Social marginalization harms lesbian, gay, bisexual, and transgender (LGBT) persons' wellbeing in Lesotho. Socio-cultural mechanisms linking LGBT stigma, depression, substance use, and HIV among LGBT persons in Lesotho are understudied. We explore associations between LGBT stigma, mental health stressors, and HIV vulnerabilities among LGBT persons in Lesotho. We conducted in-depth, semi-structured interviews with 46 LGBT persons and six key informants (e.g. healthcare providers). Participants described depression, substance use, and HIV as mutually reinforcing and situated in larger social contexts of stigma. Alcohol use was a stigma coping strategy and a way to build LGBT connections. At the same time, alcohol use elevated HIV vulnerabilities by lowering condom use uptake. Pervasive stigma reinforced barriers to healthcare engagement. Community-led support and services were leveraged to navigate stigma, reduce HIV vulnerabilities, and ultimately improve health. Findings emphasize the key role contexts play in shaping sexual and mental health among LGBT persons in Lesotho.

中文翻译：

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概念化莱索托 LGBT 人群中的 LGBT 耻辱感和相关的 HIV 脆弱性。

莱索托的社会边缘化危害女同性恋、男同性恋、双性恋和变性者 (LGBT) 的福祉。莱索托 LGBT 人群中将 LGBT 耻辱感、抑郁症、物质使用和 HIV 联系起来的社会文化机制尚未得到充分研究。我们探讨了莱索托 LGBT 人群中 LGBT 耻辱感、心理健康压力源和 HIV 脆弱性之间的关联。我们对 46 名 LGBT 人士和 6 名关键信息提供者（例如医疗保健提供者）进行了深入的半结构化访谈。参与者将抑郁症、物质使用和 HIV 描述为相辅相成，并且处于更大的耻辱社会背景中。饮酒是一种耻辱应对策略，也是建立 LGBT 联系的一种方式。同时，酒精会降低安全套的使用率，从而增加 HIV 的脆弱性。普遍的污名化加剧了医疗保健参与的障碍。社区主导的支持和服务被用来消除耻辱感，减少 HIV 脆弱性，并最终改善健康状况。调查结果强调了环境在塑造莱索托 LGBT 人群的性健康和心理健康方面发挥的关键作用。