A Qualitative Study of First HIV Test Experiences Among Sexual and Gender Minority Adolescents

Introduction: This qualitative study examined sexual and gender minority (SGM) adolescents’ first experiences with HIV testing. Methods: Data were collected from April 2018 to October 2020 as part of an HIV prevention and sex education intervention; SGM adolescents (N = 175) answered open-ended questions regarding experiences with their first HIV test and advice for other adolescents seeking HIV testing. Data were analyzed through inductive content analysis. Results: Reasons for HIV testing included (a) having sex, regardless of whether it posed a risk for HIV, (b) a desire to start PrEP, and (c) participating in HIV research studies. During their first HIV test, fears of a positive diagnosis and stigma were buffered by positive experiences with affirming providers. Participants who described being tested in clinical settings noted numerous concerns (e.g., confidentiality, stigma), in contrast to those who reported testing at home or at school-based clinics. Advice for other adolescents included having companions during testing and understanding insurance coverage and limits of confidentiality prior to getting tested. Conclusions: The analyses uncovered several facilitators and barriers to HIV testing in this population that can be addressed via individual, structural, and policy changes. Findings also underscored the need to improve HIV testing access for adolescents via clinical settings and self-testing. Policy Implications: Policies aiming to make HIV testing available for adolescents do not necessarily make testing more accessible. Adolescents should be given more specific information on where they can be tested, its costs, and what to expect when testing.