‘It’s political’: mental health of emerging adults at the intersection of racism, cisgenderism, and heterosexism

Culture Health & Sexuality · 2026-04-08

Sexuality and gender diverse Emerging Adults of Colour face disproportionate mental health risks from the compounding effects of racism, cisheteronormativity, and structural exclusion. Understanding these lived experiences is essential for developing culturally grounded, affirming approaches to mental health equity. Eighteen participants (ages 18-24) who self-identified as both sexuality and gender diverse and as having a marginalised racial identity completed in-depth interviews, which were analysed using inductive thematic analysis, followed by intersectionality-informed interpretation. Two overarching themes were identified: (1) intersectional stigma and social exclusion; and (2) mental health and engagement with care. Participants described how marginalisation within institutions, families, and identity-based communities influenced their psychological well-being, trust in care systems, and desire for intersectionally affirming spaces. While many needed mental health support, structural barriers and the scarcity of culturally competent providers limited access. Findings highlight how intersectional stigma operates across relational and structural domains. Public health and social service efforts should address social and institutional contexts that produce exclusion.

Job and Health Outcomes Among Transgender and Gender-Diverse Nurses

Journal of Transcultural Nursing · 2026-03-08

Introduction: Transgender and gender-diverse (TGD) individuals face health disparities and workplace discrimination, yet the job and health outcomes of TGD nurses remain underexplored. Purpose: To investigate how gender identity affects job and health outcomes. Methods: This cross-sectional observational study included 52,491 nurses (52,455 identifying as cisgender and 36 as TGD) in New York and Illinois surveyed in 2021. Job outcomes were burnout and job dissatisfaction. Health outcomes were depression, anxiety, and overall health ratings. Propensity score weighting was used to address confounding factors. Doubly robust methods were applied to refine estimates. Results: Compared with cisgender nurses, TGD nurses had higher odds of high burnout (adjusted odds ratio [aOR] = 2.60, p = .036), job dissatisfaction (aOR = 2.21, p = .044), poorer overall health (aOR = 3.98, p < .001), and more depressive ( b = 0.82, p = .013) and anxiety symptoms ( b = 0.76, p = .044). Conclusions: TGD nurses reported poorer job and health outcomes than cisgender nurses, underscoring the need to identify workplace factors associated with these disparities.

HIV Prevention Service Disruption among Transgender Adults in the Context of 2025 Federal Executive Orders in the United States 

SSRN Electronic Journal · 2026-01-01

Unconventional Resilience: Necessary Social Identity Management Among Asylum-Seeking Sexual and Gender-Diverse Survival Migrants.

PubMed · 2026-02-01

. 2026;116(2):222-228. https://doi.org/10.2105/AJPH.2025.308337).

Multilevel Examination of Hospital Participation in the Healthcare Equality Index (HEI): The Role of Geographic Location and State Health Care Policies

Journal of Health and Social Behavior · 2025-08-03 · 1 citations

The Healthcare Equality Index (HEI) evaluates compliance with LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender diverse individuals) inclusion in U.S. health care facilities and is associated with greater patient satisfaction. We examined how hospitals' metropolitan location and state-level LGBTQ+ health care policies are associated with voluntary HEI participation and performance. This cross-sectional study analyzed 6,120 U.S. hospitals from the 2022 American Hospital Association Annual Survey. Multilevel logistic regression assessed the relationship and varying impact of metropolitan status and state policies on HEI participation and HEI Leader status (highest performance). State policies had a stronger positive association with nonmetropolitan hospitals. Each additional policy increased HEI participation odds by 58% for nonmetropolitan hospitals (adjusted odds ratio [aOR] = 1.58; 95% confidence interval [CI] = 1.19, 2.10) and 21% for metropolitan hospitals (aOR = 1.21; 95% CI = 1.02, 1.43). No significant associations with HEI Leader status were observed. Strengthening LGBTQ+ inclusive state policies may encourage hospitals, particularly in nonmetropolitan areas, to adopt LGBTQ+ inclusion initiatives.

Sexual Empowerment Among Young Black Men Who Have Sex with Men

UNC Libraries · 2025-07-15

Sexual empowerment represents an important HIV intervention strategy, yet limited attention has examined the multidimensional nature of sexual empowerment in prior studies. Using a sample (n = 465) of young Black men who have sex with men (MSM), we used confirmatory factor analysis (CFA) to test a multifactorial operationalization of sexual empowerment. CFA indicated that a bifactor model was best suited to characterize the sexual empowerment factor (SEF), suggesting that items for four sub-constructs (self-efficacy to refuse sexual behavior, emotional support, condom use self-efficacy, and social norms on condom use) contributed to their respective constructs, while also contributing to a latent sexual empowerment construct. We then examined the association between SEF and mental health outcomes (anxiety and depression symptoms) and safer sex intentions. SEF was negatively associated with mental health outcomes and positively associated with safer sex intentions. Ultimately, individuals with greater sexual empowerment might be better equipped to develop strategies to buffer their vulnerability to HIV. We discuss the implications of SEF as a bifactor during the design and evaluation of HIV risk-reduction interventions seeking to address sexual empowerment among MSM.

Increasing HIV Testing and Viral Suppression via Stigma Reduction in a Social Networking Mobile Health Intervention Among Black and Latinx Young Men and Transgender Women Who Have Sex With Men (HealthMpowerment): Protocol for a Randomized Controlled Trial

UNC Libraries · 2025-07-09

BACKGROUND: Stigma and discrimination related to sexuality, race, ethnicity, and HIV status negatively impact HIV testing, engagement in care, and consistent viral suppression (VS) among young Black and Latinx men who have sex with men and transgender women who have sex with men (YBLMT). Few interventions address the effects of intersectional stigma among youth living with HIV and those at risk for HIV within the same virtual space. OBJECTIVE: Building on the success of the HealthMpowerment (HMP) mobile health (mHealth) intervention (HMP 1.0) and with the input of a youth advisory board, HMP 2.0 is an app-based intervention that promotes user-generated content and social support to reduce intersectional stigma and improve HIV-related outcomes among YBLMT. The primary objective of this study is to test whether participants randomized to HMP 2.0 report improvement in HIV prevention and care continuum outcomes compared with an information-only control arm. We will also explore whether participant engagement, as measured by paradata (data collected as users interact with an mHealth intervention, eg, time spent using the intervention), mediates stigma- and HIV care-related outcomes. Finally, we will assess whether changes in intersectional stigma and improvements in HIV care continuum outcomes vary across different types of social networks formed within the intervention study arms. METHODS: We will enroll 1050 YBLMT aged 15 to 29 years affected by HIV across the United States. Using an HIV-status stratified, randomized trial design, participants will be randomly assigned to 1 of the 3 app-based conditions (information-only app-based control arm, a researcher-created network arm of HMP 2.0, or a peer-referred network arm of HMP 2.0). Behavioral assessments will occur at baseline, 3, 6, 9, and 12 months. For participants living with HIV, self-collected biomarkers (viral load) are scheduled for baseline, 6, and 12 months. For HIV-negative participants, up to 3 HIV self-testing kits will be available during the study period. RESULTS: Research activities began in September 2018 and are ongoing. The University of Pennsylvania is the central institutional review board for this study (protocol #829805) with institutional reliance agreements with the University of North Carolina at Chapel Hill, Duke University, and SUNY Downstate Health Sciences University. Study recruitment began on July 20, 2020. A total of 205 participants have been enrolled as of November 20, 2020. CONCLUSIONS: Among a large sample of US-based YBLMT, this study will assess whether HMP 2.0, an app-based intervention designed to ameliorate stigma and its negative sequelae, can increase routine HIV testing among HIV-negative participants and consistent VS among participants living with HIV. If efficacious and brought to scale, this intervention has the potential to significantly impact the disproportionate burden of HIV among YBLMT in the United States. TRIAL REGISTRATION: ClinicalTrials.gov NCT03678181; https://clinicaltrials.gov/ct2/show/study/NCT03678181. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/24043.

Implementation determinants of LGBTQ+ inclusive practices in US health systems: a qualitative descriptive study of nurse leaders

BMJ Open · 2025-11-01 · 2 citations

OBJECTIVES: Despite efforts to implement lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender diverse (LGBTQ+) inclusive practices to address health disparities faced by LGBTQ+ individuals, factors that facilitate the uptake of these practices remain underexplored. Informed by the Consolidated Framework for Implementation Research (CFIR), this study explores nurse leaders' perspectives across diverse US healthcare systems regarding the facilitators and barriers to implementing LGBTQ+ inclusive practices. DESIGN: We used a qualitative descriptive design. Semistructured interviews guided by the CFIR framework were conducted from October to December 2023. The data were analysed using thematic analysis. SETTING: Diverse healthcare settings (eg, acute care hospitals and public health centres) across the USA. PARTICIPANTS: We purposively recruited 21 nurse leaders, such as chief nursing officers or chief nurse executives, who oversee nursing strategy, staffing and quality across their organisations. RESULTS: Consistent with prior frontline-focused studies, nurse leaders confirmed key inner setting and individuals facilitators (eg, LGBTQ+ specific training, electronic health record adaptation, visible executive engagement). Our findings add system-level detail from an executive perspective. Leaders identified actionable levers such as establishing LGBTQ+ clinical and social services, allocating protected time and budgets, and deploying dedicated implementation teams. We also identified a cross-cutting barrier: a reactive, crisis-driven organisational culture that hinders proactive inclusion efforts. Beyond the organisation, sociopolitical and legal climates shaped readiness and resourcing, with anti-LGBTQ+ laws influencing inclusion initiatives. Finally, nurse leaders highlighted the need for rigorous multilevel evaluation (eg, patient, staff, institution) and noted that common surveys inadequately capture LGBTQ+ inclusion, revealing measurement gaps that impede continuous improvement. CONCLUSIONS: Implementing LGBTQ+ inclusive practices in healthcare is essential for optimal health outcomes and social justice. Understanding the context of implementation at multiple levels is crucial. Future research should focus on testing implementation strategies, developing inclusive healthcare surveys, and supporting the role of organisational culture and leadership in promoting LGBTQ+ inclusivity.

Stigma and Mobile App Use Among Young Black Men Who Have Sex With Men.

UNC Libraries · 2025-07-23

Young black men who have sex with men (YBMSM) are disproportionately affected by HIV. Intersectional stigmas are associated with increased HIV vulnerability, and worse outcomes for YBMSM with HIV. YBMSM find sex partners through sexual networking apps, but stigma on apps has been poorly studied. We conducted cross-sectional analysis of 324 YBMSM seeking sex partners through apps to assess stigma experiences in eight dimensions compared to non-users (<em>N</em> = 150). We conducted detailed stratified analyses to identify granular stigma data. App users had higher median scores than non-users in perceived HIV discrimination, perceived HIV stigma, experienced sexual minority stigma, racial discrimination, and perceived homophobia. We demonstrate higher levels of intersectional stigmas among app users than non-users, but did not find an overall increase in stigma with increasing app use. Considering the prominent role of apps in YBMSM sexual networking, interventions that reduce stigma on apps are needed.