Elissa L. Sarno

Purpose: The present study investigated associations of sexual orientation and/or gender identity-based medical mistrust and racial/ethnic-based medical mistrust, respectively, with unmet medical care need among lesbian, gay, bisexual, transgender, queer, and/or sexually or gender diverse (LGBTQ+) people of color (POC) assigned female at birth (AFAB). We also tested the interaction of the two types of medical mistrust on unmet medical care need. Methods: Participants were 266 LGBTQ+ POC AFAB. Participants completed measures of medical mistrust based on race/ethnicity and LGBTQ+ identity. Unmet medical care need was assessed using the item: “During the past 12 months, was there ever a time where you felt that you needed health care but you didn’t receive it?” Multivariate logistic regression models were run with either type of medical mistrust, as well as their interaction, as the predictor and unmet medical care need as the outcome variable. Results: There were no significant main effects of either type of medical mistrust on unmet medical care need. However, there was an interaction between the two types of medical mistrust, such that associations between each type of medical mistrust and unmet medical care needs were stronger at higher levels of the other type of medical mistrust. Racial/ethnic medical mistrust was associated with a greater likelihood of unmet medical needs at high, but not low, levels of LGBTQ+ medical mistrust. Conclusions: Racial/ethnic medical mistrust and LGBTQ+ medical mistrust exacerbate each other’s influence on unmet medical care need. These results underscore the need for inclusive clinical practices for LGBTQ+ POC.

This study evaluated the efficacy of the 2GETHER relationship education and HIV prevention program for young male couples in reducing the risk for HIV. We conducted a randomized controlled trial of 2GETHER relative to an attention-matched and highly active positive affect enhancement program for couples. We randomized 128 young male couples (N = 256) to 2GETHER or control from 2017 to 2021. Primary biomedical outcome (i.e., rectal chlamydia and gonorrhea) was measured at baseline and 12 months and self-reported condomless anal sex was measured every 3 months across 12-month follow-up. Secondary outcomes were other HIV prevention and risk behaviors, relationship functioning, and substance use. We used multilevel models in MPlus to account for clustering with dyads and within-person change over time. Effects of time (for self-reported outcomes) were modeled using latent growth curves at the between-couple level. We observed no differences between conditions in outcomes, but there was a significant change in outcomes across 12 months. Rates of rectal sexually transmitted infections and self-reported condomless anal sex decreased significantly in both conditions. We also observed significant increases in HIV testing, improvement in relationship communication, and reduction in alcohol-related problems in both conditions across 12 months. Couples in both the 2GETHER and positive affect enhancement programs showed improvement in biomedical and behavioral indicators of HIV risk, as well as improvement in relationship communication, but without a treatment effect we cannot conclude improvement resulted from the interventions. Couple-based programs that promote connectedness, including relationship education and positive affect enhancement, have a strong potential to reduce young couples' HIV risk. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Intimate partner violence (IPV) is alarmingly prevalent among sexual and gender minority youth assigned female at birth (SGM‐AFAB), making it important to identify risk factors that can be targeted in prevention efforts for this population. Although several relationship‐level risk factors for IPV have been identified in different‐sex couples, research on SGM‐AFAB is sparse and predominantly cross‐sectional. The present study used seven waves of data from a longitudinal cohort study of SGM‐AFAB youth (n = 463) to explore relationship factors (relationship quality, destructive conflict, and self‐ and partner‐jealousy) as risk factors for perpetration and victimization of three types of IPV (physical, psychological, and coercive control). At each wave, participants reported on relationship factors and IPV for up to three romantic partners in the past 6 months. Multilevel models tested for associations between the relationship factors and IPV at three levels: between‐persons, within‐persons across time (wave), and within‐persons across relationships. Relationship quality was associated with IPV mostly at the between‐persons and within‐persons (wave) levels. Couple conflict was associated with all IPV outcomes at all levels. Partner jealousy was more consistently associated with IPV victimization; participant jealousy was more consistently linked with IPV perpetration. These novel findings suggest that, within SGM individuals, IPV may be influenced by relationship quality, destructive conflict, and jealousy as they fluctuate within individuals from relationship to relationship and within individuals over time. As such, these relationship factors represent promising potential targets for interventions to reduce IPV among SGM‐AFAB youth.

Sexual and gender minorities assigned female at birth (SGM-AFAB) experience high rates of intimate partner violence (IPV). Using multiwave longitudinal data, the present study tested the following associations of minority stress and IPV among SGM-AFAB: concurrent within-person (i.e., whether changes in minority stress co-occur with changes in IPV), prospective within-person (i.e., whether changes in minority stressors precede changes in IPV), and between-persons (i.e., whether individuals who experience more minority stress, on average, experience more IPV). Data were from Waves 1-7 (spanning 3.5 years) of a longitudinal cohort study of 488 young SGM-AFAB. At each wave, participants reported on SGM victimization, sexual orientation microaggressions, internalized heterosexism, and five types of IPV for up to three partners in the past six months. Controlling for other minority stress experiences, microaggressions showed concurrent within-person associations with two types of IPV victimization (psychological and coercive control) and three types of IPV perpetration (psychological, physical, and sexual), and between-persons associations with psychological IPV victimization and coercive control victimization and perpetration. Microaggressions also had a significant prospective within-persons association with SGM-specific IPV perpetration. SGM victimization showed no unique within-person associations with IPV but, between-persons, was associated with all types of IPV victimization (except coercive control), and psychological and sexual IPV perpetration. Internalized heterosexism was not associated with any IPV outcome. Minority stress, particularly distal stressors, appear to contribute to risk for IPV among SGM-AFAB. Clinicians working with SGM-AFAB individuals in relationships may benefit from screening for experiences of minority stress.

Relationship interventions, including healthy relationship education, couple therapy, and dyadic approaches to treating mental and physical health issues, hold promise for promoting relationship and individual health among sexual and gender minority (SGM) populations. Because SGM couples live within a context of societal stigma against their minority identities and relationships, they are likely to be best served by targeted, culturally sensitive relationship interventions that are affirming, free of hetero‐ and cis‐normativity, and address the unique stigma‐based challenges that they face. Therefore, a key goal for the field today is to conduct research evaluating and refining newly developed relationship interventions designed specifically for SGM couples. In this paper, we offer recommendations for effectively recruiting and retaining large, diverse samples of SGM couples for clinical trials of tailored relationship interventions, grounded in guidelines for psychological practice and conducting research with SGM populations. Throughout, we offer examples and lessons learned from our experiences conducting clinical trials of tailored SGM relationship education programs. We encourage the use of recruitment and retention strategies that involve members of the target SGM community from the outset, are informed by knowledge about SGM individuals and relationships, use currently preferred language for individual identities and relationships, attend to issues of confidentiality regarding sexual/gender identity or relationship involvement, and adhere to the norms of the particular community and recruitment venue.

Purpose: This study investigated conflict between sexual orientation and racial/ethnic identities as a mechanism linking minority stress to HIV-related outcomes among men who have sex with men (MSM), transgender women and gender nonbinary (TGN) people of color (POC). Methods: We tested longitudinal mediation models with sexual orientation microaggressions, internalized heterosexism (IH), and sexual orientation concealment at Time 1, and pre-exposure prophylaxis (PrEP) use and number of condomless anal sex (CAS) partners at Time 3, mediated by identity conflict at Time 2. Participants were 337 MSM and TGN POC. Data were collected in Chicago, Illinois, from September 2018 to February 2021. Results: Indirect associations of IH and sexual orientation concealment, respectively, at Time 1 with CAS partners at Time 3 through identity conflict at Time 2 were significant. Mediation models with sexual orientation microaggressions as the predictor and PrEP use as the outcome were not significant. Conclusion: Minority stress may contribute to identity conflict and increase CAS by isolating MSM and TGN POC from sexual and gender minority communities, thus restricting access to safer sex resources, and by increasing psychological distress and decreasing self-care (e.g., condom use).

Background: Young men who have sex with men (YMSM) are disproportionately impacted by the HIV epidemic in the USA, and a large number of new infections among YMSM occur in the context of main or primary partnerships. At the same time, healthy romantic relationships promote health and wellbeing by improving social support and encouraging healthy behaviors. Thus, we created 2GETHER: a relationship education and HIV prevention program for young male couples. 2GETHER is delivered face-to-face in a university setting and is composed of two group sessions and two individualized skills coaching sessions. We observed strong support of the feasibility, acceptability, and preliminary efficacy of 2GETHER in a pilot trial. Methods: We are conducting an attention-matched randomized controlled trial (RCT) to test the efficacy of 2GETHER relative to a control condition based on a well-validated positive affect enhancement program. Enrollment occurred between August 2017 and March 2021 in Chicago and surrounding areas, and we enrolled and randomized 128 dyads (N = 256 individuals). Follow-up is ongoing and we will examine primary and secondary behavioral outcomes at 12 months post-intervention, with interim follow-up at 3, 6, and 9 months post-intervention. The primary biomedical outcome is sexually transmitted infection incidence at a 12-month follow-up. Discussion: 2GETHER is innovative in that it places an equal emphasis on relationship skill building and HIV prevention. Thus, the program has the potential to impact numerous health-related outcomes. Despite challenges related to the recruitment of couples and the COVID-19 pandemic, we were able to enroll a robust sample of young male couples with sufficient power to detect effects on study outcomes. Trial registration: ClinicalTrials.gov NCT03186534.

Sexual and gender minorities assigned female at birth (i.e., sexual minority women, transgender men, and gender diverse [SMW TGD] individuals) experience disproportionately high rates of anxiety, depression, and substance use problems. Romantic relationship involvement has been shown to be beneficial for mental health and substance use among sexual and gender minorities. However, few studies have explored the impact of relationship quality on mental health, or if high relationship quality can reduce the negative impact of minority stress on wellbeing in this population. The present study examined within-persons associations of romantic relationship quality with symptoms of anxiety and depression, and alcohol and cannabis use problems among SMW TGD individuals in romantic relationships, and tested relationship quality as a moderator of associations of minority stress with mental health and substance use. Participants were 213 SMW TGD individuals (mean age: 20.63; 70.9% cisgender women, 7.5% transgender men, 19.2% gender diverse). Within-persons, higher relationship quality was associated with better mental health and substance use outcomes. Relationship quality at the between-persons level moderated the within-persons association of internalized heterosexism with depression, and of microaggressions with cannabis use problems. No other interaction effects were significant. The within-persons associations found in this study lend important support to relationship interventions based on theories that improvements in romantic relationship quality will result in improved wellbeing over time. Results can inform relationship education interventions to reduce mental health and substance use disparities in SMW TGD communities.

The prevalence of anxiety and depressive (i.e., internalizing) disorders is higher among bi+ individuals (i.e., individuals with attractions to more than one gender and/or identify as bisexual or pansexual) compared to both heterosexual and lesbian/gay individuals. Cross-sectional research has demonstrated that stressors unique to bi+ individuals are associated with internalizing symptoms. However, longitudinal research examining these associations and underlying mechanisms is extremely limited. We utilized five waves of data (six months between waves) from a diverse sample of bi+ individuals assigned female at birth (age 16–32; 29% gender minority; 72.9% racial/ethnic minority) to examine: (1) prospective associations between 3 bi+ stressors (enacted, internalized, anticipated bi+ stigma) and internalizing symptoms; (2) potential mediating role of rumination in these associations; and (3) potential mediating roles of internalized and anticipated bi+ stigma in associations between enacted bi+ stigma and internalizing symptoms. At the within-person level, when participants experienced more bi+ stressors than usual during a particular wave, they experienced subsequent increases in internalizing symptoms. Increases in rumination mediated these associations. Associations between enacted bi+ stigma and internalizing symptoms were mediated by increases in internalized and anticipated bi+ stigma. Findings indicate that bi+ stressors prospectively predict increases in internalizing symptoms and rumination may play a mechanistic role. Further, findings suggest that internalized and anticipated bi+ stigma may play mechanistic roles in the associations between enacted bi+ stigma and internalizing symptoms. Interventions targeting rumination, internalized stigma, and anticipated bi+ stigma may help to reduce internalizing symptoms among bi+ individuals.