UNAIDS, 20 Ave Appia, 1211, Geneva, Switzerland.
Aix-Marseille University, CNRS, EHESS, Centrale Marseille, Aix-Marseille School of Economics, 5-9 Boulevard Maurice Bourdet 13205, Marseille, France.
BMC Public Health. 2024 Jan 18;24(1):215. doi: 10.1186/s12889-023-17493-8.
Sexual and gender diverse people face intersecting factors affecting their well-being and livelihood. These include homophobic reactions, stigma or discrimination at the workplace and in healthcare facilities, economic vulnerability, lack of social support, and HIV. This study aimed to examine the association between such factors and symptoms of anxiety and depression among sexual and gender diverse people.
This study is based on a sample of 108,389 gay, bisexual, queer and questioning men, and transfeminine people from 161 countries collected through a cross-sectional internet survey. We developed a multinomial logistic regression for each group to study the associations of the above factors at different severity scores for anxiety and depression symptoms.
Almost a third (30.3%) of the participants reported experiencing moderate to severe symptoms of anxiety and depression. Higher severity scores were found for transfeminine people (39%), and queer or questioning people (34.8%). Severe symptoms of anxiety and depression were strongly correlated with economic hardship for all groups. Compared to those who are HIV-negative, those living with HIV were more likely to report severe symptoms of anxiety and depression, and the highest score was among those who do not know their HIV status. Transfeminine people were the most exposed group, with more than 80% higher risk for those living with HIV suffering from anxiety and depression. Finally, homophobic reactions were strongly associated with anxiety and depression. The relative risk of severe anxiety and depression was 3.47 times higher for transfeminine people facing transphobic reactions than those with no symptoms. Moreover, anxiety and depression correlate with stigma or discrimination in the workplace and healthcare facilities.
The strong association between the severity of anxiety and depression, and socioeconomic inequality and HIV status highlights the need for concrete actions to meet the United Nations' pledge to end inequalities faced by communities and people affected by HIV. Moreover, the association between stigma or discrimination and anxiety and depression among sexual and gender diverse people is alarming. There is a need for bold structural public health interventions, particularly for transfeminine, queer and questioning people who represent three communities under the radar of national HIV programmes.
性和性别多样化的人面临着影响他们福祉和生计的多种因素。这些因素包括对同性恋的反感反应、工作场所和医疗保健机构的污名化或歧视、经济脆弱性、缺乏社会支持以及艾滋病毒。本研究旨在探讨这些因素与性和性别多样化人群的焦虑和抑郁症状之间的关联。
本研究基于来自 161 个国家的 108389 名男同性恋、双性恋、酷儿和疑问男性以及跨性别女性的样本，通过横断面互联网调查收集。我们为每个群体开发了一个多项逻辑回归模型，以研究上述因素与焦虑和抑郁症状不同严重程度评分之间的关联。
几乎三分之一（30.3%）的参与者报告经历了中度至重度的焦虑和抑郁症状。跨性别女性（39%）和酷儿或疑问者（34.8%）的严重程度评分较高。所有群体的严重焦虑和抑郁症状与经济困难密切相关。与 HIV 阴性者相比，HIV 感染者更有可能报告严重的焦虑和抑郁症状，而不知道自己 HIV 状况的人得分最高。跨性别女性是最易受影响的群体，HIV 感染者中焦虑和抑郁的风险高出 80%以上。最后，对同性恋的反感反应与焦虑和抑郁密切相关。面临恐跨性别反应的跨性别女性患焦虑和抑郁的相对风险是无症状者的 3.47 倍。此外，焦虑和抑郁与工作场所和医疗保健设施中的污名化或歧视相关。
焦虑和抑郁的严重程度与社会经济不平等和 HIV 状况之间的强烈关联突出表明，需要采取具体行动，以实现联合国承诺，消除社区和受 HIV 影响者面临的不平等现象。此外，性和性别多样化人群中的污名化或歧视与焦虑和抑郁之间的关联令人震惊。需要采取大胆的结构性公共卫生干预措施，特别是针对跨性别女性、酷儿和疑问者，他们是国家艾滋病毒规划中未被关注的三个群体。
