Centering Pleasure in HIV Prevention: Provider Perspectives on Implementing a Sex-Positive Counseling Tool for Young Sexual and Gender Minorities of Color in the United States

Introduction Young adults of color who identify as sexual or gender minorities (YSGM) experience some of the highest HIV incidence rates in the United States. Despite demonstrated interest in pre-exposure prophylaxis (PrEP), uptake and adherence remain suboptimal. Emerging frameworks call for pleasure-based approaches to improve PrEP engagement. We aimed to examine how such approaches can be integrated into existing services and how providers perceive their feasibility and acceptability. Methods We conducted 30 in-depth interviews with healthcare providers in California and North Carolina, United States (15 in each). Using a semi-structured guide informed by the Consolidated Framework for Implementation Research, interviews explored attitudes toward pleasure-based counseling, as well as potential implementation barriers and facilitators of the Wellnessmeter, a tool for facilitating holistic discussions around sexual health. Transcripts were analyzed thematically using a deductive approach guided by the Implementation Research Logic Model. Results Providers expressed enthusiasm for pleasure-based tools, viewing them as an innovation to reframe HIV prevention from risk avoidance toward sexual wellbeing and trust. They believed the Wellnessmeter would encourage discussions of pleasure, consent, and confidence and help identify unmet needs. Implementation barriers included time constraints, competing priorities, limited provider training, and the need for linguistic and cultural adaptation. Organizational readiness, leadership support, and clear role delineation were viewed as critical for successful implementation. Discussion Providers viewed pleasure-based counseling as a shift toward more affirming, client-centered HIV prevention, with potential to reduce stigma and enhance PrEP conversations. Feasibility was shaped by visit time, workflow constraints, training needs, and organizational capacity.