Abstract
BackgroundIn Cote D’Ivoire, there has been limited coverage of evidence-based sexual health services specifically supporting men who have sex with men (MSM). To date, there has been limited study of the determinants of engagement in these services including multiple intersecting stigmas and depression.Methods1301 MSM aged 18 years and older, were recruited using respondent-driven sampling in Abidjan, Yamoussoukro, Gagnoa and Bouake, Cote d’Ivoire from January 2015 to October 2015. Inclusion criteria included anal sex with another man in the past 12 months were to complete a structured questionnaire including the Patient Health Questionnaire (PHQ)-9 to screen for depression. Chi-Square tests were used to test difference in healthcare utilization across variables, and multiple logistic regression was used to test the association between depression and health care utilization represented by HIV and sexually transmittable infection testing and treatment.ResultsDepression (aOR:1.40, 95% CI: 1.07–1.84), being aged 25–29 years (aOR:1.84, 95% CI: 1.11–3.03),unemployed (aOR:0.64, 95% CI: 0.42–0.98), being a student (aOR:0.67, 95% CI: 0.48–0.96), being identified as male (aOR:0.44, 95% CI: 0.29–0.67), and identifying as homosexual (aOR:0.74, 95% CI:0.56–0.99) were significantly associated with utilization of sexual health care services in the final multivariable model. Healthcare enacted stigma (aOR: 1.55, 95% CI: 1.03–2.33) was associated with utilizing sexual health care services, but perceived healthcare stigma, social stigma and family stigma were not.ConclusionGiven higher levels of depressive symptomatology among those engaging in sexual health care services, this engagement represents an opportunity for service integration which may have synergistic benefits for both sexual and mental health. Moreover, MSM in Cote D’Ivoire who had engaged in sexual health services were more likely to report having experienced health-care enacted stigma. Taken together, these results reinforce the need for stigma mitigation interventions to support sustained engagement in HIV prevention, treatment and care services as a means of reducing health disparities among MSM in Cote d’Ivoire.
Highlights
In Cote D’Ivoire, there has been limited coverage of evidence-based sexual health services supporting men who have sex with men (MSM)
While literature is rich with research on depression among MSM in high income countries, the same cannot be said of low and middle income countries [7] such as Cote d’Ivoire, or more broadly across West Africa
Abidjan had the highest percentage of participants who self-reported as HIV positive (61.1%, 33/54) and Gagnoa the least (1.9%, 1/54)
Summary
In Cote D’Ivoire, there has been limited coverage of evidence-based sexual health services supporting men who have sex with men (MSM). There has been limited study of the determinants of engagement in these services including multiple intersecting stigmas and depression. While literature is rich with research on depression among MSM in high income countries, the same cannot be said of low and middle income countries [7] such as Cote d’Ivoire, or more broadly across West Africa. Studies in Tanzania and South Africa have estimated the prevalence of depression among MSM to be 46.3 and 44% respectively [5, 7]. The prevalence of depression in Cote d’Ivoire is estimated to be 20% among adults receiving psychiatric services [8]. Neighboring West African countries have limited data on depression, with only some data for specific demographic groups including university students (39.2%) [9] in Ghana and Cote d’Ivoire [9, 10]
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