Dyadic Moderators of the Minority Stress-HIV Risk Association in Male Couples.

Minority stressors have been linked to HIV risk behaviors among gay, bisexual, queer, and other men who have sex with men (MSM). Committed partnerships are a key context for new HIV infections and coping with minority stress among MSM, but very little work has tested the minority stress-HIV risk link among male couples, and little is known about how processes within one's relationship may exacerbate or buffer this association. The present study examined links between minority stress (i.e., internalized stigma, microaggressions) and HIV transmission risk behaviors (i.e., condomless anal sex with outside partners, breaks in relationship agreements) among male couples, as well as relationship-based moderators (i.e., social support, dyadic coping) of these associations. An analytic sample of male couples from a large cohort study (analytic N = 410 individuals, 205 dyads) completed self-report measures of minority stress, relationship-based moderators, and HIV transmission risk behaviors which were submitted to moderated actor-partner interdependence models (APIMs). In many cases, coping with stress with one's partner buffered the minority stress-HIV transmission link risk. However, findings also suggested situations in which partners may overburden one another with coping, thus exacerbating HIV-related risk behaviors.

Relationship risk factors for intimate partner violence among sexual and gender minorities: A multilevel analysis.

Intimate partner violence (IPV) is alarmingly prevalent among sexual and gender minority youth assigned female at birth (SGM-AFAB), making it important to identify risk factors that can be targeted in prevention efforts for this population. Although several relationship-level risk factors for IPV have been identified in different-sex couples, research on SGM-AFAB is sparse and predominantly cross-sectional. The present study used seven waves of data from a longitudinal cohort study of SGM-AFAB youth (n = 463) to explore relationship factors (relationship quality, destructive conflict, and self- and partner-jealousy) as risk factors for perpetration and victimization of three types of IPV (physical, psychological, and coercive control). At each wave, participants reported on relationship factors and IPV for up to three romantic partners in the past 6 months. Multilevel models tested for associations between the relationship factors and IPV at three levels: between-persons, within-persons across time (wave), and within-persons across relationships. Relationship quality was associated with IPV mostly at the between-persons and within-persons (wave) levels. Couple conflict was associated with all IPV outcomes at all levels. Partner jealousy was more consistently associated with IPV victimization; participant jealousy was more consistently linked with IPV perpetration. These novel findings suggest that, within SGM individuals, IPV may be influenced by relationship quality, destructive conflict, and jealousy as they fluctuate within individuals from relationship to relationship and within individuals over time. As such, these relationship factors represent promising potential targets for interventions to reduce IPV among SGM-AFAB youth.

Recruiting and retaining sexual and gender minority couples in intervention research: Lessons learned from trials of tailored relationship education programs.

Relationship interventions, including healthy relationship education, couple therapy, and dyadic approaches to treating mental and physical health issues, hold promise for promoting relationship and individual health among sexual and gender minority (SGM) populations. Because SGM couples live within a context of societal stigma against their minority identities and relationships, they are likely to be best served by targeted, culturally sensitive relationship interventions that are affirming, free of hetero- and cis-normativity, and address the unique stigma-based challenges that they face. Therefore, a key goal for the field today is to conduct research evaluating and refining newly developed relationship interventions designed specifically for SGM couples. In this paper, we offer recommendations for effectively recruiting and retaining large, diverse samples of SGM couples for clinical trials of tailored relationship interventions, grounded in guidelines for psychological practice and conducting research with SGM populations. Throughout, we offer examples and lessons learned from our experiences conducting clinical trials of tailored SGM relationship education programs. We encourage the use of recruitment and retention strategies that involve members of the target SGM community from the outset, are informed by knowledge about SGM individuals and relationships, use currently preferred language for individual identities and relationships, attend to issues of confidentiality regarding sexual/gender identity or relationship involvement, and adhere to the norms of the particular community and recruitment venue.

"The Main Concern is HIV, Everything Else is Fixable": Indifference Toward Sexually Transmitted Infections in the Era of Biomedical HIV Prevention.

With the advent of biomedical HIV prevention, attitudes toward and cultural norms around condom use and sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (MSM) are changing. Participants of 2GETHER, a randomized controlled trial of a relationship education and HIV prevention program for male couples, have acknowledged that having condomless anal sex put them at increased risk for STIs. Nonetheless, facilitators of the program have increasingly observed that participants were indifferent toward STIs and unmotivated to engage in preventative behaviors, particularly if they used pre-exposure prophylaxis. Participants' reasons for their lack of motivation to take precautions against STIs are reviewed. Implications of these attitudes for public health interventions to reduce rates of STIs among MSM, including frequent screening and treatment of STIs and potential messaging around condom use, are discussed.

Sexual Health of Rural and Urban Young Male Couples in the United States: Differences in HIV Testing, Pre-exposure Prophylaxis Use, and Condom Use.

Young men who have sex with men (YMSM) are disproportionally affected by HIV, and main partnerships account for a large proportion of new HIV infections. HIV prevention is largely focused on urban YMSM, and less is known about sexual health of rural male couples. The present study used data from a randomized controlled trial of a relationship education and HIV prevention program for male couples to test associations of rurality with HIV/STI testing, PrEP use, number of sexual partners, and condomless anal sex (CAS) acts. Participants were 430 YMSM in relationships. Rural YMSM were less likely to have been tested for HIV/STIs, and to have used PrEP, compared to urban YMSM. Although higher rurality was associated with fewer CAS acts, CAS was not infrequent among rural YMSM, highlighting the need for increased HIV prevention geared toward young male couples living in rural, less resourced areas.

Minority Stressors and Identity Affirmation as Predictors of Condomless Sex Among Self-Identified Bisexual Men: The Role of Partner Gender.

Bisexual men are at increased risk for HIV/STI and early pregnancy involvement compared to heterosexual men, and minority stressors (e.g., enacted and internalized stigma) are associated with sexual risk behavior in samples of gay and bisexual men. However, few studies have specifically focused on bisexual men, and little is known about the unique predictors of sexual risk behavior in this population. Further, few studies have focused on positive sexual orientation-related factors such as identity affirmation, which may be protective against sexual risk behavior. As such, the goals of the current study were to examine minority stressors and identity affirmation as predictors of condomless sex among self-identified bisexual men, and whether these associations differed as a function of partner gender. We used four waves of data spanning 24 months from a subset of self-identified bisexual men in a larger cohort of gay and bisexual men ages 16-29 years at enrollment. At each wave, participants reported on up to four partners, allowing us to examine within-person associations. We used mixed effects negative binomial models to examine the associations between our predictors (discrimination, internalized binegativity, and identity affirmation) and condomless sex acts. In addition, we tested whether partner gender moderated each of the associations by including interaction effects in each of the models. Results indicated that higher levels of internalized binegativity and lower levels of identity affirmation were associated with less condomless sex with female partners, but they were not associated with condomless sex with male partners. Discrimination was not associated with condomless sex with male or female partners. These findings suggest that predictors of condom use among self-identified bisexual men differ as a function of partner gender, and they highlight the need to identify strategies to promote sexual health while also supporting positive identity development in this population.

Examining minority stress, dyadic coping, and internalizing symptoms among male same-sex couples using actor-partner interdependence models.

Minority stress processes have been consistently linked to increased internalizing symptoms among sexual minority individuals. However, very little research has studied the impact of minority stress on the mental health of same-sex couples. The present study examined associations of actor and partner heterosexist microaggressions and internalized heterosexism with internalizing symptoms, moderated by dyadic coping, among male same-sex couples. Participants were 774 men who have sex with men (387 dyads). Results of actor-partner interdependence models showed that actor, but not partner, minority stress was positively associated with internalizing symptoms. Dyadic coping moderated the association of actor heterosexist microaggressions on internalizing symptoms such that for those who engaged in more dyadic coping, the association of heterosexist microaggressions with internalizing symptoms was weaker. Dyadic coping also moderated the association of partner internalized heterosexism on internalizing symptoms. For those who engaged in more dyadic coping, their partner's internalized heterosexism was associated with greater internalizing symptoms. Although dyadic coping may buffer the effects of minority stress on internalizing symptoms, if partners rely too heavily on one another to cope with stress, it may be detrimental to their mental health. Implications for relationship education interventions for same-sex couples are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Intersectional minority stress and identity conflict among sexual and gender minority people of color assigned female at birth.

Objective: Sexual and gender minority people of color (SGM-POC) experience intersectional forms of minority stress, including heterosexism within racial/ethnic minority communities, which can contribute to feelings of conflict between SGM and racial/ethnic identities. Internalized stigma may be a consequence of sexual orientation-based discrimination but has not been tested as a mechanism linking intersectional minority stress to identity conflict among SGM-POC. We hypothesized that the association between experiences of heterosexism in racial/ethnic minority communities and identity conflict would be mediated by internalized stigma among SGM assigned female at birth (SGM-AFAB). Method: Participants were 316 SGM-AFAB who identified as POC. Data were collected as a part of an ongoing longitudinal cohort study of young SGM-AFAB. We tested the longitudinal mediation using data from baseline, 6-month follow-up, and 1-year follow-up assessments. Results: Internalized stigma at 6-month follow-up partially mediated the association between experiences of heterosexism in racial/ethnic minority communities at baseline and identity conflict at 1-year follow-up. Conclusions: For SGM-POC, experiences of heterosexism within their racial/ethnic communities may lead to internalization of those negative attitudes. A consequence of internalizing heterosexist attitudes from one's racial/ethnic group could be a feeling that one's sexual orientation and racial/ethnic identities must remain separate, perhaps to maintain connection to one's racial/ethnic community. Identifying internalized stigma as a mediating process is critical to better understand identity development for SGM-POC, and has important clinical implications for working with this population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Bisexual Men's Experiences with Discrimination, Internalized Binegativity, and Identity Affirmation: Differences by Partner Gender.

Bisexual individuals experience unique forms of discrimination related to their sexual orientation (e.g., anti-bisexual prejudice), which occurs from both heterosexual and gay/lesbian individuals. Bisexual individuals may experience stigma differently depending on the gender of their relationship or sexual partners, because they may be perceived as heterosexual if they have a partner of a different gender and as gay/lesbian if they have a partner of the same gender. The present longitudinal study investigated within-persons differences in anti-bisexual experiences, internalized binegativity, and bisexual identity affirmation based on the gender of participants' serious relationship partners and gender of sex partners in a sample of 180 young bisexual men. Results indicated that young bisexual men experienced more interpersonal hostility from both heterosexual and gay/lesbian individuals when their serious relationship partner was female. No significant differences were found in other types of anti-bisexual prejudice, internalized binegativity, or bisexual identity affirmation by serious partner gender. For sexual partner gender, men who had only male sex partners experienced more sexual orientation instability attitudes from heterosexual and lesbian/gay individuals; men with only female sex partners experienced more sexual irresponsibility attitudes from heterosexuals, but not from lesbian/gay individuals; and, like those with female serious relationship partners, men with only female sex partners had more frequent experiences of interpersonal hostility from heterosexual and lesbian/gay individuals. Results indicate that bisexual men experience unique forms of prejudice based on the gender of their relationship and sexual partners. Implications for the mental health of bisexual men are discussed.

When in doubt, sit quietly: A qualitative investigation of experienced therapists' perceptions of self-disclosure.

Using consensual qualitative research (CQR), we analyzed 13 interviews of experienced psychotherapists about general intentions for therapist self-disclosure (TSD), experiences with successful TSDs, experiences with unsuccessful TSDs, and instances of unmanifested urges to disclose. For TSD generally (i.e., not about a specific instance), typical intentions were to facilitate exploration and build and maintain the therapeutic relationship. Therapists typically reported becoming more comfortable using TSD over time. In successful TSDs, the typical content was accurate, relevant similarities between therapist and client; typical consequences were positive. In unsuccessful TSDs, the typical antecedent was countertransference reactions; the typical intention was to provide support; typical content involved therapists mistakenly perceiving similarities with clients; and the general consequences were negative. In instances when therapists repressed the urge to disclose, the typical antecedent was countertransference and the content typically seemed relevant to the client's issues. We conclude that effective use of TSD requires general attunement to the client's dynamics, attunement to the client's readiness in the moment, ability to manage countertransference, and ability to use a specific TSD appropriately. Implications for practice, training, and research are discussed. (PsycINFO Database Record

Affect and Condom Use Among Men Who have Sex with Men: A Daily Diary Study.

Men who have sex with men (MSM) are disproportionally affected by HIV. Although some theoretical models created to explain why individuals engage in risky sexual behavior contain an affective component, there has been relatively little focus on the influence of affect on sexual risk-taking. The goal of this study is to investigate the association between affect and condom use among MSM using an archival dataset from a survey of users of a popular sex-oriented website. Multilevel modeling was used to analyze daily diary data from 2871 MSM. At the within-person level, positive affect was positively related to condomless anal sex (CAS), whereas negative affect was negatively related to CAS. However, these results were qualified by interactions of trait affect and relationship to sex partner. These findings suggest that interventions focused on emotional regulation may have the potential to reduce CAS among MSM.

The ups and downs of being lesbian, gay, and bisexual: A daily experience perspective on minority stress and support processes.

Daily diary methods were used to explore identity-related stress and support processes as they occurred from day-to-day in a sample of 61 lesbian, gay, and bisexual (LGB) young adults. At the end of each day for 7-10 consecutive days, participants reported on daily identity-salient experiences (ISEs), proximal minority stressors (internalized stigma, expectations of rejection), and affect (positive, negative). A multilevel latent covariate model was used to examine within- and between-person interrelations among these variables. Participants described a variety of positive and negative ISEs with both heterosexual and LGB people. These ISEs accounted for change in affect from 1 day to the next, even controlling for positive and negative experiences unrelated to identity. For example, relative to the previous day, participants experienced increases in positive affect on days featuring positive ISEs with both heterosexual people and LGB people. ISEs also predicted daily proximal stress variables, and findings differed at the 2 levels of analysis. For example, at the within-person level, participants experienced decreases in internalized stigma on days featuring positive ISEs with heterosexuals. At the between-person level, however, findings indicated that participants who generally had the highest levels of internalized stigma were more likely than others to report negative ISEs with LGB people and less likely to report positive ISEs with LGB people. Finally, proximal stress variables predicted affect at the within-person level: Affect improved on days when levels of internalized stigma and expected rejection were lower than usual. (PsycINFO Database Record

When identities collide: Conflicts in allegiances among LGB people of color.

Little research has examined the management of multiple minority identities among lesbian, gay, and bisexual (LGB) people of color, despite a growing theoretical literature on such identity intersections. The present study focused on the intersectional construct of conflicts in allegiances (CIA), defined as perceived incompatibility between one's racial/ethnic and sexual orientation identities. CIA was investigated in relation to experiences of parental heterosexism, racism in LGB communities, outness, and racial/ethnic and sexual orientation group identity. Participants were 124 LGB people of color (main sample) and 124 LGB White people (comparison sample) who completed self-report measures of the main variables as part of a larger survey of same-sex couples. CIA was positively correlated with experiences of racism within LGB communities and perceived heterosexism in one's mother (but not one's father), and negatively correlated with outness to family (but not outness to others in one's everyday life). An interaction was found between racial/ethnic and LGB group identity with respect to behavioral engagement: CIA levels were highest among participants with high racial/ethnic behavioral engagement and low sexual orientation behavioral engagement. Results highlight the role of minority and family contexts in CIA among LGB people of color, and, more broadly, the potential value of studying intersectional variables using quantitative methods. Longitudinal and experimental studies are needed to address questions about direction of influence raised by findings.

Minority stress and romantic relationship functioning among young sexual minority women.

Growing research suggests that minority stress adversely affects relationship functioning among same-gender couples. However, studies have predominantly focused on concurrent, between-persons associations and neglected the relationships sexual minority people have with partners of other genders. We used multiwave longitudinal data from 200 young sexual minority women in relationships with cisgender men, cisgender women, and transgender or nonbinary individuals to assess between- and within-person associations between minority stress and relationship functioning and to test for differences in these associations by partner gender. Participants reported on minority stressors (couple marginalization; microaggressions; internalized heterosexism) and relationship functioning (quality; destructive conflict) from the same partnership at 3-7 assessments (M = 4.44), collected at 6-month intervals. Multilevel models assessing each minority stressor separately revealed between-person associations of each stressor with worse relationship quality and conflict; however, only couple marginalization showed within-person associations with relationship functioning. In multilevel models including all three minority stressors, couple marginalization showed unique within- and between-persons associations with worse relationship functioning; microaggressions were only uniquely associated with couple conflict at the between-persons level. Moderation analyses revealed a negative between-persons association of microaggressions with relationship quality only for participants with cisgender male partners, and a positive within-person association of microaggressions with relationship quality only for those with cisgender female partners. Several associations were weaker for participants with transgender or nonbinary compared to cisgender partners. Findings highlight the importance of couple-level minority stress and partner gender in understanding how sexual minority stress affects relationship functioning. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Minority Stress and Intimate Partner Violence among Sexual and Gender Minorities assigned Female at Birth.

Objective: Sexual and gender minorities assigned female at birth (SGM-AFAB) experience high rates of intimate partner violence (IPV). Using multiwave longitudinal data, the present study tested the following associations of minority stress and IPV among SGM-AFAB: concurrent within-person (i.e., whether changes in minority stress co-occur with changes in IPV), prospective within-person (i.e., whether changes in minority stressors precede changes in IPV), and between-persons (i.e., whether individuals who experience more minority stress, on average, experience more IPV). Method: Data were from Waves 1-7 (spanning 3.5 years) of a longitudinal cohort study of 488 young SGM-AFAB. At each wave, participants reported on SGM victimization, sexual orientation microaggressions, internalized heterosexism, and five types of IPV for up to three partners in the past six months. Results: Controlling for other minority stress experiences, microaggressions showed concurrent within-person associations with two types of IPV victimization (psychological and coercive control) and three types of IPV perpetration (psychological, physical, and sexual), and between-persons associations with psychological IPV victimization and coercive control victimization and perpetration. Microaggressions also had a significant prospective within-persons association with SGM-specific IPV perpetration. SGM victimization showed no unique within-person associations with IPV but, between-persons, was associated with all types of IPV victimization (except coercive control), and psychological and sexual IPV perpetration. Internalized heterosexism was not associated with any IPV outcome. Conclusions: Minority stress, particularly distal stressors, appear to contribute to risk for IPV among SGM-AFAB. Clinicians working with SGM-AFAB individuals in relationships may benefit from screening for experiences of minority stress.

Biomedical and behavioral outcomes of 2GETHER: A randomized controlled trial of a telehealth HIV prevention program for young male couples.

OBJECTIVE: This study evaluated the efficacy of the 2GETHER relationship education and HIV prevention program for young male couples in reducing risk for HIV. METHOD: We conducted a comparative effectiveness randomized controlled trial of 2GETHER, a five-session hybrid group- and couple-based intervention delivered via videoconference, relative to a single-session HIV testing and risk reduction counseling protocol delivered to couples. We randomized 200 young male couples (N = 400) to 2GETHER or control from 2018 to 2020. Primary biomedical (i.e., rectal Chlamydia and Gonorrhea infection) and behavioral outcomes (i.e., condomless anal sex [CAS]) were measured at 12-months postintervention. Secondary outcomes were other HIV prevention and risk behaviors, relationship quality, and substance use. Multilevel regression was used to model intervention outcomes to account for clustering within couples. Postintervention change over time was modeled as a latent linear growth curve at the within-persons level. RESULTS: We observed significant intervention effects on primary biomedical and behavioral HIV risk outcomes. Participants in 2GETHER had significantly lower odds of rectal STIs at 12-months relative to control. We also observed significantly steeper declines in the number of CAS partners and acts from baseline to 12-month follow-up in 2GETHER relative to control. Few differences were observed for secondary relationship and HIV-related outcomes. CONCLUSIONS: 2GETHER is an efficacious intervention that has a significant impact on both biomedical and behavioral HIV prevention outcomes among male couples. Couple-based HIV prevention programs enhanced with evidence-based relationship education may effectively reduce the most proximal predictors of HIV infection. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Relationship quality and mental health among sexual and gender minorities.

Sexual and gender minorities assigned female at birth (i.e., sexual minority women, transgender men, and gender diverse [SMW TGD] individuals) experience disproportionately high rates of anxiety, depression, and substance use problems. Romantic relationship involvement has been shown to be beneficial to mental health and substance use among sexual and gender minorities. However, few studies have explored the impact of relationship quality on mental health, or if high relationship quality can reduce the negative impact of minority stress on well-being in this population. The present study examined within-persons associations of romantic relationship quality with symptoms of anxiety and depression, and alcohol and cannabis use problems among SMW TGD individuals in romantic relationships, and tested relationship quality as a moderator of associations of minority stress with mental health and substance use. Participants were 213 SMW TGD individuals (mean age: 20.63; 70.9% cisgender women, 7.5% transgender men, and 19.2% gender diverse). Within-persons, higher relationship quality was associated with better mental health and substance use outcomes. Relationship quality at the between-persons level moderated the within-persons association of internalized heterosexism with depression, and of microaggressions with cannabis use problems. No other interaction effects were significant. The within-persons associations found in this study lend important support to relationship interventions based on theories that improvements in romantic relationship quality will result in improved well-being over time. Results can inform relationship education interventions to reduce mental health and substance use disparities in SMW TGD communities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Minority Stress, Identity Conflict, and HIV-Related Outcomes Among Men Who Have Sex with Men, Transgender Women, and Gender Nonbinary People of Color.

Purpose: This study investigated conflict between sexual orientation and racial/ethnic identities as a mechanism linking minority stress to HIV-related outcomes among men who have sex with men (MSM), transgender women and gender nonbinary (TGN) people of color (POC). Methods: We tested longitudinal mediation models with sexual orientation microaggressions, internalized heterosexism (IH), and sexual orientation concealment at Time 1, and pre-exposure prophylaxis (PrEP) use and number of condomless anal sex (CAS) partners at Time 3, mediated by identity conflict at Time 2. Participants were 337 MSM and TGN POC. Data were collected in Chicago, Illinois, from September 2018 to February 2021. Results: Indirect associations of IH and sexual orientation concealment, respectively, at Time 1 with CAS partners at Time 3 through identity conflict at Time 2 were significant. Mediation models with sexual orientation microaggressions as the predictor and PrEP use as the outcome were not significant. Conclusion: Minority stress may contribute to identity conflict and increase CAS by isolating MSM and TGN POC from sexual and gender minority communities, thus restricting access to safer sex resources, and by increasing psychological distress and decreasing self-care (e.g., condom use).

Protocol for an attention-matched randomized controlled trial of 2GETHER: a relationship education and HIV prevention program for young male couples.

BACKGROUND: Young men who have sex with men (YMSM) are disproportionately impacted by the HIV epidemic in the USA, and a large number of new infections among YMSM occur in the context of main or primary partnerships. At the same time, healthy romantic relationships promote health and wellbeing by improving social support and encouraging healthy behaviors. Thus, we created 2GETHER: a relationship education and HIV prevention program for young male couples. 2GETHER is delivered face-to-face in a university setting and is composed of two group sessions and two individualized skills coaching sessions. We observed strong support of the feasibility, acceptability, and preliminary efficacy of 2GETHER in a pilot trial. METHODS: We are conducting an attention-matched randomized controlled trial (RCT) to test the efficacy of 2GETHER relative to a control condition based on a well-validated positive affect enhancement program. Enrollment occurred between August 2017 and March 2021 in Chicago and surrounding areas, and we enrolled and randomized 128 dyads (N = 256 individuals). Follow-up is ongoing and we will examine primary and secondary behavioral outcomes at 12 months post-intervention, with interim follow-up at 3, 6, and 9 months post-intervention. The primary biomedical outcome is sexually transmitted infection incidence at a 12-month follow-up. DISCUSSION: 2GETHER is innovative in that it places an equal emphasis on relationship skill building and HIV prevention. Thus, the program has the potential to impact numerous health-related outcomes. Despite challenges related to the recruitment of couples and the COVID-19 pandemic, we were able to enroll a robust sample of young male couples with sufficient power to detect effects on study outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT03186534 .

Prospective associations between bi+ minority stressors and internalizing symptoms: The mediating roles of general and group-specific processes.

Objective: The prevalence of anxiety and depressive (i.e., internalizing) disorders is higher among bi+ individuals (i.e., individuals with attractions to more than one gender and/or who identify as bisexual or pansexual) compared to both heterosexual and lesbian/gay individuals. Cross-sectional research has demonstrated that stressors unique to bi+ individuals are associated with internalizing symptoms. However, longitudinal research examining these associations and underlying mechanisms is extremely limited. Method: We utilized five waves of data (6 months between waves) from a diverse sample of bi+ individuals assigned female at birth (age 16-32; 29% gender minority; 72.9% racial/ethnic minority) to examine: (a) prospective associations between three bi+ stressors (enacted, internalized, anticipated bi+ stigma) and internalizing symptoms; (b) potential mediating role of rumination in these associations; and (c) potential mediating roles of internalized and anticipated bi+ stigma in associations between enacted bi+ stigma and internalizing symptoms. Results: At the within-person level, when participants experienced more bi+ stressors than usual during a particular wave, they experienced subsequent increases in internalizing symptoms. Increases in rumination mediated these associations. Associations between enacted bi+ stigma and internalizing symptoms were mediated by increases in internalized and anticipated bi+ stigma. Conclusions: Findings indicate that bi+ stressors prospectively predict increases in internalizing symptoms and rumination may play a mechanistic role. Further, findings suggest that internalized and anticipated bi+ stigma may play mechanistic roles in the associations between enacted bi+ stigma and internalizing symptoms. Interventions targeting rumination, internalized stigma, and anticipated bi+ stigma may help to reduce internalizing symptoms among bi+ individuals. (PsycInfo Database Record (c) 2021 APA, all rights reserved).