Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore Maryland, USA.
Johns Hopkins Center for Communication Programs (CCP), Baltimore, USA.
BMC Infect Dis. 2019 Mar 5;19(1):211. doi: 10.1186/s12879-019-3711-2.
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.
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.
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").
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.
撒哈拉以南非洲的男男性行为者（MSM）和跨性别女性受到高度的性行为相关污名化，这可能影响他们的心理健康和性风险行为。对自己的性行为公开或已经披露的 MSM 和跨性别女性似乎受到污名化的影响最大。了解污名化在这些关键人群中增加 HIV 风险的作用机制对于支持干预措施的制定非常重要。
本研究于 2014 年 10 月至 12 月，通过从埃斯瓦蒂尼（斯威士兰）的链式转诊抽样法，从 532 名参与者中招募了 419 名顺性别 MSM 和 109 名跨性别女性，他们接受了有关人口统计学、污名、向家庭成员和卫生保健工作者披露同性性行为、心理健康和性行为方面的调查。本研究使用潜在类别分析（LCA）来确定污名/公开的潜在结构，并使用多项逻辑回归来确定与潜在结构和性行为风险的关联。
出现了三个潜在类别：1）那些报告污名化可能性较低的人（55%；502 人中有 276 人）；2）那些报告污名化可能性较高的人，包括身体暴力和对医疗保健的恐惧/回避，并且没有“公开”（11%；502 人中有 54 人）；3）那些报告污名化可能性较高的人，包括言语骚扰和来自家庭和朋友的污名化，并且已经“公开”（34%；502 人中有 172 人）。与“低污名”类别相比，来自城市地区的参与者（调整后的优势比 [AOR] = 2.78，95%置信区间 [CI] = 1.53-5.07）和进行无保护肛交的参与者（AOR = 1.85，95% CI = 1.17-2.91）更有可能属于“高污名，公开”类别。相比之下，同时有男性或女性伴侣的参与者更有可能属于“高污名，不公开”类别（AOR = 2.73，95% CI = 1.05-7.07）。抑郁与两个高污名类别都有关联（AOR = 3.14，95% CI = 1.50-6.55“不公开”，AOR = 2.42，95% CI = 1.51-3.87“公开”）。
社区层面的性行为污名与 MSM 和跨性别女性的个体层面风险行为有关，这些关联因性行为公开程度而异。实现基于证据的污名干预措施的充分覆盖可能是实现 MSM 和跨性别女性艾滋病毒预防和治疗干预措施潜在影响的关键。
