Acceptability of Multilevel Sexual Health Interventions and Sexually Transmitted Infection Screening and Testing Among Persons With HIV Across Three Clinical Sites in Florida.
Manavalan P, Gadkowski L, et al. • Journal of acquired immune deficiency syndromes (1999) • 2025
Acceptability of multilevel sexual health interventions—including ACASI-based sexual health history taking, self-collected extragenital STI testing, and LGBTQ+ welcoming environment measures—was high among people with HIV across three Florida clinics, with notable STI positivity rates including 11.9% of rectal samples positive for chlamydia and 6.5% of pharyngeal samples positive for gonorrhea.
Key Findings
Results
Acceptability of all three multilevel sexual health interventions was high among people with HIV across the three clinical sites.
Interventions were implemented across 3 Ryan White HIV/AIDS Program (RWHAP)-funded clinics in Florida between August 2020 and August 2021.
The three interventions included comprehensive sexual health history (SHH) taking using audio computer-assisted self-interview (ACASI) software, self-collected extragenital gonorrhea and chlamydia testing, and introduction of an LGBTQ+ welcoming environment.
Acceptability was assessed among people with HIV (PWH) at all three sites.
Results
Youth, lesbian/gay/bisexual, and Hispanic individuals were significantly more likely to notice and like LGBTQ+ welcoming measures compared to other groups.
Differences in acceptability of the LGBTQ+ welcoming environment were examined among youth and sexual, racial, and ethnic minorities.
The finding was statistically significant for youth, LGB individuals, and Hispanic individuals specifically regarding noticing and liking the welcoming measures.
This suggests LGBTQ+ welcoming environments may be especially meaningful to these subpopulations within HIV clinical care settings.
Results
The proportion of recommended STI tests completed based on the sexual health history assessment was high.
STI testing recommendations were generated from the comprehensive sexual health history (SHH) taken via ACASI software.
The study determined the proportion of appropriate STI testing completed based on the SHH assessment.
This indicates that ACASI-guided sexual health histories can effectively drive appropriate STI test ordering in clinical settings.
Results
Only a subset of at-risk individuals completed STI rescreening 3–6 months after initial evaluation.
The study examined whether STI at-risk individuals underwent STI screening 3–6 months after initial evaluation.
Despite high initial testing completion, rescreening rates among at-risk individuals were notably incomplete.
This gap in repeat screening represents an unmet need in the STI care continuum for people with HIV.
Results
Approximately 11.9% of rectal samples tested positive for chlamydia among the study population.
Rectal chlamydia positivity was measured using self-collected extragenital samples.
The positivity rate of 11.9% was observed among priority intervention groups in Florida.
This rate highlights a substantial burden of extragenital chlamydia infection among people with HIV in Florida.
Results
Approximately 6.5% of pharyngeal samples tested positive for gonorrhea among the study population.
Pharyngeal gonorrhea positivity was measured using self-collected extragenital samples.
The positivity rate of 6.5% was found among priority intervention groups in Florida.
Pharyngeal gonorrhea is frequently missed without extragenital testing, underscoring the importance of the self-collection protocol.
Background
Florida has the third highest rate of HIV in the United States and high rates of sexually transmitted infections, indicating unmet HIV and STI prevention needs.
This epidemiological context motivated the implementation of multilevel interventions across RWHAP-funded clinics.
The study period ran from August 2020 to August 2021.
The interventions were designed to address gaps in the STI care continuum specifically for people with HIV (PWH).
What This Means
This research suggests that offering people with HIV (PWH) a package of sexual health services—including a private, computer-based questionnaire about sexual behavior, the ability to collect their own swabs for gonorrhea and chlamydia testing from the throat and rectum, and a clinic environment designed to be welcoming to LGBTQ+ patients—is well-received by patients. The study was conducted at three HIV clinics in Florida from 2020 to 2021, a state with some of the highest rates of both HIV and other sexually transmitted infections (STIs) in the country. Patients broadly accepted and appreciated these services, and groups including young people, lesbian/gay/bisexual individuals, and Hispanic individuals were especially likely to notice and value the LGBTQ+-inclusive environment.
The study also found that when patients were guided by the computer questionnaire, a high proportion of the recommended STI tests were actually completed. This is important because STIs in the throat and rectum often cause no symptoms and are frequently missed unless specifically tested. Indeed, nearly 12% of rectal samples tested positive for chlamydia and about 6.5% of throat samples tested positive for gonorrhea, demonstrating that these infections are common and would have gone undetected without extragenital (beyond the genitals) testing. However, fewer patients returned for recommended follow-up retesting 3–6 months later, pointing to a gap that still needs to be addressed.
This research suggests that integrating comprehensive sexual health care—including private self-reporting tools, self-collected extragenital STI testing, and inclusive clinic environments—into routine HIV care is both feasible and acceptable to diverse patient populations. The high STI positivity rates found reinforce the importance of routine extragenital screening for PWH, particularly in high-burden states like Florida. The findings point to the need for improved strategies to support patients in completing recommended repeat screenings over time.
Manavalan P, Gadkowski L, Sachdeva A, Guha S, Porvasnik S, Nelson J, et al.. (2025). Acceptability of Multilevel Sexual Health Interventions and Sexually Transmitted Infection Screening and Testing Among Persons With HIV Across Three Clinical Sites in Florida.. Journal of acquired immune deficiency syndromes (1999). https://doi.org/10.1097/QAI.0000000000003569