Studies conducted in 2005, 2006 and 2007 in Western countries have consistently demonstrated that as a consequence of more frequent discrimination, gender non-conforming (GNC) gay and bisexual men experience more mental distress than gender conforming gay or bisexual men. Similar studies have not been undertaken in low and middle-income countries, despite the fact that gender non-conformity is evident in expressions of same-sex sexuality in such countries.
The recent South African (SA) study explored two things. Firstly, whether GNC among gay and bisexual black men in SA, was associated with depression and, if this is the case, whether the association was mediated or moderated by discrimination.
Secondly, the study explored the potential protective effect of being “out” as same-sex oriented as well as community involvement on the relationship between GNC and depression.
The study found that in South Africa GNC is pervasive in the expression of same-sex sexuality. It also found that the expression of same-sex sexuality seems to reproduce a binary of masculinity and femininity among gay and bisexual men much more than in developed countries.
Furthermore, the study showed that some gay and bisexual black men in SA openly display feminine behaviours and participate in traditionally feminine occupations, while others display more masculine identities. For example, within some black same-sex relationships, there are “wives” and “husbands” with clearly defined boundaries.
The study surveyed a subsample of 353 black gay-identified or bisexual men from a total sample of 2010 self-identified lesbian, gay, bisexual and transgender (LGBT) persons who participated in a community-based survey conducted in three provinces in South Africa. To assess GNC, the question, “How do you present yourself?” was asked and participants either selected “feminine way”, “no preference” or “masculine way”. About 43% of the men reported that they presented themselves in a feminine way, 13% had no preference and 45% presented themselves in a masculine way. The participants who selected “no preference” were combined with those who selected the masculine way. Thus the gender non-conformity variable had two categories: 1 = feminine and 2 = masculine.
Depression was assessed through the following example items: “I have trouble getting to sleep or staying awake” and “I have suicidal thoughts.” School discrimination was assessed through the following survey question: “When you were at school did you experience any of the following things because of your sexual orientation?” Example items included, “verbal abuse and harassment” and “negative jokes about LGB individuals”.
General discrimination was assessed by asking the question “Have you personally experienced physical abuse and/or property attacks because of your sexual orientation in the last 24 months?” Gay community involvement was assessed by using example items such as: “How frequently do you socialise at LGBT restaurants?” For level of outness, participants were asked to indicate to how many of their friends, family and co-workers they were “out” to.
Contrary to the researchers’ expectations, the results — published in the Archives of Sexual Behavior last year — were totally different from those of Western countries mentioned earlier. In the SA study, the results revealed that black GNC gay and bisexual men did not experience more depression or discrimination compared to their black gender conforming counterparts.
The absence of a relationship between GNC and depression seems to suggest that either the relationship between GNC and mental health as found in Western studies does not exist among black South African gay and bisexual males, or that there is a third variable masking the relationship between the two. It could be that in the SA context, GNC men are more resilient and consequently less affected by the increased levels of discrimination.
The researchers also tested the potential role of two resilience factors: outness and gay community involvement, but they found that these factors did not buffer the relationship between GNC and depression. Consequently, they speculated that other resiliency factors, not assessed, may be in operation in this study.
For example, it could be that GNC men may have higher levels of self-esteem compared to gender conforming gay and bisexual men and these feelings of self-esteem might counteract the effects of increased discrimination. Alternatively, it could be that GNC gay and bisexual men might, as a consequence of discrimination, have developed more successful coping mechanisms which weakened the effects of discrimination on mental health and these coping mechanisms might have been developed at a very early stage.
It could also be that GNC men may have developed protection consisting of social networks of friends and families. Support for this notion comes from the fact that it is common for feminine gay black men in a South African township to “visit with the females in the community and participate in traditionally female activities.” Furthermore, in SA, it appears that the dominant perception among many black persons is that same-sex sexuality is strongly associated with femininity and that in the system of hegemonic masculinity, identification with femininity is the major way of expressing a gay identity.
The SA study seems to suggest that the relationship between GNC and mental health in gay and bisexual men might be less universal than what was previously understood. Its findings also suggest that cultural perceptions around gender, masculinity and femininity play significant roles in how GNC gay and bisexual black men integrate into South African society.
The study was undertaken by Stephanie H. Cook (Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health), Theo G. M. Sandfort (HIV Center for Clinical and Behavioral Studies, New York State, Psychiatric Institute and Columbia University) and Juan A. Nel and Eileen P. Rich (Department of Psychology, University of South Africa). This article flows from a collaboration between OUT LGBT Well-being and UNISA’s Community Engagement Project.
Written by Khulukazi Soldati