{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T13:02:51Z","timestamp":1784379771197,"version":"3.55.0"},"reference-count":56,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"funder":[{"DOI":"10.13039\/501100001407","name":"Department of Biotechnology, Ministry of Science and Technology, India","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001407","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009053","name":"Wellcome Trust DBT India Alliance","doi-asserted-by":"publisher","award":["IA\/CRC\/22\/1\/600436"],"award-info":[{"award-number":["IA\/CRC\/22\/1\/600436"]}],"id":[{"id":"10.13039\/501100009053","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009053","name":"Wellcome Trust DBT India Alliance","doi-asserted-by":"publisher","award":["IA\/CPHS\/16\/1\/502667"],"award-info":[{"award-number":["IA\/CPHS\/16\/1\/502667"]}],"id":[{"id":"10.13039\/501100009053","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Social Science & Medicine"],"published-print":{"date-parts":[[2026,8]]},"DOI":"10.1016\/j.socscimed.2026.119392","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:52:56Z","timestamp":1778547176000},"page":"119392","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Psychosocial problems, sexual violence victimization, and substance use among sexual and gender minorities in India: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (I-MAIHDA)"],"prefix":"10.1016","volume":"403","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9998-9135","authenticated-orcid":false,"given":"Venkatesan","family":"Chakrapani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8498-9829","authenticated-orcid":false,"given":"Ayden I.","family":"Scheim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6397-7917","authenticated-orcid":false,"given":"Alexander C.","family":"Tsai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murali","family":"Shunmugam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murugesan","family":"Sivasubramanian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"101774615","key":"10.1016\/j.socscimed.2026.119392_bib1","article-title":"COVID-19 pandemic and transgender migrant women in India: Socio-economic vulnerability and vaccine hesitancy","volume":"8","author":"Acharya","year":"2023","journal-title":"J Migr Health"},{"key":"10.1016\/j.socscimed.2026.119392_bib2","author":"Atrey"},{"issue":"5","key":"10.1016\/j.socscimed.2026.119392_bib3","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0284901","article-title":"Exploring access to HIV-related services and programmatic gaps for men having sex with men (MSM) in rural India- a qualitative study","volume":"18","author":"Bangar","year":"2023","journal-title":"PLoS One"},{"key":"10.1016\/j.socscimed.2026.119392_bib4","article-title":"Intersectionality in quantitative research: a systematic review of its emergence and applications of theory and methods","volume":"14","author":"Bauer","year":"2021","journal-title":"SSM Popul. Health"},{"key":"10.1016\/j.socscimed.2026.119392_bib5","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.socscimed.2018.12.015","article-title":"Methods for analytic intercategorical intersectionality in quantitative research: discrimination as a mediator of health inequalities","volume":"226","author":"Bauer","year":"2019","journal-title":"Soc. Sci. Med."},{"issue":"Suppl. 2","key":"10.1016\/j.socscimed.2026.119392_bib6","doi-asserted-by":"crossref","first-page":"ii42","DOI":"10.1136\/jech-2011-200475","article-title":"Personal, interpersonal and structural challenges to accessing HIV testing, treatment and care services among female sex workers, men who have sex with men and transgenders in Karnataka state, South India","volume":"66","author":"Beattie","year":"2012","journal-title":"J. Epidemiol. Community Health"},{"key":"10.1016\/j.socscimed.2026.119392_bib7","doi-asserted-by":"crossref","DOI":"10.1016\/j.socscimed.2024.116955","article-title":"Extending intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to study individual longitudinal trajectories, with application to mental health in the UK","volume":"351","author":"Bell","year":"2024","journal-title":"Soc. Sci. Med."},{"key":"10.1016\/j.socscimed.2026.119392_bib8","article-title":"Pathways between intersectional stigma and HIV treatment engagement among men who have sex with men (MSM) in India","volume":"22","author":"Bhutada","year":"2023","journal-title":"J. Int. Assoc. Phys. AIDS Care"},{"issue":"7","key":"10.1016\/j.socscimed.2026.119392_bib9","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.2105\/AJPH.2012.300750","article-title":"The problem with the phrase women and minorities: Intersectionality-an important theoretical framework for public health","volume":"102","author":"Bowleg","year":"2012","journal-title":"Am. J. Publ. Health"},{"issue":"1","key":"10.1016\/j.socscimed.2026.119392_bib11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v080.i01","article-title":"Brms: an R package for bayesian multilevel models using stan","volume":"80","author":"B\u00fcrkner","year":"2017","journal-title":"J. Stat. Software"},{"issue":"6","key":"10.1016\/j.socscimed.2026.119392_bib10","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1016\/j.beth.2024.02.011","article-title":"State of the science: LGBTQ-affirmative psychotherapy","volume":"55","author":"Burger","year":"2024","journal-title":"Behav. Ther."},{"issue":"16","key":"10.1016\/j.socscimed.2026.119392_bib12","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1001\/archinte.158.16.1789","article-title":"The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory care quality improvement project (ACQUIP). Alcohol use disorders identification test","volume":"158","author":"Bush","year":"1998","journal-title":"Arch. Intern. Med."},{"issue":"4","key":"10.1016\/j.socscimed.2026.119392_bib19","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0001362","article-title":"A scoping review of lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) people\u2019s health in India","volume":"3","author":"Chakrapani","year":"2023","journal-title":"PLoS Glob. Public Health"},{"issue":"4","key":"10.1016\/j.socscimed.2026.119392_bib13","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1080\/09540121.2022.2099511","article-title":"Intersectional stigma and gender non-affirmation hinder HIV care engagement among transgender women living with HIV in India","volume":"35","author":"Chakrapani","year":"2023","journal-title":"AIDS Care"},{"issue":"10","key":"10.1016\/j.socscimed.2026.119392_bib14","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0000437","article-title":"Syndemic violence victimization, alcohol and drug use, and HIV transmission risk behavior among HIV-negative transgender women in India: a cross-sectional, population-based study","volume":"2","author":"Chakrapani","year":"2022","journal-title":"PLOS Glob. Publ. Health"},{"key":"10.1016\/j.socscimed.2026.119392_bib15","series-title":"Transgender Sex Work & Society","article-title":"Hijras\/transwomen and sex work in India: from marginalization to social protection","author":"Chakrapani","year":"2018"},{"key":"10.1016\/j.socscimed.2026.119392_bib16","series-title":"LGBTQ Mental Health: International Perspectives and Experiences","article-title":"Stigma toward and mental health of Hijras\/Trans women and self-identified men who have sex with men in India","author":"Chakrapani","year":"2020"},{"issue":"2","key":"10.1016\/j.socscimed.2026.119392_bib17","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1080\/17441692.2015.1091024","article-title":"Syndemics of depression, alcohol use, and victimisation, and their association with HIV-related sexual risk among men who have sex with men and transgender women in India","volume":"12","author":"Chakrapani","year":"2017","journal-title":"Glob. Public Health"},{"issue":"4","key":"10.1016\/j.socscimed.2026.119392_bib18","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1521\/aeap.2007.19.4.346","article-title":"Structural violence against Kothi-identified men who have sex with men in Chennai, India: a qualitative investigation","volume":"19","author":"Chakrapani","year":"2007","journal-title":"AIDS Educ. Prev."},{"key":"10.1016\/j.socscimed.2026.119392_bib20","series-title":"Sex in Development: Science, Sexuality, and Morality in Global Perspective","first-page":"269","article-title":"The kothi wars: AIDS cosmopolitanism and the morality of classification","author":"Cohen","year":"2006"},{"issue":"3","key":"10.1016\/j.socscimed.2026.119392_bib21","first-page":"690","volume":"20","author":"Collins","year":"2021","journal-title":"Intersectionality as Critical Social Theory: Intersectionality as Critical Social Theory"},{"key":"10.1016\/j.socscimed.2026.119392_bib22","article-title":"Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics","author":"Crenshaw","year":"1989","journal-title":"Univ. Chicago Leg Forum"},{"key":"10.1016\/j.socscimed.2026.119392_bib23","first-page":"1","article-title":"Navtej Singh Johar v Union of India: decriminalising India's sodomy law","author":"Dixit","year":"2019","journal-title":"Int. J. Hum. Right."},{"key":"10.1016\/j.socscimed.2026.119392_bib24","doi-asserted-by":"crossref","DOI":"10.1016\/j.socscimed.2024.116898","article-title":"Clarifications on the intersectional MAIHDA approach: a conceptual guide and response to Wilkes and Karimi (2024)","volume":"350","author":"Evans","year":"2024","journal-title":"Soc. Sci. Med."},{"key":"10.1016\/j.socscimed.2026.119392_bib25","article-title":"A tutorial for conducting intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)","volume":"26","author":"Evans","year":"2024","journal-title":"SSM Popul. Health"},{"key":"10.1016\/j.socscimed.2026.119392_bib26","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.socscimed.2017.11.011","article-title":"A multilevel approach to modeling health inequalities at the intersection of multiple social identities","volume":"203","author":"Evans","year":"2018","journal-title":"Soc. Sci. Med."},{"issue":"3","key":"10.1016\/j.socscimed.2026.119392_bib27","first-page":"581","article-title":"Exploring the social dynamics of hijras in India: a comprehensive survey of literature","volume":"29","author":"Farah","year":"2023","journal-title":"Educational Administration: Theory and Practice"},{"issue":"8","key":"10.1016\/j.socscimed.2026.119392_bib28","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1080\/13691058.2016.1271141","article-title":"Stigma, violence and HIV vulnerability among transgender persons in sex work in Maharashtra, India","volume":"19","author":"Ganju","year":"2017","journal-title":"Cult. Health Sex."},{"key":"10.1016\/j.socscimed.2026.119392_bib29","series-title":"Bayesian Data Analysis","author":"Gelman","year":"2004"},{"issue":"2","key":"10.1016\/j.socscimed.2026.119392_bib30","first-page":"31","article-title":"Budhadev Karmaskar v. State of West Bengal: recognizing sex work as a profession","volume":"6","author":"Jain","year":"2023","journal-title":"Journal of Constitutional Law and Jurisprudence"},{"issue":"5","key":"10.1016\/j.socscimed.2026.119392_bib32","doi-asserted-by":"crossref","first-page":"317","DOI":"10.7326\/0003-4819-146-5-200703060-00004","article-title":"Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection","volume":"146","author":"Kroenke","year":"2007","journal-title":"Ann. Intern. Med."},{"issue":"2","key":"10.1016\/j.socscimed.2026.119392_bib33","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1177\/00490857241248989","article-title":"Caste concerns in transgender communities in India: contesting cohesiveness, broadening horizon(s)","volume":"54","author":"Kumar","year":"2024","journal-title":"Soc. Change"},{"key":"10.1016\/j.socscimed.2026.119392_bib34","series-title":"The Health Gap: the Challenge of an Unequal World","author":"Marmot","year":"2016"},{"issue":"3","key":"10.1016\/j.socscimed.2026.119392_bib35","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.1086\/426800","article-title":"The complexity of intersectionality","volume":"30","author":"McCall","year":"2005","journal-title":"Signs"},{"issue":"2","key":"10.1016\/j.socscimed.2026.119392_bib36","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1093\/aje\/kwu108","article-title":"Invited commentary: multilevel analysis of individual heterogeneity-a fundamental critique of the current probabilistic risk factor epidemiology","volume":"180","author":"Merlo","year":"2014","journal-title":"Am. J. Epidemiol."},{"key":"10.1016\/j.socscimed.2026.119392_bib37","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.ssmph.2018.05.006","article-title":"General and specific contextual effects in multilevel regression analyses and their paradoxical relationship: a conceptual tutorial","volume":"5","author":"Merlo","year":"2018","journal-title":"SSM Popul. Health"},{"key":"10.1016\/j.socscimed.2026.119392_bib31","series-title":"The Transgender Persons (Protection of Rights) Amendment Act, 2026 (No. 3 of 2026)","author":"Ministry of Law and Justice","year":"2026"},{"key":"10.1016\/j.socscimed.2026.119392_bib39","series-title":"National Integrated Biological and Behavioural Surveillance (IBBS), India 2014-15","year":"2015"},{"key":"10.1016\/j.socscimed.2026.119392_bib40","series-title":"National IBBS 2014-15: Hijras\/Transgender People","year":"2016"},{"key":"10.1016\/j.socscimed.2026.119392_bib41","series-title":"HIV Sentinel Surveillance plus 2021 high-risk Group and Bridge Populations","year":"2024"},{"key":"10.1016\/j.socscimed.2026.119392_bib42","series-title":"Sankalak: Status of National AIDS & STD Response","year":"2024"},{"issue":"19","key":"10.1016\/j.socscimed.2026.119392_bib43","doi-asserted-by":"crossref","first-page":"47","DOI":"10.14197\/atr.201222194","article-title":"The thirunangai promise: gender as a contingent outcome of migration and economic exchange","author":"Nataraj","year":"2022","journal-title":"Anti-Trafficking Review"},{"key":"10.1016\/j.socscimed.2026.119392_bib44","article-title":"Understanding the Well-Being of LGBTQI+ Populations","year":"2020"},{"key":"10.1016\/j.socscimed.2026.119392_bib46","author":"PRS Legislative Research"},{"issue":"3","key":"10.1016\/j.socscimed.2026.119392_bib45","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1080\/13648470500291410","article-title":"Geographies of contagion: Hijras, Kothis, and the politics of sexual marginality in Hyderabad","volume":"12","author":"Reddy","year":"2005","journal-title":"Anthropol. Med."},{"issue":"1","key":"10.1016\/j.socscimed.2026.119392_bib47","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18231\/j.ijfcm.2021.001","article-title":"Modified Kuppuswamy socioeconomic scale updated for the year 2021","volume":"8","author":"Saleem","year":"2021","journal-title":"Indian J. Forensic Community Med."},{"key":"10.1016\/j.socscimed.2026.119392_bib48","first-page":"1","article-title":"Navigating queerness and religion in India: a phenomenological queer ethnography","author":"Sharma","year":"2025","journal-title":"Religion"},{"issue":"4","key":"10.1016\/j.socscimed.2026.119392_bib49","doi-asserted-by":"crossref","DOI":"10.4103\/ijph.ijph_1717_22","article-title":"Use of smartphones for social and sexual networking among transgender women in South India: implications for developing smartphone-based online HIV prevention interventions","volume":"67","author":"Shunmugam","year":"2023","journal-title":"Indian J. Publ. Health"},{"key":"10.1016\/j.socscimed.2026.119392_bib50","article-title":"Polyvictimization, sex work, and depressive symptoms among transgender women and men who have sex with men","author":"Srivastava","year":"2021","journal-title":"J. Interpers Violence"},{"key":"10.1016\/j.socscimed.2026.119392_bib51","series-title":"The Sexual Orientation and Gender Presentation of Hijra, Kothi, and Panthi in Mumbai, India","author":"Stief","year":"2016"},{"key":"10.1016\/j.socscimed.2026.119392_bib52","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.socscimed.2018.03.032","article-title":"Is there synergy in syndemics? Psychosocial conditions and sexual risk among men who have sex with men in India","volume":"206","author":"Tomori","year":"2018","journal-title":"Soc. Sci. Med."},{"issue":"1","key":"10.1016\/j.socscimed.2026.119392_bib53","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s13178-024-00984-7","article-title":"Transgender rights in India's legal system: a critical analysis","volume":"22","author":"Waggy","year":"2025","journal-title":"Sex. Res. Soc. Pol."},{"issue":"1","key":"10.1016\/j.socscimed.2026.119392_bib54","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1177\/2631831820918129","article-title":"What do we know about LGBTQIA+ Mental Health in India? A review of research from 2009 to 2019","volume":"2","author":"Wandrekar","year":"2020","journal-title":"Journal of Psychosexual Health"},{"issue":"3","key":"10.1016\/j.socscimed.2026.119392_bib55","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1080\/19317611.2016.1193079","article-title":"Recruitment strategies of Indian men who have sex with men in the state of Maharashtra into an online survey","volume":"28","author":"Wilkerson","year":"2016","journal-title":"Int. J. Sex. Health"},{"issue":"10042","key":"10.1016\/j.socscimed.2026.119392_bib56","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/S0140-6736(16)30653-5","article-title":"Synergies in health and human rights: a call to action to improve transgender health","volume":"388","author":"Winter","year":"2016","journal-title":"Lancet"},{"issue":"7","key":"10.1016\/j.socscimed.2026.119392_bib57","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1007\/s10461-014-0699-x","article-title":"Association between alcohol use and HIV-related sexual risk behaviors among men who have sex with men (MSM): findings from a multi-site bio-behavioral survey in India","volume":"18","author":"Yadav","year":"2014","journal-title":"AIDS Behav."}],"container-title":["Social Science & Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0277953626004685?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0277953626004685?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T12:11:41Z","timestamp":1784376701000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0277953626004685"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":56,"alternative-id":["S0277953626004685"],"URL":"https:\/\/doi.org\/10.1016\/j.socscimed.2026.119392","relation":{},"ISSN":["0277-9536"],"issn-type":[{"value":"0277-9536","type":"print"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Psychosocial problems, sexual violence victimization, and substance use among sexual and gender minorities in India: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (I-MAIHDA)","name":"articletitle","label":"Article Title"},{"value":"Social Science & Medicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.socscimed.2026.119392","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}],"article-number":"119392"}}