Depression, Substance Abuse, and Stigma among Kenyan Men Who Have Sex with Men

Abstract

Objective(s): Mental health conditions can have a severe impact on quality of life and interfere with health-related behaviors such as medication adherence. We aimed to determine the prevalence and correlates of depression and other psychosocial characteristics among self-identified men who have sex with men (MSM) in coastal Kenya. Design: Psychosocial and sociodemographic characteristics were determined for 112 MSM participating in two ongoing HIV-positive and -negative cohorts in Mtwapa, Kenya. Methods: We used multivariable linear regression to assess associations with depression score. Bivariate correlation coefficients were used to assess correlations between model covariates. Results: One-third of participants met criteria for major depressive disorder (16.1%, 95% CI: 9.8%-24.2%) or other depressive disorder (15.2%, 95% CI: 9.1%-23.2%). Alcohol abuse was reported by 45% (95% CI: 35.2%-54.3%) of respondents and other substance abuse by 59.8% (95% CI: 50.1%-69.0%). Sexual and HIV stigma were moderate at 11 (IQR 6-17) and 25 (IQR 23-29), respectively. There were significant correlations between alcohol use, other substance use, sexual stigma, and childhood and recent abuse. In the multivariable linear regression model, depression score was associated with sexual stigma (beta=0.17, 95% CI 0.03-0.32) and marriage to a woman (beta=-2.41 95% CI -4.74 - -0.09). Conclusions: We found moderate-to-high levels of depression, alcohol and other substance abuse, and low-to-moderate levels of sexual and HIV stigma. These mental health conditions and psychosocial factors are highly inter-correlated and are exacerbated by experience of trauma or abuse. Comprehensive mental health services are needed in this population to address these issues.