Minority Stress Among Men Who Have Sex with Men (MSM) in Kazakhstan

Background and Purpose: Minority stress models posit that MSM may experience disproportionately high levels of psychological distress due to a greater risk of exposure to stressors related to non-heteronormative social identities and/or sexual behaviors. Research on the experiences of minority stress among MSM in Kazakhstan can better inform their mental health care and advocacy, but is currently lacking. Guided by minority stress models, we tested hypotheses that minority stressors would be associated with psychological distress in a sample of MSM in Kazakhstan.

Methods: MSM in Almaty, Nur-Sultan, and Shymkent were recruited into a NIDA-funded, stepped-wedge clinical trial of a social network-based HIV prevention intervention. Data from 304 MSM were collected via structured interviews when all study cities were in the pre-implementation phase (July 2018 – February 2019). Psychological distress was assessed using the short-version of the Depression, Anxiety, Stress Scales (DASS-21; Henry & Crawford, 2005). Minority stressors included recent experiences of victimization and discrimination (Herek & Berrill, 1995) and levels of internalized homophobia (Herek et al., 1998). Multiple regression analyses were conducted to examine the associations between minority stressors and DASS-21 subscales for depression (α=0.85), anxiety (α=0.76), and stress (α=0.81).

Results: DASS-21 subscale scores for depression (M=8.9, SD=7.6), anxiety (M=7.4, SD=6.6), and stress (M=12.7, SD=7.8) indicate that 25.3% (n=77), 32.9% (n=100), and 21.7% (n=66) of the sample could be considered experiencing at least moderate levels of depression, anxiety, and stress, respectively. The majority (71.4%, n=217) of the sample reported experiencing in the past 6 months at least one form of victimization and 30.3% (n=92) at least one form of discrimination. The most frequent forms of victimization and discrimination were being insulted on social media (42.8%, n=130) and discrimination from family members (10.9%, n=33), respectively. Experiences of victimization positively correlated with experiences of discrimination (r=0.61, p<0.01), as well as the DASS-21 subscales (Depression: r=0.16, p<0.01; Anxiety: r=0.23, p<0.01; Stress: r=0.22, p<0.01). Similarly, experiences of discrimination positively correlated with the DASS-21 subscales (Depression: r=0.24, p<0.01; Anxiety: r=0.25, p<0.01; Stress: r=0.25, p<0.01). Internalized homophobia positively correlated with Depression scores (r=0.14, p<0.01). When controlling for sociodemographic covariates, Depression scores were significantly associated with experiences of discrimination (B=1.5, 95%CI=0.6-2.3, p<0.01), and internalized homophobia (B=0.2, 95%CI=0.0-0.3, p=0.01); Anxiety scores with experiences of discrimination (B=1.0, 95%CI=2.7-1.8, p<0.01); and Stress scores with experiences of discrimination (B=1.3, 95%CI=0.4-2.2, p<0.01).

Conclusions and Implications: To our knowledge, this is the first empirical study of minority stress among MSM in Kazakhstan. Overall, minority stressors and psychological distress in this sample were highly correlated with each other. Experiences of discrimination, in particular, were consistently significantly associated with higher levels of distress. The significant associations of experiences of victimization and, to some extent, internalized homophobia with distress became attenuated by adjustment with experiences of discrimination, suggesting the need for additional research to elucidate more detailed relationships and pathways among these constructs. In summary, findings support the minority stress model for MSM in Kazakhstan, especially through addressing stigma and discrimination, when promoting mental health in this vulnerable population.