Abstract:
Using data from a study about HIV risk among Black South African MSM, we aimed to ascertain whether
unexpected findings about the relationship between gender nonconformity, discrimination, and mental
health in this population, as reported by Cook, Sandfort, Nel, and Rich (2013), could be replicated, and to
explore more in-depth how gender nonconformity relates to health. Cook et al. found that feminine men
were not more likely to be depressed despite the observation that they were more likely to be discriminated against and that discrimination increased the likelihood of depression. This is in contrast to what studies
among gay and bisexual men in Western countries have consistently shown. In the current study, 196 Black
South African MSM (ages between 18 and 40; mean age, 26.65 years) were surveyed. Assessments included
stressors (identity confusion, internalized homophobia, and sexual orientation-based discrimination) and
resilience factors (openness about one’s sexual orientation, social support, and identification with the gay
community). We observed that gender-nonconforming men were not more likely to be depressed despite
having experienced more discrimination, which was associated with depression. The same relationships
were observed when considering anxiety as the mental health outcome. We found an indirect negative effect
of gender nonconformity on depression through internalized homophobia, suggesting that, in this
population, internalized homophobia masks the effect of discrimination on mental distress. Implications for
the sexual minority stress model, used to guide our analyses, are discussed. Further research is needed to
disentangle the complex relationship between gender nonconformity and mental health among MSM
populations.
