Sexual Stigma, Depressive Symptoms, and HIV Vulnerability Among Gay, Bisexual, and Other Men Who Have Sex with Men in Kenya

The studies within this dissertation address sexual stigma and its associations with HIV behavioral vulnerability among gay, bisexual, and other men who have sex with men (GBMSM). GBMSM experience stigma and discrimination due to their sexual minority status. This work: 1) establishes the magnitude of reported depressive symptoms and alcohol use among GBMSM at three sites in Kenya, 2) assesses the validity and reliability of a sexual stigma scale targeted toward GBSMSM in Kenya, 3) describes the association between depressive symptoms and sexual behaviors, and 4) assesses associations between sexual stigma, depressive symptoms, alcohol use and sexual behaviors. Among 1,476 participants, 31% reported moderate to severe depressive symptoms (PHQ-9 ≥10), 44% hazardous alcohol use (AUDIT ≥8), and 51% problematic substance use (DAST-6 ≥1). Using exploratory and confirmatory factor analysis, an 8-item sexual stigma scale tailored for use among GBMSM in Kenya was validated to represent two factors: perceived sexual stigma and enacted sexual stigma. Depressive symptoms were found to be associated with condomless receptive anal intercourse and condomless insertive anal intercourse. Direct associations were found between enacted sexual stigma and number of male partners and enacted sexual stigma and condomless receptive anal intercourse (RAI). Indirect associations through alcohol use were found between both perceived and enacted sexual stigma and condomless RAI. This research contributes to the growing body of knowledge on sexual stigma among GBMSM in Kenya. It provides information on sexual stigma, its measurement, and direct and indirect associations with HIV behavioral vulnerability. Prevention programs for GBMSM should consider the effects of sexual stigma on this population and address these multiple pathways to reduce vulnerability to HIV in this population.