Synergistic epidemics of non-communicable diseases, stigma, depression, and material insecurities among sexual and gender minorities living with HIV in Nigeria

PROJECT ABSTRACT
There is an increasing burden of HIV-associated noncommunicable diseases (HIVNCD) globally, which often
cluster among populations facing persistent social and economic inequalities. One such population is sexual
and gender minorities (SGM), for whom stress resulting from discrimination leads to poorer health outcomes.
Syndemic frameworks have been utilized to explain elevated HIV risk in SGM populations but have only
recently been applied to study HIVNCD. Being an SGM is associated with real and perceived discrimination
and stigmatization. As a result, SGM experience elevated levels of victimization including intimate partner
violence (IPV) and subsequently, stress, depression, polysubstance use, and material insecurity. These factors
are well-documented risk factors for disengagement in the continuum of care among SGM. There is a critical
knowledge gap for the development of modifiable intervention strategies, however, regarding how these
syndemic factors leads to disease clustering of HIVNCD and promotes further inequities and vulnerabilities in
low- and middle-income countries (LMIC) where both HIV prevalence and social/economic barriers to
accessing health care are remarkably high. In Nigeria, where the University of Maryland, the Johns Hopkins
University, and the U.S. Military HIV Research Program have worked with SGM since 2012, 70% of SGM in
the TRUST/RV368 study (84% men who have sex with men and 16% self-identified as women) experience a
moderate-to-severe level of stigma related to discriminatory policies, and social norms that leads to avoidance
of HIV care. Prior to this proposal, we conducted a cross-sectional preliminary analysis, which suggested that
stigma and depression are associated with clusters of cardiometabolic risk factors. The proposed work builds
on the TRUST/RV368 study, the largest cohort of SGM in sub-Saharan Africa (SSA) and brings together a
multidisciplinary team of researchers to: 1) Examine association between syndemic factors and HIVNCD
outcomes; 2) Assess whether and how community-level and structural-level factors exacerbate the syndemic;
and 3) Determine whether the syndemic characterized for HIVNCD prevalence and outcomes is associated
with risk of disengaging from HIVNCD care continua.

Grant Number: 5R01HL165686-04
NIH Institute/Center: NIH
Principal Investigator: Manhattan Charurat