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. 2022 Mar-Apr;16(2):15579883221087531.
doi: 10.1177/15579883221087531.

HIV-Related Stigma, Sexual Identity, and Depressive Symptoms Among MSM Living With HIV in China: A Moderated Mediation Modeling Analysis

Tianyue Mi  1 , Guanghua Lan  2 , Xueying Yang  1 , Xiaoming Li  1 , Shan Qiao  1 , Zhiyong Shen  2 , Yuejiao Zhou  2
Affiliations

HIV-Related Stigma, Sexual Identity, and Depressive Symptoms Among MSM Living With HIV in China: A Moderated Mediation Modeling Analysis

Tianyue Mi et al. Am J Mens Health. 2022 Mar-Apr.

Abstract

Depression is one of the biggest health issues among men who have sex with men (MSM) living with HIV, where sexual identity might play an intricate role. Yet, findings of the relationship between sexual identity and depression were mixed and few studies explored its underlying mechanisms. This study aimed to examine the association between sexual identity and depression, and the potential mediating role of HIV-related stigma and moderating role of age. A cross-sectional survey was conducted among 203 MSM living with HIV in Guangxi, China. Participants provided information on sexual identity, depression, HIV-related stigma, and background information. Descriptive statistics, bivariate analysis, and path analysis were applied to examine our hypotheses. Bivariate analysis demonstrated that participants who self-identified as gay reported a lower level of HIV-related stigma and depression. Path analysis revealed an insignificant direct effect of identifying as gay on depression. Yet, the indirect pathway was significant, with identifying as gay being associated with a lower level of HIV stigma and thus a lower level of depression. This indirect effect was moderated by age. The conditional indirect effect was significant in the younger group yet ceased in the older group. The study provided information to better understand the effect of sexual identity on mental health among stigmatized sexual and gender minorities by highlighting the mediating effect of HIV-related stigma and the protective effect of age. Interventions targeting mental health of MSM living with HIV might consider placing greater emphasis on addressing HIV-related stigma among younger MSM.

Keywords: China; HIV; depression; men who have sex with men; sexual identity.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Hypothesized Moderated Mediation Model Among Sexual Identity, HIV-Related Stigma, Depression and Age
Figure 2.
Figure 2.
Moderated Mediation Model Among Sexual Identity, HIV-Related Stigma, Age, and Depression Note. Correlations between covariates and key variables have been omitted for reasons of presentation simplicity. *p < .05. ***p < .001.
Figure 3.
Figure 3.
The Moderating Effect of Age on the Relationship Between HIV-Related Stigma and Depression Note. Age groups are categorized with the mean value. For the younger group, the association between HIV-related stigma and depression was significantly positive, b = 5.27, 95% CI = [3.03, 7.50], p < .01. For the older group, the association between HIV-related stigma and depression was no longer significant, b = 1.53, 95% CI = [−1.70, 4.76], p > .05. CI = confidence interval.
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