Mental health, HIV and healthcare-related discrimination among young sexual minority men in Kenya: implications for integrated care and stigma reduction

Mental health conditions among young sexual minority men (YSMM) are a growing public health concern, yet they are understudied in sub-Saharan African settings. We aimed to estimate the prevalence of depressive and anxiety symptoms, and associated factors among YSMM in Kenya. Between February and March 2021, we conducted a cross-sectional bio-behavioral survey among YSMM aged 18 years or older and enrolled in tertiary academic institutions in Nairobi, using respondent-driven sampling. Participants completed an electronically self-administered demographic and behavioral questionnaire on REDCap. Depressive and anxiety symptoms were assessed using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) tools respectively, with scores equal to or greater than 10 indicating moderate-to-severe symptoms. HIV antibody testing followed Kenyan national guidelines. Principal component analysis was used to derive stigma-related domains, and multivariate logistic regression identified factors associated with outcomes. Data analysis was done using Stata v.17 software. Among 242 participants, median age was 21 years (IQR 19-23). Prevalence of depressive, anxiety, co-occurring depressive/anxiety symptoms and HIV were: 23.7% (95% CI: 18.4-29.5), 16.9% (95% CI: 12.4-22.3), 12.4% (95% CI: 8.5-17.2) and 8.3% (95% CI: 5.1-12.5), respectively. Factors independently associated with depressive symptoms were: living with HIV (AOR: 4.88, 95% CI: 1.18-20.18, p = 0.029), moderate-to-severe anxiety symptoms (AOR: 25.63, 95% CI: 8.58-76.61, p<0.001), healthcare-related discrimination (AOR: 1.56, 95% CI: 1.07-2.28, p = 0.020) and early years of study (AOR: 2.79, 95% CI: 1.09-7.15, p = 0.033). Factors independently associated with anxiety symptoms were: moderate-to-severe depressive symptoms (AOR: 26.10, 95% CI: 8.10-84.15, p <0.001), attending a public academic institution (AOR: 3.33, 95% CI: 1.14-10.00, p = 0.028), and boarding school history (AOR: 4.35, 95% CI: 1.14-16.67, p = 0.032). YSMM in Nairobi experience a high burden of depressive and anxiety symptoms with substantial co-occurrence. Living with HIV, experiencing healthcare-related discrimination and educational context play key roles in shaping mental health outcomes among YSMM. These findings underscore the importance of integrating mental health with HIV services, alongside stigma-reduction interventions in both healthcare and educational settings, to improve access, quality of care, and outcomes for this young key population.