Influence of multiple stigmas on psychosocial problems and condom use among MSM and transgender women in India: findings from a longitudinal S3 (stigma, syndemics and sex) cohort study

Title

Influence of multiple stigmas on psychosocial problems and condom use among MSM and transgender women in India: findings from a longitudinal S3 (stigma, syndemics and sex) cohort study

Presenter

Venkatesan Chakrapani

Authors

V. Chakrapani * (1), J. Kaur (2), A. Sebastian (3), S. Rawat (4), R. Nelson (1), D. Baruah (4), M. Shunmugam (1), A Jaya (5), P.A. Newman (6)

Institutions

(1) Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India, (2) Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, (3) National Institute of Advanced Sciences (NIAS), Bangalore, India, (4) Humsafar Trust, Mumbai, India, (5) Sahodaran, Chennai, India, (6) University of Toronto, Toronto, Canada

BACKGROUND: The disproportionate HIV burden among MSM and transgender women (TGW) in India persists along with multiple forms of stigma and psychosocial problems such as depression and problematic alcohol use. Amid limited research in India on the associations between multiple stigmas, psychosocial problems and condomless anal sex (CAS), we explored these associations, informed by minority stress and syndemic theories.
METHODS: We used two-wave data (November 2020 to Jan 2022) from an ongoing cohort study with 500 MSM and 500 TGW recruited through community-based organisations that conduct HIV preventive interventions in Chennai/Mumbai. Path analyses were conducted (Mplus-8) to predict CAS with male non-primary partners (wave-2) from stigma scores (wave-1 sexual stigma, transgender identity stigma, sex work stigma) and psychosocial variables (wave-2 depression, anxiety, internalized homonegativity, internalized transprejudice and alcohol use).
RESULTS: Among MSM (mean age=28.2 years; HIV=4.2%)) and TGW (mean age=27.6 years; HIV=4.8%), CAS (wave-2) was 23.2% and 72.3%, respectively. Compared to MSM, TGW had higher prevalence of moderate depression (MSM-4.3%; TGW-21.1%) and anxiety (MSM-16.2%; TGW-45.9%), but lower prevalence of problematic alcohol use (MSM-13.4%; TGW-12.1%). Among TGW, sex work stigma, internalized transprejudice, depression and anxiety had significant direct effects on CAS (Figure-1). Transgender identity stigma had significant direct effects on depression, anxiety and alcohol use, and significant indirect effect on CAS through anxiety. Among MSM, sexual stigma had significant direct effects on CAS, depression and anxiety, and sex work stigma had significant direct effects on internalized homonegativity and alcohol use (Figure-1).

CONCLUSIONS: Stigmas faced by MSM (sexual, sex work) and TGW (transgender identity) contributed directly and indirectly to HIV risk through multiple psychosocial problems. Expanded efforts to reduce societal stigma against transgender people, MSM and those involved in sex work, and to address population-specific psychosocial problems, are needed to promote safer sex and mental health among TGW and MSM in India.

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