Background: Daily oral PrEP is highly effective in reducing sexual transmission of HIV among adults. In May 2018, the US FDA approved PrEP for use in adolescents under 18. Little remains known about awareness of and perspectives on PrEP among sexual and gender minority (SGM) adolescents assigned male at birth (AMAB) who are at elevated risk for HIV. Research suggests only 15% awareness among SGM AMAB in 2015, and it is likely awareness has risen with time. Although new PrEP delivery methods are emerging (on demand, injectable, implantable), youth’s views on these are similarly understudied. This presentation describes SGM AMAB’s awareness and perspectives of oral and long-acting PrEP. Methods: Data were collected in 2018 in 1) a larger online survey study of 219 SGM AMAB’s geosocial networking (GSN) application use and sexual health (M=16.38±0.74 years; 39% racial/ethnic minority; 6% gender minority), which asked about PrEP knowledge, use, and perceived barriers; and 2) an ongoing online focus group study about awareness and perspectives of novel PrEP delivery methods among 31 SGM AMAB aged 14-17. We examined sociodemographic, behavioral, and attitudinal correlates of daily oral PrEP awareness, use, and barriers, and preferences for novel PrEP methods. Data were analyzed using descriptive statistics, multivariable logistic regressions, and thematic analysis. Results: Survey results revealed 54.8% had heard of daily oral PrEP and 56.1% did not know how they would access PrEP if they wanted it. Of those who had heard of PrEP, only 2.5% had used it. Most had learned about PrEP online, through media, or GSN applications. Having heard of PrEP was correlated with older age, gay identity, having used a GSN app to meet partners, greater perceived risk of HIV, greater HIV knowledge, and having been tested for HIV. In the regression model, age, app use, sexual partners, and HIV knowledge were significant predictors of awareness. Not wanting to take PrEP due to side effects was associated with younger age, having lower HIV knowledge, and racial/ethnic minority identity. Talking to a provider about PrEP was correlated with PrEP awareness and perception of reduced barriers, but did not emerge as significant in multivariable models. Focus groups suggest youth see advantages to daily oral (easier to remember) and long-acting PrEP (more discreet, longer lasting), and significant drawbacks to PrEP on demand (complexity of dosing schedule, perceived lack of spontaneity of sex). Despite high interest in PrEP, youth described lack of access to healthcare and fear of parental discovery of sexual activity/SGM status as substantial barriers. Discussion: SGM AMAB adolescents report moderate awareness of PrEP. Correlates of awareness are similar to those found among SGM adults, and the internet and social media can play a significant role in increasing awareness. Youth favored daily oral and long-acting PrEP over PrEP on demand, the latter of which may be more popular among adults. Across both studies youth reported significant structural barriers to accessing PrEP which urgently need to be addressed to facilitate successful PrEP implementation and avert new HIV infections in SGM adolescents.

Background
The burden of HIV in the U.S. is shouldered primarily by young adult men who have sex men, with substantial demographic and geographic variation across the country. Many of the risk and protective behaviors that affect HIV transmission are developed during adolescence, so early prevention efforts, including relevant sexual health education and affirming sexual health care services, are critical. Previous work has documented limited access to sexual health services among youth in general, but less research has examined this issue specific to adolescent men who have sex with men (AMSM) at a national level. Understanding AMSM’s sexual health care needs as well as regional variations is important for identifying targets for intervention and/or quality improvement.
Methods
The current study used baseline data from an ongoing effectiveness–implementation hybrid trial of SMART, a web-based HIV prevention intervention delivered to AMSM across the U.S. AMSM were recruited online via paid advertisements and social media and were eligible to enroll in SMART if they were (a) aged 13­–18 years, (b) assigned male at birth, and (c) attracted to males. In the baseline survey, participants self-reported on demographics, past exposure to sex education in school and from parents, their behavior related to sexual health care in the past year, and their confidence in accessing sexual health care. We conducted chi-square and ANOVA to examine differences by U.S. census region.
Results
Among 586 AMSM (Mage=16.5, SDage=1.3) included in this study, participants were geographically (14.7% in the Northeast, 19.3% in the Midwest, 42.2% in the South, 23.9% in the West) and racially diverse, with significant differences in race/ethnicity but not sexual orientation or gender identity across regions. A majority (66.8%) of AMSM reported being taught about HIV/AIDS in school, but a minority reported receiving any HIV information (32.2%) or guidance from their parents (38.0%). A minority (less than one-third across items) have had discussions with health care providers around their sexual health; however, AMSM were on average somewhat confident about accessing various sexual health care services, including pre-exposure prophylaxis and rectal STI testing. Significantly more AMSM in the South reported exposure to HIV/AIDS education and expectations around sex from their parents, but significantly fewer reported discussions with providers about sexual orientation, male partners, and HIV/STI prevention with male partners. AMSM in the South were also least likely to be asked by a health care provider about their sexual attractions or orientation. AMSM in the West were the most likely to speak to a health care provider about HIV testing and HIV/STI prevention specific to male partners. They were also most likely to have been asked by a health care provider about sexual orientation/attraction. We found no differences in confidence accessing care by region.
Discussion
Across the U.S. but especially in the South, more sexual health education is needed for AMSM to bolster their confidence and actual discussion of sexual health topics with health care providers. Interventions may also target providers to foster their instigating and providing a safe space for such discussions.

Background: Discrimination, including racism, homophobia, and HIV-related stigma, may contribute to the increased burden of HIV among young, black, men who have sex with men (YBMSM). The links between discrimination and health outcomes are not new but not well studied in persons living with HIV. Being a member of multiple marginalized groups such as black, HIV-positive MSM, can affect individual health. Similarly, discrimination has been described as having three interrelated levels: institutional, personally mediated, and internalized. Institutional discrimination represents socio-economic differences and systemic differences in healthcare access, resulting in lower levels of health insurance coverage among HIV-positive black MSM compared to HIV-positive MSM of other races. Racial discrimination has been associated with lower CD4 count, detectable viral load, and greater likelihood of emergency room visits among black, HIV-positive MSM. Methods: We examined associations between perceived discrimination and HIV physical health outcomes including CD4+ T cell count and HIV viral load among HIV-positive YBMSM. Data were derived from the Ele[men]t study, a PRISM cohort of black MSM aged 18-29 years in Atlanta, GA. Participants were 164 HIV-positive MSM who completed computer-assisted self-interviews, HIV counseling and testing, and laboratory testing. Logistic and ordinal regression were used to examine links between discrimination and viral suppression and CD4 count. Perceived discrimination was measured using the Everyday Discrimination and the Major Experiences of Discrimination Scales. Results: The most commonly reported lifetime major discriminatory events were being unfairly fired/denied a promotion (40%) and unfair treatment by police (33%). Among those reporting any discrimination, the most cited reason for discriminatory experiences were race (28%), sexual orientation (28%), and physical appearance (9%). Participants reporting the most discrimination had a 3.54 higher odds of a detectable viral load (OR = 3.54, 95% CI = 1.14, 11.02) compared with those not reporting any discrimination. When examining individual scale items, significant harmful effects were observed for unfairly being fired/denied a promotion (OR = 2.85, 95% CI: 1.27, 6.38) and housing discrimination (OR = 3.98, 95% CI: 1.07, 14.78) while controlling for income and current medication. Conclusions: Findings suggest a complicated relationship between perceived discrimination and HIV health. Race, sexual orientation, and HIV-related stigma were considered in concert for these individuals at multiple intersections of marginalized identity. Our results demonstrated that increasing major life event discrimination was associated with increasingly worse odds for having an undetectable viral load among YBMSM living with HIV. Notably, lack of viral suppression was linked with having been unfairly fired/denied a promotion and housing discrimination events. This relationship did not hold true when considering everyday discrimination, which had inconsistent direction of effects on viral suppression. Future study should include discrimination at structural and internal levels as well as mediating factors such as resilience and stress-related growth. Additionally, socio-economic status should be carefully considered as a social determinant of health for its differential functioning among minority groups.

Background: Psychosocial concerns (e.g., exposure to violence, substance use, mental health) are prevalent, commonly co-occurring, and associated with HIV risk among adult sexual minority men. However, no research has sampled adolescent (i.e., < 18 years old) sexual minority males (ASMM) to explore the association of these concerns with HIV risk behaviors. Lacking this information, prevention efforts for this at-risk developmental group are limited. It is important to learn when these psychosocial stressors emerge and how they become associated with HIV risk behaviors, such as condomless anal sex (CAS). Methods: From June-July 2017, ASMM were recruited across the US for an online sexual health survey. Participants received a $15 gift card for completing an online survey. All procedures, including waiver of parental consent, were approved by local IRB. Participants (N=207) were young (M age = 16, range=14-17) and diverse (61% identified as White, 16% as mixed race, 11% as Black, and 8% as Asian/Pacific Island; 20% identified as Hispanic or Latino). They completed a 30-minute survey that assessed childhood sexual abuse (CSA, using the Childhood Trauma Questionnaire), problematic alcohol use (using the AUDIT-C), substance use, mental health symptoms (i.e., depression and anxiety, using the PHQ-2 and GAD-2), and voluntary condomless anal sex with a male partner. The independent variables were dichotomized and summed to create a count of the total syndemic indicators. Logistic regression models tested the association between CAS and the count of syndemic indicators, as well as each syndemic indicator separately. Results: 26% of ASMM reported having had anal sex and 20% reported having engaged in CAS. 31% reported having experienced childhood sexual abuse, while 40% scored above the clinical cutoff on negative affect, 27% reported marijuana use, and 18% scored above the clinical cutoff for problematic alcohol use. Each additional syndemic condition participants endorsed was associated with 1.4 times the odds of having had CAS (OR=1.4, 95% CI: [1.04, 1.9]. For example, a youth reporting two syndemic indicators (e.g., marijuana use, CSA) would have 2.1 times the odds of reporting he had engaged in CAS compared to a youth with no syndemic indicators. In individual logistic regression models, both CSA (OR=2.2, 95% CI: [1.1, 4.5]) and marijuana use (OR=2.3, 95% CI: [1.1, 4.7]) were associated with CAS. However, negative affect and problematic alcohol use were not (ps>.05). Conclusions: Results demonstrated that among ASMM < 18 years old, psychosocial concerns are prevalent and additively confer risk for HIV transmission. In particular, substance use and exposure to sexual violence have the potential to show such associations early and strongly. Additional research is needed to understand why these psychosocial risk factors are associated with condomless sex at an early age. In addition, mental health and substance use prevention efforts must reach the very youngest ASMM to address these psychosocial HIV risk factors in time.