Jesse Fletcher

Dr. Jesse Fletcher Receives First R21 Award

Dr. Jesse Fletcher was recently awarded (Co-I: Dr. Jae Sevelius) an NIMH-funded grant entitled “Development and Testing of an Identity Measure for Transgender and Gender Diverse Persons” to create a multidimensional measure of gender identity specific to transfeminine persons, establish the reliability and validity of this new measure, and estimate associations between instances of identity non-verification and participants’ HIV-related (and other critical) health outcomes. This study will be the first formal application of identity theory to transfeminine persons, allowing for the creation of all the relevant identity theory metrics (e.g., multidimensional identity standards, multisource reflected appraisals, salience/prominence/commitment ratings) and mechanisms (e.g., identity non-verification as the difference between identity standards and reflected appraisals) which comprise the framework and set it apart from its compatriots (e.g., gender affirmation theory; minority stress and resilience). Evidence demonstrates that transfeminine persons (i.e., those persons assigned male sex at birth but who identify as more feminine along the gender identity spectrum) are at dramatically elevated risk for HIV and a number of other detrimental health outcomes in part as a result of pervasive exposure to gender-based stigma and discrimination. Such prejudicial treatment is internalized by transfeminine persons as “identity non-verification,” a well-established behavioral mechanism in Identity Theory which has yet to be broadly adopted by researchers studying transfeminine populations. The study would occur in two stages, beginning with a Development Stage in which in-depth interviews are carried out with a purposively sampled group of transfeminine persons evenly split by age and HIV status. This is followed by the Testing Stage (N = 150), in which the reliability and validity of the new measure could be established, and a test of how identity non-verification is associated with critical health outcomes will be carried out. A deeper and more granular understanding of how transfeminine persons see themselves, how they believe other people see them, and how differences between these two constructs are associated with HIV-related outcomes and risks (including exposure to HIV and uptake/adherence to ART or PEP/PrEP) could generate new hypotheses, better research questions, and new methods of intervening in one of the populations most affected by HIV in the US.