Impact of enacted stigma on mental health, substance use, and HIV-related behaviors among sexual minority men in Zambia

Sexual minority men (SMM) in Zambia face significant challenges including stigma, discrimination, and mental health issues, which further impact their HIV -related risk behaviors. This study aimed to investigate the associations between enacted stigma, substance abuse, HIV -related behaviors, and mental health (i.e., depression, anxiety, and post -traumatic stress disorder [PTSD] symptoms) among SMM in Zambia. SMM aged 18-35 years who reported having multiple and/or concurrent sexual partners or low and/or inconsistent condom use in the past three months were recruited from four districts in Zambia between February and November 2021. Participants completed an anonymous interviewer -administered survey. Key variables of interest were compared between participants with higher vs. lower levels of enacted stigma. Independent samples t -tests were used for continuous variables, and chi -squared tests were used for categorical variables. A total of 197 eligible SMM participated in the study (mean age = 24.41 years). Participants with a higher level of enacted stigma showed a higher level of anxiety symptoms (X-2 = 12.91, p <= .001), PTSD symptoms (X-2 = 7.13, p < .01), tobacco use (X-2 = 10.47, p < .01), cannabis use (X-2 = 5.90, p < .05), and a higher number of sexual partners (t = 1.99, p < .05) in the past three months. Stigma reduction interventions may help mitigate substance abuse, HIV -related behaviors, and adverse mental health outcomes among SMM in Zambia. Health care providers, especially psychiatricmental health nurses, can incorporate strategies for recognizing and addressing stigma into their practice through training and integrate multiple resources to create an inclusive and non -judgmental environment for SMM to improve their well-being.