An interactive text-messaging intervention had high acceptability and significantly increased study-visit retention and PrEP adherence among young individuals at risk for HIV acquisition.

One emerging avenue for the exploration of adolescents’ sexual orientation identity development is the Internet since it allows for varying degrees of anonymity and exploration. The purpose of this phenomenological study was to examine the role of the Internet in facilitating the sexual orientation identity development process of gay and bisexual male adolescents. Qualitative interviews were conducted with an ethnically diverse sample of 63 gay/bisexual male adolescents (ages 15–23). Participants reported using a range of Internet applications as they explored and came to accept their sexual orientation identity, with the intended purpose and degree of anonymity desired determining which applications were used. Youth reported that the Internet provided a range of functions with regard to the exploration and acceptance of their sexual orientation identity, including: 1) increasing self awareness of sexual orientation identity; 2) learning about gay/bisexual community life; 3) communicating with other gay/bisexual people; 4) meeting other gay/bisexual people; 5) finding comfort and acceptance with sexual orientation; and 6) facilitating the coming out process. Future research and practice may explore the Internet as a platform for promoting the healthy development of gay and bisexual male adolescents by providing a developmentally and culturally appropriate venue for the exploration and subsequent commitment to an integrated sexual orientation identity.

Background Young men who have sex with men (YMSM) in the United States have among the highest incidence of HIV and sexually transmitted infection (STI) and the lowest uptake of HIV and STI testing and pre-exposure prophylaxis (PrEP). Nearly universal mobile phone ownership among youth provides an opportunity to leverage mobile health apps to increase HIV/STI testing and PrEP uptake among YMSM. Objective The goals of this project are to develop and refine LYNX, a novel mobile app to support linkage to HIV/STIs testing and PrEP services among YMSM in the United States, and to evaluate the acceptability and feasibility of LYNX in a pilot randomized controlled trial (RCT). Methods This research protocol will be conducted in 3 phases: an iterative development phase with a series of 3 focus groups among 20 YMSM to refine the LYNX app; an open technical pilot among 15 YMSM to optimize usability of the app; and then a 6-month pilot RCT among 60 HIV-uninfected YMSM at risk for HIV acquisition. Developed using the Information, Motivation, and Behavioral skills theoretical model, the LYNX app includes an electronic diary to track sexual behaviors (information), a personalized risk score to promote accurate risk perception (information/motivation), testing reminders (motivation/behavioral skills), and access to home-based HIV/STI testing options and geospatial-based HIV/STI testing care sites (behavioral skills). Feasibility and acceptability will be assessed through app analytics of usage patterns and acceptability scales administered via computer-assisted self-interview at 3 and 6 months. We will also evaluate preliminary efficacy by comparing the proportion of YMSM who test at least once during the 6-month pilot and the proportion who successfully link to a PrEP provider in the intervention versus control groups. Results Formative work is currently underway. The LYNX pilot RCT will begin enrollment in October 2018, with study results available in 2019. Conclusions The LYNX app is one of the first mobile apps designed to increase HIV/STI testing and PrEP uptake among YMSM. As low-perceived risk is a barrier to HIV/STI testing and PrEP use among youth, the personalized risk assessment and interactive sexual diary in LYNX could assist YMSM in better understanding their HIV risk and providing motivation to test for HIV/STIs and initiate PrEP. Coupled with community-based recruitment, this novel mobile app has great potential to reach and engage YMSM not currently involved in care and increase rates of HIV/STI testing and PrEP uptake in this vulnerable population. Trial Registration ClinicalTrials.gov NCT03177512; https://clinicaltrials.gov/ct2/show/NCT03177512 (Archived by WebCite at http://www.webcitation.org/73c917wAw) International Registered Report Identifier (IRRID) PRR1-10.2196/10659