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


WEPE546 - Poster Exhibition

Influence of transgender identity stigma and HIV-related stigma on mental health: testing the minority stress model among hijras/transgender women in India

V. Chakrapani1,2, M. Shanmugam1,2, M. Sivasubramanian2, M. Samuel3, L. Carmen4, P.A. Newman5, S.R. Karmakar6, 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: Little is known about how transgender identity stigma (TGS) and HIV-related stigma (HIVS) affects mental health of hijras/transgender women in India. We adapted Meyer´s minority stress model to examine the influence of TGS and HIVS (vicarious, felt normative, enacted, internalised) on depression among hijras/transgender women (TG) in India. We hypothesised that resilient coping and social support would mediate and moderate the relationship between TGS/HIVS and depression.
Methods: A cross-sectional survey was administered to 300 TG recruited through community agencies 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 (TGS and HIVS as block 1), mediators/moderators (resilient coping - block 2, social support - block 3) and dependent (depression) variables.
Results: The majority of participants reported moderate (57%) or severe (24%) depression scores (Mean-5.9, SD-4.2) and moderate (53%) or severe (33%) TGS (Mean-38.6, SD-7.1). TGS, and vicarious and felt normative HIV-related stigma were associated with depression. Resilient coping and social support partially mediated the effect of TGS on depression. In a combined sample of HIV-positive and HIV-negative TG (n=300), social support included in the final step accounted for significant variation in depression, but when the analysis was restricted to HIV-negative TG alone (n=272), social support was not significantly associated with depression. Nevertheless, resilient coping was significantly inversely associated with depression. Resilient coping and social support did not moderate the influence of TGS on depression. Resilient coping, however, moderated the influence of felt normative HIVS on depression.
Conclusion: Our findings offer empirical support for the minority stress model that transgender identity stigma is associated with depression and social support as a possible buffer against depression, at least in HIV-positive TG. Findings may inform inclusion of multi-level stigma reduction measures within existing HIV prevention and care interventions for TG in India.

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