Experiencing Intimate Partner Violence (IPV) Is Associated with Psychosocial Health Problems Among Gay, Bisexual, and Other Men Who Have Sex with Men (GBMSM) in Nigeria, Africa.

Previous research has shown high rates of intimate partner violence (IPV) among gay, bisexual, and other men who have sex with men (GBMSM). Experiencing IPV may predispose GBMSM to psychosocial health problems. A vast majority of the research on IPV among GBMSM have been conducted in North America and Europe. To date, no published studies that we are aware of have investigated the prevalence and correlates of IPV among GBMSM in West Africa. To fill this gap in research, the present study investigated the prevalence of IPV and its' association with psychosocial health problems in a large multicity sample of community-recruited GBMSM in Nigeria. Bivariate and multivariable logistic regression analyses were utilized to examine associations between sociodemographic characteristics, psychosocial health problems, sexual risk, and experiences of IPV (N = 389). The prevalence of experiencing emotional, physical, sexual, monitoring behaviors, and controlling behavior were 45%, 31%, 20%, 55%, and 22% respectively. Experiencing all types of IPV, except physical violence, was significantly associated with increased odds of having depressive symptoms (Adjusted OR [AOR] 1.79-2.63; 95% confidence interval [CI]: 1.08-4.60) and anxiety (AOR 1.63-2.63; 95% CI: 1.01-4.18). Experiencing emotional violence (standardized beta [ß] = 0.21; standard error [SE] SE = 0.44), physical violence (ß = 0.14; SE = 0.48), and controlling behaviors (ß = 0.11; SE = 0.54) was associated with increased odds of loneliness. Experiencing all types of IPV was associated with history of suicide thoughts (AOR 2.20-3.68; 95% CI: 1.28-6.32) and suicide attempt (AOR 2.36-3.42; 95% CI: 1.20-6.75). Additionally, we observed a dose-response relationship, whereby increasing number of IPV was associated with a higher likelihood of reporting psychosocial health problems. Lastly, after adjusting for other psychosocial health problems and demographic characteristics, there remained a significant association between experiencing IPV and reporting a history of suicide thoughts and suicide attempt. Consequently, it is imperative that health interventions aimed at improving psychosocial health of GBMSM explore experience and perpetration of IPV.

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.

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 (ß = 0.60, 95% CI: 0.44-0.72, p ≤ .001), substance use (ß = 0.43, 95% CI: 0.27-0.59, p = .004), and psychological problems (ß = 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.

Correlates of Geosocial Networking Applications (GSN Apps) Usage among Gay, Bisexual, and Other Men Who Have Sex with Men in Nigeria, Africa.

Geosocial networking applications (GSN apps) are widely utilized by gay, bisexual, and other men who have sex with men (GBMSM) to meet potential sexual/romantic partners, foster friendships, and build community. However, GSN apps usage has been linked to elevated levels of HIV sexual risk behavior among GBMSM. Little is known about how GSN apps can facilitate HIV sexual risk behaviors, especially among GBMSM in Africa. To fill this gap in research, the present study aimed to characterize the frequency of GSN apps usage and its association with sociodemographic characteristics, sexual health, healthcare access, psychosocial problems, and substance use in a large multicity sample of community-recruited GBMSM in Nigeria (N = 406). Bivariate and multivariable ordinal logistic regression procedures were used to examine factors associated with GSN apps usage. We found that 52.6% of participants reported recent (≤ 3 months) GSN apps use to meet sexual partners. Factors associated with increased odds of GSN apps usage included: being single, having a university degree or higher, reporting higher recent receptive anal sexual acts, being aware of PrEP, having a primary care provider, and reporting higher levels of identity concealment. HIV-related intervention delivered through GSN apps may help curb the spread of HIV among Nigerian GBMSM.

Transactional Sex Is Associated with Income Level and Psychosocial Health Problems among Gay and Bisexual Men (GBM) in Nigeria, Africa.

Gay and bisexual men (GBM) who report engagement in transactional sex are at increased risk for HIV acquisition. The current study aimed to assess the prevalence of transactional sex and its association with demographic characteristics, social marginalization, HIV sexual risk behaviors, psychosocial health problems, and access to healthcare services among a multi-site sample of GBM in Nigeria. Bivariate and multivariable logistic regression were used to examine factors associated with engagement in transactional sex in the previous 3 months. More than a third (39.6%) of the participants reported engagement in transactional sex in the previous 3 months. In the multivariable model, factors associated with engagement in transactional sex included: reporting a monthly income of 30,000 Naira [adjusted odds ratio (aOR) 1.98; 95% CI: 1.12 to 3.35], compared to 30,000 or more Naira monthly income, reporting 4 or more receptive anal sex acts in the previous 30 days (aOR 2.45; 95% CI: 1.31 to 4.57) compared to reporting none, and having depressive symptoms (aOR 1.82; 95% CI: 1.06 to 3.14). There is an urgent need for interventions that address the economic disenfranchisement and psychosocial problems experienced by GBM in Nigeria, which has implications for sexual health.

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.

Nigerian gay, bisexual, and other men who have sex with men (GBMSM) experience social marginalisation, discrimination and violence due to their sexual orientation and same-sex attraction, which may affect mental health, substance use, and HIV sexual risk behavior. The goal of the current study was to conduct formative qualitative research to gain better understanding of these issues among GBMSM in Lagos, Nigeria. Face-to-face, semi-structured, in-depth interviews were conducted with 30 GBMSM in Lagos, Nigeria. Data were analysed using a deductive content analysis approach. We found that Nigerian GBMSM experienced both general life stressors as well as proximal and distal sexual minority identity stressors, including rejection by family members, harassment, and physical violence perpetrated by the general public and police officers. Participants described dealing with mental health problems within the context of family rejection, experienced stigma due to sexual orientation, and feelings of social isolation. Substance use was described as occurring within the context of social settings. Lastly, some participants mentioned that they engaged in risky sexual behaviour while under the influence of alcohol and drugs. These findings call for comprehensive and innovative, GBMSM-affirming behavioural healthcare, substance cessation services, and innovative HIV prevention interventions specifically designed and tailored for Nigerian GBMSM.

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.

BACKGROUND: Gay, bisexual, and other men who have sex with men (GBMSM) in Nigeria experience social marginalization, discrimination and violence due to their sexual identity, which may negatively impact physical, mental, and sexual health outcomes. Studies on GBMSM in Africa utilize measurement scales developed largely for populations in the Global North. The validity and reliability of these instruments-to our knowledge-have never been thoroughly investigated among GBMSM in Nigeria. The aim of the current study was to determine the validity and reliability of the English versions of the Center for Epidemiologic Studies Depression Scale (CESD-R), Multidimensional Scale of Perceived Social Support (MSPSS), and LGBT Minority Stress Measure among a large multi-state sample of GBMSM Nigeria. METHODS: Between January and June 2019, we conducted cognitive interviews (N = 30) and quantitative assessments (N = 406) with GBMSM in Nigeria. The cognitive interviews assessed comprehension of scale items and elicited suggestions for scale modifications. The quantitative assessment was used to gather psychosocial health data and to evaluate psychometric properties and construct validity of the modified scales. We utilized confirmatory factor analysis to assess factor structure, correlation coefficients, and Cronbach's alpha to examine scale validity and internal consistency. RESULTS: Based on participant feedback from the cognitive interviews, we made slight modifications (i.e., culturally appropriate word substitutions) to all three scales. Results of quantitative analyses indicated good psychometric properties including high factor loadings, internal consistency and construct validity among the CESD-R, MSPSS, and LGBT Minority Stress Measure among GBMSM in Nigeria. CONCLUSION: These results suggests that modifying research scales to be more culturally relevant likely do not jeopardize their validity and reliability. We found that modified scales measuring depressive symptoms, perceived social support, and minority stress among GBMSM in Nigeria remained valid. More research is needed to explore whether the psychometric properties remain if the scales are translated into broken English (Pidgin) and other traditional Nigerian languages (Yoruba, Igbo and Hausa).

Poor sleep health is associated with increased mental health problems, substance use, and HIV sexual risk behavior in a large, multistate sample of gay, bisexual and other men who have sex with men (GBMSM) in Nigeria, Africa.

BACKGROUND: Poor sleep health has been linked to mental health problems, substance use, and sexual risk-taking among gay, bisexual, and other men who have sex with men (GBMSM). No known published study has examined these relationships among African GBMSM. Consequently, we investigated poor sleep health and associated health-related factors among a large multistate sample of Nigerian GBMSM. METHODS: Between March and June 2019, 406 GBMSM were recruited from Abuja, Delta, Lagos, and Plateau and asked to complete an interviewer-administered survey. Bivariate and multivariable logistic regression models were constructed to examine the relationship between poor sleep health and other health-related factors. RESULTS: In the past month, 45.5% of participants reported sleeping an average of 6 hours or less every night, and 30.7% reported experiencing a sleep problem. Factors associated with increased odds of reporting short sleep included: residing in Delta [adjusted odds ratio (aOR) 2.16; 95% confidence interval (CI): 1.15 to 4.04] and Lagos (aOR 2.40; 95% CI: 1.29 to 4.45), depressive symptoms (aOR 1.94; 95% CI: 1.13 to 3.32), and reporting lifetime history of using four or more drugs (aOR 2.52; 95% CI: 1.06 to 6.01). Reporting condom use at last anal sex was associated with decreased odds of reporting short sleep in the last month (aOR 0.54; 95% CI: 0.31 to 0.92). Factors associated with increased odds of reporting sleep problems included: reporting an STI diagnosis in the last year (aOR 1.79; 95% CI: 1.05 to 3.05) and reporting monthly or higher polydrug use in the last 3 months (aOR 2.19; 95% CI: 1.14 to 4.24). DISCUSSION: Sleep health interventions should be developed for Nigerian GBMSM, which may improve mental health and reduce substance use and sexual risk-taking.

Awareness, willingness to use, and history of HIV PrEP use among gay, bisexual, and other men who have sex with men in Nigeria.

BACKGROUND: Nigerian gay, bisexual, and other men who have sex with men (GBMSM) are disproportionately affected by HIV, with an estimated prevalence of between 11-35%. Pre-exposure prophylaxis (PrEP) has the potential to significantly decrease incident HIV infections among Nigerian GBMSM. Understanding the relationship between socio-demographic, sexual risk behavior, and psychosocial factors with PrEP awareness, willingness to use, and history of use among this group is pivotal to maximizing PrEP uptake. METHODS: Between March and June 2019, 419 participants completed an interviewer-administered survey assessing PrEP awareness, willingness to use, and history of use; socio-demographics; sexual risk behavior; and psychosocial factors. Bivariate and multivariable logistic regression were used to examine factors associated with PrEP awareness, willingness to use, and history of use. RESULTS: 53.6% were aware of PrEP; 80.1% were willing to use PrEP; and 29.7% had previously used PrEP. In multivariable analysis, factors associated with an increased odds of PrEP awareness include residing in Abuja [adjusted odds ratio (aOR) 5.02; 95% confidence interval (CI): 2.13 to 11.83] and Lagos (aOR 12.30; 95% CI: 4.92 to 30.67) vs. residing in Plateau, living with HIV (aOR 2.56; 95% CI: 1.54 to 4.72), using location-based apps for seeking sexual partners (aOR 4.06; 95% CI: 2.28 to 7.24), having health insurance (aOR 2.31; 95% CI: 1.08 to 4.40), history of suicidal thoughts (aOR 2.05; 95% CI: 1.02 to 4.10), and history of PrEP use (aOR 45.5; 95% CI: 5.60 to 370.04). Decreasing clinically significant depressive symptoms was associated with lower willingness to use PrEP (aOR 0.96; 95% CI: 0.92 to 0.99). Lastly, factors associated with increased odds of having a history of PrEP use were those reporting 6 or more insertive anal sex acts in the last 30 days compared to those with none (aOR 5.76; 95% CI: 1.58 to 20.98) and being aware of PrEP (aOR 29.6; 95% CI: 3.78 to 231.84). DISCUSSION: Nearly half of the Nigerian GBMSM in this study had no prior awareness of PrEP, but after being informed about its potential benefits, the majority were willing to use it. However, PrEP uptake among Nigerian GBMSM remains low. Findings suggest that educational messages are necessary to ensure appropriate PrEP scale-up, especially tailored towards Nigerian GBMSM.