Wellness-based HIV prevention counseling for young sexual/gender minorities of color in the United States

Abstract

Providers often counsel young sexual/gender minority (YSGM) of color about HIV "risk" in ways that feel unrelatable and stigmatizing. Our study explored: (1) needs for sexual wellness-based HIV prevention among 18-29-year-old YSGM of color, (2) challenges and opportunities in using this counseling approach, and (3) preliminary feasibility and acceptability of a wellness-based counseling intervention. Aim 1 collected surveys and in-depth interviews with YSGM of color. Aim 2 recruited providers to understand their needs when counseling YSGM of color and implementing wellness-based approaches. Aim 3 piloted the intervention with providers and included exit surveys and focus groups to assess acceptability and feasibility; however, this aim was cut short due to funding cuts in early 2025. In Aim 1, 23 interviews and 70 surveys were completed, with 94.3% identifying as sexual minorities. Nearly two-thirds reported that consulting a health professional who uses a sex-positive approach for HIV prevention would increase their ability to effectively use pre-exposure prophylaxis (PrEP). In Aim 3, we trained 23 providers across three sites and conducted one site debrief. If feasibility and acceptability are demonstrated, this intervention is positioned for rapid dissemination to reduce HIV prevalence among a group that has historically benefitted less from PrEP.