Strong link found between gay-related stigma and HIV prevalence in Nigeria

As the intensity of stigma towards gay and other men who have sex with men increases, so does the prevalence of HIV and other sexually transmitted infections (STIs), as revealed by a new study published in the International AIDS Society Journal this month.

In every region of the world, men who have sex with men are more affected by HIV than other male populations. Gay-related stigma has long been known to be a major driver of infections in this group, however this new research shows just how strong this relationship is. 

Men who have sex with men from two facilities in Lagos and Abuja in Nigeria were asked to complete behavioural questionnaires, while also receiving testing and counselling for HIV and other STIs. The questionnaire measured stigma according to nine key stigma indicators – including experiences of physical violence, rape, rejection from friends, discriminatory remarks from family, refusal from police to protect, verbal harassment, blackmail, fear of seeking healthcare and fear of walking in public.

Participants were then classified into three sub-groups: those who had experienced high, medium and low levels of stigma. Classifying participants in this way provided greater insight into the effects of different experiences that are often joined together under the broad label of ‘stigma’ – allowing researchers to see which specific experiences were more strongly associated with increased HIV risk.

They found that HIV prevalence was strongly related to the level of stigma experienced by the participants, with those who experienced severe stigma more likely to be living with HIV and diagnosed with other STIs.

The researchers argue that this provides further evidence of a causal relationship between gay-related stigma and HIV prevalence.

They also showed that those who had disclosed their sexuality were far more likely to have experienced higher levels of stigma, meaning they were more likely to have experienced all nine stigma indicators – but especially to have been victims of physical violence and blackmail.

Fear of seeking healthcare was common regardless of the level of stigma experienced – 14% of people categorised as experiencing ‘low-level’ stigma reported fear of getting healthcare. But it was still more common among those experiencing high levels of stigma, with 63% reporting fear of healthcare services. 

Understanding how common the fear of engaging in healthcare is among gay men in Nigeria gives us an insight into how a causal relationship between stigma and HIV infection might work, as men are more at risk of HIV if they feel unable to access the sexual health services they need.

Getting to grips with how experiences of stigma differ among these groups will help us to develop better targeted interventions.

Previous research has suggested that peer education along with sensitisation training for health workers can be one of the most effective ways to reduce stigma towards men who have sex with men. The results from this study support this suggestion, showing that it could be one of the best ways of reaching the broadest range of men who have sex with men in Nigeria, as fear of seeking health services was the most commonly reported stigma experience.