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Previous research has shown that acceptability and appeal of prevention methods vary across youth, and over-emphasis on any one strategy may overlook youth\u2019s autonomy to make their own informed decisions about their sexual health. We use a socioecological framework to understand factors influencing sexual health promotion choices among youth at-risk for or living with HIV. Youth ages 16\u201324\u00a0years old in Los Angeles and New Orleans participated in a strengths-based coaching intervention in Adolescent HIV Medicine Trials Network (ATN) studies. A total of 257 youth completed a baseline strengths assessment with a coach. We analyzed qualitative strengths assessment coach case notes to understand youth\u2019s sexual health promotion preferences and influencing factors across socioecological levels. Participants described 7 types of sexual health promotion strategies: Relationship dynamics; Not sexually active; STI testing; Condom use; PrEP use; PEP use; and HIV Viral suppression. Participants also described factors at intrapersonal, interpersonal, and community levels that impacted their preferred sexual health promotion strategies. Youth at-risk for or living with HIV make informed decisions around their sexual health based on a variety of intersecting factors across socioecological levels. These complex decisions demonstrate youth\u2019s autonomy and emphasize the importance of better incorporating patient-centered care within youth\u2019s sexual health.<\/jats:p>","DOI":"10.1007\/s10461-026-05226-y","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:17:54Z","timestamp":1784265474000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Socioecological Perspective on Sexual Health Promotion Choices Among Youth At-Risk for and Living with HIV in Los Angeles and New Orleans"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9305-4751","authenticated-orcid":false,"given":"Curtis","family":"Wong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine A.","family":"Lewis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice M.","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hailey","family":"Valles","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dianna","family":"Polanco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yara","family":"Tapia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel A.","family":"Ocasio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhitishah","family":"Yuva Raju","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth M.","family":"Arnold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4570-6352","authenticated-orcid":false,"given":"Dallas","family":"Swendeman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"A. 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(PubMed PMID: 35941562).","journal-title":"BMC Infect Dis"}],"container-title":["AIDS and Behavior"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10461-026-05226-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10461-026-05226-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10461-026-05226-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:17:58Z","timestamp":1784265478000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10461-026-05226-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,17]]},"references-count":34,"alternative-id":["5226"],"URL":"https:\/\/doi.org\/10.1007\/s10461-026-05226-y","relation":{},"ISSN":["1090-7165","1573-3254"],"issn-type":[{"value":"1090-7165","type":"print"},{"value":"1573-3254","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,17]]},"assertion":[{"value":"24 June 2026","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 July 2026","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Dr. Arnold was a consultant on project funded by Merck, Sharpe, and Dohme and has current funding from this entity. However, these projects are not related to the current study\/manuscript. All other authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing Interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures were approved by the University of California, Los Angeles Institutional Review Board and the Adolescent Medicine Trials Network (ATN) Study Monitoring Committee. The IRB number is IRB#16\u2013001372-AM-00036. All participants provided voluntary informed consent.","order":2,"name":"Ethics","label":"Ethical Approval","group":{"name":"EthicsHeading","label":"Declarations"}}]}}