Barriers and Facilitators to HIV Testing among Adolescents and Young Adults in Washington, DC: Formative Research to Inform the Development of an mHealth Intervention (Preprint)

Abstract

Adolescents and young adults (AYA) in the United States (U.S.), and Washington, District of Columbia (DC) specifically, are disproportionately impacted by HIV. Both the U.S. Ending the HIV Epidemic (EHE) initiative and DC-specific plans emphasize HIV testing, and innovative strategies to encourage testing among AYA are needed.

The purpose of this study was to identify sexual behaviors, HIV knowledge, HIV perceptions (e.g., susceptibility and severity), and perceived barriers and facilitators to HIV testing among youth at risk for HIV in DC.

The current study was part of a larger study to determine the acceptability of using a life-and-dating simulation game to increase HIV testing among AYA. Focus groups and surveys, stratified by self-reported sexual orientation, were conducted among and administered to AYA ages 13-24 in the DC. HIV knowledge was explored during focus groups and measured using an adapted version of the Brief HIV Knowledge Questionnaire. Survey data were summarized using descriptive statistics and compared by self-reported sexual orientation. Transcripts were thematically analyzed.

Of the 46 AYA who participated in the focus groups, 30 (65%) identified as heterosexual and 16 (35%) identified as lesbian, gay, bisexual, transgender, or queer (LGBTQ) A higher proportion of LGBTQ youth reported sexual activity [75% (n=12/16) vs. 60% (n=18/30)], condomless sex [92% (n=11/12) vs. 83% (n=15/18)], and HIV testing [81% (n=13/16) vs. 58% (n=17/29)] than heterosexual youth. HIV prevention (“condoms” and “PrEP”) and transmission (“exchange of fluids”) knowledge was high, and most AYA (77%, n=34/44) perceived HIV testing as beneficial. However, youth also demonstrated some misinformation concerning HIV: An average of 67% participants believed an HIV test could deliver accurate results 1-week post potential exposure, and an average of 72% believed an HIV vaccine exists. Youth also identified individual (“…people… are scared”), interpersonal (“it’s an awkward conversation”), and structural (“…people don’t…know where they can go”) barriers to testing. Most AYA indicated that they were very likely to use the demonstrated game prototype to help with getting tested for HIV (median 3.0, using a scale ranging from 0 to 3, with 3 indicating high likelihood), and strongly agreed that the game was interesting, fun, and easy to learn (all median 5.0, using a scale ranging from 1 to 5, with 5 indicating strong agreement).

These results suggest a need for multi-level HIV testing interventions and informed the development of a mHealth intervention aiming to increase HIV knowledge and risk perception among AYA, while reducing barriers to testing at the individual and structural levels, supporting efforts to end the domestic HIV epidemic.