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Stigma and outness about sexual behaviors among cisgender men who have sex with men and transgender women in Eswatini: a latent class analysis.
BMC Infect Dis. 2019 Mar 05; 19(1):211.BI

Abstract

BACKGROUND

Men who have sex with men (MSM) and transgender women in Sub-Saharan Africa are subjected to high levels of sexual behavior-related stigma, which may affect mental health and sexual risk behaviors. MSM and transgender women who are open about, or have disclosed their sexual behaviors appear to be most affected by stigma. Characterizing the mechanism of action of stigma in potentiating HIV-risks among these key populations is important to support the development of interventions.

METHODS

In this study, a total of 532 individuals were recruited across Eswatini (Swaziland) through chain-referral-sampling from October - December 2014, including 419 cisgender MSM and 109 transgender women. Participants were surveyed about demographics, stigma, outness of same-sex practices to family members and healthcare workers, and mental and sexual health. This study used latent class analysis (LCA) to determine latent constructs of stigma/outness, and used multinomial logistic regression to determine associations with underlying constructs and sexual risk behaviors.

RESULTS

Three latent classes emerged: 1) Those who reported low probabilities of stigma (55%; 276/502); 2) Those who reported high probabilities of stigma including physical violence and fear/avoidance of healthcare, and were not "out" (11%; 54/502); and 3) Those who reported high probabilities of stigma including verbal harassment and stigma from family and friends, and were "out" (34%; 172/502). Relative to the "low stigma" class, participants from an urban area (adjusted odds ratio [AOR] = 2.78, 95% Confidence Interval [CI] = 1.53-5.07) and who engaged in condomless anal sex (AOR = 1.85, 95% CI = 1.17-2.91) were more likely to belong to the "high stigma, 'out'" class. In contrast, those who had a concurrent male or female partner were more likely to belong to the "high stigma, not 'out'" class AOR = 2.73, 95% CI = 1.05-7.07). Depression was associated with membership in both high-stigma classes (AOR = 3.14, 95% CI = 1.50-6.55 "not out", AOR = 2.42, 95% CI = 1.51-3.87 "out").

CONCLUSIONS

Sexual behavior stigma at a community level is associated with individual-level risk behaviors among MSM and transgender women, and these associations vary by level of outness about sexual practices. Achieving sufficient coverage of evidence-based stigma interventions may be key to realizing the potential impact of HIV prevention and treatment interventions for MSM and transgender women in Eswatini.

Authors+Show Affiliations

Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore Maryland, USA. clyons8@jhu.edu.Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore Maryland, USA.Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore Maryland, USA.Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore Maryland, USA.Johns Hopkins Center for Communication Programs (CCP), Baltimore, USA.Johns Hopkins Center for Communication Programs (CCP), Mbabane, Swaziland.Ministry of Health, Swaziland National AIDS Program, Mbabane, Swaziland.Health Plus 4 Men, Manzini, Swaziland.Johns Hopkins Center for Communication Programs (CCP), Baltimore, USA.Health Plus 4 Men, Manzini, Swaziland.Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore Maryland, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30832602

Citation

Lyons, Carrie, et al. "Stigma and Outness About Sexual Behaviors Among Cisgender Men Who Have Sex With Men and Transgender Women in Eswatini: a Latent Class Analysis." BMC Infectious Diseases, vol. 19, no. 1, 2019, p. 211.
Lyons C, Stahlman S, Holland C, et al. Stigma and outness about sexual behaviors among cisgender men who have sex with men and transgender women in Eswatini: a latent class analysis. BMC Infect Dis. 2019;19(1):211.
Lyons, C., Stahlman, S., Holland, C., Ketende, S., Van Lith, L., Kochelani, D., Mavimbela, M., Sithole, B., Maloney, L., Maziya, S., & Baral, S. (2019). Stigma and outness about sexual behaviors among cisgender men who have sex with men and transgender women in Eswatini: a latent class analysis. BMC Infectious Diseases, 19(1), 211. https://doi.org/10.1186/s12879-019-3711-2
Lyons C, et al. Stigma and Outness About Sexual Behaviors Among Cisgender Men Who Have Sex With Men and Transgender Women in Eswatini: a Latent Class Analysis. BMC Infect Dis. 2019 Mar 5;19(1):211. PubMed PMID: 30832602.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Stigma and outness about sexual behaviors among cisgender men who have sex with men and transgender women in Eswatini: a latent class analysis. AU - Lyons,Carrie, AU - Stahlman,Shauna, AU - Holland,Claire, AU - Ketende,Sosthenes, AU - Van Lith,Lynn, AU - Kochelani,Duncan, AU - Mavimbela,Mpumelelo, AU - Sithole,Bhekie, AU - Maloney,Libet, AU - Maziya,Sibusiso, AU - Baral,Stefan, Y1 - 2019/03/05/ PY - 2017/05/02/received PY - 2019/01/10/accepted PY - 2019/3/6/entrez PY - 2019/3/6/pubmed PY - 2019/4/12/medline KW - Disclosure KW - Men who have sex with men KW - Stigma KW - Swaziland KW - Transgender women SP - 211 EP - 211 JF - BMC infectious diseases JO - BMC Infect. Dis. VL - 19 IS - 1 N2 - BACKGROUND: Men who have sex with men (MSM) and transgender women in Sub-Saharan Africa are subjected to high levels of sexual behavior-related stigma, which may affect mental health and sexual risk behaviors. MSM and transgender women who are open about, or have disclosed their sexual behaviors appear to be most affected by stigma. Characterizing the mechanism of action of stigma in potentiating HIV-risks among these key populations is important to support the development of interventions. METHODS: In this study, a total of 532 individuals were recruited across Eswatini (Swaziland) through chain-referral-sampling from October - December 2014, including 419 cisgender MSM and 109 transgender women. Participants were surveyed about demographics, stigma, outness of same-sex practices to family members and healthcare workers, and mental and sexual health. This study used latent class analysis (LCA) to determine latent constructs of stigma/outness, and used multinomial logistic regression to determine associations with underlying constructs and sexual risk behaviors. RESULTS: Three latent classes emerged: 1) Those who reported low probabilities of stigma (55%; 276/502); 2) Those who reported high probabilities of stigma including physical violence and fear/avoidance of healthcare, and were not "out" (11%; 54/502); and 3) Those who reported high probabilities of stigma including verbal harassment and stigma from family and friends, and were "out" (34%; 172/502). Relative to the "low stigma" class, participants from an urban area (adjusted odds ratio [AOR] = 2.78, 95% Confidence Interval [CI] = 1.53-5.07) and who engaged in condomless anal sex (AOR = 1.85, 95% CI = 1.17-2.91) were more likely to belong to the "high stigma, 'out'" class. In contrast, those who had a concurrent male or female partner were more likely to belong to the "high stigma, not 'out'" class AOR = 2.73, 95% CI = 1.05-7.07). Depression was associated with membership in both high-stigma classes (AOR = 3.14, 95% CI = 1.50-6.55 "not out", AOR = 2.42, 95% CI = 1.51-3.87 "out"). CONCLUSIONS: Sexual behavior stigma at a community level is associated with individual-level risk behaviors among MSM and transgender women, and these associations vary by level of outness about sexual practices. Achieving sufficient coverage of evidence-based stigma interventions may be key to realizing the potential impact of HIV prevention and treatment interventions for MSM and transgender women in Eswatini. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/30832602/Stigma_and_outness_about_sexual_behaviors_among_cisgender_men_who_have_sex_with_men_and_transgender_women_in_Eswatini:_a_latent_class_analysis_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-3711-2 DB - PRIME DP - Unbound Medicine ER -