The Relationship Between Sexual Behavior Stigma and Depression Among Men Who have Sex with Men and Transgender Women in Kigali, Rwanda: a Cross-sectional Study

• Type of Material: Article
• Authors: N. Okonkwo, Johns Hopkins University; Jean Olivier Twahirwa Rwema, Johns Hopkins University; C. Lyons, Johns Hopkins University; B. Liestman, Johns Hopkins University; J. Nyombayire, Project San Francisco, Kigali, Rwanda; O. Olawore, Johns Hopkins University; S. Nzansimana, Rwanda Biomedical Center; P. Mugwaneza, Rwanda Biomedical Center; A. Kagaba, Health Development Initiative, Kigali, Rwanda; Patrick S Sullivan, Emory University; Susan A Allen, Emory University; E. Karita, Project San Francisco, Kigali, Rwanda; S. Baral, Johns Hopkins University
• Language: English
• Date: 2021-11-08
• Publisher: Springer Nature
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021, The Author(s), under exclusive licence to Springer Science Business Media, LLC, part of Springer Nature
• Final Published Version (URL): https://doi.org/10.1007/s11469-021-00699-5
• Title of Journal or Parent Work: International Journal of Mental Health and Addiction
• Volume: 20
• Issue: 6
• Start Page: 3228
• End Page: 3243
• Keywords: Rwanda; TGW (transgender women); Depression; Stigma; MSM (men who have sex with men); Mental health
• Research Categories: Health Sciences, Public Health; Health Sciences, Mental Health; Health Sciences, Epidemiology

Abstract

To evaluate the role of sexual behavior stigma as a determinant of depressive symptoms among men who have sex with men (MSM) and transgender women (TGW) in Kigali, Rwanda. MSM/TGW aged ≥18 years were recruited using respondent-driven sampling (RDS) between March–August, 2018. Mental health was assessed using the Patient Health Questionnaire (PHQ-9). Sexual behavior stigma from friends and family, healthcare workers, and community members was assessed using a validated instrument. Multinomial logistic regression models were used to determine the association between sexual behavior stigma and depressive symptoms and depression. Secondary analyses further compared depression and depressive symptoms among MSM and TGW. Among the 736 participants included, 14% (106/736) identified as TGW. Depression 8.9% (RDS-adjusted, 7.6%; 95% CI, 4.6–10.6) and mild/moderate symptoms of depression 26.4% (RDS-adjusted, 24.1%; 95% CI, 19.4–28.7) were common and higher among TGW compared to MSM (p < 0.001). Anticipated (41%), perceived (36%), and enacted (45%) stigmas were highly prevalent, and were also significantly higher among TGW (p < 0.001). In multivariable RDS-adjusted analysis, anticipated (relative risk ratio (RRR), 1.88; 95% CI, 1.11–3.19) and perceived (RRR, 2.06; 95% CI, 1.12–3.79) stigmas were associated with a higher prevalence of depressive symptoms. Anticipated (RRR, 4.78; 95% CI, 1.74–13.13) and enacted (RRR, 3.09; 95% CI, 1.61–5.93) stigmas were also associated with a higher prevalence of depression. In secondary analyses, the significant differences between MSM and TGW were lost after adjusting for stigma. These data demonstrate a high burden of depressive symptoms and depression among MSM/TGW in Kigali. Conceptually, stigma is a likely antecedent of mental health stress among MSM and TGW suggesting the potential utility of scaling up stigma mitigation interventions to improve the quality of life and mental health outcomes among sexual and gender minority communities in Rwanda.