which decreased willingness to seek services at general health facilities. MSM reported feeling safe at the MSM-friendly study clinic but still described a need for psychosocial support services. Addressing stigma and unmet mental health needs among Nigerian MSM has the potential to improve HIV testing uptake.


Men who have sex with men Stigma Latent class analysis HIV testing Suicidal ideation Mental health 



We are very grateful to the individuals who participated in this study. Despite the sexual stigma they have experienced and continue to experience, they chose to be a part of this study. We are also very grateful to the study staff who have remained dedicated to the mission of TRUST/RV368 throughout.


The following members of the TRUST/RV368 Study Group were collaborators in this study: Cristina Rodriguez-Hart; Stefan Baral; Trevor A. Crowell; Hongjie Liu; Man Charurat; Rebecca G. Nowak.


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.


This work was supported by a cooperative agreement (W81XWH-11-2-0174) between the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., and the U.S. Department of Defense (DoD). This study is also supported by funds from the US National Institutes of Health under Award No. R01MH099001 and R01AI120913 and training grant T32 A1050056-12, the US Military HIV Research Program (Grant No. W81XWH-07-2-0067), Fogarty AITRP (D43TW01041), and the President’s Emergency Plan for AIDS Relief through cooperative agreement U2G IPS000651 from the HHS/Centers for Disease Control and Prevention (CDC), Global AIDS Program with IHVN.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

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.

Informed Consent

Informed consent was obtained from all individual participants included in the study. 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.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Cristina Rodriguez-Hart
    • 1
    • 2
    Email author
  • Cory Bradley
    • 2
  • Danielle German
    • 2
  • Rashelle Musci
    • 3
  • Ifeanyi Orazulike
    • 4
  • Stefan Baral
    • 5
  • Hongjie Liu
    • 6
  • Trevor A. Crowell
    • 7
    • 8
  • Man Charurat
    • 1
  • Rebecca G. Nowak
    • 1
  • the TRUST/RV368 Study Group
  1. 1.Institute of Human VirologyUniversity of Maryland School of MedicineBaltimoreUSA
  2. 2.Department of Health, Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.International Center on Advocacy and Rights to HealthAbujaNigeria
  5. 5.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  6. 6.School of Public HealthUniversity of MarylandCollege ParkUSA
  7. 7.U.S. Military HIV Research ProgramWalter Reed Army Institute of ResearchSilver SpringUSA
  8. 8.Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaUSA

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