“We have to figure it out ourselves”: Transfeminine adolescents’ online sexual experiences and recommendations for supporting their sexual health and wellbeing

The internet plays a significant role in adolescent sexual development. Sexual and gender minority (SGM) adolescents are more likely than their cisgender, heterosexual peers to use online spaces for sexual and romantic purposes, as they may have a smaller pool of potential partners and more concerns about the risks of in-person partner seeking. Among SGM adolescents, gender identity may shape how youth navigate online spaces for sexual purposes but there is limited research focused on transgender and gender diverse (TGD) adolescents’ online partner seeking. Previous research has focused on cisgender gay and bisexual boys’ experiences with sexual networking applications designed for adult men who have sex with men. This perspective article integrates clinical expertise and survey data from transfeminine adolescents (N = 21) in the United States reporting their online sexual behavior and experiences. We use qualitative data to describe the sexual health, safety, and wellbeing of transfeminine adolescents and offer suggestions for clinical assessment of online versus offline sexual activity and call for inclusive sexual health resources for transfeminine adolescents

The Impact of Gain- and Loss-Framed Messages on Young Adults' Sexual Decision Making: An Experimental Study

Messages that frame a target behavior in terms of its benefits (gain frame) or costs (loss frame) have been widely and successfully used for health promotion and risk reduction. However, the impact of framed messages on decisions to have sex and sexual risk, as well as moderators of these effects, has remained largely unexplored. We used a computerized laboratory task to test the effects of framed messages about condom use on young adults' sexual decision making. Participants (N = 127) listened to both gain- and loss-framed messages and rated their intentions to have sex with partners who posed a high and low risk for sexually transmitted infections (STIs). The effects of message frame, partner risk, participant gender, ability to adopt the messages, and message presentation order on intentions to have sex were examined. Intentions to have sex with high-risk partners significantly decreased after the loss-framed message, but not after the gain-framed message, and intentions to have sex increased for participants who received the gain-framed message first. Yet, participants found it easier to adopt the gain-framed message. Results suggest that loss-framed messages may be particularly effective in reducing intentions to have sex with partners who might pose a higher risk for STIs, and that message presentation order may alter the relative effectiveness of gain- and loss-framed messages on sexual decision making. Future studies should examine the precise conditions under which gain- and loss-framed messages can promote healthy sexual behaviors and reduce sexual risk behaviors

Developing technology-based interventions for infectious diseases: ethical considerations for young sexual and gender minority people

Compared to their heterosexual and cisgender peers, young sexual and gender minority (YSGM) people are more likely to contract sexually transmitted infections (STIs; e.g., HIV) and to face adverse consequences of emerging infections, such as COVID-19 and mpox. To reduce these sexual health disparities, technology-based interventions (TBIs) for STIs and emerging infections among YSGM adolescents and young adults have been developed. In this Perspective, we discuss ethical issues, ethical principles, and recommendations in the development and implementation of TBIs to address STIs and emerging infections among YSGM. Our discussion covers: (1) confidentiality, privacy, and data security (e.g., if TBI use is revealed, YSGM are at increased risk of discrimination and family rejection); (2) empowerment and autonomy (e.g., designing TBIs that can still function if YSGM users opt-out of multiple features and data collection requests); (3) evidence-based and quality controlled (e.g., going above and beyond minimum FDA effectiveness standards to protect vulnerable YSGM people); (4) cultural sensitivity and tailoring (e.g., using YSGM-specific models of prevention and intervention); (5) balancing inclusivity vs. group specificity (e.g., honoring YSGM heterogeneity); (6) duty to care (e.g., providing avenues to contact affirming healthcare professionals); (7) equitable access (e.g., prioritizing YSGM people living in low-resource, high-stigma areas); and (8) digital temperance (e.g., being careful with gamification because YSGM experience substantial screen time compared to their peers). We conclude that a community-engaged, YSGM-centered approach to TBI development and implementation is paramount to ethically preventing and treating STIs and emerging infections with innovative technology

Patient–Provider Communication Barriers and Facilitators to HIV and STI Preventive Services for Adolescent MSM

Adolescent males who have sex with males (AMSM) are at increased risk of contracting HIV/AIDS and other sexually transmitted infections (STIs). Healthcare providers are a critical source of HIV/STI prevention, yet little is known about AMSM patient–provider sexual health communications and services. To explore this issue, we surveyed a national sample of 198 AMSM 14–17 years. Four online psychometrically validated scales indicated over half the youth avoided communicating their sexual orientation and sexual health concerns to providers due to fear of heterosexist bias, concern their sexual health information would be disclosed to parents, and a general belief that sexual minority youth do not receive equitable treatment in health care settings. Youth who reported their physicians had initiated discussion about their sexual orientation were significantly more likely to have received HIV/STI preventive services and testing. Discussion includes the importance of medical training that meets the unique sexual health needs of AMSM. Keywords Adolescent · HIV · Sexually transmitted infections · Healthcare · Men who have sex with men · MSM · Prevention · Stigma · Mistrust · Discrimination · Physician · Patient–provider communication

The Subtleties of Self-Presentation: A study of sensitive disclosure among sexual minority adolescents

Disclosing sensitive information online, such as an LGBTQ+ identity or potentially stigmatized behavior, can be necessary for many reasons, especially for those who identify as LGBTQ+ and may rely on social platforms for meeting others and social support. At the same time, these disclosures can lead to harassment and stigmatization. Evidence suggests that today's social platforms provide many more options and opportunities for sensitive disclosure than are possible offline, but we lack a taxonomy of disclosure strategies. Drawing on Goffman's self-presentation framework, we examined two types of sensitive disclosure within the cisgender male adolescent gay, bisexual, and/or queer (GBQ) population: revealing one's GBQ identity on social media and revealing the use of an anti-HIV medication, pre-exposure prophylaxis (PrEP), on both social media and dating apps. We find that today's online environment, with its different affordances, provides new opportunities for disclosure, such as the use of associations, repeated over time. Participants had distinct ideas about what disclosures were normative and relevant to particular social platforms and audiences. Lastly, we discuss suggestions for how platform design might promote sensitive disclosure