Who's Your Daddy? Exploring the Relationship between Chosen Family, Future Orientation, and Harm Reduction

Sexual and gender minority (SGM) individuals are disproportionately at risk for negative physical and mental health outcomes, including suicidality, mood disorders, substance use, and STI/HIV diagnosis. Social support, including identity-based support systems, is a substantiated protective factor mitigating these risks; however, the majority of research has focused on men who have sex with men (MSM). Little is known about how SGM assigned female at birth and/or trans-females (AFAB/TF) form/maintain social networks, and the extent to which these “chosen families” (non-biological kinship formed in addition to or instead of biological or legal ties) may mitigate negative health outcomes.

Social networks perform several functions that help to buffer SGM-specific stressors (e.g., discrimination, violence, abuse, and rejection) contributing to negative physical/mental health. First, chosen families create affective bonds and belonging resulting from rejection. Social networks may consist of elders who promote harm reductive healing-centered practices, serving as role models of what is possible in the future, and thereby helping SGM AFAB/TF to develop positive future orientation (a protective factor characterized by hopefulness, goal setting, and optimism linked to better psychosocial outcomes). In contrast, negative future orientation is significantly associated with multiple risk behaviors, including substance use, delinquency, and unsafe sex.

This qualitative study explored how AFAB/TF engaged in risk-taking behaviors (e.g., substance use/abuse, risky sexual interactions) build chosen family networks and the structure of those networks (e.g., density, types of individuals, types of support provided). Moreover, we investigated whether and how chosen family networks change risk-taking behaviors and future orientation over time, with an emphasis on the capacity of queer elders to promote harm reduction strategies.

A flexible narrative approach, with timelines and network mapping as elicitation tools during semi-structured interviews, investigated factors influencing participants’ future orientation, the role of chosen family, and how each concept exerted ongoing and differential influence on risk behavior and harm reduction. Using snowball convenience sampling methods, this study recruited ten queer elders and twenty SGM AFAB/TF aged 18-26 years old engaged in risk-taking behaviors. Interviews were audio-recorded, transcribed, and imported into NVivo software. Data was analyzed/coded using a phenomenological approach. Findings included bidirectional intergenerational benefits of mutual aid, which increased positive future orientation and uptake of harm reduction; anticipatory loss as a catalyst for care; navigational capacity-building as a unique form of harm reduction.

No studies to date have examined how social support networks are formed, maintained, or function to support harm reduction strategies and build positive future orientation among AFAB/TF. These subpopulations—adolescents/youth and older adults, bisexual and gender diverse people, including those assigned female at birth—are often underrepresented in SGM research. Moreover, the unique characteristics of queer elders as hubs for social support networks have been under-theorized, resulting in under-utilization for interventions. This qualitative study provides insights for practice, policy, and future research, not only through gleaning phenomenological findings but also through expanding a conceptual framework that encompasses assets already extant within SGM networks, formed through both necessity and nurturance.