Mental health, HIV and healthcare-related discrimination among young sexual minority men in Kenya: implications for integrated care and stigma reduction
TL;DR
The importance of integrating mental health with HIV services, alongside stigma-reduction interventions in both healthcare and educational settings, to improve access, quality of care, and outcomes for this young key population of young sexual minority men in Kenya is underscore.
Abstract
Mental health conditions among young sexual minority men (YSMM) are a growing public health concern, yet they are understudied in sub-Saharan African settings. We aimed to estimate the prevalence of depressive and anxiety symptoms, and associated factors among YSMM in Kenya. Between February and March 2021, we conducted a cross-sectional bio-behavioral survey among YSMM aged 18 years or older and enrolled in tertiary academic institutions in Nairobi, using respondent-driven sampling. Participants completed an electronically self-administered demographic and behavioral questionnaire on REDCap. Depressive and anxiety symptoms were assessed using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) tools respectively, with scores equal to or greater than 10 indicating moderate-to-severe symptoms. HIV antibody testing followed Kenyan national guidelines. Principal component analysis was used to derive stigma-related domains, and multivariate logistic regression identified factors associated with outcomes. Data analysis was done using Stata v.17 software. Among 242 participants, median age was 21 years (IQR 19-23). Prevalence of depressive, anxiety, co-occurring depressive/anxiety symptoms and HIV were: 23.7% (95% CI: 18.4-29.5), 16.9% (95% CI: 12.4-22.3), 12.4% (95% CI: 8.5-17.2) and 8.3% (95% CI: 5.1-12.5), respectively. Factors independently associated with depressive symptoms were: living with HIV (AOR: 4.88, 95% CI: 1.18-20.18, p = 0.029), moderate-to-severe anxiety symptoms (AOR: 25.63, 95% CI: 8.58-76.61, p<0.001), healthcare-related discrimination (AOR: 1.56, 95% CI: 1.07-2.28, p = 0.020) and early years of study (AOR: 2.79, 95% CI: 1.09-7.15, p = 0.033). Factors independently associated with anxiety symptoms were: moderate-to-severe depressive symptoms (AOR: 26.10, 95% CI: 8.10-84.15, p <0.001), attending a public academic institution (AOR: 3.33, 95% CI: 1.14-10.00, p = 0.028), and boarding school history (AOR: 4.35, 95% CI: 1.14-16.67, p = 0.032). YSMM in Nairobi experience a high burden of depressive and anxiety symptoms with substantial co-occurrence. Living with HIV, experiencing healthcare-related discrimination and educational context play key roles in shaping mental health outcomes among YSMM. These findings underscore the importance of integrating mental health with HIV services, alongside stigma-reduction interventions in both healthcare and educational settings, to improve access, quality of care, and outcomes for this young key population.