Gregory Swann

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.

Sexual and gender minority people assigned female at birth (SGM-AFAB) experience disproportionately high rates of intimate partner violence victimization (IPVV), raising concerns about effects on their mental health. However, research on the psychological effects of IPVV among SGM people is sparse, primarily cross-sectional, and narrow in its assessment of IPVV and mental health. We aimed to extend this literature by using multiwave longitudinal data to assess the effects of multiple forms of IPVV on SGM-AFAB mental health. A racially diverse sample of 488 SGM-AFAB individuals (age 16–32 at baseline) completed 7 waves of data across 3.5 years, reporting at each wave on psychological, physical, sexual, coercive control, and SGM-specific IPVV and polyvictimization (i.e., experiencing multiple types of IPVV), as well as depressive and anxiety symptoms, problematic alcohol and cannabis use, suicide contemplation and attempts, and self-harm. Using multilevel models, we estimated the within- and between-person associations between each type of IPVV and each mental health outcome. Results revealed the most robust effects of IPVV on depressive and anxiety symptoms, which were associated with almost all IPVV types at both the between- and within-person levels. Psychological, physical, and sexual IPVV and polyvictimization also showed both within- and between-person associations with self-harm behaviors. Most IPVV types showed between-person associations with consideration of suicide and suicide attempts. Though less consistent across IPVV type and level of analysis (within- vs. between), IPVV was also associated with problematic substance use. Together, findings indicate clear negative effects of IPVV on the mental health of SGM-AFAB individuals, underscoring the need for policy and interventions aimed at preventing IPVV and supporting IPVV survivors in this vulnerable population.

This study evaluated the efficacy of the 2GETHER relationship education and HIV prevention program for young male couples in reducing the risk for HIV. We conducted a randomized controlled trial of 2GETHER relative to an attention-matched and highly active positive affect enhancement program for couples. We randomized 128 young male couples (N = 256) to 2GETHER or control from 2017 to 2021. Primary biomedical outcome (i.e., rectal chlamydia and gonorrhea) was measured at baseline and 12 months and self-reported condomless anal sex was measured every 3 months across 12-month follow-up. Secondary outcomes were other HIV prevention and risk behaviors, relationship functioning, and substance use. We used multilevel models in MPlus to account for clustering with dyads and within-person change over time. Effects of time (for self-reported outcomes) were modeled using latent growth curves at the between-couple level. We observed no differences between conditions in outcomes, but there was a significant change in outcomes across 12 months. Rates of rectal sexually transmitted infections and self-reported condomless anal sex decreased significantly in both conditions. We also observed significant increases in HIV testing, improvement in relationship communication, and reduction in alcohol-related problems in both conditions across 12 months. Couples in both the 2GETHER and positive affect enhancement programs showed improvement in biomedical and behavioral indicators of HIV risk, as well as improvement in relationship communication, but without a treatment effect we cannot conclude improvement resulted from the interventions. Couple-based programs that promote connectedness, including relationship education and positive affect enhancement, have a strong potential to reduce young couples' HIV risk. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Background: Young men who have sex with men (YMSM) are disproportionately impacted by the HIV epidemic in the USA, and a large number of new infections among YMSM occur in the context of main or primary partnerships. At the same time, healthy romantic relationships promote health and wellbeing by improving social support and encouraging healthy behaviors. Thus, we created 2GETHER: a relationship education and HIV prevention program for young male couples. 2GETHER is delivered face-to-face in a university setting and is composed of two group sessions and two individualized skills coaching sessions. We observed strong support of the feasibility, acceptability, and preliminary efficacy of 2GETHER in a pilot trial. Methods: We are conducting an attention-matched randomized controlled trial (RCT) to test the efficacy of 2GETHER relative to a control condition based on a well-validated positive affect enhancement program. Enrollment occurred between August 2017 and March 2021 in Chicago and surrounding areas, and we enrolled and randomized 128 dyads (N = 256 individuals). Follow-up is ongoing and we will examine primary and secondary behavioral outcomes at 12 months post-intervention, with interim follow-up at 3, 6, and 9 months post-intervention. The primary biomedical outcome is sexually transmitted infection incidence at a 12-month follow-up. Discussion: 2GETHER is innovative in that it places an equal emphasis on relationship skill building and HIV prevention. Thus, the program has the potential to impact numerous health-related outcomes. Despite challenges related to the recruitment of couples and the COVID-19 pandemic, we were able to enroll a robust sample of young male couples with sufficient power to detect effects on study outcomes. Trial registration: ClinicalTrials.gov NCT03186534.

Introduction The Sexual Orientation Microaggression Inventory (SOMI) has been used to measure sexual orientation-based microaggression experiences. However, at 19 items, the SOMI may be difficult to fit into survey batteries where microaggressions are not the primary predictor or the time researchers have with each participant is very limited. Methods We sought to identify an eight-item short form of the SOMI (SOMI-SF) in a sample of sexual minority (SM) youth (N = 879) and confirm the validity and reliability of the SOMI-SF by administering both versions to separate cohorts of male-assigned (N = 533) and female-assigned (N = 430) at birth SM youth. Data were collected from April 2018 to May 2020. Results We found high reliability (α > 0.80) and validity (significant association with SM victimization, depression symptoms, anxiety symptoms, and internalized stigma) in all three samples for the SOMI-SF. Conclusions For researchers looking to conserve time and limit burden, the SOMI-SF is a high-quality option for measuring sexual orientation microaggressions. Policy Implications The greater ease of administering the SOMI-SF means that sexual orientation microaggressions can be measured in a greater number of contexts. With a growing literature linking these experiences to poorer health outcomes for SM populations, measuring these experiences quickly and accurately can improve our understanding of the mechanisms creating those links and impact policy necessary to alleviate them.

Many sexual minority youth of color experience enacted stigma based on each of their minority identities. We examined whether experiences of racist discrimination and heterosexist microaggressions were associated with intimate partner violence (IPV) among female-assigned at birth (FAB) sexual minority youth of color. Data were drawn from a larger study of FAB sexual and gender minority youth (FAB400; N = 488). We selected racial/ethnic minority participants who reported a sexual minority identity and reported a romantic relationship in the previous 6 months (N = 249). Negative binomial models were used to test for associations between enacted stigma (racial discrimination and heterosexist microaggressions) and IPV (psychological, physical, sexual, and sexual minority-specific) perpetration and victimization. When considered separately, both forms of enacted stigma was positively associated with perpetration and victimization across all four types of IPV. In multivariate models, racial discrimination and heterosexist microaggressions both had unique, additive effects on psychological IPV perpetration and physical- and sexual minority-specific IPV victimization. Only racial discrimination was uniquely associated with physical perpetration and psychological victimization. Only heterosexist microaggression was uniquely associated with sexual minority-specific perpetration and sexual IPV perpetration and victimization. Findings illustrate how enacted stigma based on each minority identity intersect to raise risk for IPV among sexual minority youth of color.

Female-assigned at birth sexual and gender minorities (FAB SGM) are at elevated risk of experiencing intimate partner violence (IPV), yet little longitudinal research has been conducted with this population. In the current study, we attempted to understand how patterns of IPV victimization and perpetration, measured across a wide range of IPV behaviors (psychological, physical, sexual, cyber, and SGM-specific), changed over time for FAB SGM youth. Participants came from a longitudinal cohort study of FAB SGM late adolescents and young adults (FAB400; N = 488) and included anyone who reported a romantic partner at one of the first three waves (six months apart; N = 433). Latent class analysis (LCA) was run at each wave to determine the best-fitting class structure across IPV experiences. These were followed up with latent transition analyses (LTAs) to determine patterns of movement between classes over the course of the three waves. Lastly, we looked at the effects of staying with the same romantic partner on transitions. We found that the same three-class structure replicated across all three waves of the study. That class structure identified no/low, psychological, and high IPV classes at each wave. In the LTA, when transitions occurred for FAB SGM, they were much more likely to transition to a class defined by lower likelihoods of experiencing IPV (i.e., psychological to no/low) than they were to a class defined by higher likelihoods of IPV (i.e., psychological to high). However, we found that FAB SGM youth were less likely to transition to a less severe IPV class if they maintained the same serious romantic partner across waves. This finding, in particular, suggests that IPV is often relationship specific for FAB SGM and that efforts to reduce IPV in SGM communities must consider intervening at the relationship level to effect meaningful change.

Very little research has examined sexual satisfaction in young gay, bisexual, queer, and other men who have sex with men (YMSM). Sexual satisfaction has important implications for individual wellbeing and is a central component of romantic relationship functioning and satisfaction. In order to fill this gap, this study examined interpersonal and intrapersonal factors associated with sexual satisfaction in a large sample of young male couples. Data for these analyses came from the baseline visits of two ongoing randomized controlled trials of 2GETHER, a relationship education and HIV prevention program for young male couples. Participants for the current analytic sample were 419 couples (individual N = 838) from across the United States who were diverse in terms of race/ethnicity, HIV status, and geographic region. Analyses found that relationship functioning (i.e., relationship satisfaction, communication) was positively associated with sexual satisfaction, while not having a specified relationship agreement (i.e., monogamy/non-monogamy agreement) was associated with less sexual satisfaction. Intrapersonal factors (i.e., depression, substance use) were associated with sexual satisfaction, but most of these effects became non-significant in a full multivariate model. Relationship functioning plays a central role in sexual satisfaction and should be addressed in couple-based programs to optimize relationship functioning and sexual health.

Background: Young men who have sex with men have a high HIV incidence, and a substantial proportion of incident infections occur in the context of main partnerships. However, romantic relationships also provide numerous benefits to individual health and wellbeing. 2GETHER is a relationship education and HIV prevention program for young male couples, and the 2GETHER USA randomized controlled trial (RCT) was launched to establish the efficacy of an online version of 2GETHER. Objective: The objective of 2GETHER is to optimize relationship functioning in young male couples as a method to improve communication about sexual risk behaviors and reduce HIV transmission. In the 2GETHER USA study, 2GETHER was adapted for online administration to couples across the United States via videoconferencing. The intervention in question aims to address the unique needs of couples from varied racial/ethnic backgrounds and geographic regions. Methods: This is a comparative effectiveness RCT of 2GETHER USA relative to existing public health practice (control). 2GETHER USA is a hybrid group- and individual-level intervention that delivers three weekly online group discussion sessions for skills delivery, followed by two individualized couple sessions that focus on skills implementation in each couple. The control condition differs by participant HIV status: (1) the Testing Together protocol for concordant HIV-negative couples; (2) medication adherence and risk reduction counseling for concordant HIV-positive couples; or (3) both protocols for serodiscordant couples. Follow-up assessments are delivered at 3-, 6-, 9-, and 12-months post-intervention in both conditions. Testing for rectal and urethral Chlamydia and Gonorrhea occurs at baseline and 12-month follow-up. The primary behavioral outcome is condomless anal sex with serodiscordant serious partners or any casual partners. The primary biomedical outcome is sexually transmitted infection incidence at a 12-month follow-up. Results: As of October 11, 2019, the trial has enrolled and randomized 140 dyads (Individual N=280). Enrollment will continue until we randomize 200 dyads (N=400). Assessment of intervention outcomes at 3-, 6-, 9-, and 12-months is ongoing. Conclusions: 2GETHER is innovative in that it integrates relationship education and HIV prevention for optimizing the health and wellbeing of young male couples. The 2GETHER USA online adaptation has the potential to reach couples across the United States and reduce barriers to accessing health care services that are affirming of sexual minority identities for those who live in rural or under-resourced areas. Trial Registration: ClinicalTrials.gov NCT03284541; https://clinicaltrials.gov/ct2/show/NCT03284541 International Registered Report Identifier (IRRID): DERR1-10.2196/15883

BACKGROUND Young men who have sex with men have a high HIV incidence, and a substantial proportion of incident infections occur in the context of main partnerships. However, romantic relationships also provide numerous benefits to individual health and wellbeing. 2GETHER is a relationship education and HIV prevention program for young male couples, and the 2GETHER USA randomized controlled trial (RCT) was launched to establish the efficacy of an online version of 2GETHER. OBJECTIVE The objective of 2GETHER is to optimize relationship functioning in young male couples as a method to improve communication about sexual risk behaviors and reduce HIV transmission. In the 2GETHER USA study, 2GETHER was adapted for online administration to couples across the United States via videoconferencing. The intervention in question aims to address the unique needs of couples from varied racial/ethnic backgrounds and geographic regions. METHODS This is a comparative effectiveness RCT of 2GETHER USA relative to existing public health practice (control). 2GETHER USA is a hybrid group- and individual-level intervention that delivers three weekly online group discussion sessions for skills delivery, followed by two individualized couple sessions that focus on skills implementation in each couple. The control condition differs by participant HIV status: (1) the Testing Together protocol for concordant HIV-negative couples; (2) medication adherence and risk reduction counseling for concordant HIV-positive couples; or (3) both protocols for serodiscordant couples. Follow-up assessments are delivered at 3-, 6-, 9-, and 12-months post-intervention in both conditions. Testing for rectal and urethral Chlamydia and Gonorrhea occurs at baseline and 12-month follow-up. The primary behavioral outcome is condomless anal sex with serodiscordant serious partners or any casual partners. The primary biomedical outcome is sexually transmitted infection incidence at a 12-month follow-up. RESULTS As of October 11, 2019, the trial has enrolled and randomized 140 dyads (Individual N=280). Enrollment will continue until we randomize 200 dyads (N=400). Assessment of intervention outcomes at 3-, 6-, 9-, and 12-months is ongoing. CONCLUSIONS 2GETHER is innovative in that it integrates relationship education and HIV prevention for optimizing the health and wellbeing of young male couples. The 2GETHER USA online adaptation has the potential to reach couples across the United States and reduce barriers to accessing health care services that are affirming of sexual minority identities for those who live in rural or under-resourced areas. CLINICALTRIAL ClinicalTrials.gov NCT03284541; https://clinicaltrials.gov/ct2/show/NCT03284541 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/15883