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Associations between HIV and sexual stigmas, and mental health and alcohol use among MSM newly diagnosed with HIV in India: a longitudinal observational cohort study

Title
Associations between HIV and sexual stigmas, and mental health and alcohol use among MSM newly diagnosed with HIV in India: a longitudinal observational cohort study
Presenter
Fazlur Rahman Gulfam
Authors
J. Kaur (1), A. Gupta (2), V. Chakrapani (3), F.R. Gulfam * (2), A. Ahalawat (2), J. Ross (4), N. Chopra (4), D. Datta (4), S. Safren (5), V.V. Patel (4)
Institutions
(1) Postgraduate Institute of Medical Education & Research, Chandigarh, India, (2) Alliance India (India HIV/AIDS Alliance), New Delhi, India, (3) Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India, (4) Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Health System, New York, United States, (5) University of Miami, Florida, United States

BACKGROUND: Little is known about the associations between HIV- and sexuality-related stigmas, and mental health and alcohol use among MSM living with HIV in India. The minority stress theory postulates that minorities experience stress stemming from experiences of stigma, placing them at risk of negative psychosocial outcomes. We investigated the association between stigmas related to HIV and same-sex sexuality, and depression, anxiety, and alcohol use among MSM newly diagnosed with HIV (MSMLH) in India.
METHODS: We used three-wave data (baseline, 3- and 6-month follow-up) from a longitudinal observational study conducted among 227 MSMLH in 2020-21, across 11 states with high/moderate HIV prevalence. The outcomes were depression (PHQ-9), anxiety (GAD-2), and alcohol use (AUDIT-C) scores. Predictors included enacted HIV stigma, internalised HIV stigma, enacted sexual stigma, and internalised sexual stigma. To obtain robust population-averaged estimates and to handle repeated measures, generalized estimating equations (GEE) was used. All multivariable GEE analyses were conducted in Stata-16.
RESULTS: Participants' mean±SD age was 33.3±9.9 years. The mean±SD scores of predictor variables are provided in Table-1. The mean±SD scores of outcome variables were: depression 4.76±7.32, anxiety 2.53±2.31, and alcohol use .32±.88. Enacted stigmas significantly predicted depression, anxiety, and alcohol use (Table-1). An increase in enacted HIV and sexual stigma scores increased outcome scores. That is, for every unit increase in enacted HIV stigma, depression, anxiety, and alcohol scores increased by 7.32, 2.75, and .35 units, respectively. Similarly, for every unit increase in enacted sexual stigma, depression, anxiety, and alcohol scores increased by 1.24, .34, and .09 units, respectively.

Table 1. Predictors of mental health and alcohol use among men who have sex with men (MSM) newly diagnosed with HIV (N=227)
Predictors (scores)Outcomes (scores)
StigmasMean (SD)DepressionAnxietyAlcohol
Estimate (95% CI); p-value
Enacted HIV stigma.58 (.57)7.32 (5.28, 9.36)***2.75 (2.27, 3.23)***.35 (.07, .64)*
Internalised HIV stigma1.16 (.57)-2.07 (-4.57, .43).15 (-.44, .74)-.05 (-.29, .18)
Enacted sexual stigma2.09 (1.38)1.24 (.56, 1.93)***.34 (.19 .50)***.09 (.01, .17)*
Internalisedsexual stigma1.80 (.63)-1.39 (-3.03, .25).31 (-.18, .80).17 (-.05, .39)
Note. *p<.05, ***p<.001

CONCLUSIONS: Enacted HIV and sexual stigmas contributed to poor psychosocial outcomes among MSM newly diagnosed with HIV. Findings call for stigma reduction campaigns to reduce stigma and discrimination faced by MSMLH, and to screen for and address mental health challenges faced by them due to those stigmas.

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