CHARACTERIZING AND MEASURING FAMILY ENVIRONMENTS OF TRANSFEMININE ADULTS WITH HIV: A MIXED-METHODS STUDY IN SANTO DOMINGO, DOMINICAN REPUBLIC

Background: Research assessing how family impacts trans people’s health often operationalizes families as either accepting/supportive or rejecting. Yet nascent research finds that families’ behaviors and attitudes are more complex, often encompassing acceptance, support, and rejection simultaneously. This dissertation leveraged mixed-methods research to advance understanding of family environments experienced by transfeminine adults with HIV in the Dominican Republic (DR). Methods: In the first study, I conducted secondary analysis of qualitative in-depth interviews (n = 20) to characterize family environment typologies of transfeminine adults with HIV. In the second study, I developed the Spanish-language Transfeminine Adult Family Environment Scale (TAFES) through a multi-step process informed by individuals with lived experience and expert feedback. I assessed the construct validity of the TAFES in a sample of transfeminine adults with HIV (n = 79) with exploratory factor analyses, convergent and discriminant validity. Finally, I examined correlations between the TAFES subscales and anxiety symptoms, depressive symptoms, and recent drug use. Results: In the first study, I characterized six family environment typologies. Some form of acceptance, support, and rejection was present across most family environments, while complete rejection or acceptance was only present in two of the family environments. While several family environments included acceptance and/or support, gender affirmation from family was less commonly experienced. In the second study, I developed a 24-item measure. A 23-item TAFES with a three-factor solution (1. Gender Affirmation; 2. Rejection; 3. General Acceptance and Support) best explained the data. All subscales had high internal consistency reliability and demonstrated convergent and discriminant validity. Gender Affirmation and General Acceptance and Support were significantly negatively correlated with depressive symptoms score, while correlations between the other subscales and mental health outcomes were not significant. In both studies, gender affirmation emerged as an important construct distinct from acceptance, demonstrating that family can be perceived as accepting even when not engaging in gender affirming behaviors.Conclusions: Acceptance, support, gender affirmation, and rejection are important constructs that create a transfeminine adult’s family environment. This dissertation provides researchers with rich description of family environment typologies and a tool to measure family environments and inform future family-based interventions.