ABSTRACT
PURPOSE: Research on the relationship between sexual orientation-related stigma and risks for HIV among men who have sex with men (MSM) is limited. This study tests a hypothesis that substance use and depressive symptoms mediate the relationship between stigma in the health care system and HIV-related risk practices among MSM in Maseru, Lesotho. METHODS: In 2014, we conducted a cross-sectional study among MSM in Lesotho accrued via respondent-driven sampling including a survey and biological testing for HIV. The hypothesis was tested using structural equation modeling. RESULTS: Of the 318 participants, 22.3% had experienced stigma in the health care system. Stigma in the health care system was associated with depression (ß = 0.329, P = .018) and alcohol use (ß = 1.417, P = .001). Noninjection illicit drug use (ß = 0.837, P = .039) and alcohol use (ß = 0.282, P = .000) significantly predicted number of sex partners. Stigma was directly associated with condomless anal sex (ß = 0.441, P = .036), and no indirect association was found. CONCLUSIONS: Alcohol use and depressive symptoms mediate the relationship between MSM stigma in the health care system and reported number of sex partners. The implications are significant with a focus on the need for comprehensive interventions addressing stigma and mental health when aiming to improve more proximal HIV-related risk practices for MSM.
