4 - (SYM 2) Weaving Behavioral HIV Prevention Strategies into the Fabric of Youth's Lives

HIV and STIs disproportionately affect youth, who account for 1 in 5 new HIV infections and half of new STI infections in the U.S. However, most behavioral HIV/STI prevention interventions are developed in controlled settings that do not reflect the real world. This approach overlooks the fact that youth have numerous competing interests that may take precedence over enrolling in an HIV/STI prevention program, such as normative developmental tasks of belonging, dating, navigating identity, and sex. Thus, a critical implementation challenge is: how do interventionists ensure HIV/STI prevention programs are salient enough for youth such that uptake and effectiveness remains strong in real-world settings? One solution involves adjunctive interventions, which are implementation strategies that focus on individuals’ capacity, opportunity, or motivation to engage in a health intervention. Here I will discuss two examples of adjunctive interventions intended to facilitate engagement in adolescent HIV prevention behaviors. First, we are testing a 6-week daily text-messaging program aimed at increasing HIV testing in LGBTQ+ adolescents. HIV-focused content (e.g., transmission, testing, prevention, treatment) is distributed throughout the intervention and comprises half of the content, whereas other content focuses on relationships, consent, mental health, substance use, and seeking healthcare as a minor. Group chats enable youth to socialize with others who are also engaging in the intervention. Second, we are implementing a social marketing campaign, PrEP4Teens, aimed at increasing awareness, knowledge, and interest in HIV pre-exposure prophylaxis, a highly effective prevention medication regimen. In addition to a robust online presence, PrEP4Teens engages youth in creative activities (vogue and house/ball culture; art workshops; history of health advocacy and HIV/LGBTQ rights movements), and leadership roles that promote autonomy. Through the course of PrEP4Teens youth learn a holistic perspective on health and wellbeing, of which sexual health and PrEP is a major focus. Both interventions demonstrate high engagement and retention, and mixed-methods post-intervention feedback indicates high acceptability, particularly because of the broader health focus of the programs. Adjunctive interventions that include more expansive content have the potential to be more engaging, implementable in real world settings, and can impact outcomes across several domains of youth health in addition to HIV.