Multilevel Factors Impacting PrEP Engagement Among Young Gay Men and Young Transgender Women in Thailand: A Qualitative Analysis.

Half of new HIV infections in Thailand are among young people, the majority of whom are young gay and other men who have sex with men (YMSM) and young transgender women (YTGW). Amid low pre-exposure prophylaxis (PrEP) coverage, we explored practice-based factors that impact PrEP engagement among YMSM and YTGW. In 2018, we conducted 4 focus group discussions with 20 YMSM and 5 YTGW, and 22 in-depth interviews (5 in 2022) with healthcare providers (HCPs), community-based organization (CBO)/nongovernmental organization (NGO) staff, and peer educators. The inclusion of PrEP in universal healthcare coverage, including YMSM and YTGW, is a substantial facilitator of PrEP use; however, systemic barriers at microsocial (lack of communication about PrEP from HCPs, teachers, parents), mesosocial (healthcare-service fragmentation, lack of PrEP-competent HCPs), and macrosocial levels (annual quotas on free HIV-testing, HIV- and sexual-stigma) constrain and disincentivize adolescents' engagement with PrEP. National scale-up of youth-friendly and LGBT-affirmative CBO/NGO clinics, HCP training, and tailored programs to support adolescents' adherence may promote PrEP engagement among YMSM and YTGW in Thailand.

Peer education interventions for HIV prevention and sexual health with young people in Mekong Region countries: a scoping review and conceptual framework.

WHO-recommended rights-based approaches to sexual health emphasise participatory and youth-centred processes. Among these, peer education (PE) interventions are commonly used to promote HIV prevention and sexual health for young people, particularly in low-resource, high HIV prevalence contexts. We conducted a scoping review to identify key characteristics, implementation challenges, and knowledge gaps in the literature regarding PE interventions in Mekong Region countries. Out of 6521 publications identified through database searches, 17 peer-reviewed articles were included in the review (n = 21,469 participants). Studies from Thailand (n = 7), Vietnam (n = 5), Myanmar (n = 3), Cambodia (n = 1), and Lao PDR (n = 1) included adolescent and young key populations (n = 11) and general population youth (n = 6). Findings from quantitative (descriptive) and qualitative (thematic) analysis illustrate benefits and challenges of various elements of multicomponent PE interventions in reaching vulnerable young people and improving HIV prevention and sexual health outcomes. Focal knowledge gaps emerged in regard to peer educator outcomes (increased knowledge, skill-building, empowerment); interpersonal processes between peer educators and young people (role modelling, social dynamics); and social-structural contexts (sociocultural influences, gendered power relations), which may affect PE programme implementation and effectiveness. Future research should evaluate the potential benefits of complementing evidence-based intervention approaches - focused predominantly on assessing individual-level behavioural outcomes conceptualised as external to PE programmes - with evidence-making intervention approaches that support rights-based PE programmes: incorporating a focus on dialectical and relational processes between peer educators and young people; assessing salutary outcomes among peer educators themselves; and evaluating the situated implementation of youth-engaged PE interventions in complex sociocultural systems.

'No test, no disease': Multilevel barriers to HIV testing among young men who have sex with men and transgender women in three semi-urban areas in Thailand.

Young gay and other men who have sex with men and young transgender women in Thailand continue to be at high risk for HIV infection. We explored multilevel influences on HIV testing in order to inform the design of tailored interventions. We conducted four focus group discussions with 16-20-year-old gay men and transgender persons (n = 25) and 17 key informant interviews with healthcare providers, NGO leaders, and youth advocates. Focus groups and interviews were transcribed and reviewed using thematic analysis in Thai and English language by a bilingual team. We identified intersecting, culturally situated barriers at individual (lack of HIV knowledge, low HIV risk perception, denial), social (intersectional sexual- and HIV-related stigma, lack of family communication), institutional (inadequate and non-LGBT-inclusive sexual health education in schools, lack of youth-friendly clinics) and policy levels (parental consent requirements for HIV testing by minors). Multilevel and multisystem factors coalesce to form extensive barriers to HIV testing access and utilisation and promote disengagement from HIV prevention more broadly. Multicomponent, youth-engaged interventions informed by Thai sociocultural history and practices are needed in renewed approaches to HIV prevention and testing to end the epidemic among young gay and transgender people in Thailand.