Kathryn Macapagal

Technology has and will continue to have a significant impact on queer people’s health and well-being; however, it is not guaranteed that these implementations lead to meaningful advancements. Through a scoping review of 69 queer health technology papers in the ACM Digital Library, we review who queer health and well-being research has centered, what health topics have been targeted, and how technology has been used to address them. Our results identify trends in health foci and intervention implementation strategies, revealing opportunities for upstream efforts that work across individual, community, and structural levels. We therefore argue for greater attention towards structural constructions of queer health and well-being, specific and intentional groupings when developing interventions, and four commitments for designing and carrying out technology-enabled health interventions: commitments to holistic constructions of problem spaces, leverage points, and unintended harms; to reflexive practices for challenging assumptions; to accountability to community needs and flourishing; and to expansion towards situated and relational understandings of health. This work culminates in a framework and research agenda for queer health technology that provides guidance for future interventions.

Background: Sexual and gender minority (SGM) adolescents who can benefit from HIV testing due to their sexual behavior (eg, condomless anal or vaginal sex) report suboptimal HIV testing rates. However, interventions designed to increase HIV testing rates among SGM adolescents are lacking, and even when effective interventions exist, reaching SGM adolescents outside research settings can be a challenge. This hybrid type 1 study aims to evaluate the effectiveness of Sharing Health Education Resources (SHER), a multimedia messaging service (MMS) intervention in increasing adolescent HIV testing rates and to address implementation challenges of reaching and engaging SGM adolescents in digital interventions in real-world settings. Objective: This study first aims to adapt a digital sexual health intervention previously designed for adolescent sexual minority males to be inclusive of all SGM adolescents and reflect new advancements in HIV prevention science. The second aim is to test the adapted intervention through a hybrid type-1 effectiveness-implementation randomized controlled trial (RCT) with the primary outcome of HIV testing. The third aim is to gather expert recommendations on how to best reach and engage SGM adolescents outside of research settings. Methods: SHER is guided by the information-motivation-behavioral skills theory and expands upon a previous intervention tested in a 2014 pilot trial. The previous version of the intervention significantly increased self-reported HIV testing among adolescent sexual minority males compared to an information-only control. Updates to this intervention in this study were driven by stakeholder and adolescent feedback and included modernizing technology, content, and gender inclusivity. An RCT will compare the impact of SHER versus an information-only control condition on HIV testing rates among 360 US SGM adolescents aged 13‐19 years. The implementation aim is focused on understanding expert and adolescent perspectives on best practices for reaching and engaging SGM adolescents outside of research settings. Results: Data collection regarding intervention updates was concluded in January 2025 with publication of results planned in fall 2026. As of April 2026, 295 participants have been enrolled into the RCT, with the conclusion of data collection, analysis, and publication of results planned for Winter 2027. All data collection regarding best practices for reaching and engaging SGM adolescents outside of research settings was completed in September 2025, with publication of results planned for Summer 2026. Conclusions: This study will evaluate whether an MMS messaging intervention based on health behavior change theory will increase SGM adolescent HIV testing relative to an information-only version of this intervention. This study will also produce expert- and adolescent-informed best practices for reaching SGM adolescents for sexual health interventions in real-world settings. Overall, this study aims to contribute to increased engagement in sexual health care and HIV testing in SGM adolescents engaging in HIV transmission risk behaviors.

Background: Lesbian, gay, bisexual, transgender, and queer/questioning, plus (LGBTQ+) youth experience significant health challenges relative to their peers, including higher rates of HIV, sexually transmitted infections, and mental health symptoms, partly due to minority stressors. Digital health interventions hold promise for addressing these issues, but their effectiveness hinges on human-centered co-design that ensures relevance and engagement. Objective: This study aimed to examine the use of Discord as a platform for conducting human-centered design (HCD) activities to adapt a digital text-based intervention designed to improve HIV testing rates among LGBTQ+ youth. Methods: We recruited 21 LGBTQ+ youth (aged 13-18 years) in the United States via social media and participant registries, oversampling minoritized gender, racial, and ethnic identities to ensure diverse representation. Over 9 months, participants engaged in structured HCD activities on a private Discord server, including polls, open-ended discussions, and interactive feedback tasks. Design insights were collected iteratively and used to refine the intervention in real time. We also surveyed participants to examine the acceptability of Discord as a tool for hosting the HCD process. Results: We identified best practices for integrating HCD methods within Discord, including cocreating the server environment with participants and enabling real-time iteration of intervention components based on youth input. The privacy of the Discord server supported psychological safety; facilitated open and effective communication between participants and the research team; and fostered an informal, familiar atmosphere. Conclusions: Discord provides an effective and acceptable environment for conducting HCD processes in the design of digital health interventions. Its structural features, including anonymity, accessibility, and community-driven interaction, facilitated meaningful youth engagement in co-design activities. These insights offer a model for leveraging social media platforms to support participatory intervention development for LGBTQ+ populations.

Background: Despite the growing use of digital platforms for sexual health education, many tools fail to meet the needs of LGBTQ+ (lesbian, gay, bisexual, transgender, and queer) teenagers, who often lack access to inclusive, affirming resources. Artificial intelligence (AI)–enabled chatbots have emerged as promising tools to address these gaps, but concerns remain around bias, usability, and trustworthiness—particularly for queer and transgender teenagers. Participatory design approaches centered around marginalized teenagers are critical to ensuring these tools are relevant, trustworthy, and equitable; yet, few studies have systematically engaged LGBTQ+ teenagers in the co-design of AI-powered sexual health interventions. Objective: This paper examines LGBTQ+ teenagers’ perceptions of Roo, Planned Parenthood Federation of America’s (PPFA) AI-powered sexual education chatbot to identify opportunities and challenges in delivering LGBTQ+-inclusive, affirming sexual health information. Methods: Embedded within Sharing Health Education Resources, a hybrid effectiveness implementation trial of a digital HIV prevention intervention for LGBTQ+ teenagers, we collaborated with PPFA to create a customized instance of Roo for integration into this study. We engaged a Youth Advisory Council comprising 15 LGBTQ+ teenagers to independently explore and interact with Roo, then gathered feedback through a week-long asynchronous discussion on a private Discord (Discord Inc) server. The research team posed open-ended questions prompting participants to reflect on Roo’s inclusivity, usability, and content priorities. We used rapid qualitative analysis organized around our research questions. Results: Participants expressed both skepticism and curiosity about AI’s role in delivering sexual health information, offering critical insights on the chatbot’s language, trustworthiness, and relevance. Teenagers identified key limitations in Roo’s inclusivity, tone, and interface, particularly around transgender-specific content, conversational depth, and stigma reduction. These findings informed targeted content updates, interface refinements, and transparency improvements, implemented by PPFA to enhance Roo for broader use. Specific changes included expanding LGBTQ+ affirming content, revising language to eliminate gendered assumptions, incorporating concrete statistics and contextualized examples to reduce stigma, and adding clearer disclosures around Roo’s AI capabilities and limitations. Conclusions: Academic and nonprofit collaborations can leverage participatory methods to enhance digital health tools in real-world contexts. LGBTQ+ teenagers served not only as testers but as co-designers, shaping the chatbot’s evolution and surfacing broader lessons about trust, AI literacy, and health equity. This study demonstrates that marginalized teenagers possess the critical insights needed to meaningfully shape AI-enabled health interventions when provided with structured opportunities for engagement. This partnership offers a scalable model for integrating community voice into the development, evaluation, and implementation of inclusive, AI-enabled health technologies.

BACKGROUND Sexual and gender minority (SGM) adolescents who can benefit from HIV testing due to their sexual behavior (e.g., condomless anal or vaginal sex) report suboptimal HIV testing rates. However, interventions designed to increase HIV testing rates among SGM adolescents are lacking, and even when effective interventions exist, reaching SGM adolescents outside research settings can be a challenge. OBJECTIVE This hybrid type 1 study aims to evaluate the effectiveness of SHER, an MMS messaging intervention in increasing adolescent HIV testing rates and to address implementation challenges of reaching and engaging SGM adolescents into digital interventions in real-world settings. METHODS SHER is guided by the Information-Motivation-Behavioral Skills theory and expands upon a previous intervention tested in a 2014 pilot trial. The previous version of the intervention significantly increased self-reported HIV testing among adolescent sexual minority males compared to an information only control. Updates to this intervention in the present study were driven by stakeholder and adolescent feedback and included modernizing technology, content, and gender inclusivity. An ongoing randomized controlled trial is comparing the impact of SHER vs. an information-only control condition on HIV testing rates among 360 U.S. SGM adolescents ages 13-19. The implementation aim is focused on understanding expert and adolescent perspectives on best practices for reaching and engaging SGM adolescents outside of research settings. RESULTS - CONCLUSIONS This study will evaluate whether an MMS messaging intervention based on health behavior change theory will increase SGM adolescent HIV testing relative to an information-only version of this intervention. This study will also produce expert- and adolescent-informed best practices for reaching SGM adolescents for sexual health interventions in real-world settings. Overall, this study aims to contribute to increased engagement in sexual healthcare and HIV testing in SGM adolescents engaging in HIV transmission risk behaviors. CLINICALTRIAL

BACKGROUND Lesbian, gay, bisexual, transgender, and queer/questioning, plus (LGBTQ+) youth experience significant health challenges relative to their peers, including higher rates of HIV, sexually transmitted infections, and mental health symptoms, partly due to minority stressors. Digital health interventions hold promise for addressing these issues, but their effectiveness hinges on human-centered co-design that ensures relevance and engagement. OBJECTIVE This study aimed to examine the use of Discord as a platform for conducting human-centered design (HCD) activities to adapt a digital text-based intervention designed to improve HIV testing rates among LGBTQ+ youth. METHODS We recruited 21 LGBTQ+ youth (aged 13-18 years) in the United States via social media and participant registries, oversampling minoritized gender, racial, and ethnic identities to ensure diverse representation. Over 9 months, participants engaged in structured HCD activities on a private Discord server, including polls, open-ended discussions, and interactive feedback tasks. Design insights were collected iteratively and used to refine the intervention in real time. We also surveyed participants to examine the acceptability of Discord as a tool for hosting the HCD process. RESULTS We identified best practices for integrating HCD methods within Discord, including cocreating the server environment with participants and enabling real-time iteration of intervention components based on youth input. The privacy of the Discord server supported psychological safety; facilitated open and effective communication between participants and the research team; and fostered an informal, familiar atmosphere. CONCLUSIONS Discord provides an effective and acceptable environment for conducting HCD processes in the design of digital health interventions. Its structural features, including anonymity, accessibility, and community-driven interaction, facilitated meaningful youth engagement in co-design activities. These insights offer a model for leveraging social media platforms to support participatory intervention development for LGBTQ+ populations.

BACKGROUND Despite the growing use of digital platforms for sexual health education, many tools fail to meet the needs of LGBTQ+ adolescents, who often lack access to inclusive, affirming resources. Artificial intelligence (AI)–enabled chatbots have emerged as promising tools to address these gaps, but concerns remain around bias, usability, and trustworthiness–particularly for queer and trans youth. OBJECTIVE This paper describes the development and implementation of an academic-nonprofit partnership between Northwestern University and Planned Parenthood Federation of America (PPFA) to adapt Roo, PPFA’s AI-powered sexual health chatbot, for LGBTQ+ teens. METHODS As part of a larger hybrid effectiveness-implementation trial, the research team collaborated with PPFA to create a customized instance of Roo and gathered feedback from a Youth Advisory Council (YAC) of LBGTQ+ teens via a private Discord server. Using a participatory, research-through-design approach, we analyzed structured qualitative feedback with rapid qualitative analysis to identify content gaps, usability concerns, and trust-related issues. RESULTS Participants expressed both skepticism and curiosity about AI’s role in delivering sexual health information, offering critical insights on the chatbot’s language, trustworthiness, and relevance. Teens identified key limitations in Roo’s inclusivity, tone, and interface, particularly around trans-specific content, conversational depth, and stigma reduction. These findings informed targeted content updates, interface refinements, and transparency improvements, implemented by PPFA to enhance Roo for broader use. CONCLUSIONS Academic-nonprofit collaborations can leverage participatory methods to enhance digital health tools in real-world contexts. LGBTQ+ teens served not only as testers but as co-designers, shaping the chatbot’s evolution and surfacing broader lessons about trust, AI literacy, and health equity. This partnership offers a scalable model for integrating community voice into the development, evaluation, and implementation of inclusive, AI-enabled health technologies.