HIV status modifies the association between gender identity and depression among sexual and gender minorities in Nigeria, with PLHIV who were non-binary showing supra-additive joint effects (aOR 4.10) exceeding what either risk factor alone would predict.
Overall, 18% of SGM participants in Abuja, Nigeria exhibited major depression symptomatology as assessed by the PHQ-9.
Depressive symptoms were more prevalent among transgender women and non-binary individuals than among cisgender men.
In adjusted models, both transgender women and non-binary individuals had significantly higher odds of depression compared to cisgender men.
Persons living with HIV (PLHIV) had higher rates of depressive symptoms than those without HIV.
The joint effect of non-cisgender identity and HIV-positive status on depression was supra-additive, indicating a positive interaction between the two risk factors.
Financial insecurity and employment status were independently associated with depression in adjusted models.
This research studied depression among sexual and gender minority (SGM) people in Abuja, Nigeria, focusing on whether being HIV-positive changes the relationship between gender identity and depression. Nearly 1,000 participants were surveyed, and about 18% showed signs of major depression. Transgender women and non-binary individuals were more likely to be depressed than cisgender men (gay or bisexual men whose gender identity matches their sex assigned at birth), and people living with HIV were more likely to be depressed than HIV-negative participants. The most striking finding was that when non-binary identity and HIV-positive status combined, the risk of depression was much higher than simply adding the two risks together — a statistical phenomenon called a 'supra-additive interaction.' Non-binary individuals living with HIV had more than four times the odds of depression compared to HIV-negative cisgender men. Financial insecurity was also a very strong predictor of depression. This suggests that layered stigmas — related to both gender identity and HIV status — compound each other in harmful ways for mental health. This research suggests that mental health services in Nigeria and similar settings need to consider the overlapping vulnerabilities of gender minority identity and HIV status together, rather than treating them separately. Standard HIV care or general mental health programs may not adequately address the unique needs of transgender and non-binary PLHIV. Interventions that are simultaneously affirming of gender identity and sensitive to HIV-related stigma — along with addressing economic hardship — may be particularly important for reducing depression in this population.
R. Adebiyi, Chama John, Megan E. Mansfield, Andrew Mitchell, J. Jumare, R. Robinson, et al.. (2026). The moderating role of HIV status in the association between gender identity and depression among sexual and gender minorities in Abuja, Nigeria. PLOS mental health. https://doi.org/10.1371/journal.pmen.0000590