A Socioecological Perspective on Sexual Health Promotion Choices Among Youth At-Risk for and Living with HIV in Los Angeles and New Orleans
Youth in the US remain at high relative risk for HIV and sexually transmitted infections compared to other age groups despite increasing diversity in the available tools to reduce HIV risk through behavioral strategies, biomedical methods, and treatment as prevention. Previous research has shown that acceptability and appeal of prevention methods vary across youth, and over-emphasis on any one strategy may overlook youth's autonomy to make their own informed decisions about their sexual health. We use a socioecological framework to understand factors influencing sexual health promotion choices among youth at-risk for or living with HIV. Youth ages 16-24 years old in Los Angeles and New Orleans participated in a strengths-based coaching intervention in Adolescent HIV Medicine Trials Network (ATN) studies. A total of 257 youth completed a baseline strengths assessment with a coach. We analyzed qualitative strengths assessment coach case notes to understand youth's sexual health promotion preferences and influencing factors across socioecological levels. Participants described 7 types of sexual health promotion strategies: Relationship dynamics; Not sexually active; STI testing; Condom use; PrEP use; PEP use; and HIV Viral suppression. Participants also described factors at intrapersonal, interpersonal, and community levels that impacted their preferred sexual health promotion strategies. Youth at-risk for or living with HIV make informed decisions around their sexual health based on a variety of intersecting factors across socioecological levels. These complex decisions demonstrate youth's autonomy and emphasize the importance of better incorporating patient-centered care within youth's sexual health.
Authors
- T Kerin
- Wenze Tang (ORCID: https://orcid.org/0000-0002-0491-8842)
- Dianna Polanco
- Kelsey Ishimoto (ORCID: https://orcid.org/0009-0001-2031-6913)
- Sung‐Jae Lee (ORCID: https://orcid.org/0000-0002-7924-7430)
- Cathy J. Reback (ORCID: https://orcid.org/0000-0003-4375-7452)
- Rhitishah Yuva Raju
- Jasmine Fournier (ORCID: https://orcid.org/0000-0003-4256-9476)
- Antwon Chaplin (ORCID: https://orcid.org/0009-0004-6061-4247)
- Dallas T. Swendeman (ORCID: https://orcid.org/0000-0002-4570-6352)
- Stacey Urauchi
- A Team
- Sergio Jimenez
- William Gertsch (ORCID: https://orcid.org/0009-0003-0307-438X)
- Yara Tapia
- Hailey Valles
- Sue Ellen Abdalian
- Jody Kussin
- Wilson Ramos
- Katherine A. Lewis
- Catherine Donahue
- W. Scott Comulada
- Mary Jane Rotheram
- Risa Flynn
- Marguerita Lightfoot
- Elizabeth M. Arnold
- M. Isabel Fernandez
- Curtis Wong (ORCID: https://orcid.org/0009-0007-9305-4751)
- Alice M. Ma
- Ruth Cortado
- Robert Bolan
- Manuel A. Ocasio
- Demi Thomas
- Yvonne Bryson
- Jeffrey Klausner
- Panteha Hayati Rezvan
Institutions
- Tulane University (US)
- University of Southern California (US)
- Harvard University (US)
- University of Kentucky (US)
- Medical College of Wisconsin (US)
- Yale University (US)
- Stanford Health Care (US)
- Oklahoma State University Center for Health Sciences (US)
- Stanford University (US)
Publication Details
- Journal
- AIDS and Behavior
- Published
- 2026-07-17
- DOI
- https://doi.org/10.1007/s10461-026-05226-y
- Primary Topic
- Adolescent Sexual and Reproductive Health
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- National Institute of Mental Health
- National Institute on Drug Abuse
- National Center for Advancing Translational Sciences
- National Institute on Minority Health and Health Disparities
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
- Clinical and Translational Science Institute, University of California, Los Angeles
- Center for AIDS Research, University of California Los Angeles
- Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles