197. Adolescent Health Provider And Sexual And Gender Minority Youth’s Perceived Barriers And Facilitators To Comprehensive HIV Preventative Services

Abstract

This study explored perceived barriers to HIV prevention, care, and treatment by conducting focus groups with adolescent health care providers and sexual or gender minority (SGM) youth, with the purpose of gathering input for a series of comprehensive HIV prevention tools and strategies. Providers and youth were recruited from across the United States. Among providers, online synchronous focus groups were conducted in June and July 2017. Among youth, three-day asynchronous blogs were conducted in April of 2018 for both males attracted to males and those who identified as transgender. Descriptive statistics and content analysis were performed. Data were analyzed for providers and youth separately and synthesized for commonalities and differences. In total, 17 providers (6 physicians, 3 nurse practitioners and 8 school nurses) and 46 youth [16 gay males (mean age 16.3 years) and 30 transgender youth (mean age 18.6 years)] participated in these online discussions. The providers were predominantly female (75%) and White non-Hispanic (68.8%); the youth were more diverse in race/ethnicity (58.7% White non-Hispanic, 15.2% multiracial, 13.0% Hispanic, 13.0% Black), and they represented a wide spectrum of gender identities including: male, female, transgender, genderqueer, and gender nonconforming. All participants largely focused on barriers to care. Adults and SGM youth reported: 1) limited HIV pre-exposure prophylaxis (PrEP) and HIV prevention knowledge among youth, 2) difficulties in access to care (i.e., cost, transportation), 3) real and perceived risks to confidentiality, and 4) stigma. Facilitators included: 1) open and supportive adults, 2) SGM affirming care and environments, and 3) access to referrals and resources. Because few youth had access to comprehensive sexual information, and many experienced negative interactions with providers, they voiced a strong desire for providers to initiate open and inclusive conversations about HIV prevention. Findings from this study of a diverse group of providers and SGM youth provide a framework for developing interventions that provide culturally competent and effective HIV preventative care. Results will inform development and testing of a series of HIV prevention tools, including webinars, to enhance provider skills and competence in providing SGM affirming care, initiating and maintaining PrEP, and implementing strategies to ensure adolescent patient confidentiality as appropriate. Other tools could focus on novel uses of technology to enhance access to care and health educational resources designed specifically for SGM youth.