High rates of stigma, discrimination and financial hardship don't only affect the many transgender women who face these challenges. According to a study in the Journal of Family Psychology, they can affect their cisgender (non-transgender) male partners as well. The findings were not surprising to several advocates who are transgender women living with HIV, and reinforces why policy change is needed to support transgender women, their partners and their families.
The study, entitled Gender Minority Stress, Mental Health, and Relationship Quality: A Dyadic Investigation of Transgender Women and Their Cisgender Male Partners, included 191 couples living or working in the San Francisco Bay Area. Nearly 40% of the men and 19% of the women reported living with HIV.
"The results were really not shocking to me in any way," said Dee Borrego, secretary of the Positive Women's Network - United States of America (PWN-USA).
"I know in my own experience, as a trans woman living with HIV, I certainly had long periods of depression and numerous financial hardships, and I would most definitely say that they have always had an impact on the relationships I have had with men. I was glad to see that they corroborated my own lived experience and the experiences I hear from other trans women."
"For both partners, financial hardship, discrimination, and relationship stigma were associated with an increased odds of depressive distress," the study found. In addition, 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."
In other words, stigma, discrimination and financial hardship experienced by one partner frequently affected physiological well-being and relationship quality for both partners. While the study did not identify differences in these associations among people living with HIV, it noted chronic diseases may increase stress, place strain on relationships, and negatively influence mental health outcomes.
The study noted that psychosocial factors (such as depression, discrimination and financial hardship) have been associated with HIV risk behaviors among transgender women.
Again, Borrego was not surprised.
"Oftentimes, the stigma of being transgender is simply enough that people will do whatever it takes not to lose their partner, and will do whatever it takes to please their partner," she explained.
"Within the context of my own story, the man who infected me was the first partner I had ever been with where I was open about identifying as trans. He was very accepting and open to it, so I was willing to engage in a lot of risky behaviors with him because he accepted me as a trans woman, and he accepted me as a woman when the rest of society really didn't."
The study's findings point to the importance of looking at health challenges among transgender women within the context of intimate relationships and social contexts.
"Couples-based 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," the study concluded.
Borrego said she hoped study findings would inform the development of policies and programs that were sensitive to the needs of transgender women and their partners.
"My hope would certainly be that [the study] continues to drive policy changes at the local, national and international level that are inclusive of all gender identities and expressions, and provide legal protections for trans people at all levels.
"And I think [the study] underscores that if we want to make inroads as a culture and as a community in addressing the needs of trans people, we have to start actually listening to trans people ... and making sure that resources are actually being allocated to the trans community to address things like HIV and poverty and joblessness."
Reflecting on the study's findings, Transgender Law Centre Senior Strategist Cecilia Chung called for increased investment in anti-discrimination interventions within school and community settings.
"We need to change the trajectory of our future generations so that they don't have these negative experiences with their families, with relationships and with their peers," she said.
"Resources really need to be put into K-12 education that extends to parents and families, and into building leadership in the trans community."
Katherine Moriarty is a consultant and freelance writer, based in Vancouver. She has 10 years of experience in the intersecting fields of public health and community development, with a focus on bloodborne virus policy and programming.