Skip to main content

Advertisement

SpringerLink
Log in

Psychological Problems Mediate the Relationship Between Minority Stress and HIV Sexual Risk Among Nigerian Men Who Have Sex with Men: Testing the Minority Stress Model

  • Original Paper
  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

Gay, bisexual, and other men who have sex with men (GBMSM) in Nigeria bear a disproportionately higher burden of HIV. Meyer’s minority stress theory posits that social stress due to the discrimination, violence, and stigma experienced by lesbian, gay, and bisexual men and women (LGBs)—due to their sexual orientation—may contribute to psychological problems, including mental health problems, substance use, and HIV sexual risk-taking. Between March and June 2019, we recruited 406 GBMSM from four states in Nigeria (Abuja, Delta, Lagos, and Plateau) to complete a cross-sectional survey at local community-based organizations. We utilized structural equation modeling to test whether psychological problems and substance use mediated the relationship between minority stress and HIV sexual risk-taking (condomless anal sex and number of sexual partners) among GBMSM in Nigeria. Minority stress (β = 0.60, 95% CI: 0.44–0.72, p ≤ .001), substance use (β = 0.43, 95% CI: 0.27–0.59, p = .004), and psychological problems (β = 0.35, 95% CI: 0.28–0.45 p = .012) had moderate associations with HIV sexual risk-taking. We found that psychological problems mediated the relationship between minority stress and HIV sexual risk-taking. Interventions focused on addressing psychological problems may help mitigate the effects of minority stress on HIV sexual risk-taking among GBMSM in Nigeria.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Batchelder, A. W., Choi, K., Dale, S. K., Pierre-Louis, C., Sweek, E. W., Ironson, G., et al. (2019). Effects of syndemic psychiatric diagnoses on health indicators in men who have sex with men. Health Psychology, 38(6), 509–517.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brown, T. A. (2014). Confirmatory factor analysis for applied research. New York: Guilford Publications.

    Google Scholar 

  • Bruce, D., Harper, G. W., & Bauermeister, J. A. (2015). Minority stress, positive identity development, and depressive symptoms: Implications for resilience among sexual minority male youth. Psychology of Sexual Orientation and Gender Diversity, 2(3), 287–296.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Archives of Internal Medicine, 158(16), 1789–1795.

    Article  PubMed  Google Scholar 

  • Celentano, D. D., Valleroy, L. A., Sifakis, F., MacKellar, D. A., Hylton, J., Thiede, H., et al. (2006). Associations between substance use and sexual risk among very young men who have sex with men. Sexually Transmitted Diseases, 33(4), 265–271.

    Article  PubMed  Google Scholar 

  • Choi, K.-H., Paul, J., Ayala, G., Boylan, R., & Gregorich, S. E. (2013). Experiences of discrimination and their impact on the mental health among African American, Asian and Pacific Islander, and Latino men who have sex with men. American Journal of Public Health, 103(5), 868–874.

    Article  PubMed  PubMed Central  Google Scholar 

  • Eaton, W. W., Smith, C., Ybarra, M., Muntaner, C., & Tien, A. (2004). Center for Epidemiologic Studies Depression Scale: Review and revision (CESD and CESD-R). In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment: Instruments for adults (Vol. 1, pp. 363–377). Lawrence Erlbaum Associates Publishers.

  • Eluwa, G. I., Adebajo, S. B., Eluwa, T., Ogbanufe, O., Ilesanmi, O., & Nzelu, C. (2019). Rising HIV prevalence among men who have sex with men in Nigeria: A trend analysis. BMC Public Health, 19(1), 1201. https://doi.org/10.1186/s12889-019-7540-4.

    Article  PubMed  PubMed Central  Google Scholar 

  • English, D., Rendina, H. J., & Parsons, J. T. (2018). The effects of intersecting stigma: A longitudinal examination of minority stress, mental health, and substance use among Black, Latino, and multiracial gay and bisexual men. Psychology of Violence, 8(6), 669–679.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fingerhut, A. W., Peplau, L. A., & Gable, S. L. (2010). Identity, minority stress and psychological well-being among gay men and lesbians. Psychology and Sexuality, 1(2), 101–114.

    Article  Google Scholar 

  • Frost, D. M., Lehavot, K., & Meyer, I. H. (2015). Minority stress and physical health among sexual minority individuals. Journal of Behavioral Medicine, 38(1), 1–8.

    Article  PubMed  Google Scholar 

  • Green, K. E., & Feinstein, B. A. (2012). Substance use in lesbian, gay, and bisexual populations: An update on empirical research and implications for treatment. Psychology of Addictive Behaviors, 26(2), 265–278.

    Article  PubMed  Google Scholar 

  • Gureje, O., Abdulmalik, J., Kola, L., Musa, E., Yasamy, M. T., & Adebayo, K. (2015). Integrating mental health into primary care in Nigeria: Report of a demonstration project using the mental health gap action programme intervention guide. BMC Health Services Research, 15(1), 1–8. https://doi.org/10.1186/s12913-015-0911-3.

    Article  Google Scholar 

  • Hatzenbuehler, M. L., Nolen-Hoeksema, S., & Erickson, S. J. (2008). Minority stress predictors of HIV risk behavior, substance use, and depressive symptoms: Results from a prospective study of bereaved gay men. Health Psychology, 27(4), 455–462.

    Article  PubMed  Google Scholar 

  • Icard, L. D., Zhang, J., Jemmott, J. B., Sandfort, T. G., Rutledge, S. E., Van Greunen, D., & Martinez, O. (2020). The effects of three types of sexual orientation victimization on HIV sexual risk behavior among black south African men who have sex with men (MSM). Journal of Homosexuality, 67, 513–527.

    Article  PubMed  Google Scholar 

  • Jeffries, W. L., Marks, G., Lauby, J., Murrill, C. S., & Millett, G. A. (2013). Homophobia is associated with sexual behavior that increases risk of acquiring and transmitting HIV infection among black men who have sex with men. AIDS and Behavior, 17(4), 1442–1453.

    Article  PubMed  Google Scholar 

  • Korhonen, C., Kimani, M., Wahome, E., Otieno, F., Okall, D., Bailey, R. C., et al. (2018). Depressive symptoms and problematic alcohol and other substance use in 1476 gay, bisexual, and other MSM at three research sites in Kenya. AIDS, 32(11), 1507–1515.

    Article  PubMed  Google Scholar 

  • Lewis, R. J., Derlega, V. J., Griffin, J. L., & Krowinski, A. C. (2003). Stressors for gay men and lesbians: Life stress, gay-related stress, stigma consciousness, and depressive symptoms. Journal of Social and Clinical Psychology, 22(6), 716–729.

    Article  Google Scholar 

  • Marsh, H. W., Hau, K.-T., & Wen, Z. (2004). In search of golden rules: Comment on hypothesis-testing approaches to setting cutoff values for fit indexes and dangers in overgeneralizing Hu and Bentler’s (1999) findings. Structural Equation Modeling, 11(3), 320–341.

    Article  Google Scholar 

  • McAdams-Mahmoud, A., Stephenson, R., Rentsch, C., Cooper, H., Arriola, K. J., Jobson, G., et al. (2014). Minority stress in the lives of men who have sex with men in Cape Town, South Africa. Journal of Homosexuality, 61(6), 847–867.

    Article  PubMed  Google Scholar 

  • McCarty-Caplan, D., Jantz, I., & Swartz, J. (2014). MSM and drug use: A latent class analysis of drug use and related sexual risk behaviors. AIDS and Behavior, 18(7), 1339–1351.

    Article  PubMed  Google Scholar 

  • Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56.

    Article  PubMed  Google Scholar 

  • Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697.

    Article  PubMed  PubMed Central  Google Scholar 

  • Muthén, B. (2011). Applications of causally defined direct and indirect effects in mediation analysis using SEM in Mplus. Los Angeles: Citeseer.

    Google Scholar 

  • Newcomb, M. E., & Mustanski, B. (2011). Moderators of the relationship between internalized homophobia and risky sexual behavior in men who have sex with men: A meta-analysis. Archives of Sexual Behavior, 40(1), 189–199.

    Article  PubMed  Google Scholar 

  • Oginni, O. A., Mapayi, B. M., Afolabi, O. T., Ebuenyi, I. D., Akinsulore, A., & Mosaku, K. S. (2019). Association between risky sexual behavior and a psychosocial syndemic among Nigerian men who have sex with men. Journal of Gay and Lesbian Mental Health, 23(2), 168–185.

    Article  Google Scholar 

  • Oginni, O. A., Mapayi, B. M., Afolabi, O. T., Obiajunwa, C., & Oloniniyi, I. O. (2020). Internalized homophobia, coping, and quality of life among Nigerian gay and bisexual men. Journal of Homosexuality, 67, 1447–1470.

    Article  PubMed  Google Scholar 

  • Oginni, O. A., Mosaku, K. S., Mapayi, B. M., Akinsulore, A., & Afolabi, T. O. (2018). Depression and associated factors among gay and heterosexual male university students in Nigeria. Archives of Sexual Behavior, 47(4), 1119–1132.

    Article  PubMed  Google Scholar 

  • Ogunbajo, A., Anyamele, C., Restar, A. J., Dolezal, C., & Sandfort, T. G. (2019a). Substance use and depression among recently migrated African gay and bisexual men living in the United States. Journal of Immigrant and Minority Health, 21(6), 1224–1232.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ogunbajo, A., Iwuagwu, S., Williams, R., Biello, K. B., Kahler, C. W., Sandfort, T., & Mimiaga, M. J. (2020a). Validation of depressive symptoms, social support, and minority stress scales among gay, bisexual, and other men who have with men (GBMSM) in Nigeria, Africa: A mixed methods approach. BMC Public Health, 20, 1–12. https://doi.org/10.1186/s12889-020-09127-0.

    Article  Google Scholar 

  • Ogunbajo, A., Iwuagwu, S., Williams, R., Biello, K. B., Kahler, C. W., Sandfort, T. G., & Mimiaga, M. J. (2020b). Experiences of minority stress among gay, bisexual, and other men who have sex with men (GBMSM) in Nigeria, Africa: The intersection of mental health, substance use, and HIV sexual risk behavior. Global Public Health, 20. https://doi.org/10.1080/17441692.2020.1834598.

  • Ogunbajo, A., Iwuagwu, S., Williams, R., Biello, K., & Mimiaga, M. J. (2019b). Awareness, willingness to use, and history of HIV PrEP use among gay, bisexual, and other men who have sex with men in Nigeria. PLoS ONE, 14(12), e0226384.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ogunbajo, A., Kang, A., Shangani, S., Wade, R. M., Onyango, D. P., Odero, W. W., & Harper, G. W. (2019c). Awareness and acceptability of pre-exposure prophylaxis (PrEP) among gay, bisexual and other men who have sex with men (GBMSM) in Kenya. AIDS Care, 31, 1185–1192.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ogunbajo, A., Leblanc, N. M., Kushwaha, S., Boakye, F., Hanson, S., Smith, M. D., & Nelson, L. E. (2020c). Knowledge and acceptability of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in Ghana. AIDS Care, 32, 330–336.

    Article  PubMed  Google Scholar 

  • Ogunbajo, A., Oke, T., Jin, H., Rashidi, W., Iwuagwu, S., Harper, G. W., et al. (2020d). A syndemic of psychosocial health problems is associated with increased HIV sexual risk among Nigerian gay, bisexual, and other men who have sex with men (GBMSM). AIDS Care, 32, 337–343.

    Article  PubMed  Google Scholar 

  • Okanlawon, K. (2018). Cultures of public intervention regarding LGBTQ issues after Nigeria’s same-sex marriage prohibition act (SSMPA). College Literature, 45(4), 641–651.

    Article  Google Scholar 

  • Pachankis, J. E., Hatzenbuehler, M. L., Hickson, F., Weatherburn, P., Berg, R. C., Marcus, U., & Schmidt, A. J. (2015). Hidden from health: Structural stigma, sexual orientation concealment, and HIV across 38 countries in the European MSM internet survey. AIDS, 29(10), 1239–1246.

    Article  PubMed  Google Scholar 

  • Ramirez-Valles, J., Garcia, D., Campbell, R. T., Diaz, R. M., & Heckathorn, D. D. (2008). HIV infection, sexual risk behavior, and substance use among Latino gay and bisexual men and transgender persons. American Journal of Public Health, 98(6), 1036–1042.

    Article  PubMed  PubMed Central  Google Scholar 

  • Reisner, S. L., Mimiaga, M. J., Skeer, M., Bright, D., Cranston, K., Isenberg, D., et al. (2009). Clinically significant depressive symptoms as a risk factor for HIV infection among black MSM in Massachusetts. AIDS and Behavior, 13(4), 798–810.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rendina, H. J., Gamarel, K. E., Pachankis, J. E., Ventuneac, A., Grov, C., & Parsons, J. T. (2017). Extending the minority stress model to incorporate HIV-positive gay and bisexual men’s experiences: A longitudinal examination of mental health and sexual risk behavior. Annals of Behavioral Medicine, 51(2), 147–158.

    Article  PubMed  Google Scholar 

  • Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166(10), 1092–1097.

    Article  PubMed  Google Scholar 

  • Storholm, E. D., Huang, W., Siconolfi, D. E., Pollack, L. M., Carrico, A. W., Vincent, W., et al. (2019). Sources of resilience as mediators of the effect of minority stress on stimulant use and sexual risk behavior among young black men who have sex with men. AIDS and Behavior, 23(12), 3384–3395.

    Article  PubMed  PubMed Central  Google Scholar 

  • TIERS. (2019). Report on human rights violations based on real or perceived sexual orientation and gender identity in Nigeria (Vol. 4, pp. 1–37). The Initiative for Equal Rights Publications.

  • Tucker-Seeley, R. D., Mitchell, J. A., Shires, D. A., & Modlin, C. S. (2015). Financial hardship, unmet medical need, and health self-efficacy among African American men. Health Education and Behavior, 42(3), 285–292.

    Article  PubMed  Google Scholar 

  • UNAIDS. (2017). UNAIDS Data 2017 (Vol. 1, No. 1, pp. 1–323). UNAIDS Publications.

  • Vosburgh, H. W., Mansergh, G., Sullivan, P. S., & Purcell, D. W. (2012). A review of the literature on event-level substance use and sexual risk behavior among men who have sex with men. AIDS and Behavior, 16(6), 1394–1410.

    Article  PubMed  Google Scholar 

  • Vu, L., Adebajo, S., Tun, W., Sheehy, M., Karlyn, A., Njab, J., et al. (2013). High HIV prevalence among men who have sex with men in Nigeria: Implications for combination prevention. JAIDS Journal of Acquired Immune Deficiency Syndromes, 63(2), 221–227.

    Article  PubMed  Google Scholar 

  • Wong, C. F., Schrager, S. M., Holloway, I. W., Meyer, I. H., & Kipke, M. D. (2014). Minority stress experiences and psychological well-being: The impact of support from and connection to social networks within the Los Angeles house and ball communities. Prevention Science, 15(1), 44–55.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wong, C. F., Weiss, G., Ayala, G., & Kipke, M. D. (2010). Harassment, discrimination, violence, and illicit drug use among young men who have sex with men. AIDS Education and Prevention, 22(4), 286–298.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We will like to thank all the participants of the study for their time and efforts. We would also like to thank the staff at Centre for Right to Health (Abuja) Equality Triangle Initiative (Delta), Improved Sexual Health and Rights Advocacy Initiative (ISHRAI, Lagos) and Hope Alive Health Awareness Initiative (Plateau). We also extend our gratitude to Olubiyi Oludipe (ISHRAI), Bala Mohammed Salisu (Hope Alive Health Awareness Initiative), Chucks Onuoha, Prince Bethel, Eke Chukwudi, Tochukwu Okereke, Josiah Djagvidi, Victor Brownson, and Odi Iorfa Agev, for providing logistical support to the Project.

Author information

Authors and Affiliations

  1. Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St., Box G-S121-3, Providence, RI, 02912, USA

    Adedotun Ogunbajo, Katie Biello, Christopher W. Kahler & Matthew J. Mimiaga

  2. Center for Health Equity, Brown University School of Public Health, Providence, RI, USA

    Adedotun Ogunbajo, Katie Biello & Matthew J. Mimiaga

  3. Centre for Right to Health, Abuja, Nigeria

    Stella Iwuagwu

  4. Equality Triangle for Health and Peoples’ Development Initiative, Warri, Delta, Nigeria

    Rashidi Williams

  5. Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA

    Katie Biello & Matthew J. Mimiaga

  6. The Fenway Institute, Fenway Health, Boston, MA, USA

    Katie Biello & Matthew J. Mimiaga

  7. HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA

    Theodorus G. M. Sandfort

  8. Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA

    Matthew J. Mimiaga

Authors
  1. Adedotun Ogunbajo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stella Iwuagwu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rashidi Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Katie Biello
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christopher W. Kahler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Theodorus G. M. Sandfort
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Matthew J. Mimiaga
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adedotun Ogunbajo.

Ethics declarations

Conflict of interest

This study was supported by a R36 dissertation grant from the National Institute on Drug Abuse [DA047216] (principal investigator [PI]: Adedotun Ogunbajo) and by the Robert Wood Johnson Foundation Health Policy Research Scholars Program, for which the first author is a scholar but the foundation did not provide direct Project support.

Ethical Approval

The study protocols were approved by the institutional review boards at Brown University and the Nigerian Institute of Medical Research.

Informed Consent

Each participant provided verbal informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 13 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ogunbajo, A., Iwuagwu, S., Williams, R. et al. Psychological Problems Mediate the Relationship Between Minority Stress and HIV Sexual Risk Among Nigerian Men Who Have Sex with Men: Testing the Minority Stress Model. Arch Sex Behav 50, 3163–3174 (2021). https://doi.org/10.1007/s10508-021-01943-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-021-01943-8

Keywords

Search

Navigation