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)

BACKGROUND 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 are needed. OBJECTIVE 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 and to identify potential differences based on self-reported sexual orientation. The results from this study were used to inform the development of an mHealth intervention to increase HIV testing among AYA living in Washington, DC. METHODS This study conducted focus groups and surveys stratified by sexual orientation to identify the sociodemographics, sexual behaviors, HIV knowledge, and perceived barriers and facilitators to HIV testing among AYA ages 13-24 in the DC. HIV knowledge was explored during focus groups and measured using an adapted version of the HIV Knowledge Questionnaire. Survey data were summarized using descriptive statistics and compared by self-reported sexual orientation. Transcripts were thematically analyzed. RESULTS A higher proportion of lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth (n=16) reported sexual activity (75% vs. 60%), condomless sex (92% vs. 83%), and HIV testing (81% vs. 58%) than heterosexual youth (n=30, p-values all >0.05). HIV prevention knowledge (“condoms” and “PrEP”) and transmission (“exchange of fluids”) was high and most AYA (77%) perceived HIV testing as beneficial. However, youth also demonstrated some misinformation concerning HIV: Most participants believed an HIV test could deliver accurate results 1-week post potential exposure (67%) and that an HIV vaccine exists (72%). Youth also identified individual (“…people… are scared”) and structural (“…people don’t…know where they can go”) barriers to testing. Most AYA were very likely to use the demonstrated game prototype to help with getting testing for HIV and strongly agreed that the game was interesting, fun, and easy to learn. CONCLUSIONS 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.