Reducing HIV vaccine and prevention hesitancy among sexual and gender minority adolescents

Project Summary Adolescents and young adults are disproportionately affected by HIV in the USA, accounting for 21% of new infections, with sexual and gender minority (SGM) youth carrying the greatest burden of disease. Recently, phase I trials of potential HIV vaccines have opened possibilities for more prevention options available to youth (in addition to oral and injectable PrEP). However, implementation of biomedical HIV prevention (e.g., PrEP) among youth is hindered by numerous barriers that will likely affect HIV vaccine uptake, including misinformation/lack of information, medical mistrust, and stigma. Youth-focused messaging on biomedical HIV prevention is nearly nonexistent, leaving SGM teens with incomplete knowledge and fostering misunderstanding and negative perceptions about biomedical HIV prevention methods. In addition, lessons learned from the rollout of the HPV and COVID-19 vaccines indicate that unclear public health messaging, dis- or misinformation from media/online sources, and vaccine stigma contributed to lack of trust, delayed uptake, or outright refusal of vaccines. As HIV vaccines are in development, and PrEP remains underutilized among SGM adolescents, now is the best time to understand and address biomedical HIV prevention concerns and misinformation among youth. Therefore, this study proposes to preemptively debunk (i.e., "prebunk") misinformation about HIV vaccines, improve attitudes regarding multiple methods of biomedical HIV prevention, and improve awareness, intentions, and uptake among SGM youth. In Aim 1, using an online survey, we will gain comprehensive understanding of biomedical-HIV-prevention-related knowledge, social norms and attitudes, and behavioral intent among a diverse nationwide sample of 700 SGM youth age 13-21. In Aim 2, we will develop 8 brief youth-centered video vignettes aimed at prebunking vaccine misinformation and presenting one or more complementary biomedical prevention methods (vaccine, PrEP, condoms). These video messages will be delivered through narrative storytelling formats that are relevant, compelling, and persuasive for youth. We will obtain feedback about the video vignettes from SGM youth and adult stakeholders at multiple timepoints during video production and integrate this feedback into the final cuts. In Aim 3, we will test the effectiveness of our messages in a randomized controlled trial with 500 SGM youth, which will compare the video messages against an information-only control (e.g., publicly available information from CDC on HIV vaccines and other forms of biomedical prevention). Three-month post-test outcomes include vaccine acceptability and intentions, vaccine beliefs, and proxies for vaccine uptake (e.g., prevention information seeking, HIV/STI testing, PrEP initiation.) Within this aim, we will also explore barriers and facilitators to online- and in-person implementation via interviews with staff in community/clinical settings and experts in entertainment education and streaming media.