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Results indicated that sexism was positively associated with psychological distress, alcohol-related consequences, and drug-related consequences, respectively. In addition, sexism was associated with worse mental and behavioral health outcomes among SMW who identify as gender minorities or are masculine-presenting compared to SMW who identify as cisgender or are feminine-presenting. Findings provide evidence that the health impact of gender-based stressors among SMW may differ based on whether SMW identify as gender minorities and based