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Depression and Sexual Stigma Are Associated With Cardiometabolic Risk Among Sexual and Gender Minorities Living With HIV in Nigeria
 
 
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cardiometabolic risk factors increased with severity of depression and sexual stigma, potentially predisposing SGM living with HIV to cardiometabolic diseases, CMRF (cardiometabolic risk factors).
 
Noncommunicable diseases (NCDs)1 constitute one of the most common causes of disability globally. The World Health Organization and American Society of Endocrinology recognize cardiometabolic diseases as multifactorial disease entities characterized by insulin resistance, impaired glucose tolerance, dyslipidemia, hypertension, and central adiposity.2-4
 
Stigma and social discrimination are known cardiovascular stressors that result in secretion of stress hormones and physiological changes.21 Prolonged exposure to various forms of stigma, including racial,22 sex,23 and weight24 stigma, can cause chronic stress, sympathetic nervous system stimulation, and other cardiovascular responses. Evidence has also shown that sexual and ethnic minorities who report discrimination have elicited a similar ‚Äúcardiovascular conundrum‚ÄĚ.25 However, the relationship between sexual stigma and cardiometabolic risk is not well elucidated.
 
Abstract
 
Background:

 
People living with HIV are vulnerable to cardiometabolic diseases. We assessed the prevalence of cardiometabolic risk factors (CMRF) and associations with sexual stigma and depression among sexual and gender minorities (SGM) in Abuja and Lagos, Nigeria.
 
Methods:
 
The TRUST/RV368 study enrolled SGM between March 2013 and February 2020. Participants were assessed for depression, sexual stigma, and CMRF. Robust multinomial logistic regression was used to estimate adjusted odds ratio (aORs) and 95% confidence intervals (CIs) for associations of depression, sexual stigma, and other factors with increasing numbers of CMRF.
 
Sixty-two percent of the participants were on ART, 36% were virally suppressed, and 88% had CD4 count of ≥200 cells/μL (Table 1). Nineteen percent of the participants were overweight, 37% were prehypertensive, 60% had abnormal triglycerides, and 31% had abnormal HDL. Eighty-four percent of the participants had at least 1 CMRF (95% CI: 82% to 87%). Prevalence of ≥3 CMRF was 24% (95% CI: 21% to 27%; Table 2).
 
Results:
 
Among 761 SGM, the mean age was 25.0 ± 6.0 years; 580 (76%) identified as cisgender men, 641 (84%) had ≥1 CMRF, 355 (47%) had mild-severe depression, and 405 (53%) reported moderate-high sexual stigma. Compared with individuals without depression, those with mild (aOR 8.28; 95% CI: 4.18 to 16.40) or moderate-severe depression(aOR 41.69; 95% CI: 9.60 to 181.04) were more likely to have 3-5 CMRF. Individuals with medium (aOR 3.17; 95% CI: 1.79 to 5.61) and high sexual stigma (aOR 14.42; 95% CI: 2.88 to 72.29) compared with those with low sexual stigma were more likely to have 3-5 CMRF. Participants age 25-34 years were less likely to have 3-5 CMRF (aOR 0.41; 95% CI: 0.23 to 0.73) compared with participants age younger than 25 years.
 
the odds of having 1-2 CMRF increased with severity of depression from 3.40 (95% CI: 1.88 to 6.15) with mild depression to 9.44 (95% CI: 2.27 to 39.31) with moderate-severe depression. Similarly, the odds of having 3-5 CMRF were 8.28 (95% CI: 4.18 to 16.40) with mild depression and 41.69 (95% CI: 9.60 to 181.04) with moderate-severe depression compared with those without depression. The odds of having 1-2 CMRF were also higher if participants belonged to the medium sexual stigma subgroup [adjusted odds ratio (aOR) 1.76; 95% CI: 1.10 to 2.82] compared with those in the low stigma class. Furthermore, compared with participants without sexual stigma, the odds of 3-5 CMRFs were 3.17 (95% CI: 1.79 to 5.61) among those in the medium sexual stigma class and 14.42 (95% CI: 2.88 to 72.29) in the high sexual stigma class compared with those in the low stigma class.
 
Conclusion:
 
CMRF increased with severity of depression and sexual stigma, potentially predisposing SGM living with HIV to cardiometabolic diseases. Integrating interventions that address depression and sexual stigma in HIV care programs for SGM may improve cardiometabolic outcomes.
 
Noncommunicable diseases (NCDs)1 constitute one of the most common causes of disability globally. The World Health Organization and American Society of Endocrinology recognize cardiometabolic diseases as multifactorial disease entities characterized by insulin resistance, impaired glucose tolerance, dyslipidemia, hypertension, and central adiposity.2-4
 
People with cardiometabolic diseases are twice as likely to die of coronary heart disease and three times more likely to suffer heart attacks or strokes, than those who do not have cardiometabolic diseases.2
 
A recent meta-analysis of cardiometabolic diseases among persons living with HIV (PLHIV) from low- and middle-income countries (LMICs) reported prevalence estimates of hypertension (21.2%), hypercholesterolemia (22.2%), hypertriglyceridemia (27.2%), low high-density lipoprotein (52.3%), and obesity (7.8%).5 Although numerous systematic reviews have reported high prevalence of cardiometabolic diseases in Nigeria ranging from 18% to 32% in the general population of persons not living with HIV,6,7there is a dearth of studies on cardiometabolic diseases among sexual and gender minorities (SGM), especially those living with HIV.
 
HIV is considered an independent risk factor for cardiovascular events.8 The cardiometabolic effects of HIV, such as abnormal lipid and glucose metabolism, fat redistribution, chronic inflammation, and vascular endothelial dysfunction, may contribute to cardiovascular end-organ disease.8-11 Furthermore, studies have linked antiretroviral therapy (ART) as a causal agent for cardiometabolic risk in PLHIV.12,13
 
Mental health disorders seem to be associated with increased risk of NCDs.14 Studies in the general population of people without HIV have reported associations between depression and disease entities related to cardiometabolic risks, such as diabetes and cardiovascular disease.15,16 This has been linked to poor dietary habits, substance use, and low physical activity among other mediators, such as delayed diagnosis of coexisting diseases resulting from neglect.17
 
The cardiometabolic effects of HIV have also been linked to mental health disorders, specifically depression.18,19Moreover, the widespread co-occurrence of comorbidities such as NCDs with mental health disorders makes treatment of both conditions challenging with poorer prognoses.20
 
To our knowledge, data exploring relationships between cardiometabolic risk, depression, and sexual stigma among SGM are scarce. The aim of this study was to investigate these associations in a cohort of SGM living with HIV in Nigeria.

 
 
 
 
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