title: Gender Nonconformity, Discrimination, and Mental Health Among Black South African Men Who Have Sex with Men: A Further Exploration of Unexpected Findings.
abstract: Using data from a study about HIV risk among Black South African MSM, we aimed to ascertain whether unexpected findings about the relationship between gender nonconformity, discrimination, and mental health in this population, as reported by Cook, Sandfort, Nel, and Rich (2013), could be replicated, and to explore more in-depth how gender nonconformity relates to health. Cook et al. found that feminine men were not more likely to be depressed despite the observation that they were more likely to be discriminated against and that discrimination increased the likelihood of depression. This is in contrast to what studies among gay and bisexual men in Western countries have consistently shown. In the current study, 196 Black South African MSM (ages between 18 and 40; M age, 26.65 years) were surveyed. Assessments included stressors (identity confusion, internalized homophobia, and sexual orientation-based discrimination) and resilience factors (openness about one's sexual orientation, social support, and identification with the gay community). We observed that gender-nonconforming men were not more likely to be depressed despite having experienced more discrimination, which was associated with depression. The same relationships were observed when considering anxiety as the mental health outcome. We found an indirect negative effect of gender nonconformity on depression through internalized homophobia, suggesting that, in this population, internalized homophobia masks the effect of discrimination on mental distress. Implications for the sexual minority stress model, used to guide our analyses, are discussed. Further research is needed to disentangle the complex relationship between gender nonconformity and mental health among MSM populations.
authors.affiliation: Division of Gender, Sexuality and Health, Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA. Tgs2001@columbia.edu.
authors.forename: Theo
authors.initials: T
authors.lastname: Sandfort
authors.affiliation: Department of Education, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Henny
authors.initials: H
authors.lastname: Bos
authors.affiliation: Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Knox
authors.affiliation: Human and Social Development, Human Sciences Research Council, Pretoria, South Africa.|University of Pretoria, Pretoria, South Africa.
authors.forename: Vasu
authors.initials: V
authors.lastname: Reddy
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D063509:Homophobia; D018451:Homosexuality, Male / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D008913:Minority Groups / Q000523:psychology / Q000706:statistics & numerical data*; D012649:Self Concept; D012925:Social Conformity; D012944:Social Support
keywords: Discrimination; Gender nonconformity; Men who have sex with men; Mental health; Sexual orientation; South Africa