Validating a Unified Model of Border Identity Stress, HIV Risk, and Mental Health Across Three U.S. Health Disparity Populations - BACKGROUND. Border identity groups—such as those who are bisexual/pansexual (bi+), Biracial/Multiracial, or gender nonbinary—challenge our nation's most basic group dichotomies (e.g., gay/straight, Black/White, man/woman) and are rapidly growing segments of the U.S. population. As NIH health disparity populations, it is unsurprising that border identity groups tend to demonstrate elevated HIV and mental health inequities as compared with the general U.S. population. However, more vexing are studies showing that bi+, Multiracial, and nonbinary people demonstrate greater sexual/mental health risk than their respective monosexual minority, monoracial minority, and binary gender minority counterparts. The potential drivers of these co-occurring health inequities are insufficiently theorized, poorly measured, and unevenly studied across groups. Yet, accumulating research supports an intriguing hypothesis—that bi+, Multiracial, and nonbinary populations demonstrate similar health risk profiles because, beyond traditional minority stressors, they are vulnerable to a distinct set of stigma-related stressors encountered by individuals holding identities that defy socially sanctioned dichotomies (i.e., border identity stressors). OBJECTIVE. In response to NIMH PAR-23-062 and NOT-MH-23-270, this R01 builds upon preliminary research to (a) develop a multigroup measure of border identity stress, (b) test a unified model of border identity stress, HIV risk, and mental health problems among bi+, Multiracial, and nonbinary adults, and (c) identify mutable mechanisms and protective factors concerning relations between border identity stress and co-occurring sexual and mental health risks. SPECIFIC AIMS. PI Jackson will work with Co-Is Bowleg, Esserman, Huynh, and Poteat to: develop a community-informed multigroup border identity stress scale—optimized for cross-sectional, longitudinal, and EMA HIV research (Aim 1); test longitudinally a conceptual model of border identity stress, HIV risk, and mental health—testing theorized mediators and moderators across bi+, Multiracial, and nonbinary adults (Aim 2); and detect relations between border identity stressors, daily HIV risk factors, and mental health symptoms among three higher-risk border identity subgroups via a 14-day microlongitudinal study—isolating daily mechanisms for intervention (Aim 3). SIGNIFICANCE. By highlighting how previously hidden forms of stigma drive health risk among bi+, Multiracial, and nonbinary adults, this model is poised to facilitate the development of much-needed interventions among three NIH health disparity groups disproportionately burdened by HIV—and is poised to shift how the field conceptualizes stigma, measures stigma-related stress, and combines stigmatized groups for study. DISSEMINATION. In addition to scholarly publications, we will produce and disseminate several scientific products (e.g., infographic summaries) for community members and health professionals, including: (1) bi+, Multiracial, and nonbinary research participants, (2) AIDS service organizations within Ending the HIV Epidemic priority jurisdictions, and (3) a national network of mental health providers serving stigmatized clients.
