(PS7-A14) Adapting an Existing Relationship Education and HIV Prevention Intervention for Gender Diverse Youth

Background: 2GETHER is a relationship education and HIV prevention program initially designed for young cisgender sexual minority male couples. The 2GETHER intervention package demonstrated preliminary feasibility, acceptability, and efficacy in previous trials in reducing HIV risk behaviors and improving relationship functioning (Newcomb et al., 2017, 2020). In an ongoing Hybrid Type I Effectiveness-Implementation trial of the intervention, we upgraded 2GETHER to include gender diverse youth who partner with cisgender men, including transfeminine, transmasculine, and non-binary youth. This project illustrates our adaptation process and identifies key areas for content updates.

Method: The adaptation team comprised of researchers who are members of the LGBTQ community, including cisgender sexual minority, non-binary, and transmasculine researchers. We leveraged the strengths and lived experiences of our team and reviewed existing intervention content to identify areas in need of adaptation. Additionally, we sought to directly involve perspectives from gender diverse youth in the adaptation process. Therefore, we formed and collaborated with a paid community advisory board (CAB) made up of racially diverse transgender and non-binary youth. CAB members were recruited from listservs and social media platforms (n=9). We conducted five online focus groups with CAB members to elicit reactions to the content (e.g., usability, appropriateness) and the degree to which the intervention content reflected their lived experiences. After all content was approved and uploaded to our online servers, CAB members tested the final intervention and provided additional feedback on the acceptability of the entire online intervention.  

Results: In collaboration with our CAB, we identified 3 types of adaptations that are needed to make this (and future) interventions more affirming of gender diverse experiences. First, “additional content” was needed to address experiences unique to gender diverse youth. For example, in the Sexual Health module, we updated our language around body parts to be inclusive of gender minorities and included prevention information applicable for people with vaginas (e.g., pregnancy risk, receptive partner condom use, etc.). Second, “content adaptation” was needed in certain modules to illustrate how certain experiences may impact gender minorities differently than cisgender sexual minorities. For example, we included scenarios in the Stress and Coping module depicting minority stressors unique to gender diverse youth and ways to cope with them. Third, “increased representation” of gender diverse youth was needed for content in which the skills are the same regardless of gender identity, like communication skills.

Conclusion: We upgraded the 2GETHER intervention to address existing disparities between the need and availability of sexual health interventions tailored for gender diverse youth who partner with cisgender men (Scheim et al., 2016). The outlined key areas may guide future researchers in expanding interventions to address sexual health disparities for gender diverse youth.