P2.A001: Comparing HIV Literacy in Adolescents and Young Adults

Background: Health literacy regarding management and decision making of HIV is integral in promoting adherence to treatment regimens and avoiding HIV-associated sequelae, especially in adolescent and young adult (AYA) patients. However, there is limited study on health literacy in AYAs living with HIV, limiting effective interventions that could address important knowledge gaps in this sub-population which may impact not only their health outcomes, but larger population health outcomes.

Methods: This is a cross-sectional survey study administered to HIV-positive youth and age-matched peers seeking health services over a 15-week period. Participant age, HIV status, sexual activity, and previous history of STIs were collected through a de-identified survey, and participants were asked questions designed to gauge health literacy regarding HIV and sexually transmitted infections in the following themes: curability of STIs, activities that increase risk of HIV, HIV prevention, and HIV diagnosis and management. We measured the association of answering questions correctly based on HIV status, mode of transmission, and viral load using bivariate logistic regression on Stata/BE 17.0.

Results: 76 AYAs participated in this survey, with the largest cohort between the ages of 22-25 (42.3%), self-identifying as female (53.9%), and living with HIV (60.5%). Of those living with HIV, 25 participants acquired HIV perinatally (54.1%) and 21 (45.5%) through sexual activity (8 via heterosexual sex (17.4%) and 13 (28.3%) via MSM (Table 1)). 21 (27.6%) participants correctly identified curable STIs, 14 (18.4%) identified activities associated with increased risk of HIV transmission, 19 (25%) participants identified the sexual activities with highest risk of HIV, 27 (35.5%) correctly identified all the methods of HIV prevention. AYAs living with HIV had significantly higher odds of identifying ways to prevent HIV [3.4 (1.2, 9.8)]. In comparison to those who acquired HIV perinatally, those who acquired HIV from sexual activity were almost 8 times more likely to identify ways to prevent HIV [7.9 (2.1, 29.6)] and had significantly higher odds of identifying the test to measure viral load [4.1 (1.1, 14.6)]. Those with HIV, specifically non-suppressed viral load, were less likely to identify treatable STIs, though this was not statistically significant (Table 2). Those with unsuppressed viral load were less likely to identify the tests used to monitor HIV, however this was not statistically significant.

Conclusion: AYA show significant deficits in knowledge related to the prevention and management of STIs & HIV, particularly AYA living with HIV acquired perinatally. This may highlight important missed opportunities in the provision of continual, age-appropriate patient education for AYA living with HIV, regardless of how long they have lived with their disease. While those living with a chronic illness are often assumed to be experts, this study demonstrates the need for frequent assessment and ongoing education and counseling to ensure optimal care.