Young sexual minority men (SMM) experience higher rates of intimate partner violence (IPV) compared to their heterosexual counterparts, and these experiences were associated with adverse health and mental health outcomes including HIV, substance use, and psychological distress. However, little is known about the association between IPV victimization and HIV prevention services such as pre-exposure prophylaxis (PrEP). This dissertation aimed to describe the prevalence of IPV victimization, perpetration, and bi-directional violence among a sample of cisgender young SMM who use substances. It examined the associations between different types of IPV victimization and PrEP utilization, explores the mediating effects of PrEP stigma and alcohol, tobacco, and other drug use on the relationship between IPV and PrEP utilization, and built and verified a machine learning model to predict self-reported IPV victimization using social media and mobile phone use data. The study found alarmingly high rates of IPV victimization, perpetration, and bi-directional violence among a sample of cisgender young SMM recruited from 2021 to 2023, particularly emotional IPV. The results indicated that experiencing emotional, monitoring, and controlling IPV victimization were associated with suboptimal PrEP utilization, such as lower likelihood of using PrEP for HIV prevention and suboptimal PrEP adherence. Additionally, the study found that PrEP stigma and nicotine use mediate the relationship between IPV victimization and PrEP use and adherence. Finally, social media data and mobile phone use activities can be used to predict self-reported IPV victimization through machine learning techniques when adequate data is available. These findings highlight the elevated vulnerabilities of cisgender young SMM to IPV and underscore the need to promote IPV screening and services across different settings. Future research is necessary to understand the longitudinal impact of IPV experiences on PrEP utilization and to explore the underlying mechanisms. There is potential to utilize machine learning, social media data, and mobile phone activities to identify young SMM who experience or are at risk of IPV, indicating opportunities for integrated eHealth and technology-based IPV services and interventions.

We know little about how transgender adolescents and their parents perceive and experience transgender adolescents’ gender identity development, minority stress, and the parent-adolescent stress (hereafter referred to as dyadic stress), and parent support factors related to adolescent gender affirmation processes and mental health. Transgender adolescents face minority stressors related to social inequality, stigma, and inadequate social support as they navigate being transgender across multiple social environments.

This qualitative study used a Life History Calendar approach to conduct separate and simultaneous interviews with 20 transgender–parent dyads to explore dyadic perspectives of adolescent minority stress, parent support, and adolescent gender affirmation processes related to adolescent gender identity development. Adolescents were between the ages of 12 and 17 and had initiated puberty blockers and/or gender affirming hormones with the last 12 months.

Differences emerged related to minority stress, adolescent gender affirmation processes, adolescent mental health and parent support between adolescents who were known by parents to be transgender during childhood before puberty and adolescents who disclosed their gender to their parents after puberty. Minority stress contributed to adolescent gender affirmation processes, parent support, and adolescent mental health. While parents supported their child’s gender affirmation process, adolescent continued to experience high rates psychological distress and minority stress across salient social domains. At the same time, parents experienced their own stress related to perceived loss, disclosure decisions, and adolescent gender affirmation. Parent support and acceptance were critical to transgender adolescents’ gender identity development and gender affirmation processes both before and after adolescents disclosed that they were transgender to their parents.

Evidence from the present study contributes to existing knowledge by: (1) underscoring the importance of parent support for transgender adolescents; (2) building upon previous minority stress models to understand how minority stress and parent support potentially contribute to adolescent mental health and gender affirmation processes; and (3) identifying potentially important minority stress, parent support, and gender affirmation processes related to time between adolescent gender identity disclosure to parents and puberty.

The right to health care has been a central catalyst of transgender social movements. The social meanings of “transgender health care” have come under acute pressure in the recent period of increased institutional recognition, research funding, political backlash, and social inequality. This dissertation is comprised of three papers that examine how “transgender health care” is negotiated and mobilized for institutional and social change through an in-depth study that focused on transmasculine health in Los Angeles County, California. The research was conducted alongside a community-based participatory action research initiative led by a grassroots organization working to advance gender, racial, and economic justice.

This multiple-methods dissertation includes two papers that are guided by a constructivist grounded theory analysis and based in interviews with 26 transmasculine participants and a third paper that uses cross-sectional data from a community-designed survey of 300 transmasculine adults. The first paper builds on popular trans critiques of clinical healthcare to theorize compelling care as a social process through which decentralized acts of self-defense reflect and marshal collective action for building power in clinical medicine. The second paper situates the relational and community-building processes of transmasculine people as health care work outside clinical medicine, surfacing a distinctly racialized gendered care burden and elucidating community-generated frameworks for health and healing interventions. The third paper builds on community-organized mobilizations for transgender healthcare services as institution-building and healthcare resource redistribution using community survey data to model the strategy as structural health equity intervention with demonstrative health benefits. Taken together, the three papers intervene in the medical and political relegation of “transgender health care” to discreet forms of clinical medicine or specialization, recasting transgender health care as a social change phenomenon that is influencing healthcare institutions and reshaping the terms of health caring.

Purpose of review

Recent findings