This paper describes the protocol for a web-based survey (N=206) examining HIV prevention knowledge, PrEP awareness, and sexual health education gaps among sexual and gender minority adolescents aged 14-17 in Alabama, including a 7-step fraud and bot detection protocol for web-based recruitment.
Key Findings
Background
Alabama has an undiagnosed HIV rate of over 20%, with youth and young adults—particularly sexual and gender minority individuals—being the only demographic group in the United States with rising rates of new HIV infections.
The undiagnosed HIV rate in Alabama exceeds 20%.
Sexual and gender minority youth are identified as being at elevated risk for HIV acquisition.
Youth and young adults are described as 'the only demographic group in the United States with rising rates of new infections.'
This epidemiological context motivated the study's focus on adolescents aged 14-17 in Alabama.
Background
Alabama's school-based sexual health and HIV prevention education is strictly regulated and does not address the unique needs of sexual and gender minority teenagers.
The paper states that school-based sexual health and HIV prevention education in Alabama 'is strictly regulated.'
Existing education does not address the unique needs of sexual and gender minority teenagers.
This gap makes comprehensive sexual health education 'a high-priority prevention strategy for HIV and sexually transmitted infections.'
The survey was designed to understand knowledge gaps related to sexual health, HIV prevention, and pre-exposure prophylaxis (PrEP).
Methods
The study enrolled 206 participants aged 14-17 who were assigned male at birth, sexually attracted to male youth, and lived in Alabama, recruited between September 2023 and March 2024.
Total sample size is N=206.
Recruitment occurred between September 2023 and March 2024.
Half of participants were recruited through community partners (Magic City Acceptance Academy and Magic City Acceptance Center).
The other half were recruited via web-based social media.
Eligibility criteria included being assigned male at birth, sexually attracted to male youth, aged 14-17, and residing in Alabama.
Methods
A 7-step fraud and bot detection protocol was implemented to reduce the likelihood of collecting false information from web-based recruitment.
The protocol was specifically applied to web-based (social media) recruitment.
The protocol is described as a '7-step fraud and bot detection protocol.'
Its purpose was 'to reduce the likelihood of collecting false information.'
This approach addresses a recognized methodological challenge in web-based survey research with hard-to-reach populations.
Results
Preliminary sample characteristics showed a mean age of 16.21 years, with approximately a quarter identifying as transgender or gender nonconforming, and 6% identifying as transgender women.
Sample mean age was 16.21 years (SD 0.88).
About a quarter of participants identified as transgender or gender nonconforming.
6% stated their gender as a transgender woman.
30% self-reported their race as African American or Black.
12% identified as Hispanic or Latinx.
Results
More than half of the preliminary sample reported being sexually active in the past 6 months.
Over 50% of participants reported sexual activity in the prior 6 months.
This finding is presented as a preliminary result from the ongoing analysis (N=206).
Primary data analyses were described as ongoing and expected to conclude in mid-2025.
This level of sexual activity underscores the relevance of HIV prevention and PrEP education in this age group.
Methods
The study plans to use multivariable logistic regression to examine associations between personal characteristics and key constructs including HIV knowledge, PrEP awareness, and prevention preferences.
Analyses will be conducted using SPSS 29 (IBM Corp) or SAS 9.4 (SAS Institute).
Frequencies will be computed for each measure and summary scores constructed for scales such as HIV and PrEP knowledge.
Internal consistency of scales will be assessed.
The survey also evaluated preferences related to prevention modalities and trusted sources of health information.
Primary data analyses were planned to be completed in mid-2025.
Conclusions
If findings are promising, results will be used as preliminary data to support the development of an intervention addressing knowledge gaps and prevention preferences among sexual and gender minority teenagers in Alabama.
The ultimate goal is to inform an intervention targeting an 'underserved, hard-to-reach, but also high-priority population for public health efforts to Ending the HIV Epidemic.'
Key outcomes of interest include HIV knowledge, PrEP awareness, PrEP preferences, and related outcomes.
The population is framed within the national 'Ending the HIV Epidemic' initiative.
The study is described as a protocol paper, meaning full outcome data are not yet reported.
What This Means
This research describes a study designed to understand what LGBTQ+ teenagers in Alabama know—and don't know—about HIV prevention, including a medication called PrEP (pre-exposure prophylaxis) that can prevent HIV infection. The study surveyed 206 young people aged 14 to 17 who were assigned male at birth, attracted to other males, and living in Alabama, between September 2023 and March 2024. Alabama was chosen because it has a high rate of undiagnosed HIV, and its schools are restricted from teaching comprehensive sexual health education that addresses the needs of LGBTQ+ youth. Early findings show that the average participant was about 16 years old, about one quarter identified as transgender or gender nonconforming, nearly a third identified as Black or African American, and more than half reported being sexually active in the past six months.
The study used two recruitment methods—community organizations and social media—and developed a special seven-step process to screen out fake or bot-generated survey responses, which is an important methodological challenge when recruiting sensitive populations online. Researchers are still analyzing the full dataset and plan to report complete results by mid-2025. The study also asked participants about their preferred ways to receive health information and what kinds of HIV prevention tools they would be most likely to use.
This research suggests that there are likely significant gaps in HIV and PrEP knowledge among LGBTQ+ teenagers in Alabama, a group that faces both elevated HIV risk and limited access to relevant sex education. If the findings confirm these gaps, the researchers intend to use them to design a targeted educational intervention. This work matters because sexual and gender minority youth are one of the few groups in the U.S. where new HIV infections are still increasing, and reaching them with accurate, relevant prevention information during adolescence could have meaningful public health impact.
Budhwani H, Yigit I, Bruce J, Bond C, Johnson A. (2025). Adolescent Youth Survey on HIV Prevention and Sexual Health Education in Alabama: Protocol for a Web-Based Survey With Fraud Protection Study.. JMIR research protocols. https://doi.org/10.2196/63114