Depressive symptoms and substance use as mediators of stigma affecting men who have sex with men in Lesotho: a structural equation modeling approach.

Purpose: Research on the relationship between sexual orientation related stigma and risks for HIV among men who have sex with men (MSM) is limited. This study tests a hypothesis that substance use and depressive symptoms mediate the relationship between stigma in the health care system and HIV related risk practices among MSM in Maseru, Lesotho. Methods: In 2014, we conducted a cross-sectional study among MSM in Lesotho accrued via respondent driven sampling including a survey and biological testing for HIV. The hypothesis was tested using structural equation modeling. Results: Of the 318 participants, 223% had experienced stigma in the health care system. Stigma in the health care system was associated with depression (beta = 0329, P = .018) and alcohol use (beta = 1.417, P = .001). Noninjection illicit drug use (beta = 0.837, P = .039) and alcohol use (beta = 0282, P = .000) significantly predicted number of sex partners. Stigma was directly associated with condomless anal sex (beta = 0.441, P = .036), and no indirect association was found. Conclusions: Alcohol use and depressive symptoms mediate the relationship between MSM stigma in the health care system and reported number of sex partners. The implications are significant with a focus on the need for comprehensive interventions addressing stigma and mental health when aiming to improve more proximal HIV-related risk practices for MSM. (C) 2016 Elsevier Inc. All rights reserved.