Measuring Discomfort in Health Research Relative to Everyday Events and Routine Care: An Application to Sexual and Gender Minority Youth

Ethical Aspects of Involving Adolescents in HIV Research: A Systematic Review of the Empiric Literature

OBJECTIVE

To evaluate the ethics of involving adolescents in HIV research, we conducted a systematic review of the empiric literature.

METHODS

Electronic databases Ovid Medline, Embase, and CINAHL were systematically searched using controlled vocabulary terms related to ethics, HIV, specified age groups, and empiric research studies. We reviewed titles and abstracts, including studies that collected qualitative or quantitative data, evaluated ethical issues in HIV research, and included adolescents. Studies were appraised for quality, data were extracted, and studies were analyzed using narrative synthesis.

RESULTS

We included 41 studies: 24 qualitative, 11 quantitative, 6 mixed methods; 22 from high-income countries (HIC), 18 from low- or middle-income countries (LMIC), and 1 from both HIC and LMIC. Adolescent, parent, and community perspectives assert the benefits of involving minors in HIV research. Participants in LMIC expressed mixed views regarding parental consent requirements and confidentiality, given adolescents' both increasing autonomy and continued need for adult support. In studies in HIC, sexual or gender minority youth would not participate in research if parental consent were required or if there were confidentiality concerns. There was variation in the comprehension of research concepts, but adolescents generally demonstrated good comprehension of informed consent. Informed consent processes can be improved to increase comprehension and study accessibility. Vulnerable participants face complex social barriers that should be considered in study design.

CONCLUSIONS

Data support the inclusion of adolescents in HIV research. Empiric research can inform consent processes and procedural safeguards to ensure appropriate access.

Risks and Benefits of Adolescent Girls' Participation in Online Sexting Survey Research

The increasingly ubiquitous use of sexting among adolescent girls underscores the importance of empirical data on their sexting behaviors, motivations, and outcomes. To date, the majority of sexting studies have been conducted online; however, little is known about the extent to which responding to such socially sensitive questions may cause participant discomfort or distress. Research on this question is critical since in the absence of empirical data, institutional review boards (IRBs) may permit or place restrictions on online sexting studies based on an under- or overestimation of adolescent participation risk. The current online study asked 210 girls (aged 14-18 years, 55% non-Hispanic White, with sexting experience in the past 12 months) who previously registered to take online surveys on (1) their anticipated comfort in responding to a sexting survey include items on sexting motivations, positive and negative sexting consequences, and related sexual behaviors; (2) their perceptions of sexting research benefits/harms; and (3) comfort discussing similar topics in everyday life and with health professionals. Overall, participants were comfortable responding to sexting survey questions, rated sexting research as high benefits and low risks, and felt about the same as or more comfortable completing a sexting survey than discussing similar topics with peers, parents, or healthcare professionals. Findings suggest that anonymous online sexting studies can be classified as minimal risk research for adolescent girls and provide empirical support for IRB decisions to waive guardian permission for participation in such studies.

The CAN-DO-IT Model: a Process for Developing and Refining Online Recruitment in HIV/AIDS and Sexual Health Research

PURPOSE OF REVIEW

HIV/AIDS and sexual health research has increasingly relied on online recruitment in recent years. However, as potential online recruitment avenues (e.g., dating and sexual networking applications, websites, social media) have proliferated, navigating this process has become increasingly complex. This paper presents a practical model to guide researchers through online recruitment irrespective of platform.

RECENT FINDINGS

The CAN-DO-IT model reflects 7 iterative steps based on work by the authors and other investigators: conceptualize scope of recruitment campaign, acquire necessary expertise, navigate online platforms, develop advertisements, optimize recruitment-to-enrollment workflow, implement advertising campaign, and track performance of campaigns and respond accordingly. Online recruitment can accelerate HIV/AIDS research, yet relatively limited guidance exists to facilitate this process across platforms. The CAN-DO-IT model presents one approach to demystify online recruitment and reduce enrollment barriers.

Factors Associated With HIV Testing in Teenage Men Who Have Sex With Men

BACKGROUND

Adolescent men who have sex with men (AMSM) have a high rate of HIV diagnoses. An estimated 14.5% of HIV infections in the United States are undiagnosed; but among 13- to 24-year-olds, the rate is 51.4%. We describe HIV testing rates and identifies salient individual, family, school, and health care influences among AMSM.

METHODS

Data were collected as part of SMART, an ongoing pragmatic trial of an online HIV prevention intervention for AMSM (N = 699). Measures included lifetime HIV testing, demographics, sexual behaviors, condom use, HIV education from school and family, sexual health communication with doctors, HIV knowledge, and risk attitudes.

RESULTS

Only 23.2% of participants had ever had an HIV test. Rates of testing increased with age (5.6% in 13- to 14-year-olds; 15.8% in 15- to 16-year-olds; 37.8% in 17- to 18-year-olds), and sexual experience was a strong predictor of testing (odds ratio: 6.54; 95% confidence interval: 3.95-11.49; P < .001). Most participants had a regular doctor (67.5%), but few had conversations about same-sex sexual behaviors (21.3%), HIV testing (19.2%), or sexual orientation (29.2%). Speaking to a doctor about HIV testing had a large effect (odds ratio: 25.29; confidence interval: 15.91-41.16; P < .001), with 75.4% who had such conversations having been tested, compared to only 10.8% of those who had not had such conversations.

CONCLUSIONS

Despite higher risk, few participants reported ever having received an HIV test. Data indicate pediatricians are an important, but largely untapped, source of testing and could be integral to achieving testing rates needed to end the epidemic.