Tool), and childhood trauma (abridged CECA). Depression, alcohol use, and other substance use were rated using validated categories of increasing severity (e.g., WHO risk zones I-IV for AUDIT) and summary scores were created for sexual and HIV stigma. Recent and childhood trauma were combined into a binary indicator of any past trauma or abuse. Spearman correlation and Wilcoxon rank sum tests were used to identify associations. Findings: Forty-two percent of participants had moderate to severe depressive symptoms, 45% engaged in hazardous or harmful drinking behaviour, and 60% had moderate to severe abuse of other substances. Median sexual and HIV stigma scores were 11 (IQR 6-17, range 0-33) and 25 (IQR 23-29, range 11-44, seropositive exclusive), respectively. There was a positive correlation between depression category and alcohol use category (rho¼0.33, p¼0.0004), and a weaker positive correlation between depression category and other substance use category (rho¼0.22, p¼0.0165). Alcohol use category and substance use category had a strong positive correlation (rho¼0.39, p < 0.0001). Sexual stigma was positively correlated with depression (rho¼0.49, p < 0.0001), alcohol use (rho¼0.39, p < 0.0001), and other substance use (rho¼0.29, p¼0.0023). HIV status and HIV-related stigma (among seropositives) were not correlated with any of the measures. Depression category was higher among men with a history of trauma or abuse (median 2.5 vs 1, p < 0.0001). Similar associations were found between trauma and alcohol use (median 1.5 vs 1, p¼ 0.0501), other substance use (median 3 vs. 2, p¼0.0041), and sexual stigma (median 12.5 vs. 5.5, p < 0.0001). Trauma was not associated with HIV status or HIV-related stigma. Interpretation: This population of Kenyan MSM reported moderate-to-high levels of depression and of alcohol and substance abuse, and low-to-moderate levels of sexual stigma. These mental health conditions and social factors are highly inter-correlated and are exacerbated by experience of trauma or abuse. Comprehensive mental health services are needed in this population to address these issues.
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