7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013)

Abstract

WEPE545 - Poster Exhibition


Influence of sexual minority stigma and HIV-related stigma on mental health: testing the minority stress model among men who have sex with men in India

V. Chakrapani1,2, M. Shanmugam1,2, M. Sivasubramanian2, M. Samuel3, L. Carmen4, P.A. Newman5, P. Dhall6, J. Syed2

1Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India, 2The Humsafar Trust, Mumbai, India, 3Department of Social Work, Madras Christian College, Chennai, India, 4Faculty of Social Work, University of Calgary, Calgary, Canada, 5Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada, 6Solidarity and Action against the HIV Infection in India (SAATHII), Kolkata, India

Background: We adapted Meyer´s minority stress model to examine the influence of sexual stigma (SxS)/gender non-conformity stigma (GNS) and HIV-related stigma (HIVS: vicarious, felt normative, enacted and internalised) on depression among men who have sex with men (MSM) in India. We hypothesised that resilient coping and social support would act as moderators and/or mediators.
Methods: We used sequential explanatory mixed methods design: First, a cross-sectional survey was administered to 300 MSM recruited from 3 urban (Mumbai, Delhi and Kolkata) and 3 rural (Sangli, Kancheepuram and Kumbakonam) sites. Hierarchical block regression analyses were conducted to measure associations between independent (SxS/GNS and HIVS as block 1), mediators/moderators (resilient coping - block 2, social support - block 3) and dependent (depression) variables. Second, we conducted qualitative in-depth interviews among 10 confirming cases and 10 disconfirming cases from the survey sample, and analysed the data using constant comparison and 'process tracing' techniques.
Results: A significant proportion of participants reported moderate (21%) or severe (15%) depression scores (Mean-5.12, SD-4.1); and moderate (55%;n=113/205) or severe (7%;n=15/205) GNS. Sexual minority stigma (SxS/GNS), and vicarious and felt normative HIV-related stigma were associated with depression. Resilient coping and social support partially mediated the effect of sexual minority stigma on depression, but they did not moderate the influence of SxS/GNS on depression. Social support, however, moderated the influence of HIV-related vicarious stigma on depression. Qualitative findings helped to better understand the mechanisms of how stigma influences mental health: societal stigma contributed to internalised homophobia; discriminatory incidents based on sexuality or HIV-positive status seemed to have a cumulative effect on the mental health - resulting in depression and alcohol use; and HIV-positive self-identified MSM believed that they became HIV-positive because of their sexuality, which further heightened their internalised homophobia.
Conclusion: Inferences from quantitative and qualitative analyses offer empirical support for the minority stress model that stigma targeting sexual minorities is associated with depression and social support may act as a possible buffer against depression. Study findings may inform inclusion of multi-level stigma reduction measures within existing HIV prevention and care interventions for MSM in India.

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