Online sexual, reproductive, and transgender healthcare for LGBTQI+ youth: A scoping review

BackgroundLesbian, gay, bisexual, trans, queer, questioning, intersex, and other sexual and gender minority (LGBTQI+) youth have poor sexual and reproductive health outcomes and low uptake of sexual and reproductive healthcare (SRHC). Online SRHC and transgender healthcare could overcome known barriers to in-person SRHC, such as confidentiality concerns. Therefore, we aimed to describe existing literature on online SRHC and transgender healthcare for LGBTQI+ youth, synthesise study findings, and make recommendations for future research. MethodsWe conducted a scoping review following the Joanna-Briggs Institute methodology. Eligibility were online SRHC and transgender healthcare for LGBTQI+ youth (aged 10-35 years) in high-income countries. Search strings were framed around the eligibility criteria and 265 search terms were selected to identify published literature from nine databases. Searches were exported to Rayyan and studies screened by two reviewers. Data from included studies were extracted to Excel and analyzed descriptively. ResultsOf 91 included papers, 41 were quantitative, 26 were qualitative, and 24 were mixed methods. Seventy-one papers focused on sexual health (HIV/sexually transmitted infection (STI) prevention 52/71; HIV management 9/71; sexual health per se 9/71; and HIV stigma reduction 2/71); 3/91 on reproductive health (pregnancy prevention 2/3); 2/91 sexual and reproductive health; and 16/91 on transgender health (gender identity/transition per se 8/16; gender affirming care 8/16). Papers explored the provision of or engagement with education/information (72/91); non-clinical support (56/91, e.g., reminders for HIV/STI testing); and clinical care (18/91) for sexual health (10/18, e.g., home HIV/STI self-sampling kits 6/10) or transgender health (8/18, i.e., eConsultation with a healthcare provider 8/8). Studies targeted young men who have sex with men (62/91) for sexual health; trans and gender diverse youth (26/91) for transgender healthcare (16/26) and sexual health (14/26); LGBTQI+ youth (6/91); and young sexual minority women (4/91) for reproductive health (3/4) and sexual and reproductive health (1/4). ConclusionsThere is a large and varied literature base for online SRHC and transgender healthcare for LGBTQI+ youth. However, most research focused on sexual healthcare, particularly HIV/STI prevention, for men who have sex with men. Very little explored reproduction or sexual health other than HIV prevention. Young sexual minority women and trans and gender diverse youth are notably under-researched for online SRHC. Research is needed to understand how to enhance the potential of online healthcare for LGBTQI+ youth.