Latent Constructs of Economic Marginality Associated with Sexual Behavior, Healthcare Access and HIV Outcomes Among Transgender and Nonbinary People in Three U.S. Cities

Transgender and nonbinary people (TNB) in the U.S. experience high HIV prevalence and diverse economic hardships. Yet a comprehensive understanding of how multiple, simultaneously occurring hardships-termed economic marginality-are together associated with healthcare and HIV outcomes is needed. Leveraging survey data from a sample of 330 TNB people in three U.S. cities, we conducted an exploratory mixed-source principal component analysis of latent factors of economic experience, then estimated their associations with sexual behavior, access to healthcare, HIV status, and HIV testing frequency. Two factors emerged: a traditional socioeconomic factor related to income, education, and employment (SES), and one related to housing precarity and (lack of) assets (Precarity). Higher Precarity scores were associated with sexual behavior, cost-based healthcare avoidance, discrimination-based healthcare avoidance, and more frequent HIV testing. Findings highlight the importance of understanding profiles of economic marginalization among trans and nonbinary people and can inform efforts to address upstream, structural factors shaping healthcare access and HIV outcomes in this key population.

Limitations to Participation in Family of Origin Among Same Sex Couples: A Couple-Level Minority Stressor

Emerging studies focus on minority stressors emanating from society's stigmatization of particular relationship forms (i.e., couple-level minority stressors). The present study examines how same-sex couples experience one such couple-level minority stressor: limitations to participation in families of origin. Qualitative data are drawn from a sub-sample of same-sex couples (N = 18) who participated in a large-scale study of minority stress among 120 same-sex couples distributed equally across two study sites (Atlanta and San Francisco) in 2012 and 2013. Instances of limitations to participation in families of origin ranged in severity, falling into three distinct areas: 1) partial acceptance, where some family members were accepting and others were not, 2) mixed messages where some family members said they were accepting but behaved as though they were not and, 3) rejection, where some family members were blatantly unwelcoming or hostile. These types of exclusion were also evidenced in dyadic minority stress processes of stress proliferation (e.g., stress discrepancies and stress contagion) causing additional stress for both partners. These narratives portray struggles associated with experiences of couple-level minority stress faced by people in same-sex relationships.

Noncanonical Role of Telomerase in Regulation of Microvascular Redox Environment With Implications for Coronary Artery Disease

Telomerase reverse transcriptase (TERT) (catalytic subunit of telomerase) is linked to the development of coronary artery disease (CAD); however, whether the role of nuclear vs. mitchondrial actions of TERT is involved is not determined. Dominant-negative TERT splice variants contribute to decreased mitochondrial integrity and promote elevated reactive oxygen species production. We hypothesize that a decrease in mitochondrial TERT would increase _mtDNA damage, promoting a pro-oxidative redox environment. The goal of this study is to define whether mitochondrial TERT is sufficient to maintain nitric oxide as the underlying mechanism of flow-mediated dilation by preserving _mtDNA integrity.Immunoblots and quantitative polymerase chain reaction were used to show elevated levels of splice variants α- and β-deletion TERT tissue from subjects with and without CAD. Genetic, pharmacological, and molecular tools were used to manipulate TERT localization. Isolated vessel preparations and fluorescence-based quantification of _mtH₂O₂ and NO showed that reduction of TERT in the nucleus increased flow induced NO and decreased _mtH₂O₂ levels, while prevention of mitochondrial import of TERT augmented pathological effects. Further elevated _mtDNA damage was observed in tissue from subjects with CAD and initiation of _mtDNA repair mechanisms was sufficient to restore NO-mediated dilation in vessels from patients with CAD. The work presented is the first evidence that catalytically active mitochondrial TERT, independent of its nuclear functions, plays a critical physiological role in preserving NO-mediated vasodilation and the balance of mitochondrial to nuclear TERT is fundamentally altered in states of human disease that are driven by increased expression of dominant negative splice variants.

Past Experiences and Anticipated Futures in the Lives of Transgender and Nonbinary People

Transgender and nonbinary people's life experiences are highly heterogenous and shaped by broader structural and cultural forces. We analyze experiences identified on lifeline interviews from 87 transgender and nonbinary adults in Atlanta, New York City, and San Francisco. We find that the type, timing, and relative importance of these experiences varied across categories. For example, experiences related to "Rejection and violence" were more often identified in childhood and in the past, whereas experiences related to "Gender-affirming medical interventions" were more often in adulthood and anticipated futures. Experiences related to "Community involvement," "Extracurriculars," "Gender exploration and revelation," and "Gender-affirming medical interventions" were labeled by respondents as relatively more important compared to other experiences, whereas experiences related to "Family of origin relationships," "Place of residence," "Rejection and violence," and "Sexuality" less important. These experiences were patterned according to the respondents' gender, birth cohort, race/ethnicity, and geographic location. In analyzing these lifeline data, we advance theoretical understandings of the salience of a variety of key experiences for transgender and nonbinary people at different points in the life course. Our life course approach provides empirical analyses of intra-individual processes over time for transgender and nonbinary people and provides insight into the usefulness of a lifeline method for life course studies more generally as it draws attention to within-person assessments of the distribution and importance of events over the course of a lifetime.

Prospective relationships between stigma, mental health, and resilience in a multi-city cohort of transgender and nonbinary individuals in the United States, 2016-2019

PURPOSE

Gender-based stigma is a fundamental cause of mental health disparities among transgender and non-binary (TGNB) individuals, while resilience factors may be protective. We examined prospective relationships between gender-based enacted stigma, psychological distress, and resilience factors among TGNB individuals.

METHODS

Between 2016 and 2017, we enrolled 330 TGNB individuals in three metropolitan areas in the U.S. in a prospective cohort study focused on gender identity development, risk, and resilience across the lifespan. Using multilevel regression, we examined prospective associations between enacted gender-based stigma and psychological distress (measured by the Global Severity Index/BSI-18), and examined transgender pride and social support as moderators, adjusting for age, sex assigned at birth, race/ethnicity, education, and income.

RESULTS

Our sample was diverse in age (M = 34.4, range 16-87) and race/ethnicity (56.4% non-White). Over 2 years of follow-up, there was a decrease in reported gender-based stigma (b = - 0.61, p < 0.001) and transgender pride (b = - 0.14, p = 0.003), increase in social support (b = 0.21, p < 0.001), and no change in psychological distress. In adjusted analyses, gender-based stigma was positively associated with psychological distress (b = 1.10, p < 0.001) and social support was negatively associated with psychological distress (b = - 2.60, p < 0.001). Transgender pride moderated the relationship between stigma and psychological distress (p < 0.01), such that the association was stronger for lower levels of transgender pride.

CONCLUSIONS

Our study provides longitudinal evidence for the deleterious role of gender-based stigma among TGNB individuals. Future interventions should consider fostering transgender pride and social support to promote mental health and mitigate negative effects of gender-based stigma.

The Chicago Health and Life Experiences of Women Couples Study: Protocol for a Study of Stress, Hazardous Drinking, and Intimate Partner Aggression Among Sexual Minority Women and Their Partners

BACKGROUND

Large gaps exist in research on alcohol use and intimate partner aggression (IPA) among sexual minority women (SMW; eg, lesbian, bisexual). Dyadic research with SMW and their partners can illuminate how couple-level factors operate in conjunction with individual-level factors to shape well-being in this understudied and vulnerable population. Given the traditionally gendered lens with which women are primarily viewed as victims and men as perpetrators, understanding the dynamics of IPA in same-sex female couples can also advance research and practice related to IPA more generally.

OBJECTIVE

Guided by a recent extension of the minority stress model that includes relational (couple-level) sexual minority stress and the I-cubed theoretical perspective on IPA, we will collect individual and dyadic data to better characterize the links between hazardous drinking and IPA among SMW and their partners. First, this study aims to examine the associations among minority stress, hazardous drinking, and IPA in SMW and their partners. Minority stressors will be assessed as both individual and couple-level constructs, thus further extending the minority stress model. Second, we aim to examine potential mediators and moderators of the associations among minority stress, hazardous drinking, and IPA. Finally, we aim to test models guided by the I-cubed theoretical perspective that includes instigating (eg, relationship conflict), impelling (eg, negative affect and trait anger), and inhibiting (eg, relationship commitment and emotion regulation) or disinhibiting (eg, hazardous drinking) influences on IPA perpetration.

METHODS

This United States National Institutes of Health-funded project will draw from a large and diverse cohort of SMW currently enrolled in the Chicago Health and Life Experiences of Women (CHLEW) study-a 21-year longitudinal study of risk factors and consequences associated with SMW hazardous drinking. SMW currently enrolled in the CHLEW and their partners will be invited to participate in the CHLEW Couples Study. By analyzing dyadic data using actor-partner interdependence models, we will examine how each partner's minority stress, hazardous drinking, and IPA experiences are associated with both her own and her partner's minority stress, hazardous drinking, and IPA perpetration.

RESULTS

Data collection began in February 2021 and will likely continue through 2023. Initial results should be available by mid-2024.

CONCLUSIONS

The CHLEW Couples Study will fill important gaps in knowledge and provide the basis for future research aimed at clarifying the causal pathways linking hazardous drinking and IPA among SMW. This will support the development of culturally appropriate targeted individual and dyadic prevention and intervention strategies.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/28080.

Stigmatization, Resilience, and Mental Health Among a Diverse Community Sample of Transgender and Gender Nonbinary Individuals in the U.S

Transgender and gender nonbinary (TGNB) individuals were recently designated a health disparity population by the U.S. National Institutes of Health. We examined the effect of gender-related discrimination and resilience factors on the mental health of a community sample diverse in gender identity, age, and race/ethnicity. We report on the baseline data of a longitudinal study of transgender identity development across the lifespan with 330 TGNB individuals recruited through venue-based recruitment in three major metropolitan areas in the U.S. Mean age of participants was 34.4 years (SD = 13.7). Structured interviews collected self-report data on sociodemographics, gender-related discrimination, mental health, and resilience. We used hierarchical regression to examine the association between gender-related discrimination and psychological distress (BSI-18) and tested the moderating effect of family support, transgender community connectedness, gender literacy, and transgender activism on this relationship. In adjusted analyses, gender-related discrimination was positively associated with psychological distress. Family support was negatively associated with psychological distress. Contrary to our expectations, gender literacy and transgender activism were positively associated with psychological distress, while no significant relationship was found for transgender community connectedness. Family support, transgender community connectedness, gender literacy, and transgender activism did not moderate the effect of gender-related discrimination on psychological distress. Future mental health interventions should consider leveraging family support among TGNB individuals. Longitudinal studies are needed to better understand the role of gender literacy and activism with respect to mental health and development of identity and resilience among TGNB people.

Trans adolescents' perceptions and experiences of their parents' supportive and rejecting behaviors

Transgender (trans) adolescents consistently report higher rates of adverse mental health outcomes compared to their cisgender peers. Parental support is a recognized adolescent protective factor; however, little is known about the specific parental behaviors that trans adolescents perceive as most or least supportive. To address this gap, we analyzed data from qualitative interviews conducted with an ethnically diverse, urban-based sample of trans adolescents (N = 24; 16-20 years old) to describe (a) the spectrum of specific parental behaviors across 3 categories-rejecting, supportive, and mixed (i.e., simultaneous supportive and rejecting behaviors)-and (b) the perceived psychosocial consequences across these 3 categories of parental behaviors. Qualitative data were gathered through lifeline interviews (i.e., visual representations from birth to present) and photo elicitation (i.e., photographs representing parental support and/or rejection). Supportive behaviors included instances where parents made independent efforts to learn about trans issues or help their child obtain gender-affirming health care. Rejecting behaviors included instances when parents refused to use their child's name or pronouns or failed to show empathy when their child struggled with gender-identity-related challenges. Mixed behaviors included examples when parents expressed support of their child's gender identity, but not of their sexual orientation (or vice versa). Overall, participants reported that rejecting and mixed parental behaviors contributed to a range of psychosocial problems (e.g., depression and suicidal ideation), while supportive behaviors increased positive wellbeing. These findings expand upon descriptions of parental support and rejection within the trans adolescent literature and can help practitioners target specific behaviors for interventions. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Invalidation Experiences Among Non-Binary Adolescents

Mental health disparities among transgender adolescents are well documented and have generally been attributed to minority stress. However, significantly less is known about the minority stress experiences of non-binary adolescents or those who do not identify as exclusively male or female. This study qualitatively explored the unique ways that non-binary adolescents experience minority stress and how it influences their mental health and well-being. Lifeline methodology and photo elicitation were used to interview 14 ethnically diverse non-binary adolescents between the ages of 16 and 20, residing in New York City (NYC) and the San Franscicso Bay Area (SFBA). We present participants' experiences using a novel construct of invalidation, defined as the refusal to accept one's identity as real or true. Our findings indicate that invalidation is conceptually distinct from the established minority stressor of "non-affirmation." Non-binary adolescents experienced myriad forms of invalidation within multiple social contexts, which contributed to negative affective and cognitive processes, including confusion, self-doubt, rumination, and internalized shame. For many participants, the cumulative stressors related to invalidation contributed to poor mental health outcomes. Data from this study suggest that identity invalidation is a unique form of minority stress that may especially affect non-binary individuals, with significant implications for their social and emotional well-being.

Measuring a New Stress Domain: Validation of the Couple-Level Minority Stress Scale

Existing social stress frameworks largely conceive of stress as emanating from individual experience. Recent theory and research concerning minority stress have focused on same-sex couples' experiences of both eventful and chronic stressors associated with being in a stigmatized relationship, including having ongoing or episodic fears of discrimination, and experiencing actual acts of discrimination. Such couple-level minority stressors represent a novel domain of social stress affecting minority populations that is only beginning to become a focus in empirical investigations testing minority stress theory. This article presents the results of psychometric analyses of dyadic data from 106 same-sex couples from across the U.S., introducing the Couple-Level Minority Stress (CLMS) scale featuring eight new couple-level minority stress factors: (1) Couple-Level Stigma; (2) Couple-Level Discrimination; (3) Seeking Safety as a Couple; (4) Perceived Unequal Relationship Recognition; (5) Couple-Level Visibility; (6) Managing Stereotypes about Same-Sex Couples; (7) Lack of Integration with Families of Origin; and (8) Lack of Social Support for Couples. The CLMS demonstrated a clear factor structure with satisfactory model-data fit and subscale reliabilities. The CLMS also exhibited validity as a correlate of one indicator of relationship quality (relationship satisfaction) and three indicators of mental health (nonspecific psychological distress, depressive symptomatology, and problematic drinking) when controlling for individual-level minority stressors and has great potential to extend and enrich minority stress research, particularly studies that deepen understandings of longstanding health inequities based on sexual orientation.

PARENTHOOD AND MARRIAGE WITHIN SAME-SEX COUPLES: AN ANALYSIS USING SURVEY, TIMELINE, AND IN-DEPTH INTERVIEW DATA

In this study, the authors analyze data from Project SHARe, a mixed-methods study of same-sex couples in two cities, Atlanta and San Francisco. This study considers both past experiences of parenthood and marriage among same-sex couples, as well as what same-sex couples anticipate will occur regarding their own future experiences of parenthood and marriage, based on analysis of survey responses, timeline data, and in-depth interviews.

Masculinity and Minority Stress among Men in Same-sex Relationships

Although previous research has examined associations among masculinity, sexual orientation, minority stress, and mental health, these studies focused exclusively on individuals as units of analysis. This study investigates how men in same-sex relationships uniquely experience minority stress associated with their perceptions and performances of masculinity, as individuals and as couples. Qualitative, dyadic data are drawn from in-depth interviews with 24 male couples (48 partners), discussing two main stress themes-Threatened by Others' Gender Performances and Straight-acting Masculinity as Individual-level Insulation with Couple-level Challenges. Primary findings are (1) men in same-sex relationships are vulnerable to new forms of minority stress because their relationships increase visibility via others' masculinity, and (2) being in a same-sex relationship influences partners' self-perceptions of masculinity and their relationship dynamics. Findings improve insights regarding gender performance in minority stress processes affecting sexual minority men and their intimate relationships with one another. By virtue of their sexual minority and relationship statuses, men in same-sex relationships experience unique, masculinity-related stressors.

Differential Influence of Weight Status on Chronic Diseases by Reported Sexual Orientation Identity in Men

PURPOSE

This study examined whether the association between weight status and four chronic diseases (heart disease, hypertension, lifetime asthma, and type 2 diabetes) varied according to sexual orientation identity among adult men, controlling for demographic, socioeconomic, and other factors.

METHODS

Pooled data from male adult participants (n = 72,214) in the 2003-2012 California Health Interview Survey were used along with logistic regression models to estimate whether the associations between weight status and chronic diseases varied by sexual orientation identity.

RESULTS

Weight status was positively associated with each of the chronic diseases (hypertension, heart disease, asthma, and diabetes) among both gay and bisexual men and heterosexual men; however, the associations varied significantly by sexual orientation identity. Among gay and bisexual men, the associations were stronger and statistically significant-with the exception of lifetime asthma-particularly for men in the obese classifications, before and after controlling for age, marital status, race/ethnicity, education, income, health insurance status, food security level, smoking, and nativity.

CONCLUSIONS

Weight status had stronger detrimental associations with chronic disease among gay and bisexual men despite these men having greater socioeconomic advantage and lower body mass index than heterosexual men. Future research should examine mechanisms, including stress related to minority status, which may lead to greater risks for chronic diseases among sexual minority men.

Understanding how emerging same-sex couples make meaning of minority stress: A narrative approach

Minority stress-in the form of experiences of prejudice and discrimination-can have negative consequences on individuals in same-sex relationships. However, little is known about the ways in which members of same-sex couples make meaning of minority stress, especially in the context of newly formed relationships that may be most vulnerable to minority stressors. The present study draws upon emerging understandings of couple-level minority stress to investigate the ways in which newly formed same-sex couples make meaning of their minority stress experiences jointly as a couple. A narrative analysis was conducted using data from dyadic interviews with 40 same-sex couples who had been together for at least 6 months but less than 3 years. Analyses highlighted six distinct narrative strategies used by couples when making-meaning of their minority stress experiences: "minority stress made couples stronger," "minority stress contaminates positive experiences," "minority stress is not a big deal," "couples resign in the face of minority stress," "minority stress is worse than expected," and "couples hope minority stress experiences will get better." These findings not only provide valuable evidence for couple-level minority stress constructs, but crucially give a nuanced insight into how same-sex couples that are in the early stages of relationship development, make meaning of their minority stress experiences. Findings have important implications for the design and implementation of effective clinical and counseling interventions aimed at reducing negative outcomes among individuals in same-sex relationships, and the potential for relationship dissolution resulting from minority stress experiences. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Healthcare Experiences Among Young Adults Who Identify as Genderqueer or Nonbinary

PURPOSE

Research on healthcare among gender-diverse populations has largely focused on people who describe their gender in binary terms, either as trans men or trans women. This qualitative study examined the healthcare experiences of young adults who identify as genderqueer or nonbinary (GQ/NB).

METHODS

Participants (N = 10) were interviewed about experiences seeking and accessing healthcare. All were young adults (ages 23-33) in the San Francisco Bay area who had accessed healthcare at least once in the prior 6 months. A semistructured interview guide elicited conversations about gender identity and experiences of healthcare. Interview transcripts were analyzed using emergent coding analysis to identify themes.

RESULTS

Participants faced unique challenges even at clinics specializing in gender-affirming healthcare. They felt misunderstood by providers who approached them from a binary transgender perspective and consequently often did not receive care sensitive to nonbinary identities. In response to this perceived bias, participants sometimes "borrowed" a binary transgender label to receive care, modified the healthcare they were prescribed, or went without healthcare. The GQ/NB young adults in our study regularly felt disrespected and frustrated as they sought and accessed healthcare. Participants felt that the binary transgender narrative pressured them to conform to binary medical narratives throughout healthcare interactions.

CONCLUSIONS

GQ/NB young adults have unique healthcare needs but often do not feel understood by their providers. There is a need for existing healthcare systems to serve GQ/NB young adults more effectively.

Anticipatory Minority Stressors among Same-sex Couples: A Relationship Timeline Approach

The authors build on previous stress theories by drawing attention to the concept of anticipatory couple-level minority stressors (i.e., stressors expected to occur in the future that emanate from the stigmatization of certain relationship forms). A focus on anticipatory couple-level minority stressors brings with it the potential for important insight into vulnerabilities and resiliencies of people in same-sex relationships, the focus of this study. The authors use relationship timelines to examine stressors among a diverse sample of same-sex couples (n = 120). Respondents in same-sex relationships anticipated stressors that are likely not unique to same-sex couples (e.g., purchasing a home together) but labeled many of these anticipatory stressors as reflecting the stigmatization of their same-sex relationship. Respondents rated anticipatory minority stressors as more stressful than other anticipatory stressors. Moreover, stressors varied by gender, age, and relationship duration although not race/ethnicity or geographic site. This analysis is a preliminary step in examining how unique anticipatory couple-level minority stressors function as determinants of relationship quality, mental and physical health, and health disparities faced by sexual minority populations. Attempts to understand current stress levels should consider anticipatory stressors alongside past and current life events, chronic strains, daily hassles, and minority stressors, as these processes are impossible to disentangle and may be consequential for current well-being.

Legal Marriage, Unequal Recognition, and Mental Health among Same-Sex Couples

The authors examined whether the perception of unequal relationship recognition, a novel, couple-level minority stressor, has negative consequences for mental health among same-sex couples. Data came from a dyadic study of 100 (N = 200) same-sex couples in the U.S. Being in a legal marriage was associated with lower perceived unequal recognition and better mental health; being in a registered domestic partnership or civil union - not also legally married - was associated with greater perceived unequal recognition and worse mental health. Actor Partner Interdependence Models tested associations between legal relationship status, unequal relationship recognition, and mental health (nonspecific psychological distress, depressive symptomatology, and problematic drinking), net controls (age, gender, race/ethnicity, education, and income). Unequal recognition was consistently associated with worse mental health, independent of legal relationship status. Legal changes affecting relationship recognition should not be seen as simple remedies for addressing the mental health effects of institutionalized discrimination.

Couple-level Minority Stress: An Examination of Same-sex Couples' Unique Experiences

Social stress resulting from stigma, prejudice, and discrimination-"minority stress"-negatively impacts sexual minority individuals' health and relational well-being. The present study examined how being in a same-sex couple can result in exposure to unique minority stressors not accounted for at the individual level. Relationship timeline interviews were conducted with 120 same-sex couples equally distributed across two study sites (Atlanta and San Francisco), gender (male and female), and relationship duration (at least six months but less than three years, at least three years but less than seven years, and seven or more years). Directed content analyses identified 17 unique couple-level minority stressors experienced within nine distinct social contexts. Analyses also revealed experiences of dyadic minority stress processes (stress discrepancies and stress contagion). These findings can be useful in future efforts to better understand and address the cumulative impact of minority stress on relational well-being and individual health.

The Relationship Timeline: A Method for the Study of Shared Lived Experiences in Relational Contexts

Lifeline methods-graphic illustrations of the pathways of lived experience traveled by individuals from birth to anticipated death-have been useful in the study of lived experience. Existing lifeline methods and research focus on the individual experience; absent from this literature are the collective experiences of those in intimate relationships. In this paper, based on our research with 120 same-sex couples, we present a method to allow for the joint creation of relationship timelines, which serve as the basis for eliciting dyadic data in multiple forms: graphic representations of relationship development through couples' creation of a timeline of key events and periods; qualitative narratives of couples' shared experiences; and quantitative ratings of significant events and periods in their lives together. Lessons learned from the application of this Relationship Timeline Method are discussed, as are implications for future study of the shared lived experience.

Community-based service use by people with AIDS: the relevance of informal caregivers

This paper reports on community-based service use by persons with AIDS or disabling HIV (PWAs) who have an informal caregiver, with specific focus on four categories of service: nursing care; practical help; psychological services; and help with the management of personal affairs. Data are drawn from a large-scale community-based survey of caregivers in San Francisco and Los Angeles (n = 642). Caregivers report that PWAs make substantial use of community-based support: 85% use at least one service; half or more use psychological services (51%) and practical help (61%). Multivariate logistic regression models fit for each of the four categories of service use include bothPWA and caregiver characteristics as determinants, applying the widely recognized Andersen model. Our analytic models best fit nursing care and practical help outcomes and portray the complexity inherent in Andersen's framework. Correlates of service use vary by service type, illustrating the need to further study the fullest possible array of community-based services. Alongside traits of the PWA, caregiver characteristics are found to be important determinants of PWA service use, highlighting the relevance of informal caregiving to the larger system of AIDS care.

Health-Related Worry among Informal Aids Caregivers

We examine health-related worries among a sample of informal AIDS caregivers ( N = 640), people caring for a friend, loved one or kin outside the formal health care system. Two dimensions of worry are assessed: (1) a generalized sense of vulnerability to sickness; and (2) perceptions of care provision as risky in itself. Many informal AIDS caregivers, whether they are HIV seronegative or seropositive, harbor considerable worry about their own vulnerability to sickness, yet relatively few appear to worry about caregiving as a risky activity per se. We document important variation in the levels and correlates of worry across caregivers as they differ by serostatus and health. We also uncover variation in worry rooted in sociodemographic background and the differential experience of care-related stress. Prevailing theories of risk perception help to illustrate why informal caregivers might differ from other populations in their view of AIDS. Vignettes and quotes culled from marginal comments, which were systematically recorded by trained interviewers during implementation of the survey, supplement the quantitative data.

Met and Unmet Need for Medicaid Home- and Community-Based Services in the States

This study examined the met and unmet need for Medicaid personal care services (PCS) and home- and community-based service (HCBS) waivers across the states. Medicaid directors and state officials working with PCS and HCBS were interviewed by telephone in l998-1999 to collect descriptive and statistical data. A total of 26 states offered PCS to 467,487 participants in l998-1999, and 49 states offered waiver services to 561,510 participants in l997. In spite of wide variations in total HCBS participants per capita, 42 states reported inadequate waiver slots and waiting lists. Even in states with the highest participant rate per capita, state officials reported waiting lists for theHCBSwaiver programand many target groups that were not adequately covered by the current HCBS waivers. A number of barriers existed to expanding HCBS services, including an inadequate supply of home- and community-based providers, limited state legislative support for the programs, and federal regulatory barriers such as restrictions on need criteria.

Internalized gay ageism, mattering, and depressive symptoms among midlife and older gay-identified men

OBJECTIVE

In this paper we introduce the construct of "internalized gay ageism," or the sense that one feels denigrated or depreciated because of aging in the context of a gay male identity, which we identify as an unexplored aspect of sexual minority stress specific to midlife and older gay-identified men.

METHODS

Using a social stress process framework, we examine the association between internalized gay ageism and depressive symptoms, and whether one's sense of mattering mediates or moderates this association, controlling for three decades of depressive symptom histories. The sample is 312 gay-identified men (average age = 60.7 years, range = 48-78, 61% HIV-negative) participating in the Multicenter AIDS Cohort Study (MACS) since 1984/85, one of the largest and longest running studies of the natural history of HIV/AIDS in the U.S., who provided contemporary (2012/13) reports of stress experiences.

RESULTS

We find that internalized gay ageism can reliably be measured among these men, is positively associated with depressive symptoms net of an array of other factors that may also influence symptomatology (including depressive symptom histories), and mattering partially mediates but does not moderate its effect on depressive symptoms.

CONCLUSION

Midlife and older gay men have traversed unparalleled historical changes across their adult lives and have paved the way for younger generations of sexual minorities to live in a time of less institutionalized discrimination. Still, they are at distinct risk for feeling socially invisible and devalued in their later years.

Minority Stress and Stress Proliferation Among Same-Sex and Other Marginalized Couples

Drawing from 2 largely isolated approaches to the study of social stress-stress proliferation and minority stress-the authors theorize about stress and mental health among same-sex couples. With this integrated stress framework, they hypothesized that couple-level minority stressors may be experienced by individual partners and jointly by couples as a result of the stigmatized status of their same-sex relationship-a novel concept. They also consider dyadic minority stress processes, which result from the relational experience of individual-level minority stressors between partners. Because this framework includes stressors emanating from both status- (e.g., sexual minority) and role-based (e.g., partner) stress domains, it facilitates the study of stress proliferation linking minority stress (e.g., discrimination), more commonly experienced relational stress (e.g., conflict), and mental health. This framework can be applied to the study of stress and health among other marginalized couples, such as interracial/ethnic, interfaith, and age-discrepant couples.

Similar Others in Same-Sex Couples' Social Networks

Same-sex couples experience unique minority stressors. It is known that strong social networks facilitate access to psychosocial resources that help people reduce and manage stress. However, little is known about the social networks of same-sex couples, in particular their connections to other same-sex couples, which is important to understand given that the presence of similar others in social networks can ameliorate social stress for stigmatized populations. In this brief report, we present data from a diverse sample of 120 same-sex couples in Atlanta and San Francisco. The median number of other same-sex couples known was 12; couples where one partner was non-Hispanic White and the other a person of color knew relatively few other same-sex couples; and there was a high degree of homophily within the social networks of same-sex couples. These data establish a useful starting point for future investigations of couples' social networks, especially couples whose relationships are stigmatized or marginalized in some way. Better understandings of the size, composition, and functions of same-sex couples' social networks are critically needed.

Nonevent stress contributes to mental health disparities based on sexual orientation: evidence from a personal projects analysis

This study examined the role of nonevent stress--in the form of frustrated personal project pursuits in the arenas of relationships and work--as a contributing factor to mental health disparities between heterosexual and lesbian, gay, and bisexual (LGB) populations. A purposive sample of 431 LGB (55%) and heterosexually identified (45%) individuals living in the United States and Canada completed the Personal Project Inventory by describing and rating core personal projects they were pursuing. The intensity of perceived barriers to the achievement of relationship- and work-related personal projects served as indicators nonevent stress. Hierarchical linear regression models tested the hypothesis that nonevent stress contributes to the association between sexual orientation and two indicators of mental health: depressive symptoms and psychological well-being. LGB individuals had significantly more depressive symptoms and lower levels of psychological well-being than heterosexuals. Indicators of nonevent stress were significantly associated with mental health outcomes and their inclusion in models attenuated sexual orientation differences in mental health. The critical indirect pathway leading from sexual minority status to mental health occurred via barriers to relationship projects from interpersonal sources. This research suggests that nonevent stress because of structural and interpersonal stigma may contribute to mental health disparities between LGB and heterosexual individuals. The findings have important implications for policy reform around same-sex relationship recognition and workplace discrimination. Future research and clinical work will benefit by expanding existing foci on stress to include nonevent stressors to better understand and address mental health problems, particularly in LGB populations.

Stress and mental health among midlife and older gay-identified men

OBJECTIVES

We investigated associations between stress and mental health (positive affect, depressive symptoms) among HIV-negative and HIV-positive midlife and older gay-identified men, along with the mediating and moderating effects of mastery and emotional support. We also studied the mental health effects of same-sex marriage.

METHODS

We obtained data from self-administered questionnaires completed in 2009 or 2010 by a subsample (n = 202; average age = 56.91 years; age range = 44-75 years) of participants in the University of California, Los Angeles component of the Multicenter AIDS Cohort Study, one of the largest and longest-running natural-history studies of HIV/AIDS in the United States.

RESULTS

Both sexual minority stress (perceived gay-related stigma, excessive HIV bereavements) and aging-related stress (independence and fiscal concerns) appeared to have been detrimental to mental health. Sense of mastery partially mediated these associations. Being legally married was significantly protective net of all covariates, including having a domestic partner but not being married. Education, HIV status, and race/ethnicity had no significant effects.

CONCLUSIONS

Sexual minority and aging-related stress significantly affected the emotional lives of these men. Personal sense of mastery may help to sustain them as they age. We observed specific mental health benefits of same-sex legal marriage.

Nanoparticle inhalation impairs coronary microvascular reactivity via a local reactive oxygen species-dependent mechanism

We have shown that nanoparticle inhalation impairs endothelium-dependent vasodilation in coronary arterioles. It is unknown whether local reactive oxygen species (ROS) contribute to this effect. Rats were exposed to TiO(2) nanoparticles via inhalation to produce a pulmonary deposition of 10 microg. Coronary arterioles were isolated from the left anterior descending artery distribution, and responses to acetylcholine, arachidonic acid, and U46619 were assessed. Contributions of nitric oxide synthase and prostaglandin were assessed via competitive inhibition with N(G)-Monomethyl-L-Arginine (L-NMMA) and indomethacin. Microvascular wall ROS were quantified via dihydroethidium (DHE) fluorescence. Coronary arterioles from rats exposed to nano-TiO(2) exhibited an attenuated vasodilator response to ACh, and this coincided with a 45% increase in DHE fluorescence. Coincubation with 2,2,6,6-tetramethylpiperidine-N-oxyl and catalase ameliorated impairments in ACh-induced vasodilation from nanoparticle exposed rats. Incubation with either L-NMMA or indomethacin significantly attenuated ACh-induced vasodilation in sham-control rats, but had no effect in rats exposed to nano-TiO(2). Arachidonic acid induced vasoconstriction in coronary arterioles from rats exposed to nano-TiO(2), but dilated arterioles from sham-control rats. These results suggest that nanoparticle exposure significantly impairs endothelium-dependent vasoreactivity in coronary arterioles, and this may be due in large part to increases in microvascular ROS. Furthermore, altered prostanoid formation may also contribute to this dysfunction. Such disturbances in coronary microvascular function may contribute to the cardiac events associated with exposure to particles in this size range.

Nanoparticle inhalation impairs endothelium-dependent vasodilation in subepicardial arterioles

Exposure to fine particulate matter (PM, mean aerodynamic diameter <or=2.5 microm) has been shown to be a risk factor for cardiovascular disease mortality and may contribute to acute coronary events such as myocardial infarction (MI). There is sufficient reason to believe that smaller particles, such as nanoparticles, might be even more detrimental than larger sized particles due to their increased surface area and higher pulmonary deposition. Our laboratory showed that nanoparticle inhalation impairs endothelium-dependent arteriolar vasodilation in skeletal muscle. However, it is not known whether coronary microvascular endothelial function is affected in a similar manner. Rats were exposed to filtered air (control) or TiO(2) nanoparticles (primary particle diameter, approximately 21 nm) via inhalation at concentrations that produced measured depositions (10 microg) relevant to ambient air pollution. Subepicardial arterioles ( approximately 150 mum in diameter) were isolated and responses to transmural pressure, flow-induced dilation (FID), acetylcholine (ACh), the Ca(2+) ionophore A23187, and sodium nitroprusside (SNP) were assessed. Myogenic responsiveness was preserved between groups. In addition, there was no difference in the vasodilation to SNP, signifying that smooth muscle sensitivity to nitric oxide (NO) is unaffected by nano-TiO(2) exposure. However, inhalation of nano-TiO(2) produced an increase in spontaneous tone in coronary arterioles and also impaired endothelium-dependent FID. In addition, ACh-induced and A23187-induced vasodilation was also blunted in arterioles after inhalation of nano-TiO(2). Data showed that nanoparticle exposure significantly impairs endothelium-dependent vasodilation in subepicardial arterioles. Such disturbances in coronary microvascular function are consistent with the cardiac events associated with particle pollution exposure.

Stress buffering effects of family support in AIDS caregiving

This study examines the effects of family support on AIDS caregiver stress over time, comparing HIV-positive and HIV-negative gay-identified men who care for a friend or partner living with HIV (PLWH). Support from the care-recipient's family of origin is assessed, and the stress buffering effects of this type of support are explored longitudinally within a stress proliferation framework for 276 men (114 were HIV-positive, 162 were HIV-negative). Among HIV-positive caregivers, emotional distress is associated with high caregiving stress and low PLWH family support. Emotional distress among HIV-negative caregivers is also associated with caregiving stress, but is not significantly influenced by support from the PLWH's family. For both groups, increasing emotional distress over a seven-month period is a function of increasing caregiver stress, but not PLWH family support. The effects of financial worry and role overload on caregiver emotional distress are conditional upon PLWH family support at Time 1 among HIV-positive caregivers, such that support buffers the distressing impact of financial worry, but may exacerbate the distressing impact of role overload. In addition to characterizing processes of stress proliferation and social support, this research also illustrates how families of choice and families of origin simultaneously shape the experience of the caregiving role and its influence on the wellbeing of gay men.

Urban U.S. hospitals and the mission to provide HIV-related services: changes and correlates

In 1988, the vast majority of urban U.S. hospitals (84 percent) exhibited some formal response to the demand for HIV-related services. Despite the fact that HIV-related care is now normative in many respects and the demand for inpatient care has decreased, nearly half of hospitals surveyed in 1997 (42 percent) report no formalized service provision, suggesting a heightened distinction between hospitals in terms of their varying commitments to providing HIV-related services. Certain organizational variables (such as ownership, size, system affiliation, and stigmatized services and post-acute care services indices) were connected to HIV-related services provision. When the sample was controlled for other variables, the study found that changes in teaching status, changes in bed size, and changes in post-acute services from 1988 to 1997 did influence the provision of HIV-related services. Despite significant changes over the study period in the treatment of persons living with HIV/AIDS, and structural changes in the delivery of U.S. healthcare, the organizational-level predictors of HIV-related service provision have remained remarkably stable among U.S. hospitals in urban settings. These data also suggest that organizational missions consistent with serving indigent and socially marginalized populations continue to influence the ways that the pluralistic U.S. hospital system organizes HIV-related care.

State long-term care screening and assessment programs

Long-term care screening and assessment programs were designed by states to control long-term care costs and to prevent unnecessary institutionalization of Medicaid participants. This study reports data collected by telephone survey of state officials in all 50 states and Washington, D.C. on state variation in LTC screening and assessment programs. The majority of the state screening and assessment programs cover an array of LTC services but this has resulted in multiple separate screening programs for different long-term care services and eligibility groups. Only three states coordinated screening and assessment across long-term care programs by operating a single state administrative agency, using uniform need criteria and standard tools, and having automated databases (Arizona, Colorado, and Maine). The design and implementation of multiple and separate screening and assessment programs in most states may create potential barriers to client access, information about services and choice of services.

State Medicaid programs offering personal care services

Two Medicaid programs offer personal care services: (1) the Title XIX Personal Care Services (PCS) optional State plan benefit; and (2) the 1915(c) home and community-based services (HCBS) waivers. By 1998-1999, 26 States offered the PCS optional State plan benefit; 45 offered personal care services via a waiver(s). Nationwide, the former program was larger. The latter was the more popular administrative mechanism, possibly because it more reliably controls growth. States vary dramatically in terms of Medicaid personal care. Medicaid personal care participants per 1,000 State population ranged from 7.33 to 0.04. Per capita expenditures ranged from $91.21 to $0.02.

Medicaid 1915(c) home and community-based services waivers across the states

This article provides State-level data on the Medicaid 1915(c) home and community-based services (HCBS) waivers program. Medicaid 1915(c) waiver participants were 32 percent of the Medicaid participants in institutional care in 1997. These data document wide interstate variation in organizational oversight and program policies for the waivers. Many structural barriers to HCBS waiver growth existed. Case management services, in some form, were normative for most HCBS waiver participants, but formal mechanisms to assess client satisfaction and service quality were less common. Substantial new growth in this program may require fundamental changes in HCBS waiver policies.

A nuclear encoded and mitochondrial imported dicistronic tRNA precursor in Trypanosoma brucei

The mitochondrial tRNAs of Trypanosoma brucei are nuclear encoded and imported into the mitochondrion. A heterogeneous population of RNAs having characteristics of precursor tRNAs have previously been identified within the mitochondrion of T. brucei, suggesting that import occurs via a precursor molecule. In order to identify nuclear genes encoding tRNAs targeted to the mitochondrion, individual mitochondrial tRNAs were separated using two-dimensional gel electrophoresis and enzymatically sequenced. A 1.1-kilobase pair genomic DNA fragment was cloned containing three tRNA genes, tRNA(1)(Ser), tRNA(Leu), and tRNA(2)(Ser). Dicistronic precursors containing the tRNA(1)(Ser) and tRNA(Leu) transcripts with a 59-nucleotide intergenic sequence were identified by reverse transcriptase and polymerase chain reactions and the 5' end of the precursors determined. The dicistronic precursor tRNA is present both in the cytosol and the mitochondrion supporting a model for tRNA import involving precursor tRNA transcripts.

The integration of informal care, case management and community-based services for persons with HIV/AIDS

This research examines the integration of informal and formal care for persons with HIV/AIDS. Data come from a panel survey of informal HIV/AIDS caregivers (N = 642) and are analyzed using a modified version of the Behavioral Model that allows for inclusion of predisposing, enabling and need characteristics of persons with HIV/AIDS and their caregivers. The outcome component of our model emphasizes the role of case management as an intermediary service designed to facilitate linkage to other services. Results indicate: substantial use of case management and other services among persons receiving informal care; characteristics of care recipients, caregivers and dyads directly influence case management and service use; case management positively influences service use at baseline and change in service use over time; and the association between case management and service use generates indirect influences on service use related to characteristics of care recipients, caregivers and dyads. These results highlight the importance of case management as a mechanism for integrating informal and formal care and demonstrate that service utilization is influenced by the social context of illness.

AIDS caregiving and health among midlife and older women

This study reports on analyses of survey data from 121 midlife and older women engaged in AIDS caregiving in Los Angeles and San Francisco. These data revealed that these women provided substantial support to persons living with HIV or AIDS (PWAs) despite other role commitments associated with family and work. Although the characteristics of these women differed according to their relationship to the PWA (mother, wife, sister, or friend), they tended to be similar with regard to both the amount of care provided and its impact on their health. The results indicated that the severity of the PWA's illness and the duration of caregiving were more consequential to health than were the hands-on tasks of caregiving.

The forms and mechanisms of stress proliferation: the case of AIDS caregivers

Processes of stress proliferation are explored in a sample of informal caregivers to people with AIDS. Proliferation refers to the tendency for stressors to beget stressors. Two forms of proliferation are explored, each based on the distinction between primary and secondary stressors. Among AIDS caregivers, primary stressors are the hardships rooted in the caregiving role. Secondary stressors result from primary stressors, but arise in roles and activities outside of caregiving. One form of proliferation is the expansion of primary stressors, reflected in an increase in role overload and a growing sense of being a captive of the caregiver role. Expansion is largely driven by the course of AIDS and the elevation of demands it places on the caregiver. The second form of proliferation is the surfacing of secondary stressors in social and leisure life and in the occupational realm. This form arises from the strains imposed by the emerging caregiver role on the other roles and activities of the caregiver. It is proposed that the systematic assessment of proliferated stressors can help illuminate the dynamic connections between stress and health.

Support service use by persons with AIDS and their caregivers

The purpose of this study was to identify factors related to the use and non-use of emotional and practical support services by persons with AIDS (PWAs) and their informal caregivers. Unmet need for PWA support services and perceived barriers to the use of these types of services were also identified. Structured interviews were conducted with 472 self-selected informal AIDS caregivers in greater Los Angeles and the San Francisco Bay area. Data from a cross-sectional survey interview were analysed using logistic regression models fit for three categories of service use. Use of support services was substantial in this sample. Case management, caregiver HIV status, education, co-residence, and type of interpersonal relationship were important predictors of service use. Unmet need for PWA services was also substantial. The PWA's unwillingness to use services and lack of access were identified as key barriers to service use. Even in the presence of an informal caregiver, PWAs require considerable supplemental assistance from institutional sources. The presence of informal assistance to PWAs does not eliminate the need for institutional support. Moreover, caregivers themselves demonstrate considerable need for support.

Adoption of HIV-related services among urban US hospitals: 1988 and 1991

Recent reports document that US hospitals vary considerably, notably by ownership, in the number of acquired immunodeficiency syndrome (AIDS) patients they treat. Still, little is known about other types of hospital response to human immunodeficiency virus (HIV) and AIDS and the relative strength of ownership as a determining factor. With annual survey data from the American Hospital Association the authors examine the formal adoption of HIV-related services among urban US hospitals at the turn of the decade. Descriptive analyses of 2 years of data (1988 and 1991) are presented. A multivariate logistic regression analysis, conducted on the 1991 data, tests for unique ownership effects on the likelihood that hospitals are heavy investors in HIV-related care. Patterns of service adoption for 1991 strongly resemble those for 1988. Nearly three fourths of urban US hospitals offer general inpatient AIDS care, and over half provide HIV testing. Few urban hospitals offer outpatient services; even fewer operate AIDS units. A substantial minority report no formal adoption of HIV-related services. For-profit hospitals stand out as least likely to formally adopt these HIV-related services. Those adopting a comprehensive set of HIV-related services typically are public or secular, not-for-profit in ownership, large, affiliated with a medical school, and high volume users of Medicaid funding. The logistic regression analysis suggests that public ownership is a key determinant of greater service investment, even after controlling for other explanatory factors. This study appears to mirror a familiar pattern of hospital response to undercompensated care in the United States.

Examining HIV-related knowledge among adults in the U.S

Supplemental AIDS data from the 1987 National Health Interview Survey indicate that adults in the U.S. know the most frequent modes of HIV transmission, but lack a more comprehensive understanding of HIV and AIDS. Elements from a diffusion model were isolated to create a path-analytic framework for examining the effects of population or recipient characteristics and information sources or communication channels on HIV-related knowledge with these data. This multivariate analysis suggests that persons of lower socioeconomic status, older adults, those from racial/ethnic minority groups, those living outside of metropolitan areas, men, and those citing mass media (television or newspapers) as their primary source of information about HIV and AIDS have slightly lower levels of HIV-related knowledge. Decomposition of the effects in the path analysis suggests that use of information sources or channels, as measured by survey data, accounts for little of the observed variation in HIV-related knowledge. The implications of these results for future research and HIV-related education are discussed.

Generation of a restriction fragment length polymorphism linkage map for Toxoplasma gondii

We have constructed a genetic linkage map for the parasitic protozoan, Toxoplasma gondii, using randomly selected low copy number DNA markers that define restriction fragment length polymorphisms (RFLPs). The inheritance patterns of 64 RFLP markers and two phenotypic markers were analyzed among 19 recombinant haploid progeny selected from two parallel genetic crosses between PLK and CEP strains. In these first successful interstrain crosses, these RFLP markers segregated into 11 distinct genetic linkage groups that showed close correlation with physical linkage groups previously defined by molecular karyotype. Separate linkage maps, constructed for each of the 11 chromosomes, indicated recombination frequencies range from approximately 100 to 300 kb per centimorgan. Preliminary linkage assignments were made for the loci regulating sinefungin resistance (snf-1) on chromosome IX and adenine arabinoside (ara-1) on chromosome V by linkage to RFLP markers. Despite random segregation of separate chromosomes, the majority of chromosomes failed to demonstrate internal recombination events and in 3/19 recombinant progeny no intramolecular recombination events were detected. The relatively low rate of intrachromosomal recombination predicts that tight linkage for unknown genes can be established with a relatively small set of markers. This genetic linkage map should prove useful in mapping genes that regulate drug resistance and other biological phenotypes in this important opportunistic pathogen.

Identification of nuclear encoded precursor tRNAs within the mitochondrion of Trypanosoma brucei

RNAs that function in mitochondria are typically encoded by the mitochondrial DNA. However, the mitochondrial tRNAs of Trypanosoma brucei are encoded by the nuclear DNA and therefore must be imported into the mitochondrion. It is becoming evident that RNA import into mitochondria is phylogenetically widespread and is essential for cellular processes, but virtually nothing is known about the mechanism of RNA import. We have identified and characterized mitochondrial precursor tRNAs in T. brucei. The identification of mitochondrially located precursor tRNAs clearly indicates that mitochondrial tRNAs are imported as precursors. The mitochondrial precursor tRNAs hybridize to cloned nuclear tRNA genes, label with [alpha-32P]CTP using yeast tRNA nucleotidyltransferase and in isolated mitochondria via an endogenous nucleotidyltransferase-like activity, and are processed to mature tRNAs by Escherichia coli and yeast mitochondrial RNase P. We show that T. brucei mitochondrial extract contains an RNase P activity capable of processing a prokaryotic tRNA precursor as well as the T. brucei tRNA precursors. Precursors for tRNA(Asn) and tRNA(Leu) were detected on Northern blots of mitochondrial RNA, and the 5' ends of these RNAs were characterized by primer extension analysis. The structure of the precursor tRNAs and the significance of nuclear encoded precursor tRNAs within the mitochondrion are discussed.