The Gender Non-affirmation from Sexual Partners Scale: Psychometric Evaluation and Correlates of a Brief Stigma Scale in a Sample Transgender and Gender Diverse Community Health Center Patients

This study evaluated the psychometric performance and correlates of a 4-item GNSP scale among transgender, nonbinary, and gender diverse (TGD) adults. Data were collected in 2019-2020 via an electronic, self-reported cross-sectional survey of 2192 TGD adults accessing two U.S. LGBTQ+ community health centers. Participants reporting sex within the past 6 months (60.7%, n = 1463) were asked the 4-item GNSP scale. Analyses were internal consistency reliability (α), confirmatory factor analysis, and a multivariable logistic regression model of GNSP scale correlates (adjusted odds ratios [AOR], 95% confidence intervals [95% CI]). Mean age was 27 years (range = 18-71 years), 18.7% were people of color, and 33.6% nonbinary. 42.7% reported past 6-month GNSP. The GNSP scale showed good reliability (α = 0.78) loaded onto a single factor (eigenvalue = 2.45; variance explained = 48.7%). Higher odds of reporting GNSP included nonbinary identity (AOR = 1.63; 95% CI 1.51, 1.70), more past 6-month sexual partners (AOR = 1.19; 95% CI 1.17-1.21), a cisgender woman sexual partner (AOR = 1.51; 95% CI 1.42-1.61), a high school degree or less (AOR = 1.43; 95% CI 1.28-1.59), elevated alcohol use (AOR = 1.55; 95% CI 1.46-1.65), severe psychological distress (AOR = 1.80; 95% CI 1.68-1.92), penile sex with a condom (AOR = 1.74; 95% CI 1.59-1.90) or without a condom (AOR = 1.38; 95% CI 1.28-1.49), and current PrEP use (AOR = 1.42; 95% CI 1.25-1.61). Lower odds of reporting GNSP included older age vs. ages 18-24 (AORs range 0.65-0.75), transfeminine identity (AOR = 0.87; 95% CI 0.80-0.94), uninsured (AOR = 0.56; 95% CI 0.48-0.60), and in committed relationships (AOR = 0.36; 95% CI 0.33-0.40) or ethically non-monogamous relationships (AOR = 0.38; 95% CI 0.35-0.43). Gender non-affirmation from sexual partners was highly prevalent and may represent important intervention targets for sexual and mental health. The GNSP scale demonstrated good psychometric properties and is a promising tool for future TGD research.