Some transgender men who have sex with men (trans MSM) are vulnerable to HIV infection and face stigma from sexual partners. We evaluated a brief 4-item measure of gender non-affirmation from cisgender male partners. A non-probability sample of American trans MSM (n = 843) reporting past 6-month sexual contact with a cisgender male completed a cross-sectional survey. Psychometric analyses assessed the scale and modeled HIV risk associations. Overall, 78% experienced past 6-month gender non-affirmation from cisgender male partners. The scale demonstrated good reliability (α = 0.78). Convergent validity was supported in associations with psychological distress and anxiety (p < 0.05). Lower frequency of cisgender male partner stigma was associated with increased odds of past 6-month HIV testing and decreased odds of past 6-month condomless receptive sex (all p < 0.01). The gender non-affirmation from cisgender male sexual partners scale found negative associations with protective health behaviors and can be used to better understand the context of trans MSM risk behavior.
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Centers for Disease Control and Prevention (CDC). HIV Surveillance Report, 2016, vol. 28. November 2017; http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Accessed 10 Nov 2018.
Centers for Disease Control and Prevention (CDC). Estimated HIV incidence and prevalence in the United States, 2010–2015. HIV Surveillance Supplemental Report 2018. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Accessed 11 Nov 2018.
Poteat T, Scheim A, Xavier J, Reisner S, Baral S. Global epidemiology of HIV Infection and related syndemics affecting transgender people. J Acquir Immune Defic Syndr. 2016;72(Suppl 3):S210–9.
Bauer GR, Redman N, Bradley K, Scheim AI. Sexual health of trans men who are gay, bisexual, or who have sex with men: results from Ontario, Canada. Int J Transgend. 2013;14(2):66–74.
Scheim AI, Santos GM, Arreola S, et al. Inequities in access to HIV prevention services for transgender men: results of a global survey of men who have sex with men. J Int AIDS Soc. 2016;19(3 Suppl 2):20779.
Reisner SL, Murchison GR. A global research synthesis of HIV and STI biobehavioural risks in female-to-male transgender adults. Glob Public Health. 2016;11:1–22.
Stephenson R, Riley E, Rogers E, et al. The sexual health of transgender men: a scoping review. J Sex Res. 2017;54(4–5):424–45.
Becasen JS, Denard CL, Mullins MM, Higa DH, Sipe TA. Estimating the prevalence of HIV and sexual behaviors among the US transgender population: a systematic review and meta-analysis, 2006–2017. Am J Public Health. 2018;109:e1–8.
Pitasi MA, Oraka E, Clark H, Town M, DiNenno EA. HIV testing among transgender women and Men—27 States and Guam, 2014–2015. MMWR Morb Mortal Wkly Rep. 2017;66(33):883–7.
Hendricks ML, Testa RJ. A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the Minority Stress Model. Prof Psychol. 2012;43(5):460–7.
Sevelius JM. Gender affirmation: a framework for conceptualizing risk behavior among transgender women of color. Sex Roles. 2013;68(11–12):675–89.
Reisner SL, White Hughto JM, Pardee D, Sevelius J. Syndemics and gender affirmation: HIV sexual risk in female-to-male trans masculine adults reporting sexual contact with cisgender males. Int J STD AIDS. 2015;27:955–66.
Reisner SL, Radix A, Deutsch MB. Integrated and gender-affirming transgender clinical care and research. J Acquir Immune Defic Syndr. 2016;72(Suppl 3):S235–42.
Goffman E. Stigma: notes on the management of spoiled identity. Englewood Cliffs: Prentice Hall; 1963.
Link BG, Phelan JC. Conceptualizing stigma. Ann Rev Sociol. 2001;27:363–85.
Sevelius J. “There’s no pamphlet for the kind of sex I have”: hIV-related risk factors and protective behaviors among transgender men who have sex with nontransgender men. J Assoc Nurses AIDS Care. 2009;20(5):398–410.
Reisner SL, Perkovich B, Mimiaga MJ. A mixed methods study of the sexual health needs of New England transmen who have sex with nontransgender men. AIDS Patient Care STDS. 2010;24(8):501–13.
Major B, O’Brien LT. The social psychology of stigma. Annu Rev Psychol. 2005;56:393–421.
Reisner S, Keatley J, Baral S, et al. Transgender community voices: a participatory population perspective. Lancet. 2016;388(10042):327–30.
Reisner SL, Hughto JM, Pardee DJ, Kuhns L, Garofalo R, Mimiaga MJ. LifeSkills for men (LS4M): pilot evaluation of a gender-affirmative HIV and STI prevention intervention for young adult transgender Men who have sex with men. J Urban Health. 2016;93(1):189–205.
Kessler RC, Andrews G, Colpe LJ, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32(6):959–76.
Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.
Doove LL, Van Buuren S. Recursive partitioning for missing data imputation in the presence of interaction effects. Comput Stat Data Anal. 2014;72:92–104.
Shah AD, Bartlett JW, Carpenter J, Nicholas O, Hemingway H. Comparison of random forest and parametric imputation models for imputing missing data using MICE: a CALIBER study. Am J Epidemiol. 2014;179(6):764–74.
DeVellis RF. Scale development: theory and applications. 2nd ed. Thousand Oaks: Sage Publications Inc; 2003.
White Hughto JM, Reisner SL, Pachankis JE. Transgender stigma and health: a critical review of stigma determinants, mechanisms, and interventions. Soc Sci Med. 2015;147:222–31.
James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. The report of the 2015 US transgender survey. Washington, DC: National Center for Transgender Equality; 2016.
Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97.
Bowleg L. The problem with the phrase women and minorities: intersectionality-an important theoretical framework for public health. Am J Public Health. 2012;102(7):1267–73.
Bauer GR. Incorporating intersectionality theory into population health research methodology: challenges and the potential to advance health equity. Soc Sci Med. 2014;110:10–7.
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Reisner, S.L., Moore, C.S., Asquith, A. et al. Gender Non-affirmation from Cisgender Male Partners: Development and Validation of a Brief Stigma Scale for HIV Research with Transgender Men Who Have Sex with Men (Trans MSM). AIDS Behav 24, 331–343 (2020). https://doi.org/10.1007/s10461-019-02749-5
- HIV prevention