Renata Sanders

Adolescent Psychosocial, Social, and Cognitive Development

The goal of adolescence is to gain independence and establish a secure identity. • Adolescents’ cognitive development can result in abstract thinking that can predispose them to risktaking behavior and a sense of invincibility. • Clinicians can use the primary care visit to promote independence and prepare parents for the features experienced during adolescent development. • Parental or supervisory monitoring is critical in ensuring that teens remain safe while gradually becoming more independent.

The Intersection of Sociocultural Factors and Health-Related Behavior in Lesbian, Gay, Bisexual, and Transgender Youth: Experiences Among Young Black Gay Males as an Example

Intersectionality suggests that multiple social identities intersect at the individual or micro level of experience and reflects larger social structural inequities experienced on the macro level. This article uses intersectionality to describe how multiple stigmatized social identities can create unique challenges for young black gay and bisexual men (YBGBM). YBGBM exist at the intersection of multiple stigmatized identities compared with their majority peers. This article examines key intersecting identities and cultural expectations that exist in YBGBM and how those factors may predispose young men to adverse health outcomes and health inequality.

Introductory Learning of Inclusive Sexual History Taking: An E-Lecture, Standardized Patient Case, and Facilitated Debrief

Introduction This student-driven curriculum intervention, implemented with first-year medical students, was guided by the Association of American Medical Colleges’ standards for medical education on health care for sexual and gender minorities. Its goals are to describe the spectrum of sexual orientation and gender identity and sensitively and effectively elicit relevant information from patients about their sexual orientation and gender identity through inclusive sexual history taking. Methods Developed through student-faculty collaboration, this three-part module includes a 14-minute e-lecture on taking an inclusive sexual history, a 35-minute formative standardized patient encounter in which students take a sexual history and receive feedback, and a 20-minute facilitated group debrief on the standardized patient activity. Results Students completed a postmodule evaluation anonymously; the majority of respondents (92%) agreed that they felt more prepared to take a sexual history inclusive of sexual and gender minority patients. Most were more comfortable discussing sexual orientation (91%) and gender identity (83%) with patients after the module. Content analysis revealed an improved confidence in creating a safe space for sexual and gender minority patients and an increased awareness of biases about sexual and gender minority patients. Discussion This curriculum serves as an early foundation for students to understand sexual and gender minority identities and develop confidence in their inclusive sexual history taking skills before they provide care for patients. In addition, the student-driven curriculum development process used can serve as a template for students at other institutions hoping to collaborate with faculty to develop comprehensive sexual and gender minority curricula.

Prevalence of HIV Testing Provision at Community Organizations Serving Young People in a Mid-Atlantic City, 2013-2014

Objectives: Little is known about the prevalence of human immunodeficiency virus (HIV) testing at community organizations or the organizational characteristics associated with testing. The objective of this study was to describe (1) the prevalence of HIV testing at community organizations serving young people in a mid-Atlantic urban city and (2) the characteristics associated with organizations that provide such testing. Methods: We conducted telephone or in-person surveys between February 2013 and March 2014 with 51 directors and administrators of community organizations serving young people. We asked whether the organization provided HIV screening or testing, and we collected data on organizational characteristics (eg, setting, client, and staff member characteristics; services offered). We generated frequencies on measures and used Poisson regression analysis to examine the association between testing and organizational characteristics. Results: Of the 51 organizations surveyed, 21 provided HIV testing. Of the 30 organizations that did not provide HIV testing, only 7 had a relationship with programs that did provide it. Characteristics associated with the provision of HIV testing included offering general health services (relative risk [RR] = 4.57; 95% confidence interval [CI], 1.68-12.48; P = .003) and referral services for sexually transmitted infection screening (RR = 5.77; 95% CI, 1.70-19.59; P = .005) and HIV care (RR = 4.78; 95% CI, 1.61-14.21; P = .005), as well as among administrators who perceived their staff members were comfortable talking with young people about sexual health (RR = 3.29; 95% CI, 1.28-8.49; P = .01). Conclusions: The prevalence of HIV testing provision at organizations serving young people in this mid-Atlantic city was low, and few organizations offered linkages to HIV testing. Strategies are needed to increase the provision of HIV testing at community organizations serving young people, whether through direct or linked approaches.

Structural Interventions with an Emphasis on Poverty and Racism

HIV/AIDS continues to disproportionately affect African Americans. While African Americans represent 13% of the U.S. population, they account for nearly 50% of new HIV/AIDS infections (Centers for Disease Control and Prevention (CDC), 2008; McKinnon, 2003). Disproportionate rates are seen most among African American men who have sex with men (MSM) and women. Many African Americans at risk for acquiring HIV or other STIs disproportionately live in poverty and are plagued by communities with high rates of homelessness, unemployment, incarceration and substance abuse/dependence (Adimora & Schoenbach, 2005). How such factors increase the probability of exposure is very complex.

Missed Opportunities to Address Pregnancy Prevention With Young Men in Primary Care

Young men (aged 15-24 years) have pregnancy prevention needs, yet little is known about whether they perceive they learn about pregnancy prevention in primary care. A sample of 190 young men seen in primary care in one city from April 2014 to September 2016 were assessed on perceived learning about pregnancy prevention, background and visit characteristics, pregnancy prevention care receipt, and contraception needs at last sex. The majority of participants were non-Hispanic black (92%), aged 15 to 19 years (54%), seen for a physical examination (52%), and established patients (87%). Few participants perceived they learned about pregnancy prevention (32%), regardless of sexual activity (33% among sexually active participants, 26% among never sexually active). Poisson regression models determined that perceived learning about pregnancy prevention was independently associated with young men’s pregnancy prevention care receipt and contraception needs at last sex. Findings highlight the need to improve providers’ delivery of pregnancy prevention services to young men.

P5.29 Awareness and interest in pre-exposure prophylaxis (PREP) among young men attending a public sexually transmitted diseases (STD) clinic in a high prevalence urban setting

Introduction Young men who have sex with men (YMSM), especially African American YMSM, are disproportionately affected by HIV. Pre-Exposure Prophylaxis (PrEP) is a highly effective biomedical intervention that could prevent new HIV infections among YMSM. We assessed awareness and interest in PrEP among young men receiving care at the Baltimore City Health Department (BCHD) Sexually Transmitted Diseases (STD) Clinics. Methods We surveyed a convenience sample of 252 men ages 18–24 who attended BCHD clinics between 4/12/2016 and 10/3/2016. Participants were provided a self-administered survey that assessed awareness and interest in PrEP. Univariate and multivariable logistic regression analysis examined predictors of awareness and interest. Data collection continues to determine if awareness and interest change over time. Results Mean age was 21.5 (SD=1.98) and the majority (93.7%) self-identified as African American. Thirty-three participants (13.1%) reported sex with other men. Among all participants, 19.4% were aware of PrEP, and 44.4% were interested in learning more about PrEP. Among YMSM, 72.7% were aware of PrEP, 63.6% were interested in learning more about PrEP, and 9.1% reported current PrEP use. No current PrEP use was found in young men who did not report sex with men. In multivariable analysis adjusting for race, YMSM were more likely to be aware (AOR=19.9, p<0.001) and interested in PrEP (AOR=2.5, p=0.023) than young men who did not report sex with other men. Among YMSM, 37.5% reported learning about PrEP from healthcare providers, 36.4% from friends or sexual contacts, and 24.2% from media (internet, television, phone apps). Conclusion YMSM receiving care at the BCHD STD Clinics are likely to be aware and interested in PrEP but fewer than 10% may be taking PrEP. Given that STD Clinics serve primarily minority young males who are disproportionately affected by HIV, future work should seek to improve youth-friendly services at public health clinics and leverage awareness and interest in PrEP in order to improve uptake in this vulnerable population.

O09.6 Integration of prep in an academic adolescent clinic & impact of prep use on sexually transmitted infection (STI) rates

Introduction US youth are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) significantly reduces the risk of HIV infection and may impact sexual risk. Clinics that serve adolescents are one site proposed in reaching sexually active youth. We sought to: 1) describe the integration of PrEP into an adolescent clinic; and 2) examine impact of PrEP use on sexually transmitted infection (STI) rates. Methods Over 6 months, we integrated PrEP program into current family planning (FP) and HIV testing programs in an urban adolescent clinic. Patient lists were reviewed daily to identify those eligible for HIV testing/FP. Each eligible youth was asked about awareness of and interest in PrEP. We reviewed each chart to examine the PrEP cascade including: awareness, receipt of information, referral and referral acceptance, and PrEP use. We then examined whether PrEP use impacted rates of STI, comparing proportion of youth on PrEP with an STI in the 6 months before and after PrEP. Results 234 youth were approached as part of the the HIV/FP program. The mean age was 17.7 (S.D. 3.0), 232 were black (99%), 101 were males (43%), 133 were females (57%), 2 transgender (1%), and 24 self-identified as lesbian, gay, or bisexual (LGB) (10%). Among the 234 youth seen, 17 (7.2%) were aware of PrEP, 49 (21%) received information, and 33 (14%) were referred for PrEP. Among those referred, 24 (73%) accepted referral and 15 (45%) initiated PrEP. Rates of STI decreased from 60% (n=9) at baseline/6 months prior to 13% in the 6 months after PrEP (p=0.02). Conclusions Few sexually active youth in this setting were aware of PrEP. Coupling HIV testing/FP with an assessment of interest in PrEP and referral to PrEP services may be one access point in increasing knowledge and use of PrEP.

Do Nonclinical Community-Based Youth-Serving Professionals Talk With Young Men About Sexual and Reproductive Health and Intend to Refer Them for Care?

Young men (ages 15–24) may benefit from community-based connections to care since many have sexual and reproductive health (SRH) needs and low care use. This study describes nonclinical community-based youth-serving professionals’ (YSPs) SRH knowledge, confidence, past behaviors, and future intentions to talk with young men about SRH and refer them to care, and examines factors associated with care referral intentions. YSPs (n = 158) from 22 settings in one mid-Atlantic city answered questions about the study’s goal, their demographics and work environment from August 2014 to December 2015. Poisson regression assessed factors associated with YSPs’ care referral intentions. On average, YSPs answered 58% of knowledge questions correctly, knew 5 of 8 SRH care dimensions of where to refer young men, and perceived being somewhat/very confident talking with young men about SRH (63%) and referring them to care (77%). During the past month, the majority (63%) talked with young men about SRH but only one-third made care referrals; the majority (66%) were somewhat/very likely to refer them to care in the next 3 months. Adjusted models indicated YSPs were more likely to refer young men if they had a very supportive work environment to talk about SRH (adjusted RR = 1.51, 95% CI [1.15, 1.98]), greater confidence in SRH care referral (1.28 [1.00, 1.62]), and greater SRH care referrals in the past month (1.16 [1.02, 1.33]). Nonclinical community-based YSPs have poor-to-moderate knowledge about young men’s SRH care, and less than one-third reported referrals in the past month. Findings have implications for educating YSPs about young men’s SRH care.

Sexual Partner Characteristics, Relationship Type, and HIV Risk Among a Community Venue–Based Sample of Urban Adolescent and Young Adult Men Who Have Sex With Men

Few studies have examined sexual partnerships and HIV risk in diverse samples of African American/Black and Hispanic/Latino adolescent and young adult men who have sex with men (YMSM), a group that have a high burden of HIV in the United States. A community–venue recruitment approach was used, which identified significant differences in HIV risk by sexual partner type among 1,215 YMSM. Those with casual partners had a higher number of sexual partners, had more sexually transmitted infections (STIs), were more likely to engage in transactional sex, and to use alcohol, marijuana, or other substances compared with those with main partners only. Among those with female sexual partners, many used condoms “every time” when engaging in vaginal sex with casual partners, but a sizable proportion “never/rarely” used condoms with their main partners. Our findings demonstrate a need for tailored HIV prevention education and counseling with necessary skills regarding consistent and correct condom use with all sexual partnerships.