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Are HIV Prevention Services Reaching all LGBTQ+ Youth? An Intersectional Analysis in a National Sample

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Abstract

Although research has examined disparities in HIV prevention behaviors, intersectional research is needed to understand who may be underserved. This study examines disparities in consistent condom use, HIV testing, and PrEP awareness and use across assigned sex, gender identity, sexual orientation, and racial/ethnic identity in a large sample of sexually active LGBTQ+ youth (mean age = 16.5) who completed the 2022 LGBTQ National Teen Survey. Four social identities were included as indicators in Chi-Square Automated Interaction Detection models to uncover disparate rates of HIV preventive behaviors. Generally, HIV testing and PrEP services were higher among gay/lesbian and queer youth assigned male, and lower among those assigned female. Certain LGBTQ+ youth may be systematically missed by these services, (e.g., those assigned female; those assigned male who also identify as bisexual, pansexual, asexual, questioning, or straight (and trans/gender diverse)). Providers should strive to serve populations who are not being reached by HIV prevention services.

Resumen

Aunque las investigaciones han examinado disparidades en los comportamientos de prevención del VIH, la aplicación de un esquema interseccional es necesario para entender quienes tienen menos acceso a los cuidados de la salud. Este estudio examina disparidides en el uso del condón, las pruebas de VIH y el conocimiento y el uso de profilaxis preexposición (PrEP) entre el sexo asignado, la identidad del género, la orientación sexual, la identidad racial/étnica) en una muestra nacional de jovenes (edad promedia = 16.5), LGBTQ+. Cuatro identidades sociales estuvieron incluidas como indicadores en el modelo de la Detección de la Interacción Automática de Chi-Square para detectar diferencias de comportamientos de prevención. Generalmente, el uso de las pruebas de VIH y los servicios de PrEP estaban mas alto entre los jovenes gay/lesbiana y queer asignados masculinos y mas bajo entre jóvenes asignadas femeninas. Es posible que ciertos jovenes LGBTQ+ estén omitidos de los servicios de las pruebas de VIH y PrEP, incluyendo jóvenes que fueron asignadas feminidas, ovenes bisexuales, pansexuales, asexuales, cuestionando, o heterosexuales (transgénero/a/e o de diversos géneros) que fueron asignados masculinos. Los profesionales de salud deben luchar para servir a las poblaciones que están fuera del alcance de los servicios preventivos del VIH.

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Acknowledgements

Minnesota Student Survey data were provided by public school students in Minnesota via local public school districts and managed by the Minnesota Student Survey Interagency Team. PIQTOC (Protection at the Intersections for Queer Teens of Color) coinvestigators, including Dr. Lisa Bowleg, Dr. Ana-Maria del Río González, and Dr. Stephen T. Russell contributed to the overall study from which this manuscript is derived.

Funding

Research reported in this publication was supported by the National Institutes of Health under Award Number R01MD015722 (Eisenberg) and K01DA047918 (Watson). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Sponsors had no role in the study design; collection, analysis, and interpretation of data; writing of the report; or decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA

    Marla E. Eisenberg, Samantha E. Lawrence & Amy L. Gower

  2. Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA

    G. Nic Rider

  3. Youth and AIDS Project, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA

    Calla Brown, Val Crutcher & Andrew Schuster

  4. Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA

    Ryan J. Watson

  5. University of Connecticut, School of Social Work, Hartford, CT, USA

    Samantha E. Lawrence

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  1. Marla E. Eisenberg
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Correspondence to Marla E. Eisenberg.

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10461_2023_4230_MOESM1_ESM.docx

Supplementary Material 1: Table. Bivariate chi-square tests of association between each social identity and HIV prevention behaviors among sexually active LGBTQ+ youth, 2022

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Eisenberg, M.E., Lawrence, S.E., Gower, A.L. et al. Are HIV Prevention Services Reaching all LGBTQ+ Youth? An Intersectional Analysis in a National Sample. AIDS Behav 28, 1435–1446 (2024). https://doi.org/10.1007/s10461-023-04230-w

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