Marginalization and stigmatization heighten the vulnerability of sexual minorities to inequitable health outcomes. Although men who have sex with men (MSM) are at elevated risk for HIV infection in India in comparison with the general population, there is a lack of MSM-focused research—particularly regarding stigma and mental health outcomes. This dissertation aimed to explore the influence of sexual stigma, gender non-conformity stigma and HIV-related stigma on depression and life satisfaction among MSM in South India. This study used a cross-sectional survey design and was conducted with MSM (n=200) in two locations in Tamil Nadu, South India: Chennai (urban) and Kumbakonam (semi-urban). Due to multicollinearity between sexual stigma and gender non-conformity stigma, the stronger predictor of each outcome (gender non-conformity stigma) was included in regression models. Results were analyzed to identify the associations between independent (gender non-conformity stigma, HIV-related stigma), moderator (social support, resilient coping) and dependent (depression, life satisfaction) variables. Due to significant differences between locations across a substantial number of variables, block regression analyses were conducted separately for each location. Higher levels of depression were predicted by gender non-conformity stigma in both locations, and also by HIV-related stigma in Kumbakonam. Lower levels of depression in both locations were predicted by higher levels of social support and resilient coping. Higher life satisfaction was predicted by social support and resilient coping in both Chennai and Kumbakonam. Lower life satisfaction was predicted by gender non-conformity stigma and HIV-related stigma in Kumbakonam, but not in Chennai. Social support and resilient coping did not moderate the impact of stigma(s) on depression or life satisfaction in either location. The results indicate that the majority of participants experienced stigmatization based on same-sex sexual behaviour and/or gender non-conformity. Another striking finding of the study was the alarmingly high rates of depression, whereby over half of participants in each region reported moderate to severe depression scores. Practice and policy implications include the development, implementation and evaluation of: multi-level stigma reduction interventions that account for socio-environmental and contextual factors; mental health interventions that promote resiliency and build social support; and policy initiatives to advance human rights protection.

Marginalization and stigmatization heighten the vulnerability of sexual minorities to inequitable health outcomes. Although men who have sex with men (MSM) are at elevated risk for HIV infection in India in comparison with the general population, there is a lack of MSM-focused research—particularly regarding stigma and mental health outcomes. This dissertation aimed to explore the influence of sexual stigma, gender non-conformity stigma and HIV-related stigma on depression and life satisfaction among MSM in South India. This study used a cross-sectional survey design and was conducted with MSM (n=200) in two locations in Tamil Nadu, South India: Chennai (urban) and Kumbakonam (semi-urban). Due to multicollinearity between sexual stigma and gender non-conformity stigma, the stronger predictor of each outcome (gender non-conformity stigma) was included in regression models. Results were analyzed to identify the associations between independent (gender non-conformity stigma, HIV-related stigma), moderator (social support, resilient coping) and dependent (depression, life satisfaction) variables. Due to significant differences between locations across a substantial number of variables, block regression analyses were conducted separately for each location. Higher levels of depression were predicted by gender non-conformity stigma in both locations, and also by HIV-related stigma in Kumbakonam. Lower levels of depression in both locations were predicted by higher levels of social support and resilient coping. Higher life satisfaction was predicted by social support and resilient coping in both Chennai and Kumbakonam. Lower life satisfaction was predicted by gender non-conformity stigma and HIV-related stigma in Kumbakonam, but not in Chennai. Social support and resilient coping did not moderate the impact of stigma(s) on depression or life satisfaction in either location. The results indicate that the majority of participants experienced stigmatization based on same-sex sexual behaviour and/or gender non-conformity. Another striking finding of the study was the alarmingly high rates of depression, whereby over half of participants in each region reported moderate to severe depression scores. Practice and policy implications include the development, implementation and evaluation of: multi-level stigma reduction interventions that account for socio-environmental and contextual factors; mental health interventions that promote resiliency and build social support; and policy initiatives to advance human rights protection.