Associations of psychological distress, alcohol and substance use, and HIV risk behaviour in forcibly displaced persons and migrants in Nigeria.

Background: Forcibly displaced populations, refugees, and internally displaced persons (IDPs), and migrants face distinct challenges, increasing vulnerability to HIV infection and substance use disorders. This study assessed the associations between psychological distress, alcohol consumption, substance use, and HIV risk behaviour among these populations in Nigeria.

Methods: This was a secondary analysis of the data of a cross-sectional study, collected in five states in Nigeria (Benue, Borno, Cross Rivers, Taraba, and Yobe), in December 2024. Data collected included the dependent variable (HIV risk behavior), independent variables (psychological distress level, substance use, and alcohol consumption), and confounding variables (age, sex at birth, sexual orientation, educational level, marital status, employment/occupational status, and religious status). A stepwise approach was used in the building of four models. Model 1 presented the unadjusted bivariate analysis. Model 2 was the adjusted multivariate logistic regression. Model 3 assessed the interaction effect of psychological distress level, alcohol consumption, substance use, and being IDP on HIV risk behaviour, and Model 4 assessed the same interaction for refugees.

Results: The sample of 3,211 participants included 1237 (38.5%) migrants, 1497 (46.6%) IDPs, and 477 (14.9%) refugees. Among participants, moderate (AOR: 1.46; 95% CI: 1.38-1.56; p < 0.001) and high (AOR: 1.70; 95% CI: 1.57-1.85; p = 0.01) psychological distress significantly increased the odds of high-risk sexual behaviour. IDPs had the highest odds of engaging in risky behaviour compared to migrants (AOR: 1.59; 95% CI: 1.32-1.92; p = 0.02). Substance use further amplified risk, particularly for IDPs (OR: 3.17; 95% CI: 2.11-3.72; p < 0.001) and refugees (OR: 2.09; 95% CI: 2.02-2.37; p < 0.001) compared to migrants. No significant association was found between alcohol consumption and HIV risk behaviour.

Conclusion: This study highlights the compounded vulnerability of IDPs and refugees, driven by psychological distress and substance use. Findings underscore the urgent need for integrated interventions addressing mental health, substance use, and HIV prevention tailored to forcibly displaced populations in Nigeria.