PLOS Mental Health · Published 2026-05-04 · DOI 10.1371/journal.pmen.0000590
In Nigeria, sexual and gender minorities (SGM) experience disproportionately high rates of depression, exacerbated by layered stigma related to gender identity and HIV status. However, little is known about how HIV status may modify the relationship between gender identity and depression in this context. We conducted a cross-sectional analysis using baseline data from 977 SGM participants recruited through respondent-driven sampling at an SGM-friendly clinic in Abuja, Nigeria (2023-2024). Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), with scores ≥10 indicating major depression symptomatology. We employed multivariable logistic regression to examine associations between gender identity, HIV status, and depression, including interaction effects. Overall, 18% of participants exhibited major depression symptomatology. Depressive symptoms were more common among transgender women (25%) and non-binary individuals (26%) than cisgender men (16%), and higher among persons living with HIV (PLHIV; 20%) compared to those without (15%). In adjusted models, both transgender women (aOR 2.05; 95% CI: 1.09-3.88) and non-binary individuals (aOR 2.38; 95% CI: 1.43-3.95) had higher odds of depression than cisgender men. Financial insecurity (aOR 5.78; 95% CI: 3.77-8.86) and employment (aOR 1.73; 95% CI: 1.18-2.52) were also independently associated with depression. Notably, the joint effect of non-cisgender identity and HIV was supra-additive: PLHIV who were non-binary had an aOR of 4.10 (95% CI: 2.16-7.77) for depression, with a relative excess risk due to interaction (RERI) of 2.96. HIV status modifies the association between gender identity and depression among SGM in Nigeria. These findings underscore the need for intersectional, stigma-informed mental health interventions and affirming care models that address the unique vulnerabilities faced by PLHIV with non-cisgender identities.
Abstract from DOAJ. Public domain (CC0 1.0).
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