Background: Men who have sex with men (MSM) bear a disproportionate burden of HIV in Malawi. Early
prevention efforts in Malawi have been largely focused on preventing heterosexual and vertical transmission of HIV,
and MSM have rarely been the specific benefactors of these efforts, despite facing both higher prevalence of HIV
coupled with multiple barriers to prevention and care. To better facilitate the design of culturally relevant HIV
prevention programs and prioritize resources among MSM in resource limited settings, the objective of this analysis
was to estimate the relationship between social factors and HIV related risk behaviors and mental health.
Methods: 338 MSM were recruited using respondent-driven sampling in Blantyre, Malawi from April 2011 to March
2012. Structural equation models were built to test the association between six latent factors: participation in social
activities, social support, stigma and human rights violations, depression symptomatology, condom use, and sexual
risk behaviors, including concurrent sexual partnerships and total number of partners.
Results: The mean age of participants was 25 years old. Almost 50% (158/338) of the participants were
unemployed and 11% (37/338) were married or cohabiting with women. More than 30% (120/338) of the
participants reported sexual behavior stigma and 30% (102/338) reported depression symptomatology. Almost 50%
(153/338) of the participants reported any kind of HIV-related risk behaviors and 30% (110/338) participated in one
of the recorded social activities. Significant associations were identified between stigma and risk behaviors ( β = 0.14,
p = 0.03); stigma and depression symptomatology ( β = 0.62, p = 0.01); participation in social activities and depression
symptomatology ( β = 0.17, p = 0.01).