Page 0 of 73 FINAL REPORT (April 30, 2013) Title of the Project: Modelling the Impact of Stigma on Depression and Sexual Risk Behaviours of Men who have Sex with Men (MSM) and Hijras/Transgender (TG) people in India: Implications for HIV and Sexual Health Programs Principal Investigator and Co-Investigators: Principal Investigator Dr. Venkatesan Chakrapani, M.D. Research Adviser The Humsafar Trust 3rd Floor, Manthan Plaza, Nehru Road, Vakola Santacruz East, Mumbai – 400055 & Director / Chairperson, Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai Cell: 09841428808 Email: [email protected] Co-Investigator Prof. Miriam Samuel Head, Department of Social Work (DSW) Madras Christian College (MCC), Tambaram, Chennai-600 059. Phone: 044-22790035 Email: [email protected] Implementing Institution and other collaborating Institutions: Implementing Institution: Madras Christian College (MCC) Tambaram, Chennai-600 059 Collaborating Institution: The Humsafar Trust, 3rd Floor, Manthan Plaza, Nehru Road, Vakola Santacruz East, Mumbai – 400055 Date of commencement: February 1, 2011 Duration: 2 years Date of completion: January 31, 2013 Date of report submission: April 30, 2013 Report to ICMR. April 30, 2013. PI: Venkatesan Chakrapani, M.D. Project: “Modelling the impact of stigma on...” Page 1 of 73 Contents Acknowledgements .................................................................................................................................... 4 Acronyms and Abbreviations .................................................................................................................... 5 Executive Summary .................................................................................................................................... 6 1. OBJECTIVES........................................................................................................................................ 10 2. STUDY DESIGN AND METHODOLOGY ............................................................................................ 11 3. RESULTS ............................................................................................................................................. 21 3a. Sample Characteristics ................................................................................................................. 21 Characteristics of survey participants (n=600) ............................................................................ 21 Characteristics of in-depth interview participants (n=39) .......................................................... 24 3b. Descriptive findings ....................................................................................................................... 26 Details of scores of stigma, social support, resilient coping, depression and other scales . 26 Correlations between key constructs/variables .......................................................................... 41 T-tests: Subgroup-wise (MSM & TG) comparisons of mean scores of study variables .......... 44 3c. Hierarchical linear regression models predicting depression ................................................. 46 MSM (n=300): Hierarchical linear regression models predicting depression ......................... 46 Hijras/TG people (n=300): Hierarchical linear regression models predicting depression .... 49 3d. Hierarchical logistic regression modelling of sexual risk behaviours .................................... 52 Logistic regression modelling of sexual risk behaviours of MSM with their male partners . 52 Logistic regression modelling of sexual risk behaviours of hijras/TG with their male partners .............................................................................................................................................. 56 3e. Structural Equation Modelling (SEM) of the influence of stigma on depression ................. 60 SEM for MSM ..................................................................................................................................... 60 SEM for Hijras/TG ............................................................................................................................. 61 3f. Qualitative Findings ........................................................................................................................ 62 4. CONCLUSIONS ................................................................................................................................... 67 5. ABSTRACT (For possible publication in ICMR Bulletin)............................................................... 71 Report to ICMR. April 30, 2013. PI: Venkatesan Chakrapani, M.D. Project: “Modelling the impact of stigma on...” Page 2 of 73 List of Tables Table 1. Study sites and collaborating agencies (p-12) Table 2. Study sites and Sample size – Quantitative phase (p-12) Table 3. Site-specific recruitment details for survey (p-17) Table 4. Scales: Scores and Grading for different levels of outcomes (p-19) Table 5. Identification of confirming and disconfirming cases for qualitative in-depth interviews from the survey sample (p-20) Table 6. Site-specific details of confirming and disconfirming cases identified for qualitative in-depth interviews (p-20) Table 7. Socio-demographic characteristics of survey participants (p-22) Table 8. Sociodemographic characteristics of qualitative in-depth interview participants (p-25) Table 9. Sexual stigma item frequencies (p-27) Table 10. Sample gender non-conformity stigma item frequencies (p-28) Table 11. Transgender identity stigma item frequencies (p-29) Table 12. Vicarious and felt normative stigma scale item frequencies (p-31) Table 13. Multi-dimensional social support item frequencies (p-34) Table 14. Resilient coping item frequencies (p-36) Table 15. Beck’s depression inventory-fast screen (BDI-FS) scale item frequencies (p-37) Table 16. Life satisfaction scale item frequencies (p-39) Table 17. Correlations between stigma scales and psychosocial variables among MSM (p-42) Table 18. Correlations between stigma scales and psychosocial variables among hijras/transgender people (p-43) Table 19. Subgroup-wise (MSM & TG) comparisons of mean scores of study variables (p-45) Table 20. Hierarchical multiple linear regression analyses predicting depression among MSM from different types of stigma (n=300: includes 270 HIV-negative MSM and 30 HIV-positive MSM) (p-47) Table 21. Hierarchical multiple linear regression analyses predicting depression among MSM (n=300: includes 270 HIV-negative MSM and 30 HIV-positive MSM) from different types of stigma) (p-47) Table 22. Hierarchical multiple linear regression analyses predicting depression among HIV- negative MSM (n=270) from different types of stigma (p-48) Table 23. Hierarchical multiple linear regression analyses predicting depression among HIV-negative (n=270) MSM from different types of stigma (Perceived and enacted break-up for sexual stigma/gender non-conformity stigma) (p-48) Table 24. Hierarchical multiple linear regression analyses predicting depression among TG from different types of stigma (n=300: includes 272 HIV-negative TG and 28 HIV- positive MSM) (p-50) Table 25. Hierarchical multiple linear regression analyses predicting depression among TG (n=300: includes 272 HIV-negative TG and 28 HIV-positive TG) from different types of stigma (p-50) Table 26. Hierarchical multiple linear regression analyses predicting depression among HIV- negative TG (n=272) from different types of stigma (p-51) Report to ICMR. April 30, 2013. PI: Venkatesan Chakrapani, M.D. Project: “Modelling the impact of stigma on...” Page 3 of 73 Table 27. Hierarchical multiple linear regression analyses predicting depression among HIV- negative (n=272) TG from different types of stigma (Perceived and enacted break-up details for transgender identity stigma) (p-51) Table 28. Hierarchical logistic regression analysis of sexual and gender non-conformity stigma, HIV-related stigma, depression, alcohol use, resilient coping and social support predicting inconsistent condom use with male regular partners, controlling for demographic variables (p-52) Table 29. Hierarchical logistic regression analysis of sexual and gender non-conformity stigma, HIV-related stigma, depression, alcohol use, resilient coping and social support predicting inconsistent condom use with casual male partners, controlling for demographic variables (p-53) Table 30. Hierarchical logistic regression analysis of sexual and gender non-conformity stigma, HIV-related stigma, depression, alcohol use, resilient coping and social support predicting inconsistent condom use with paying male partners, controlling for demographic variables (p-54) Table 31. Hierarchical logistic regression analysis of sexual and gender non-conformity stigma, HIV-related stigma, depression, alcohol use, resilient coping and social support predicting condom use in last anal sex, controlling for demographic variables (p-55) Table 32. Hierarchical logistic regression analysis of transgender identity stigma and HIV- related stigma, depression, alcohol use, resilient coping and social support predicting inconsistent condom use with male regular partners, controlling for demographic variables (p-56) Table 33. Hierarchical logistic regression analysis of transgender identity stigma and HIV- related stigma, depression, alcohol use, resilient coping and social support predicting inconsistent condom use with male casual partners, controlling for demographic variables (p-57)