PROJECT ABSTRACT There is an increasing burden of HIV-associated noncommunicable diseases (HIVNCD) globally, which often cluster among populations facing persistent social and economic inequalities. One such population is sexual and gender minorities (SGM), for whom stress resulting from discrimination leads to poorer health outcomes. Syndemic frameworks have been utilized to explain elevated HIV risk in SGM populations but have only recently been applied to study HIVNCD. Being an SGM is associated with real and perceived discrimination and stigmatization. As a result, SGM experience elevated levels of victimization including intimate partner violence (IPV) and subsequently, stress, depression, polysubstance use, and material insecurity. These factors are well-documented risk factors for disengagement in the continuum of care among SGM. There is a critical knowledge gap for the development of modifiable intervention strategies, however, regarding how these syndemic factors leads to disease clustering of HIVNCD and promotes further inequities and vulnerabilities in low- and middle-income countries (LMIC) where both HIV prevalence and social/economic barriers to accessing health care are remarkably high. In Nigeria, where the University of Maryland, the Johns Hopkins University, and the U.S. Military HIV Research Program have worked with SGM since 2012, 70% of SGM in the TRUST/RV368 study (84% men who have sex with men and 16% self-identified as women) experience a moderate-to-severe level of stigma related to discriminatory policies, and social norms that leads to avoidance of HIV care. Prior to this proposal, we conducted a cross-sectional preliminary analysis, which suggested that stigma and depression are associated with clusters of cardiometabolic risk factors. The proposed work builds on the TRUST/RV368 study, the largest cohort of SGM in sub-Saharan Africa (SSA) and brings together a multidisciplinary team of researchers to: 1) Examine association between syndemic factors and HIVNCD outcomes; 2) Assess whether and how community-level and structural-level factors exacerbate the syndemic; and 3) Determine whether the syndemic characterized for HIVNCD prevalence and outcomes is associated with risk of disengaging from HIVNCD care continua.

NARRATIVE This project seeks to examine population-level clustering of syndemic factors (stigma, depression, material insecurity, polysubstance use, intimate partner violence, and police and other violence) and HIV-associated noncommunicable diseases (HIVNCD) in a population of sexual and gender minorities living with HIV/AIDS in Nigeria. It will provide critical data for informing the development of integrated, multilevel interventions intended to remediate disparities in HIVNCD and their outcomes among sexual and gender minorities in sub-Saharan Africa and other similar settings.