Introduction Sexual and gender minority (SGM) communities, including lesbian, gay, bisexual, transgender, queer, intersex, asexual, and Two-Spirit people, have historically been researched from a deficits-based approach that fails to highlight the ways communities survive and thrive in the face of adversity. This study endeavored to create a model of resources that promote SGM resilience using a sample that amplified traditionally underrepresented perspectives, including individuals from racial and/or ethnic minority groups, trans and/or gender diverse individuals, individuals on the asexual spectrum, and older adults. Methods Participant responses to three open-ended questions from The PRIDE Study’s (an online national longitudinal cohort study of SGM people) 2018 Annual Questionnaire were analyzed using constructivist grounded theory. These questions examined what brings people joy and what they appreciate most about their SGM identity. Participants (n = 315) were randomly selected from a larger sample of people who had responded to demographic questions and at least one open-ended question (N = 4,030) in a manner to ensure diverse representation across race/ethnicity, gender identity, sexual orientation, age, and region of residence. Results The proposed model includes social resources (Connecting with Others, Cultivating Family, Helping Others, Participating in Culture and Spirituality), affective generative resources (Engaging in Enriching Pursuits, Accessing Economic Resources), and introspective resources (Exploring One’s Authentic Self, Persevering through Hardship) that are theorized to contribute to SGM resilience across the life course. Conclusions SGM communities may tap into various resources to promote resilience. As public health practitioners, we can help to foster this resilience by resourcing and supporting initiatives that foster social connection, create spaces for community members to engage with various types of enrichment, facilitate access to economic resources, and provide support and inclusion for all SGM community members.

Background Mobile health (mHealth) interventions, including smartphone apps, have been found to be an effective means of increasing the uptake of HIV prevention tools, including HIV and sexually transmitted infection (STI) tests and pre-exposure prophylaxis. However, most HIV prevention mHealth apps tested in the United States have been tested among populations living in areas surrounding urban centers. Owing to reduced access to broadband internet and reliable cellular data services, it remains unclear how accessible and effective these interventions will be in rural areas. In addition, gay and bisexual men who have sex with men and gender minority populations in rural areas experience enhanced stigma when compared with their more urban counterparts, and these experiences might affect their willingness and interest in mHealth apps. Objective This study aimed to conduct online focus groups with men who have sex with men and transgender and gender diverse populations in the rural southern United States to assess their interest in mHealth HIV prevention apps and the features that they would be the most interested in using. Methods Focus group participants were recruited from a larger pool of sexual and gender minority respondents to a web-based research survey. The participants indicated that they would be willing to participate in an online focus group discussion. Focus groups were conducted via secure Zoom (Zoom Video Communications Inc) videoconferencing. During the focus group discussions, participants were asked to discuss their experiences with HIV and STI prevention and how these experiences were affected by living in a rural area. They were then shown screenshots of a new app to promote HIV and STI prevention among rural populations and asked to provide their opinions on the app’s features. The transcripts of the discussions were reviewed and coded using a constant comparative approach. Results A total of 6 focus groups were conducted with 26 participants. Most participants were cisgender gay and bisexual men who have sex with men (19/26, 73%); the remaining participants were transgender men (2/26, 8%), were nonbinary people (2/26, 8%), or had multiple gender identities (3/26, 12%). Participants reported numerous barriers to accessing HIV and STI prevention services and accurate information about HIV and STI prevention options. Overall, the participants reported a high degree of interest in mHealth interventions for HIV and STI prevention and suggested several recommendations for the features of an app-based intervention that would be the most useful for rural residents. Conclusions These focus group discussions indicate that rural residence is not a major barrier to mHealth HIV and STI prevention intervention implementation and that there is a high degree of interest in these approaches to HIV and STI prevention.

Introduction Long‐acting injectable (LAI) pre‐exposure prophylaxis (PrEP) for HIV prevention was approved by the U.S. Food and Drug Administration in 2021. LAI PrEP is more effective than oral PrEP. However, it is not clear whether the groups most at risk of HIV in the United States will use LAI PrEP. Willingness to use LAI PrEP and preference for LAI versus oral PrEP has not been reported for sexual and gender minority (SGM) people in the southern United States, where the HIV epidemic is concentrated. Our goal was to assess willingness to use LAI PrEP and preference for oral versus LAI PrEP among SGM people in the southern United States and to assess differences in willingness by demographics and sexual behaviour. Methods We conducted an online, cross‐sectional survey of SGM people aged 15–34 years in the southern United States (n = 583). Participants reported willingness to use LAI PrEP and preferences for LAI PrEP versus daily oral PrEP. We assessed bivariate associations and adjusted prevalence ratios for the LAI‐PrEP‐related outcomes and key demographic and behavioural characteristics. Results Overall, 68% of all participants (n = 393) reported being willing to use LAI PrEP that provides protection against HIV for 3 months. Of those, most (n = 320, 81%) indicated a preference for using LAI PrEP, compared to a daily oral pill or no preference. Willingness to use LAI PrEP was more common among transgender and non‐binary participants and participants who engaged in condomless anal intercourse in the last 6 months. Hispanic participants were more likely and non‐Hispanic Black participants were less likely to report willingness to use LAI PrEP compared to non‐Hispanic White participants. Conclusions Willingness to use LAI PrEP was high among SGM people in the southern United States, although there were some important differences in willingness based on demographic characteristics. Decreased willingness to use LAI PrEP among groups who are disproportionately affected by the HIV epidemic, such as non‐Hispanic Black SGM people, could exacerbate existing disparities in HIV incidence. LAI PrEP is an acceptable option among SGM populations in the southern United States, but strategies will be needed to ensure equitable implementation.

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UNSTRUCTURED Mobile health (mHealth) interventions, including smartphone apps, have been found to be an effective means of increasing uptake of HIV prevention tools, including HIV/STI testing and PrEP. However, most HIV prevention mHealth apps tested in the United States have been tested among populations that live in areas surrounding urban centers. Due to reduced access to broadband internet and reliable cellular data service, it remains unclear how accessible and effective these interventions will be in rural areas. Additionally, men who have sex with men (MSM) and gender minority populations experience in rural areas experience enhanced stigma compared to their more urban counterparts, and these experiences might affect their willingness and interest in mHealth apps. We conducted online focus groups with MSM and transgender and gender diverse populations in the rural southern United States to assess interest in mHealth HIV prevention apps and the features they would be most interested in using. Overall, participants reported a high degree of interest in mHealth interventions for HIV prevention and made several recommendations for the features of an app-based intervention that would be most useful. These focus group discussions indicate that rural residence is not a major barrier to mHealth HIV prevention intervention implementation.

Background Daily oral (DO) HIV pre-exposure prophylaxis (PrEP) effectively prevents HIV acquisition, but few men who have sex with men (MSM) currently use it. Newer options, such as on-demand (OD) oral and long-acting injectable (LA) PrEP may improve uptake, but little is understood about relative preferences among these options in practical start scenarios. Preferences for starting various PrEP options were examined among a US nationwide online convenience sample of MSM age 15+ collected September 2021 to February 2022. Methods Participants reporting no prior HIV diagnosis were given brief descripitions of each PrEP option and were asked “If [PrEP option] were available from your local doctor and you could access it for free, would you go to your doctor in the next month to start [PrEP option]?” Those who said yes to multiple options were asked to rank them in order of preference. MSM currently taking DO PrEP were asked whether they would switch to OD or LA. Willingness to start LA was examined by age, race/ethnicity, insurance, and prior awareness of LA. Results Of 5585 MSM not currently using DO PrEP, 50% (n=2805) would start at least one option with greatest preference for OD (Figure 1). Among this group, 73% (n=2060) were willing to start more than one option, with LA the most preferred option. Among the 27% (n=745) who would start only one, OD was the most preferred. Overall, 58% of DO PrEP users (n=1342/2332) would switch to either OD or LA, with LA being most preferred (Figure 2). Hispanic MSM who were not DO PrEP users were more likely to start LA compared to white MSM, and those with other/multiple health insurance were less likely to start LA compared to those on private health insurance (Table 1). Regardless of current DO PrEP use, MSM aware of LA were more likely to start it. Conclusion There is substantial interest in new PrEP options. Current DO PrEP users appear to be more aware of and interested in LA than PrEP naïve. Although OD PrEP may be favored by those who are PrEP-naïve, most selected multiple options and preferred LA PrEP. Increasing awareness of LA PrEP may bolster interest in its use. These findings highlight the potential role that newer PrEP options will play in community uptake of PrEP and can also inform patient-provider decisions about which PrEP options to consider. Disclosures Travis Sanchez, DVM, MPH, ViiV Healthcare: Grant/Research Support S. Wilson Beckham, PhD, MPH, MA, Viiv Healthcare: Advisor/Consultant Keith Rawlings, MD, ViiV Healthcare: Employee Alex R. Rinehart, PhD, ViiV Healthcare: Stocks/Bonds Supriya Sarkar, PhD, MPH, ViiV Healthcare: Salary|ViiV Healthcare: Stocks/Bonds Vani Vannappagari, MBBS, MPH, PhD, ViiV Healthcare: I am full time employee of ViiV Healthcare and receive GlaxoSmithKline stock as part of my compensation package|ViiV Healthcare: Stocks/Bonds.

Mpox vaccination is recommended for persons exposed to or at risk for mpox. Approximately 25% of an online sample of men who have sex with men (MSM) with presumed mpox exposure were vaccinated (≥1 dose). Vaccination was higher among younger MSM, MSM concerned about mpox, or MSM reporting sexual risk behaviors. Incorporating mpox vaccination into routine sexual health care and increasing 2-dose vaccination uptake is essential to preventing mpox acquisition, improving MSM sexual health, and averting future mpox outbreaks.