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Abstract

The goal of this dissertation study is to explore how HIV stigma and gender interact in the lives of people living with HIV in Hyderabad, India. This study pays particular attention to gendered experiences of depression and medical care utilization. The theoretical framework for the study integrates gender role theory with an adapted version of Goffman’s conceptualization of stigma. The study utilizes mixed methods in two interrelated phases. In Phase 1, 150 individuals living with HIV (51 cisgender women, 49 cisgender men and 50 hijra/transgender women) were recruited to complete a survey that investigated associations between HIV stigma and two outcomes: depression and medical care utilization. The mean age of participants was 38.03 years (SD=7.62); mean income was 8,8083 Rupees (SD=5,917); and mean self-reported CD4 count was 447 (SD=258). The majority of participants were Hindu (85%), spoke Telugu as their native language (89%), and were members of scheduled castes or tribes (79%). HIV stigma was found to be positively associated with both depression and medical care utilization. In phase 2, 32 individuals (16 cisgender heterosexual women and 16 hijra/transgender women), scoring on the high and low ends of the stigma scales, were recruited to participate in in-depth interviews, exploring their experiences with HIV, gender roles, and gender nonconformity. For cisgender women in India, HIV stigma was found to be impacted by restrictive gender roles, a limited ability to refuse or delay sex or marriage, and the prioritization of male partners’ health over females’ health. For hijra/transgender women in India, sex work, gender nonconformity, and the multiplicity of gender identity were found to be important factors in influencing HIV stigma. These findings emphasize the importance of tailoring HIV policies and programs to fit the specific mental and physical health needs of hijra/transgender people and cisgender women in Hyderabad, India.

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