Research pertaining to transgender and nonbinary (TNB) populations has not always reflected the concerns of TNB people and some research has perpetuated harm. Research should be guided by TNB communities to identify areas of key importance to these populations. We asked TNB focus group participants to share their perspectives on important areas for future research with TNB populations. We coded responses across groups using reflexive thematic analysis. Four themes were developed: (1) Enhance the Quality and Inclusivity of TNB Research, (2) Understand the Diversity of TNB Communities, (3) Document and Support TNB Survival in a Cisnormative System, and (4) Explore TNB Thriving. These findings highlight important topics that future research can prioritize. This work adds to a growing body of literature that emphasizes the benefits of community-engaged research and can guide future studies to better address TNB people's needs.

Introduction:Transgender and nonbinary (TNB) people experience various minority stressors, such as discrimination, which have significant effects on mental health. Even so, most of the existing literature about TNB people's experiences of minority stress has utilized models that were developed for cisgender sexual minorities, resulting in a need for measure development. Method:We drew on data from recent research describing unique forms of gender minority stress and developed eight new measures assessing TNB vigilance, gender strain, misgendering, foreshortened TNB futures, vicarious gender minority stress frequency, vicarious gender minority stress response, transitioning identity stress, and body/gender policing. We used an iterative process where we developed items from in-depth qualitative data, conducted cognitive interviews (N = 30), gathered feedback from a community advisory board, and integrated suggestions from a panel of researchers with expertise in TNB health. To validate the newly developed minority stress measures, data were then gathered (N = 854) via an online survey and from a panel company, with a split sample for the exploratory and confirmatory factor analyses. All data were collected in the U.S. Results:Results provided evidence of content, structural, convergent, discriminant, criterion, and incremental validity for all scales. Measurement invariance analyses showed that the measures are valid for use with TNB people diverse in gender and racial/ethnic identities. Discussion:These newly developed scales provide the means to measure novel forms of minority stress that TNB people have described in past research, but which are not captured by existing cisgender focused models and measures of minority stress.

More research is needed on the ways trans and nonbinary (TNB) people are resilient in the face of oppression to develop empowering interventions that mitigate mental health disparities. Much of the research on TNB resilience thus far does not consider how group-level and community-level factors, as well as privilege and oppression, influence resilience. The current study took a community-centered approach by understanding how TNB community members conceptualize resilience and gathering their perceptions of a new framework of TNB resilience, the Multidimensional Framework of TNB Resilience. The Multidimensional Framework of TNB Resilience uses a socioecological framework to highlight five dimensions of resilience (i.e., individual, interpersonal, community, societal, and intersectional). We conducted five focus groups with 26 TNB adults (62% BIPOC; 58% nonbinary), ranging in age from 20 to 66 years old ( M = 32.96) and used reflexive thematic analysis to generate themes related to TNB perceptions of resilience. Three themes were generated: (a) resilience is shaped by individual history and context; (b) safeguarding against romanticizing resilience; and (c) yes, and . . . resilience is complicated. These themes showed that the Multidimensional Framework of TNB Resilience was aligned with community perceptions of resilience. Furthermore, the results emphasized that TNB resilience differs based on context as well as power and privilege. Future research should attend to these nuances in conceptualizing and measuring resilience rather than taking a one-size-fits-all approach.

Transgender and nonbinary (TNB) people experience gender minority stressors that adversely affect their mental health and wellbeing, all of which are shaped by sociopolitical contexts. We explored TNB participants' (N = 150) perceptions of how affirming their state was and associations with minority stress and mental health variables. Qualitative themes included: (1) Degrees of stigma depend on who you are; (2) Stigma persists even with small positive advancements; (3) Cis people take an 'out of sight, out of mind' approach to TNB people; and (4) It's in the air we breathe: Cissexism is an individual, cultural, and structural issue. Across states, 41.8% of participants described views towards TNB people as negative, 41.8% as mixed, 5% as positive, 3.2% as neutral, 2.5% were unsure, and 0.6% were coded as unclear. Depression, past year enacted stigma, and negative expectations were significantly higher in negative contexts than in mixed contexts. These findings suggest that stigma and marginalisation persist across contexts, including relatively supportive places, and emphasise the importance of understanding within-state variability in terms of contextual drivers of mental health. Furthermore, anti-trans political climates have significant implications for TNB people's mental health and wellbeing, as well as exposure to minority stressors.

One way that transgender and gender diverse (TGD) people may affirm their gender is through a legal name and/or gender marker change. Legal gender affirmation is associated with less psychological distress, but research has yet to expand upon the mechanisms that may help explain this association. We examined associations between legal gender affirmation, psychological distress, and physical health in TGD people, as well as the mediating effect of exposure to enacted stigma. Data are from the baseline portion of a longitudinal mixed-methods study of how sociopolitical contexts influence marginalization, health, and resilience for TGD people. The study included 158 TGD participants from Oregon, Michigan, Nebraska, and Tennessee. Baseline data were collected September 2019–March 2020 (the overall study concluded Fall 2021). Latent variable structural equation model analyses revealed that participants who had legally affirmed their gender reported less enacted stigma, which was associated with less psychological distress and physical health issues. There was a significant indirect effect via enacted stigma, such that this variable may partially help explain why legal gender affirmation is associated with better health outcomes. Legal gender affirmation is likely to influence TGD people’s health and well-being by shaping exposure to minority stress—specifically, enacted stigma. Our findings demonstrate the importance of sociopolitical factors in health outcomes for TGD people. Given the health benefits of legal gender affirmation and the potential protection from enacted stigma, policies should be revised to make legal name and/or gender marker changes more accessible for TGD people.

BackgroundIn recent years, legislation targeting transgender and gender diverse (TGD) people has proliferated in the United States, particularly legislation focused on TGD youth and on athletic inclusion. One such law, Texas House Bill 25 (HB25), focused on prohibiting TGD youth from participating in school sports in Texas.AimsIn this study, we identified common themes from the public testimony on Texas HB25 to further understand the arguments and rhetoric used in such legislation.MethodWe used a modified version of reflexive thematic analysis to examine the content of the HB25 legislative hearing.ResultsWe established four main themes: The Political Smokescreen: Vilifying TGD People and Re-Writing Narratives about Cisgender Girls and Women; Pleading from the Perspectives of Equity and Justice; Appeals to Power: Using Money, Reputation, and Religion; and Provable Harm: Anti-TGD Legislation Leads to Documented Harms.DiscussionThis hearing and the subsequently passed bill have profound implications for TGD youth in Texas by restricting them from participating in regular activities with their cisgender peers. In addition, many people testified that the very introduction of the bill was harmful because of how dehumanizing it was to have their rights attacked. Analyzing the arguments and rhetoric used in these types of hearings can add to our understanding of anti-trans legislative initiatives.

Background: To achieve Ending the HIV Epidemic goals, key populations, including sexual minority men, need to adhere to evidence-based biomedical interventions including antiretroviral therapy as treatment (ART) or preexposure prophylaxis (PrEP). The present study integrates traditional and machine learning methods to evaluate whether a common set of factors can predict adherence to ART for both treatment and prevention. Method: Participants included 365 sexual minority men taking antiretroviral therapy as treatment or PrEP in South Florida. Survey respondents provided information on adherence to treatment or PrEP and demographic, psychosocial, and behavioral factors potentially associated with adherence. Data were analyzed using machine learning algorithms that are simple to interpret such as Classification and Regression Tree and LASSO regression variable selection, techniques that require specialized extra steps to look inside “black box models” like Multivariate Adaptive Regression Spline (MARS) and Random Forest models, and traditional stepwise logistic regression to identify factors associated with adherence. Results: Taking ART for HIV treatment or PrEP was not an important predictor for adherence in any of the models. Rather, the models suggested that a common set of predictors can be used to predict adherence to ART for both treatment and PrEP. Race/ethnicity was identified by all models as an important predictor of adherence. Additionally, depressive symptoms, anxiety symptoms

We examined transgender and gender-diverse (TGD) people's reports of their therapy experiences over the course of a year. We explored how participants' therapists integrated discussions about current events, as well as their more general perspectives on helpful and unhelpful experiences. A total of 107 participants provided data on these questions at least once over 12 months of surveys (M age = 33.79; 70.1% White), reflecting on their current therapy experiences. Through thematic analysis of qualitative data, the following themes were constructed regarding discussing sociopolitical events: (a) facilitating coping via bearing witness to clients' internal experiences and implementing other therapeutic interventions; (b) moving beyond the individual by integrating identity, systems, or contexts; (c) feeling disconnected and misunderstood. We grouped participants' helpful experiences into the following themes: (1) availability, connection, and therapeutic approaches facilitate positive experiences; (2) the necessity of knowledge, education, and affirmation of TGD identities; (3) helpful therapy means seeing the world in which clients live. We grouped participants' unhelpful experiences into the following themes: (1) logistical issues can interfere with therapy; (2) lack of depth and disconnection results in subpar therapy; (3) insufficient understandings of TGD identities results in potentially harmful practices. These findings deepen understandings of how to integrate discussions about current events into therapy and provide competent and affirming care to TGD clients.

BACKGROUND:A recent implementation science stepped-wedge trial of motivational interviewing (MI) in adolescent HIV clinics indicated variable degrees of implementation success. The present mixed-methods study analyzed trajectories of postimplementation MI competence scores and compared postimplementation qualitative interviews among the clinics with the highest levels of provider competency and the lowest levels of competency to further understand mechanisms of successful implementation. SETTING:Ten HIV clinics in the Adolescent Trials Network for HIV/AIDS Interventions. METHODS:This study used a sequential explanatory mixed-methods design. Continuous MI competency data from the parent study were structured with repeated measurements nested within providers nested within 10 sites. A mixed-effects regression model rank ordered the clinics by competence scores. Key stakeholders (N = 77) at the 10 randomized clinics completed a 1-hour qualitative interview at 12-month follow-up (immediately postimplementation). Using the phases of reflexive thematic analysis, interviews from the 3 highest competence clinics and the 3 lowest competence clinics were pragmatically analyzed. RESULTS:Thematic analysis suggested 3 central themes that influenced successful evidence-based practice (EBP) implementation. Organizational culture included the leadership, collective effort, and resources that influenced how the organization at large responded to the implementation intervention. Staff attitudes encapsulated individual providers' mindsets and attitudes about MI and the implementation intervention. EBP integration reflected the perception and use of MI by individuals and the organization as a whole. These themes and their subthemes are interconnected and exerted an influence on each other through the implementation process. CONCLUSIONS:Findings suggest additional implementation strategies to improve implementation of EBPs. Such mixed-methods research is critical to understanding the mechanisms of successful implementation of EBP and improving future implementation strategies.

Introduction: Transgender and gender diverse (TGD) individuals face disproportionate barriers to accessing affirming healthcare, ranging from individual practitioners' biases to financial constraints and societal-level cisnormativity.Method: This study identified suggestions for improving healthcare from 420 TGD individuals in the United States. Participants responded to an open-ended question about their suggestions for improving healthcare for TGD people. These responses were then coded using thematic analysis, resulting in 22 specific codes under 6 themes.Results: Results indicated a need for eliminating cisnormativity, taking a holistic approach with clients, adjusting conceptual frameworks for care, eliminating accessibility barriers, promoting affirmative interactions with TGD clients, and providing TGD-affirmative training for providers. Notably, these suggestions spanned from the broader, cultural level regarding general understandings of TGD people and gender to micro-level interactions.Conclusions: This study provides important tools for improving TGD care via a reduction of barriers and an increase in competency and affirmation.

Sexual minority men (SMM) remain disproportionately burdened by sexually transmitted infections. Although gay community involvement has been theorized to be protective against many negative health outcomes, research examining the association between community involvement and condomless anal sex (CAS) has yielded conflicting results. The current study, conducted between 2018–2020, examined whether the importance one places on various aspects of community involvement was associated with CAS among a sample of young adult SMM aged 18–34 years with body image concerns (N = 180). Gay community involvement was measured using the Importance of Gay Community Scale, and the results of an exploratory factor analysis indicated the presence of two factors: “social activism” and “going out/nightlife.” A zero-inflated Poisson regression was conducted to examine the association between gay “social activism,” “going out/nightlife,” and their interaction with the number of CAS partners. Upon examining a significant interaction, “social activism” had a protective effect against CAS at low levels of “going out/nightlife,” but this effect was non-significant at higher levels. These results suggest that encouraging gay community involvement through activism could be effective at reducing CAS and addressing the health disparity that exists within this population.

Objective: We examined sadness/hopelessness and suicide among racial/ethnic and sexual minority youth (SMY).Methods: 2017 Youth Risk Behavior Survey (YRBS) data on sadness/hopelessness and suicide were analyzed among White, Black, and Hispanic/Latino youth.Results: A main effect of sexual minority (SM) identity emerged for sadness/hopelessness, suicidal ideation, suicide plan, suicide attempts, and injurious attempts; SMY reported increased risk compared to their heterosexual peers. An interaction between Black race and SM identity emerged for sadness/hopelessness, suicidal ideation, and suicide plan; White SMY were at greater risk than Black SMY. A main effect of Black race on suicide attempts was found; Black youth reported increased risk of suicide attempts compared to White youth.Conclusions: Black SMY exhibited lower risk of sadness/hopelessness, suicide ideation, and suicide plans than their White SMY peers, whereas Black youth overall were more likely to report suicide attempts than their White peers.HIGHLIGHTSThere was an interaction of sexual minority identity and race (Black or White) for three outcomes.SM and Black identities were associated with higher risk for suicide attempts.Only SM identity was associated with increased risk of injurious suicide attempts.

Research related to the lives of transgender and gender diverse (TGD) people has grown substantially in recent years. One area of such growth has been research on TGD people's sexuality. Sexuality can include sexual behaviors, sexual attraction, and sexual identity, among other domains. Historically, sexuality of TGD people was often policed by providers with expectations of heterosexuality or the conflation of sexuality and gender experiences. This resulted in a lag in understanding the lived experiences of TGD people in relation to sexuality. In this review, we examine research that has been conducted over the past 5 years with any measurement of sexuality with TGD participants. The initial search revealed 11,891 articles. After removing duplicates, there were 6,538 articles in the abstract review stage, with 1,669 retained for full text review and 179 retained for extraction. Most studies included majority white samples, and about half were conducted solely in the United States. Most studies measured a single dimension of sexuality, specifically sexual identity, whereas only 2.2% asked about all three dimensions of identity, behavior, and attraction. Of those that inquired about sexual identity, most samples were majority sexual minorities. Many studies had issues related to inclusivity, such as the language used in response options or questions. These findings are placed within the context of the revised 2021 guidelines for practice with sexual minorities and emphasize the importance of diversifying our field's understandings and assessments of sexuality for TGD people.

Latino sexual minority men (SMM) have high HIV incidence rates but report low pre-exposure prophylaxis (PrEP) use. Medical mistrust predicts lower medical care use and could contribute to decreased PrEP engagement. This study examines how medical mistrust relates to the PrEP cascade among 151 Latino SMM aged 18-29. Logistic regressions were employed with medical mistrust predicting PrEP awareness, willingness, current use, and adherence. Greater medical mistrust was associated with decreased odds of all outcomes and may represent a barrier to PrEP engagement for Latino SMM. Further research should explore whether reducing medical mistrust among Latino SMM could increase PrEP engagement.

Latino sexual minority men (SMM) have elevated anabolic-androgenic steroid (AAS) misuse in comparison to their heterosexual and non-Latino peers. Within a gender role framework, desire to present as masculine through heightened muscularity may be related to increased AAS misuse. To assess the association between AAS misuse and a culturally-distinct masculinity, this study examined the relationship of two aspects of machismo, traditional machismo and caballerismo, with AAS misuse in the past month. Participants were 141 young adult Latino SMM recruited from the San Diego area. Participants completed a self-report questionnaire online in English or Spanish, which included measures of machismo and AAS misuse. Out of 141 participants, 27 reported AAS misuse (19.1%). Traditional machismo was positively associated with AAS misuse and caballerismo was negatively associated with AAS misuse. Traditional machismo, which emphasizes dominance, may be positively associated with AAS misuse due to its facilitation of muscle development, which could enable physical intimidation; greater musculature may also counteract assumptions about femininity and sexual orientation. Caballerismo may be negatively associated with AAS by providing a flexible masculinity model that emphasizes social cohesion over dominance. Future AAS misuse interventions could include values-based work and cognitive restructuring of masculinity schemas.