book :Read Chapter 10 in Multicultural Social Work Practice: A Competency-Based Approach to Diversity and Social Justice.
resourses TSER Trans students Educational Resourses
Chapter Systems Of Oppression: Gender And Sexual Orientation
Question 1
If you had a client whose gender and/or sexual orientation was unfamiliar to you, what questions would you ask the client to improve your understanding and help them feel supported? What other steps would you take to help raise your own awareness of the client’s identity and needs?

Question 2 
Explain one social justice issue that relates to gender/sexual orientation. Imagine you are a social worker with personal biases regarding gender identity and sexual orientation. How can you reconcile personal beliefs about gender identity and sexual orientation with the ethical obligations of diverse social work practice?

Question 3
With Introduction and Conclusion
Social Work students need to understand how policies contribute to the oppression of gender and sexual orientation and how they impact the individual or population. This assignment will help you learn these concepts.
Access and view the “LGBTQ History in Government Documents: Timeline of Documents” timeline and find an era on the timeline that interests you.
In an essay, address the following:
Describe the selected era/point on the timeline.
Cite and briefly explain the article/document(s) the timeline attached to the era/point you selected.
Reflect on that era and then relate it to your selected social issue. How does your selected social issue relate?
What are the similarities regarding the systemic oppression and social policies? Refer to Social Work Disposition #7: Standard: Social Workers’ Ethical Responsibilities to Clients when responding to this prompt.
Gender Minority Stress, Mental Health, and Relationship Quality: A Dyadic Investigation of Transgender Women and Their Cisgender Male Partners Kristi E. Gamarel Graduate Center of the City University of
New York Sari L. Reisner Harvard School of Public Health and the Fenway Institute, Fenway Health, Boston, Massachusetts Jean-Philippe Laurenceau University of Delaware Tooru Nemoto Public Health
Institute, Oakland, California Don Operario Brown University Research has demonstrated associations
between experiences of discrimination, relationship quality, and mental health. However, critical questions remain unanswered with regard to how stigma enacted and experienced at the dyadic-level
influences relationship quality and mental health for transgender women and their cisgender (nontransgender) male partners. The present study sought to examine how experiences of transgenderrelated discrimination (i.e., unfair treatment, harassment) and relationship stigma (i.e., the real or anticipated fear of rejection based on one’s romantic affiliation) were associated with both partners
relationship quality and mental health. Couples (n 191) were recruited to participate in cross-sectional survey. Dyadic analyses using actor–partner interdependence models were conducted to examine the
influence of minority stressors on clinically significant depressive distress and relationship quality. For both partners, financial hardship, discrimination, and relationship stigma were associated with an
increased odds of depressive distress. For both partners, financial hardship was associated with lower relationship quality. Among transgender women, their own and their partner’s higher relationship
stigma scores were associated with lower relationship quality; however, among male partners, only their partner’s greater relationship stigma scores were associated with lower relationship quality. Findings
provide preliminary support for dyadic crossover effects of relationship stigma on the health of partners.
Findings illustrate the importance of minority stress and dyadic stress frameworks in understanding and intervening upon mental health disparities among transgender women and their male partners. Couplesbased interventions and treatment approaches to help transgender women and their male partners cope with minority stressors are warranted to improve the health and well-being of both partners.
Keywords: couples, mental health, relationship quality, relationship stigma, transgender In the United States, transgender women (i.e., individuals assigned a male sex at birth who identify as female, male-tofemale, transgender women) are a group at elevated risk of adverse health outcomes (Institute of Medicine, 2011). Studies have reported high prevalence of depressive symptoms, discrimination, and
financial hardship in samples of transgender women (Balsam, Molina, Beadnell, Simoni, & Walters, 2011; Barrientos, Silva, Catalan, Gomez, & Longueira, 2010; Clements-Nolle, Marx, Guzman, & Katz, 2001;
Clements-Nolle, Marx, & Katz, 2006). In addition, these psychosocial factors are associated with unprotected sexual intercourse among transgender women, which place them at risk for HIV and other
sexually transmitted infections (STIs; Brennan et al., 2012; Herbst et al., 2008; Hotton, Garofalo, Kuhns, & Johnson, 2013; Nemoto, Operario, Keatley, Han, & Soma, 2004). Studies have suggested that HIV-related sexual risk behaviors among transgender women occur frequently within the context of an intimate
sexual relationship with a cisgender (i.e., nontransgender) male partner (Bockting, Robinson, & Rosser, 1998; Nemoto, Operario, Keatley, & Villegas, 2004). Cisgender refers to having a current gender identity
that is concordant with assigned sex at birth (i.e., nontransgender). Consequently, there has been a call for a greater prioritization of research to understand and address the social, relational, and psychological
factors contributing to HIV and other behavioral health risks among transgender people This article was published Online First June 16, 2014. Kristi E. Gamarel, Department of Psychology, Graduate Center of the City University of New York; Sari L. Reisner, Department of Epidemiology, Harvard School of Public Health and the Fenway Institute, Fenway Health, Boston, Massachusetts; Jean-Philippe Laurenceau,
Department of Psychology, University of Delaware; Tooru Nemoto, Public Health Institute, Oakland, California; Don Operario, Brown University School of Public Health. This project was funded by grants
R01DA018621 and R34MH093232 from the National Institutes of Health. We gratefully thank the couples who participated in the study; staff members; and colleagues Mariko Iwamoto, Lynae Darbes,
and Colleen Hoff for their valuable feedback on this project. Correspondence concerning this article should be addressed to Kristi E. Gamarel, Department of Psychology, Graduate Center of the City
University of New York, 365 5th Avenue, New York, NY 10016. E-mail: kgamarel@hunter.cuny.edu This document is copyrighted by the American Psychological Association or one of its allied publishers. This
article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Journal of Family Psychology © 2014 American Psychological Association 2014, Vol. 28, No. 4,
437– 447 0893-3200/14/$12.00 http://dx.doi.org/10.1037/a0037171 437 (Institute of Medicine, 2011;
Task Force on Gender Identity & Gender Variance, 2009). For several decades, family and relationship scholars have sought to understand the associations between chronic stressors, romantic intimate
partners, and health outcomes (Revenson & DeLongis, 2011). Bodenmann (2005) and Story and Bradbury (2004) have defined external stressors as those which originate outside of the relationship.
These can include stressors at the workplace, experiencing financial hardship, and sociocultural environmental contexts (Revenson, Kayser, & Bodenmann, 2005). Exposure to these external stressors,
as well as partners’ reactions to them, can cause internal stress within the relationship and lead to conflicts and poor relationship outcomes (Bodenmann et al., 2007; Karney, Story, & Bradbury, 2005). The
term dyadic stress has been used to conceptualize the stress that both partners in an intimate relationship experience when faced with a stressor or when there is a ‘cross-over’ of stress from one
partner to the other (Bolger, DeLongis, Kessler, & Wethington, 1989; Randall & Bodenmann, 2009). This concept is consistent with Kelley and Thibaut’s (1959) interdependence model, which suggests that
stressors experienced by one member of a dyadic partnership might also negatively impact the other member. Consistent negative correlations between external stressors, such as work and financial stress,
and relationship satisfaction have been reported among couples (Bahr, 1979; Bolger et al., 1989; Schulz et al., 2004; Story & Repetti, 2006; Bodenmann et al., 2007), indicating that experiences of external
stress are associated with lower levels of relationship satisfaction. Enacted stigma and discrimination represent important external stressors that may have deleterious effect on couples’ relationship quality
and health outcomes. Stigma has been shown to negatively influence relationship quality and mental health indicators among sexual minority couples (Frost & Meyer, 2009; Goldberg & Smith, 2011; Mohr &
Fassinger, 2006; Otis, Rostosky, Riggle, & Hamrin, 2006). Understanding how external stressors, such as stigma and discrimination, can hinder the well-being of transgender women and their male partners is important in light of the general health and psychosocial vulnerabilities in these communities (Task Force
on Gender Identity & Gender Variance, 2009) and because relationship quality has been predictive of health outcomes (KiecoltGlaser et al., 2005; Robles & Kiecolt-Glaser, 2003; KiecoltGlaser, Bane, Glaser, &
Malarkey, 2003). Minority Stress and Transgender Women Discriminatory and prejudicial attitudes toward transgender individuals continue to be pervasive in many societies (Walch, Ngamake, Francisco,
Stitt, & Shingler, 2012). Because of their gender identity or gender expression, transgender people experience high levels of gender-based stressors and violence, including family rejection and hate crimes
(Bazargan & Galvan, 2012; Bradford, Reisner, Honnold, & Xavier, 2013; Clements-Nolle et al., 2006;
Koken, Bimbi, & Parsons, 2009; Lombardi, 2009; Lombardi, Wilchins, Priesing, & Malouf, 2002; Nuttbrock
et al., 2010). Additionally, research has documented high prevalence of employment discrimination, which leads to economic marginalization and financial hardship among transgender women (Bradford et
al., 2013; Conron, Gunner, Stowell, & Landers, 2012; Lombardi et al., 2002). Scholars have proposed that the link between discrimination and health risk behaviors among transgender women may be consistent with Meyer’s (2003) minority stress model (Bockting, Miner, Swinburne Romine, Hamilton, & Coleman,
2013; Hendricks & Testa, 2012; Testa et al., 2012). According to this model, individuals who belong to socially devalued groups are vulnerable to chronic exposure in the form of discrimination and mistreatment, which in turn may lead to negative self-appraisals, concealment of one’s stigmatized
status, and expectations for future rejection (Hendricks & Testa, 2012; Meyer, 2003). Over time, minority
stressors can compromise psychological coping resources and lead to poor health outcomes, such as mental health distress. A body of research has found associations between discrimination, internalized
stigma, and depression among lesbian, gay, and bisexual (LGB) individuals (Gamarel, Reisner, Parsons, & Golub, 2012; Hatzenbuehler, Nolen-Hoeksema, & Erickson, 2008; Lehavot & Simoni, 2011; Newcomb &
Mustanski, 2010). With few exceptions (Bockting et al., 2013; Testa et al., 2012), studies have not examined these associations among transgender people. Minority Stress and Intimate Romantic Partners Intimate romantic relationships can have enhancing or compromising health effects for individuals across all populations, but they have been shown to be disproportionately challenging among socially disadvantaged individuals (Maisel & Karney, 2012). In light of the minority stressors they face as sexual and gender minority individuals, some LGBT individuals experience challenges to their relationship
quality and functioning (Otis et al., 2006; Peplau & Fingerhut, 2007). Sexual and gender minority people in romantic relationships may be ignored or rejected by parents, relatives, friends, and the larger society rather than validated, celebrated, and supported (Otis et al., 2006). As a result, romantic partners may internalize these messages about their identities and romantic affiliations. Existing studies have shown that the internalization of stigmatizing messages about LGB individuals negatively influences relationship
quality and mental health among lesbian and gay couples (Frost & Meyer, 2009; Goldberg & Smith, 2011; Mohr & Fassinger, 2006; Otis et al., 2006). The basic premise across these studies is that same-sex couples may experience added stressors on their relationship as a result of being a stigmatized minority (Rostosky, Riggle, Gray, & Hatton, 2007). Given these social and psychological dynamics, the minority
stress model has compelling implications for romantic relationships among sexual and gender minority individuals. To date, studies have only examined internalized stigma at the individuallevel, for example by
assessing exposure to and consequences of discrimination among sexual or gender minority individuals.
It becomes critical to understand how stigma is felt at the dyadiclevel when examining the impact of minority stressors on sexual minority couples in the context of an intimate, romantic relationship. In
addition, no research that we are aware of to date has examined gender minority couples—where at least one partner identifies as transgender—and the specific external stressors that partners may experience as a result of being in a relationship with a person who has a socially stigmatized identity. As
such, we propose that relationship stigma for gender minority couples manifests itself in the real or anticipated feelings of negative judgment or rejection from family members and others as a result of
one’s This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be
disseminated broadly. 438 GAMAREL, REISNER, LAURENCEAU, NEMOTO, AND OPERARIO romantic
relationship being socially devalued—for example, resulting from heteronormative and gendernormative models of relationships that pervade societies (Goldberg, 2013). Relationship stigma can therefore be defined as the internalization of negative messages about relational affiliation with socially
stigmatized individuals, including people of transgender experience. Within the minority stress framework, relationship stigma may be conceptualized as a proximal stressor that causes cognitive burden including, for example, self-consciousness, self-doubt, and a perceived need to conceal the
relationship, all of which may have a negative impact on both partners’ mental health and relationship quality (Frost & Meyer, 2009; Meyer, 2003). Within the dyadic stress framework, gender minority
stressors such as transgender-related discrimination, relationship stigma, and financial hardship experienced by one member of the dyad are hypothesized to have cross-over effects on the other
member. Dyadic stress theory highlights the need to focus on the impact of transgender-related discrimination, relationship stigma, and financial hardship from a dyadic context—that is, impacts on
both partners as a unit—rather than an individual context alone. The purpose of this study was to investigate the association between transgender-related discrimination, relationship stigma, and
financial hardship on the mental health and relationship quality of transgender women and their primary male partners. Consistent with previous research, we hypothesized that greater exposure to transgender-related discrimination, relationship stigma, and financial hardship would be associated with
elevated odds of depressive symptoms and lower relationship quality scores at the individual level (e.g., Meyer, 2003). In accordance with dyadic stress theories (Bodenmann, 2005; Randall & Bodenmann,
2009), we hypothesized that individual’s appraisals of minority stressors would also negatively influence their partners’ outcomes, such that one partner’s experiences of transgender-related discrimination, relationship stigma, and financial hardship would be associated with greater odds of depressive
symptoms and lower levels of relationship quality for their primary relationship partner. Method
Participants Participants were 191 couples comprising transgender women and their cisgender primary male partner. All cisgender male partners sampled were assigned a male sex at birth and identified
themselves as male. For parsimony, we refer to these participants as male. Transgender women and their male partners each individually completed cross-sectional questionnaires between November 2008
and November 2010 (Operario, Nemoto, Iwamoto, & Moore, 2011). The majority of the sample (79.1%) self-identified as a member of a racial/ethnic minority group (27.4% Black; 18.7% Latino; 12.6% Asian;
and 19.4% Mixed/Other). More than half of the sample reported financial hardship— earning less than $500 a month (61.3%). The average mean length of relationship was 37.9 months (SD 51.0) and average
age of all participants was 37.12 years (SD 11.25). Couples were recruited in the San Francisco Bay area in California using purposive sampling methods (Shadish, Cook, & Campbell, 2004) by identifying a range
of community spaces and venues where transgender women and male partners of transgender women congregate (e.g., community-based organizations, bars, and nightclubs) and posting flyers. Couples who
called the study were screened separately for eligibility criteria, and eligible participants were scheduled for an in-person interview at the research center or a conveniently located in a confidential space at a community-based organization. Both partners were required to attend the appointment together, but were consented and completed survey assessments separately. To be eligible, both partners must have reported each other as their primary intimate partner for at least 3 months, defined as a “partner to whom you feel committed above anyone else and with whom you have had a sexual relationship.” We included couples in which one partner in each couple identified as a transgender woman (i.e., assigned a
male sex at birth who identifies as female) and the other partner identified as a cisgender male. In addition, all participants were (a) at least 18 years old, (b) living or working in the San Francisco Bay area,
(c) English or Spanish speaking, and (d) able to provide informed consent. Procedures Surveys were administered to participants using audio computer-assisted self-interview technology. Survey items were
translated into Spanish, but Spanish version surveys were administered on paper; 5 monolingual Spanish participants completed the Spanish survey. Surveys took approximately 1 hour to complete and
participants received $50 reimbursement and a brochure with a list of local community organizations addressing transgender issues. Procedures were approved by the Institutional Review Boards at the
Public Health Institute, Oakland, University of California San Francisco, and University of Oxford, Oxford,
United Kingdom. Measures Sociodemographics. Participants self-reported their age, gender, race and
ethnicity, HIV serostatus (positive or negative/unknown), education level, and financial hardship.
Financial hardship was categorized as greater than or equal to $500 a month ($12,000 per year) versus
less than $500 a month ($12,000 per year). This coding was implemented to be at or greater than 100% of the federal poverty level in accordance with the poverty guidelines updated periodically in the Federal
Register by the U.S. Department of Health and Human Services (2009) under the authority of 42 U.S.C.9902. Participants also provided the duration of the primary relationship (in months). Depressive
symptoms. The 20-item Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977) was
administered to measure depressed mood in the past week. The CES-D consists of 20 items (i.e., could not get going). Participants responded on a 4-point scale ranging from 1 rarely or none of the time to 4
most or all of the time. Previous studies have demonstrated that the scale has good psychometric properties in LGBT samples (Operario et al., 2011; Wong, Schrager, Holloway, Meyer, & Kipke, 2014).
Internal consistency for composite scores on the CES-D were good within our sample (
.88). Participants were classified as experiencing clinically significant levels of depressive symptoms if their CES-D score was 16 or higher. This clinical cut off of 16 or above is widely accepted to indicate the
presence of clinically significant depressive symptoms (Berkman, This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the
personal use of the individual user and is not to be disseminated broadly. TRANSGENDER WOMEN AND THEIR CISGENDER MALE PARTNERS 439 Berkman, & Kasl, 1986; U.S. Department of Health & Human
Services, 2004). Relationship quality. A modified Dyadic Adjustment Scale (DAS) was used to assess overall relationship quality. The DAS measures the degree to which participants and their primary
partners tended to agree or disagree on topics such as “handling finances” and “major life decisions” (Spanier, 1976). Participants rated on a 6-point scale ranging from 0 Always disagree to 5 Always agree.
The DAS scale was condescended to the first 24 items of the original scale based on a previous study using samesex male couples, which was shown to be valid and reliable (Johnson et al., 2012). The modified DAS demonstrated good psychometric properties in the current sample (
.93), and total scores ranged from 6 to 110. Discrimination. The Everyday Discrimination Scale (Williams, Yu, Jackson, & Anderson, 1997) was adapted to assess discriminatory experiences that transgender
participants attributed to being a transgender woman (i.e., In your general day-to-day life, how often are
you treated with less respect because you are a transgender woman). Similarly, their male partners’
were asked to about their experiences of being discriminated as a result of being in a relationship with a
transgender woman (i.e., In your general day-to-day life, how often have you been called names because
you are in a relationship with a transgender woman). Response options ranged from 0 Never to 4
Always. The adaptation of the 9-item scale has demonstrated good psychometric properties in other
studies with sexual minority samples (Gamarel et al., 2012) and had high internal reliability consistency
within the current sample (
.94). Total scores in the current sample ranged from 0 to 36. Relationship stigma. A relationship stigma
scale was developed by members of the research team based on focus group discussions with an
independent sample of transgender women and their male partners (Operario, Nemoto, Iwamoto, &
Moore, 2009). Based on preliminary qualitative findings about participants’ relationship experiences,
nine items were developed to assess perceptions of stigma targeted toward their relationship (sample
item, How often do you feel uncomfortable holding hands with your partner in public?; see Table 1 for
full measure). Both transgender women and their male partner completed the same questions.
Responses options ranged from 0 Never to 4 Always. Total scores in the sample ranged from 0 to 28. An
initial exploratory principal component analysis (PCA) was performed to examine the underlying factor
structure of the nine items for transgender women and their male partners, separately. The test
identified two factors, but Cattell’s (1966) scree test indicated that only the first factor should be
retained given the pronounced “elbow.” Descriptive data and PCA loadings for each of the nine
relationship stigma items are presented in Table 1, including eigenvalues, percentage of variance for
each factor, the factor loadings for the two-factor solution, and the internal consistency reliability
coefficient (Cronbach’s alpha). Results suggested that the items originated from a single component that
accounted for 24.7% of the variance for transgender women (Kaiser-Meyer-Olsen 0.91) and 34.9%
(Kaiser-Meyer-Olsen 0.82) of the variance for their male partners. The distribution of the initial
eigenvalues supported the one factor solution as more appropriate since it was the only factor that had a
value greater than 1, which is the condition for being retained in the model (Tabachnick & Fidell, 2001).
A confirmatory factor analysis (CFA) using maximumlikelihood estimation was then performed to ensure
the items converged onto a single factor. The ratio of chi-square to the number of degrees of freedom (2
/df) was used to test whether the data fit well with the one factor solution (true if 2 /df 5 Jöreskog &
Sörbom, 1993). The Comparative Fit Index (CFI), which varies from 0 and 1, was used to compare the
proposed model with the null model. A CFA greater than 0.90 is generally considered adequate (Kline,
2005). The root mean square error of approximation (RMSEA) represents the close fit of the model to
the data where a value of 0.10 or less indicates a close fit (Tabachnick & Fidell, 2001). The CFA confirmed
the one factor-exploratory model among the sample of transgender women, 2 (20) 66.35, CFI 0.94, and
RMSEA 0.10, as Table 1 Principal Components Analysis of Relationship Stigma Scale (n 191 Couples)a
Items Component solution transgender women Component solution male partners Factor 1 Factor 2
Factor 1 Factor 2 1. How often do you feel uncomfortable going out with your partner in public? 0.49
0.20 0.53 0.13 2. How often do you feel uncomfortable going out to ‘straight’ clubs or bars with your
partner? 0.55 0.18 0.70 0.19 3. How often do you feel uncomfortable holding hands with your partner in
public? 0.45 0.27 0.70 0.14 4. How frequently have you been harassed or bothered by strangers when
you are with your partner in public? 0.81 0.40 0.51 0.06 5. How often do you experience difficulty
introducing your partner to friends, acquaintances or co-workers? 0.81 0.40 0.43 0.01 6. How often have
you had to hide your relationship from other people? 0.72 0.31 0.78 0.03 7. How often do you feel there
is something wrong about being in a relationship with your partner? 0.70 0.38 0.71 0.26 8. How often do
you feel self-conscious about being in a relationship with your partner? 0.65 0.23 0.72 0.19 9. How often
do you feel that friends and family disapprove of your relationship? 0.44 0.36 0.57 0.48 Eiguenvalues
2.22 0.99 3.14 0.94 % of Variance 24.7 11.0 34.9 10.4 Theoretical scale score range 0 to 28 0 to 28
Cronbach’s alpha (
) 0.90 0.82 a Varimax Rotation with Kaiser Normalization. This document is copyrighted by the American
Psychological Association or one of its allied publishers. This article is intended solely for the personal
use of the individual user and is not to be disseminated broadly. 440 GAMAREL, REISNER, LAURENCEAU,
NEMOTO, AND OPERARIO well as in the sample of male partners, 2 (20) 90.18, CFI 0.91, and RMSEA
0.09. Item loadings for transgender women ranged from 0.50 to 0.84, and from 0.62 to 0.83 for their
male partners. The scale demonstrated good internal consistency reliability for transgender women (
.90) and their male partners (
.82). Overview of Statistical Analysis This analysis followed procedures for dyadic data analysis described
by Kenny, Kashy, and Cook (2006). Transgender women and their male partners represent distinguishable
dyads. Within each dyad, partners differ with regard to gender, and gender has potentially meaningful
implications for the theoretical constructs examined. Descriptive statistics such as frequency
distributions or means and standard deviations were obtained to summarize demographic
characteristics, discrimination, relationship stigma, financial hardship, clinically significant depressive
distress, and relationship quality for both transgender women and their male primary partners.
Intraclass correlations (ICC) were used to assess the relationship between transgender women and male
partners’ respective scores on a particular continuous variable (Kenny et al., 2006). Nonsignificant ICCs
indicate that the responses of one partner are unrelated to their partner’s measure score, while
statistically significant values indicate significant similarity (i.e., dependence) between partner scores.
The ICC values range between 1 and 1 (in the case of dyads). An ICC of zero implies that members of the
dyad are no more similar to one another than members of different dyads. An increase in the absolute
value of the ICC implies that the partners’ responses are increasingly similar to (or dissimilar from) one
another. An ICC of 1.0 indicates that members of the same couple responded identically. Cohen’s Kappa
is an analogous measure of association for dichotomous variables; its interpretation is identical to that of
the ICC coefficient (Kenny et al., 2006). To examine relationships among the major study variables, ICCs
and Cohen’s Kappas were calculated separately for transgender women and their male partners. Models
examining the association between minority stressors (discrimination, relationship stigma, and financial
hardship), clinically significant depressive distress (binary), and relationship quality (continuous) were
conceptualized using the Actor– Partner Interdependence Model (APIM; Kenny et al., 2006). APIM
models are models that account for the organization of individuals within dyads. Two types of effects are
examined: actor effects in which an individual’s own value on a measure is used to predict his or her own
score on the outcome, and partner effects in which an individual’s score on a measure is used to predict
his or her partner’s score on the outcome. For example, a transgender woman’s probability of clinically
significant depressive distress can be predicted from her own relationship stigma scores (i.e., an actor
effect of relationship stigma) as well as from her partner’s relationship stigma score (a partner effect of
relationship stigma). Additionally, it is possible to introduce dyad-level variables that are shared by both
members of the couple (e.g., length of relationship). APIM analyses were conducted using a structural
equation modeling approach described by Kenny and colleagues (2006), which allows for testing
distinguishability within dyads to determine whether the association among variables should be
constrained equal across partners or examined separately by gender identity. All models statistically
adjusted for relationship duration (in months). Models containing race and HIV status as additional
covariates were also tested and results did not differ substantively; therefore, the models presented are
not controlled for race and HIV status. The principal components analysis (showing reliability of the
relationship stigma scale) and all APIM analyses were conducted in Mplus 6.1 (Muthén & Muthén, 2010).
Descriptive statistics, bivariate analyses, and the confirmatory factor analysis for the relationship stigma
items were conducted using SPSS version 20. Results As shown in Table 2, there was significant
dependence in race, financial hardship, HIV status, and age between partners. Transgender women were
less likely to report an HIV-positive serostatus compared to their male partners (p .001). Additionally,
transgender women reported significantly higher levels of relationship stigma compared to their male
partners (p .001). Transgender women’s relationship quality scores were inversely associated with their own discrimination and relationship stigma scores, as well as their partners’ relationship stigma scores.
Additionally, their male partners’ relationship quality scores were inversely correlated with their own discrimination scores (see Table 3) such that lower reported relationship quality was associated with
higher levels of discrimination. Relationship stigma and discrimination were positive correlated with one another for both transgender women (p .01) and their male partners (p .01). Financial hardship was not
associated with discrimination, relationship stigma, c