The Effect of Sexual and Gender Minority Violence on Depression, Hazardous Drinking, Condom Use, and HIV Acquisition: An Individual Participant Data Meta-Analysis of the CohMSM, HPTN 075, and Anza Mapema Cohort Studies in Africa

Abstract

Some sexual and gender minorities (SGM), including men who have sex with men and transgender women, are disproportionately vulnerable to HIV. Many SGM in Africa report experiencing verbal or physical violence due to their sexual and/or gender identities or behaviours. The pathways linking such SGM violence to HIV acquisition are complex. We described experiences of verbal and physical SGM violence and explored pathways to HIV acquisition among SGM assigned male sex at birth using a two-stage individual participant data meta-analysis of three African cohort studies: CohMSM (Burkina Faso, Côte d'Ivoire, Mali, Togo), HPTN 075 (Kenya, Malawi, South Africa), and Anza Mapema (Kenya). SGM violence was assessed at baseline and follow-up visits. We fit log-linear sequential conditional mean models using generalised estimating equations to estimate risk ratios linking SGM violence, moderate-to-severe depressive symptoms, hazardous drinking, condom use, and HIV acquisition, adjusted for baseline confounders and previous exposure and outcome. We pooled study estimates using random effects meta-analysis. SGM violence, mostly verbal, was reported by 36% (570/1590) participants at baseline (past 6-12 months), and 20% (321/1590) during the first year of follow-up (past 3-6 months). Baseline SGM violence was not associated with HIV acquisition (pooled adjusted risk ratio [aRR] = 1.0, 95% CI 0.5-1.9). During follow-up, SGM violence also showed no clear relationship with HIV, but was linked to depressive symptoms at the same visit (pooled aRR = 1.7, 1.3-2.1), in turn associated with hazardous drinking (pooled aRR = 1.4, 1.1-1.7). Impacts on condom use were inconclusive. SGM in Africa face high rates of violence, which are associated with depressive symptoms and hazardous drinking-potential routes to HIV vulnerability. While our study did not conclusively demonstrate higher HIV incidence among SGM reporting violence, interventions to reduce violence and support mental health remain crucial.

Keywords: HIV incidence; Homophobic violence; Individual participant data meta-analysis; Mental health; Sexual and gender minorities; Structural determinants.