Abstract
Suicide represents a public health priority, and trans and gender diverse persons and persons living with HIV continue to face disparities in suicidal ideation and attempts. Approximately 1 in 2 trans women and femmes report a prior attempt, and 1 in 2 are living with HIV. The gender minority stress model, which posits that repeated exposure to marginalization results in chronic stress may explain suicide disparities, but prior work has not examined suicide risk at the intersection of both minority stress and HIV in this high priority population. Trans women and femmes living with or at risk for HIV acquisition completed a cross-sectional psychosocial assessment including measures of gender minority stress and suicide risk. Stochastic search variable selection was used to identify data-driven minority stress predictors of suicidal ideation and attempt. Linear and negative binomial regressions were used to examine direct and indirect associations of minority stress factors with suicidal ideation and attempt. Differences in minority stress and suicide risk by HIV status were explored. Rejection, rejection sensitivity, and nondisclosure were identified as potential predictors of suicidal ideation, and rejection sensitivity was identified as a potential predictor for suicide attempt. Higher rejection, higher rejection sensitivity, and lower nondisclosure predicted higher suicidal ideation severity. Rejection indirectly increased ideation severity via rejection sensitivity, and decreased suicidal ideation severity via nondisclosure. Rejection sensitivity did not predict the presence or severity of suicide attempt history. There were no differences in minority stress or suicide risk by HIV status. Rejection-based pathways appeared important to consider in the context of HIV in this population. Assessments of and interventions for suicide may be more responsive to the needs of trans women and femmes impacted by HIV risk when they consider the effects of compounded stigma on rejection.