Recruitment and retention of an online sample for an HIV prevention intervention targeting men who have sex with men: the smart sex quest project

Opportunities for providing web-based interventions to prevent sexually transmitted infections in Peru

The popularity of Internet cafes in Peru, even in poor communities with no modern infrastructure, opens new possibilities to develop online prevention and intervention programs for sexually transmitted diseases.

Risk reduction counselling for prevention of sexually transmitted infections: how it works and how to make it work

Prevention research in the past decade has proved the efficacy of risk reduction counselling in reducing the risks for sexually transmitted infections (STIs). The question currently facing STI service providers is therefore not so much whether counselling should be part of the standard of STI care but rather how this intervention can be implemented given the logistical and resource constraints of a busy practice setting. After a brief introduction of the history and an overview of the models for risk reduction counselling and their theoretical and scientific underpinnings, the focus of this paper will be on the extent to which individual prevention models have been adopted in different clinical settings, the impediments to implementation and suggestions for improvement.

Meta-analytic examination of online sex-seeking and sexual risk behavior among men who have sex with men

OBJECTIVES

To estimate the percentage of men who have sex with men (MSM) who have used the Internet to look for sex partners and to examine the prevalence of risky sex among MSM who have and have not sought partners online.

METHODS

Meta-analyses were conducted on findings from published English-language studies. High-risk sex was self-reported unprotected anal intercourse (UAI). Analyses were stratified by method of study recruitment (online versus offline venues) and participants' human immunodeficiency virus (HIV) status.

RESULTS

In studies that recruited MSM offline, a weighted mean, based on 15 findings, indicated that 40% (95% confidence interval [CI], 35.2%-45.2%) of MSM had used the Internet to look for sex partners. In 3 findings from offline studies that stratified by participant HIV status, the weighted-mean percentage was higher among HIV-positive (49.6%; 95% CI, 44.9%-54.3%) than HIV-negative/unknown MSM (41.2%; 95% CI, 36.8%-45.6%). UAI with male sex partners was more likely among MSM who sought partners online than MSM who did not (odds ratio, 1.68; 95% CI, 1.18-2.40; k = 11). This group difference was observed for UAI with HIV-serodiscordant as well as HIV-seroconcordant partners, particularly among HIV-positive study participants. HIV-serodiscordant UAI was not more prevalent with partners met online than offline.

CONCLUSIONS

A substantial percentage of MSM use the Internet to look for sex partners, and those who do are more likely to engage in unprotected sex. Additional research is needed to determine whether the Internet may increase risk behavior beyond that which occurs when men meet partners at offline venues.

Internet-based health promotion and disease control in the 8 cities: successes, barriers, and future plans

OBJECTIVES

The objective of this paper is to provide a detailed description of Internet-based sexually transmitted disease/human immunodeficiency virus prevention in the 8 US cities most affected by syphilis in men who have sex with men.

GOAL

By reviewing the efforts under way in these 8 cities, we will understand the barriers and facilitators associated with Internet-based prevention efforts.

STUDY

This is a review of Internet activities taking place in 8 major US cities.

RESULTS

Efforts in the 8 cities vary, with some cities reporting little or no Internet-based prevention activities. Other cities have attempted banner advertising, online outreach, online partner notification, online laboratory slips for syphilis testing, and auditorium-style chat sessions.

CONCLUSION

Though a number of policy-related barriers prevent some cities from engaging in Internet-based prevention, these activities are clearly important to the overall prevention effort. In order to surmount local policy barriers, it is essential to obtain evaluation data from the programs initiated.

Review of interactive safer sex Web sites: practice and potential

The Internet is increasingly being viewed as a health promotion tool with enormous potential. However, this potential cannot be realized if Web sites do not utilize the features that make the Internet a "hybrid" mass and interpersonal communication medium. The purpose of this study was to examine interactive safer sex Web sites on a number of dimensions. A comprehensive search that included Internet search engines, links from well-known sites, and previously published reviews yielded 21 Web sites that met criteria. Web sites were coded on dimensions including targeting of the Web sites, safer sex messages presented, theoretical strategies utilized, interactivity, and other characteristics. Results indicate that a moderate amount of targeting of Web sites exists, especially on age group (e.g., teenagers); the most prevalent safer sex messages were to "use condoms" and "be sexually abstinent"; raising the perceived threat of sexually transmitted diseases and HIV was the most prevalent theoretical strategy used to motivate safer sex; and finally, a moderate amount of interactivity was found on the Web sites, with most Web sites containing 4 or 5 features out of 15 features examined. Evidence that Web sites were tailoring information or messages to individuals was not found. Implications of these results for improving safer sex Web sites and developing interventions online are discussed.

HIV behavioral research online

Internet access has caused a global revolution in the way people of all ages and genders interact. Many have turned to the Internet to seek love, companionship, and sex, prompting researchers to move behavioral studies online. The sexual behavior of men who have sex with men (MSM) has been more closely studied than that of any other group online given the abundance of gay-oriented websites and concerns about increasing transmission of HIV and other sexually transmitted infections. Not only does the Internet provide a new medium for the conduct of behavioral research and for participant recruitment into an array of research studies, it has the as yet unrealized potential to reach huge numbers of MSM with innovative harm reduction and prevention messages tailored to individualized needs, interests, and risk behavior. Internet-based research on sexual behavior has many advantages in rapidity of recruitment of diverse samples which include individuals unreachable through conventional methods (i.e., non-gay identified and geographically and socially isolated MSM, etc.). Internet-based research also presents some new methodologic challenges in study design, participant recruitment, survey implementation, and interpretation of results. In addition, there are ethical issues unique to online research including difficulties in verifying informed consent, obstacles to surveying minors, and the ability to assure anonymity. This paper presents a review of Internet-based research on sexual behavior in MSM, a general discussion of the methodologic and ethical challenges of Internet-based research, and recommendations for future interdisciplinary research.

Gay men who look for sex on the Internet: is there more HIV/STI risk with online partners?

OBJECTIVE

To examine whether the excess risk for HIV and sexually transmitted infection (STI) seen among gay men who look for sex through the Internet occurs with men they meet online (through the Internet) rather than offline (in bars, clubs, etc).

METHODS

In 2002-2003, 4225 London gay men were surveyed in an HIV treatment clinic, HIV testing clinic, gyms and on UK Internet sites (gaydar and gay.com). All men completed a self-administered questionnaire concerning Internet use and sexual risk behaviour. Unprotected anal intercourse (UAI) with a partner of unknown or discordant HIV status was classified as non-concordant.

RESULTS

Between 40 and 50% of men surveyed in the clinics and gyms used the Internet to look for sex. HIV-positive men who looked for sex through the Internet were more likely to report UAI with HIV-positive casual partners they met online rather than offline (clinic sample: met online only 9.9%, met offline only 3.8%, McNemar P < 0.05). Regardless of HIV status, however, men who looked for sex through the Internet were no more likely to report UAI with non-concordant casual partners they met online than offline (eg, HIV-negative men, Internet sample: met online only 9.7%, offline only 11.1%, McNemar P = 0.6).

CONCLUSIONS

In London, HIV-positive gay men appear to meet casual UAI partners of the same status through the Internet. This presents a risk for STI transmission. However, gay men were no more likely to meet casual UAI partners of unknown or discordant HIV status--which presents a risk for HIV transmission--online rather than offline.

Innovative Approaches to the Prevention and Control of Bacterial Sexually Transmitted Infections

Bacterial STI continues to be a major problem in developed nations. Research and evolving standards of public health practice are cause for optimism and concern. Innovations in case-finding and treatment, particularly the application of NAATs to test for chlamydial infection in nonclinical settings, are successes that merit more widespread application. EPT, selective STI screening in men, and rescreening are all promising, but are not yet in widespread use and may face significant operational barriers. To date, public health efforts to alter sexual behavior, at least through specific interventions, are more discouraging. Although some behavioral interventions have been effective, none has been widely instituted. Moreover, the likelihood that existing behavioral interventions will be widely applied seems remote. Future research efforts in this area will need to focus less on proof-of-concept efficacy trials and more on developing and testing sustainable, cost-effective interventions that focus on those at greatest risk and that can be scaled-up within the existing public health infrastructure.

The Internet and HIV study: design and methods

BACKGROUND

The Internet provides a new meeting ground, especially for gay men, that did not exist in the early 1990s. Several studies have found increased levels of high risk sexual behaviour and sexually transmissible infections (STI) among gay men who seek sex on the Internet, although the underlying processes are not fully understood. Research funded by the UK Medical Research Council (2002-2004) provided the opportunity to consider whether the Internet represents a new sexual risk environment for gay and bisexual men living in London.

METHODS

The objectives of the Internet and HIV study are to: (i) measure the extent to which gay men living in London seek sexual partners on the Internet; (ii) compare the characteristics of London gay men who do and do not seek sex on the Internet; (iii) examine whether sex with Internet-partners is less safe than with other sexual partners; (iv) compare use of the Internet with other venues where men meet sexual partners; (v) establish whether gay men use the Internet to actively seek partners for unprotected anal intercourse; (vi) determine the potential for using the Internet for HIV prevention. These objectives have been explored using quantitative and qualitative research methods in four samples of London gay men recruited and interviewed both online and offline. The four samples were: (i) gay men recruited through Internet chat rooms and profiles; (ii) HIV positive gay men attending an NHS hospital outpatients clinic; (iii) gay men seeking an HIV test in an NHS HIV testing or sexual health clinic; (iv) gay men recruited in the community.

RESULTS

Quantitative data were collected by means of confidential, anonymous self-administered questionnaires (n>4000) completed on-line by the Internet sample. Qualitative data were collected by means of one-to-one interviews (n = 128) conducted either face-to-face or on-line.

CONCLUSION

The strength of the Internet and HIV study is its methodological plurality, drawing on both qualitative and quantitative research among online and offline samples, as well as taking advantage of recent advances in web survey design. The study's findings will help us better understand the role of the Internet in relation to gay men's sexual practice.