title: Suicidal ideation among MSM in three West African countries: Associations with stigma and social capital.
abstract: BACKGROUND
  Suicidal ideation is understudied among men who have sex with men (MSM) across Sub-Saharan Africa.
  
  
  OBJECTIVE
  This study aimed to explore social capital and sexual behavior stigma associated with suicidal ideation among MSM in the West African nations of The Gambia, Burkina Faso and Togo.
  
  
  METHODS
  Participants were recruited using respondent-driven sampling and snowball sampling across multiple cities (n = 1555) from July 2011 to August 2013. During a single study visit, participants completed a survey. Logistic regression models were used to assess bivariate and multivariable associations with suicidal ideation.
  
  
  RESULTS
  The prevalence of lifetime suicidal ideation was 13% overall and ranged 6%-17% across study sites. After adjusting for potential confounders, MSM who reported stigma as a result of having sex with men were more likely to report suicidal ideation. Physical and sexual violence was strongly associated with suicidal ideation, including being physically harmed (adjusted odds ratio (aOR) = 2.94, 95% confidence interval (CI) = 1.91, 4.52), tortured (aOR = 3.86, 95% CI = 2.17, 6.86) and raped (aOR = 3.07, 95% CI = 2.05, 4.60). In contrast, increasing social participation with the broader community was associated with decreased report of suicidal ideation (aOR = 0.91, 95% CI = 0.85, 0.99).
  
  
  CONCLUSIONS
  Sexual behavior stigma should be addressed to improve mental health among MSM in Western Sub-Saharan Africa.
authors: Center for Public Health and Human Rights and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA sstahlm1@jhu.edu.
authors: Shauna
authors: S
authors: Stahlman
authors: Center for Public Health and Human Rights and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Ashley
authors: A
authors: Grosso
authors: Center for Public Health and Human Rights and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Sosthenes
authors: S
authors: Ketende
authors: Conseil National de Lutte contre le SIDA-Togo (National AIDS Council), Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo.
authors: Vincent
authors: V
authors: Pitche
authors: Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso Institut Africain de Santé Publique, Ouagadougou, Burkina Faso.
authors: Seni
authors: S
authors: Kouanda
authors: UNAIDS, Mbabane, Swaziland.
authors: Nuha
authors: N
authors: Ceesay
authors: Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso.
authors: Henri G
authors: HG
authors: Ouedraogo
authors: Programme d'Appui au Monde Associatif et Communautaire (PAMAC), Ouagadougou, Burkina Faso.
authors: Odette
authors: O
authors: Ky-Zerbo
authors: Programme d'Appui au Monde Associatif et Communautaire (PAMAC), Ouagadougou, Burkina Faso.
authors: Marcel
authors: M
authors: Lougue
authors: Enda Santé Senegal, Dakar, Sénégal.
authors: Daouda
authors: D
authors: Diouf
authors: Arc-en-ciel, Lomé, Togo.
authors: Simplice
authors: S
authors: Anato
authors: Espoir Vie, Lomé, Togo.
authors: Jules
authors: J
authors: Tchalla
authors: Center for Public Health and Human Rights and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Stefan
authors: S
authors: Baral
mesh_terms: D000328:Adult; D000354:Africa, Western; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D015999:Multivariate Analysis; D016017:Odds Ratio; D066270:Social Capital; D057545:Social Stigma; D059020:Suicidal Ideation; D014754:Violence; D055815:Young Adult
keywords: Stigma; West Africa; men who have sex with men; social capital; suicidal ideation