Adapting the minority stress model: Associations between gender non-conformity stigma, HIV-related stigma and depression among men who have sex with men in South India Carmen H. Logie a, b, * , Peter A. Newman c , Venkatesan Chakrapani d, e , Murali Shunmugam d, e a Faculty of Social Work, University of Calgary, Calgary, Canada b Women’s College Research Institute, University of Toronto, 790 Bay Street, 7th Floor, Toronto, Canada c Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada d Indian Network of People Living with HIV/AIDS, Chennai, India e Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India article info Article history: Available online 21 February 2012 Keywords: Men who have sex with men India Stigma Gender non-conformity HIV Depression Coping Social support abstract Marginalization and stigmatization heighten the vulnerability of sexual minorities to inequitable mental health outcomes. There is a dearth of information regarding stigma and mental health among men who have sex with men (MSM) in India. We adapted Meyer’s minority stress model to explore associations between stigma and depression among MSM in South India. The study objective was to examine the influence of sexual stigma, gender non-conformity stigma (GNS) and HIV-related stigma (HIV-S) on depression among MSM in South India. A cross-sectional survey was administered to MSM in urban (Chennai) (n ¼ 100) and semi-urban (Kumbakonam) (n ¼ 100) locations in Tamil Nadu. The majority of participants reported moderate/severe depression scores. Participants in Chennai reported significantly higher levels of GNS, social support and resilient coping, and lower levels of HIV-S and depression, than participants in Kumbakonam. Hierarchical block regression analyses were conducted to measure asso- ciations between independent (GNS, HIV-S), moderator (social support, resilient coping) and dependent (depression) variables. Sexual stigma was not included in regression analyses due to multicollinearity with GNS. The first regression analyses assessed associations between depression and stigma subtypes. In Chennai, perceived GNS was associated with depression; in Kumbakonam enacted/perceived GNS and vicarious HIV-S were associated with depression. In the moderation analyses, overall GNS and HIV-S scores (subtypes combined) accounted for a significant amount of variability in depression in both locations, although HIV-S was only a significant predictor in Kumbakonam. Social support and resilient coping were associated with lower depression but did not moderate the influence of HIV-S or GNS on depression. Differences in stigma, coping, social support and depression between locations highlight the salience of considering geographical context in stigma analyses. Associations between HIV-S and depression among HIV-negative MSM emphasize the significance of symbolic stigma. Findings may inform multi-level stigma reduction and health promotion interventions with MSM in South India. Ó 2012 Elsevier Ltd. All rights reserved. Introduction Globally, sexual minority populations experience significantly poorer mental health in comparison with heterosexual people (King et al., 2008). Extensive evidence demonstrates that sexual minorities are disproportionately affected by stigma and discrimi- nation (e.g. Frisell, Lichenstein, Rahman, & Langstrom, 2010; Frost & Meyer, 2009; Hatzenbuehler, Nolen-Hoeksema, & Erickson, 2008; Wohl et al., 2011). The minority stress model posits that chronic stress resulting from sexual stigma contributes to mental health problems among sexual minorities (Meyer, 1995, 2003). Sexual stigma refers to devaluing of sexual minorities, negative attitudes and lower levels of status afforded to non-heterosexual sexual behaviors, identities, relationships and communities (Herek, 2007). There is a scarcity of research, however, measuring sexual stigma and its mental health effects among sexual minorities in developing countries (Caceres, Aggleton, & Galea, 2008; Parker, 2001). The minority stress model describes that chronic stressors in the lives of sexual minorities include: internalized stigma, in which a stigmatized individual accepts negative beliefs, views and feelings * Corresponding author. Women’s College Research Institute, University of Toronto, 790 Bay Street, 7th Floor, Toronto, Canada. Tel.: þ1 4168284203. E-mail addresses: carmen.logie@utoronto.ca, logiech@yahoo.com (C.H. Logie). Contents lists available at SciVerse ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed 0277-9536/$ e see front matter Ó 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2012.01.008 Social Science & Medicine 74 (2012) 1261e1268