HIV Stigma and Depression for Cisgender Women and Hijras/Transgender Women in Hyderabad, India

Background. HIV stigma in India has been recognized as a barrier to early detection of HIV, disclosure of HIV status to partners, and accessing healthcare services. The goal of this study was to explore how stigma differentially affects cisgender women and hijras/transgender women living with HIV in Hyderabad, India, particularly in terms of experiencing depression and utilizing medical care.

Methods. A mixed methods design was implemented in two interrelated phases. In Phase 1, 150 individuals living with HIV (50 cisgender men, 50 cisgender women, 50 hijras/transgender women) were recruited to complete a structured survey, conducted in either Hindi/Urdu or Telugu. HIV stigma scale scores were used to predict depression and medical care utilization, controlling for demographic variables. In Phase 2, thirty individuals (15 cisgender heterosexual women and 15 hijras/transgender women-- those who had the highest and lowest scores on the stigma scales), were recruited to complete in-depth interviews on their experiences with living with HIV, gender roles and nonconformity, poverty, caste and religion. Interviews were intended to understand the gendered experience of HIV stigma and to contextualize the answers from the survey.

Results. Initial quantitative data indicates that cisgender women and hijras/transgender women are significantly more likely than cisgender men to be depressed and less likely to utilize medical care. Qualitative data revealed that for cisgender women in India, HIV stigma is impacted by restrictive gender roles, a limited ability to refuse or delay sex or marriage, and the prioritization of male partners’ health over females. For hijras/transgender women in India, sex work and gender nonconformity were important factors in impacting HIV stigma.

Conclusions. Interventions to improve the health of people living with HIV in India need to take into account the specific needs of both cisgender women and hijras/transgender women. Interventions that decrease the gendered experience of stigma will also likely improve women’s health care utilization and ameliorate women’s mental health.