Prevalence of Late Presenters and Advanced HIV Disease in HIV Patients and Their Related Factors in Iran: Results from 19 Years of National Surveillance HIV Data

Late presenters (LP) and Advanced HIV Disease (AHD) represent important missed opportunities to reduce secondary transmission and undesirable HIV outcomes. Despite efforts, the diagnoses are still delayed for the majority of patients. This cross-sectional study was conducted using the Iranian national HIV surveillance database from 2001 to 2019, to determine the factors affecting AHD and LP in Iran. To determine LP (CD4 ≤ 350 cells/μL) and AHD (CD4 ≤ 200 cells/μL), the first patients' CD4 at baseline were used. To examine the relationship between the covariates and LP or AHD, a Logistic Regression was applied. The adjusted odds ratio (AOR) stated to report the relationship. Totally, 13,571 patients were included in the study. Of these, 4,060 (29.92%) were AHD and 7,161 (52.77%) LP. Female gender [AOR = 0.88, 95% confidence interval (CI): 0.80-0.97], higher education (AOR = 0.80, 95% CI: 0.69-0.93), and having a positive HIV spouse (AOR = 0.75, 95% CI = 0.66-0.85) significantly decreased odds of LP (p < .05). However, older age (AOR = 2.53, 95% CI: 2.20-2.91) was a risk factor for LP. For AHD, years of detection (AOR = 1.16, 95% CI: 1.06-1.27), older age (AOR = 2.49, 95% CI: 2.12-2.92), and having a spouse with high-risk behavior (AOR = 1.23, 95% CI: 1.02-1.49) led to higher odds. (p < .05). Also, female (AOR = 0.82, 95% CI: 0.73-0.92) and having a positive HIV spouse (AOR = 0.67, 95% CI: 0.58-0.78) were protective factors for ADH. The present study estimated that approximately two-thirds of HIV patients are LP and one-third are AHD in Iran. Older age, male gender, lower education, and having a spouse with high-risk behavior were the factors affecting LP and AHD. Thus, to reduce the percentage of patients with LP and AHD in Iran, improvements in knowledge and periodic screening programs are necessary for these groups.

STI testing among young people attending music festivals in New South Wales, Australia: exploring the client segmentation concept in the 'Down to Test' program

Background The 'Down to Test (DTT)' campaign is a sexually transmissible infection (STI) social marketing intervention delivered through outdoor music festival activations and supported by digital media communications in New South Wales, Australia. This paper investigates whether and how the tailored messages reached the intended audience. Methods Data was collected through three annual rounds of online surveys post campaign exposure, targeting young people (aged 15-29years) attending 14 music festivals in NSW from October 2017 to March 2020. Descriptive statistics, principal component analysis and multivariable logic regression were applied to identify the key client segment and factors associated with a strong intention for future STI screening. Results Of the 10044 participants with a valid urine specimen submitted, 261 (2.8%) tested positive for chlamydia. Altogether, 1776 participants (median age=22) self-completed the evaluation surveys online with more being female (73.4%) than male (26.2%). Participants were mostly Australian-born (89.5%), heterosexual (82.6%) and the majority being sexually active (96.7%). Rates of self-reported lifetime STI testing (70.4%) and intention for future STI screening ('definitely yes' in the next 12months, 39.0%) were also high. The most significant factor associated with future intention for STI testing is the Sexual Experience and Perception Factor (adjusted odds ratio [AOR]=2.02; 95%CI 1.76-2.32; P<0.001), followed by the Sexual Beliefs and Attitudes Factor (AOR=1.14; 95% CI 1.01-1.30; P<0.05). Conclusions The NSW state-wide DTT campaign has largely reached sexually active youth who are attentive to sexual health promotion messages and contributed to enhanced STI screening in a fun and peer-supportive environment.

What do young people in high-income countries want from STI testing services? A systematic review

BACKGROUND

There are upward trends of STI rates among young people in most high-income countries. We reviewed the literature to provide a summary of information to support health services with the aim of increasing testing of STIs among young people living in high-income countries.

METHODS

We conducted a systematic review (Prospero: CRD42020179720) using PubMed, Embase, PsychINFO and CINAHL. The search was performed on 10 January 2020 for studies between January 2000 and 10 January 2020. Two reviewers independently screened articles, and any discrepancies were resolved by a third reviewer. Studies were included if they were performed in high-income countries and contained data on both young people (<26 years) and STI testing preferences. Data regarding the characteristics of STI testing services that young people preferred was extracted. We categorised these characteristics using the framework of a social-ecological model.

RESULTS

We identified 1440 studies, and 63 studies were included in the final review. We found 32 studies that addressed individual factors, 62 studies that addressed service factors and 17 studies that addressed societal factors. At an individual level, we identified eight attributes including the need for improved sexual health education. At a service level, 14 attributes were identified including preferences from different subgroups of young people (such as sexual and ethnic minorities) for the types of services. At a societal level, we identified two attributes including the need to address stigma associated with STIs.

CONCLUSION

We provide an overview of the growing body of literature capturing the preferences of young people for STI testing services. To optimise the uptake of STI testing among young people, factors from all socioecological levels should be considered. In addition, understanding and accounting for distinct preferences from subgroups of young people could increase demand for STI testing services for those at greatest need.

Delivery strategies for optimizing uptake of contraceptives among adolescents aged 15-19 years in Nsanje District, Malawi

Background

Despite documented benefits of contraceptives, uptake among young people aged 20–24 years is high compared to adolescents aged 15–19 years in Malawi. As the world’s population of 15–19-year-olds continues to grow the need to meet the increasing demand for contraceptive services and information that address adolescent-specific needs cannot be underestimated. To inform Sexual and Reproductive health services for the youth, we explored strategies for optimizing uptake of contraceptives among this age group.

Methods

An exploratory qualitative cross-sectional study was conducted at Nsanje District Hospital and Nyamadzere Community Day Secondary School guided by Social-Ecological Framework to understand strategies that may optimize the uptake of contraceptives among adolescents aged 15–19. Nsanje district was purposively selected based on the reason that it is the second district in Malawi with the highest rate of adolescent childbearing of girls aged 15–19 years. We conducted a Focus Group Discussion (FGD) with 9 traditional leaders, 11 Key Informant Interviews (KIIs) with health workers, 20 In-depth Interviews (IDIs) with 12 adolescents, 4 teachers, and 4 parents. All data were digitally recorded, transcribed verbatim into English. The data was analyzed and managed using deductive thematic analysis guided by Social-Ecological Framework.

Results

Adolescents suggested accessing contraceptives from local drug stores, pharmacies and hospitals at a health system level and through Youth Centres, clubs, and corners at a Community level. There is a need to ensure a continuous supply of various kinds of contraceptives and the presence of youth-friendly health care workers in the specified areas.

Conclusion

There is no one way of delivering contraceptives to adolescents. Multiple avenues existent at the health facility and community could be leveraged to optimize delivery and uptake of contraceptives in a manner that is not intimidating to an adolescent while involving key stakeholders.

Effectiveness of School-Based Teen Pregnancy Prevention Programs in the USA: a Systematic Review and Meta-Analysis

School-based programs have been a mainstay of youth pregnancy prevention efforts in the USA. We conducted a systematic review and meta-analysis to assess their effectiveness. Eligible studies evaluated the effect on pregnancy rates of programs delivered in elementary, middle, or high schools in the USA and Canada, published between January 1985 and September 2016. The primary outcome was pregnancy; secondary outcomes were delay in sexual initiation, condom use, and oral contraception use. Randomized controlled trials (RCTs) and non-RCTs with comparator groups were eligible. We developed a comprehensive search strategy, applied to major bibliographic databases, article bibliographies, gray literature, and contact with authors. We calculated risk ratios (RR) with 95% confidence intervals (CI) for each outcome and pooled data in random effects meta-analysis. We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess evidence quality. Ten RCTs and 11 non-RCTs conducted from 1984 to 2016 yielded 30 unique pooled comparisons for pregnancy, of which 24 were not statistically significant. Six showed statistically significant changes in pregnancy rates: two with increased risk (RR 1.30, 95% CI 1.02-1.65; and RR 1.39, 95% CI 1.10-1.75) and four with decreased risk ranging from RR 0.56, 95% CI 0.41-0.77, to RR 0.75, 95% CI 0.58-0.96. All studies were at high risk of bias, and the quality of evidence was low or very low. Identified evidence indicated no consistent difference in rates of pregnancies between intervention recipients and controls.

Learning what our target audiences think and do: extending segmentation to all four bases

Background

While acknowledged as one of social marketing’s necessities, limited reporting of segmentation exists. The current study seeks to extend segmentation drawing on all four segmentation bases within the context of Queensland young adult sexual health behaviour.

Methods

An online survey was used to collect data from 15 to 29 year old people in Queensland, Australia. Data collection was undertaken online to capture the broader population of young adults and in person on campuses to gather data from students who were currently enrolled at University. Quotas were set to ensure a broad representation was attained reflecting the States demography.

Results

Two-step cluster analysis revealed three different segments. The most important variables in segment formation were age, household type, experience of risky sexual encounters and previously being tested or treated for sexually transmissible infections (STIs). The results suggest that demographic and behavioural variables were the most effective in segment definition.

Conclusions

This study investigated young people aged 15–29 in Queensland, Australia to examine group differences drawing from four bases. This study revealed three distinct segments in a sexual health context and highlighted the importance of behavioural variables in segment formation, insight and understanding.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6696-2) contains supplementary material, which is available to authorized users.

Features of successful sexual health promotion programs for young people: findings from a review of systematic reviews

ISSUE ADDRESSED

Young people have a high burden of sexual and reproductive health (SRH) problems, and it is important to reach this group through health promotion initiatives. We conducted a systematic review of reviews to identify successful elements of health promotion programs for improving SRH of young people.

METHODS

We identified and collated systematic reviews published in 2005-2015 which focused on young people (10-24 years), reported on SRH outcomes (pregnancy, sexually transmissible infections, condoms/contraceptive use, risky sexual behaviour, sexual healthcare access or intimate partner violence), and included primary studies predominantly conducted in high-income countries. This report focuses on features of successful SRH programs identified in the interpretation and discussion of included systematic reviews.

RESULTS

We identified 66 systematic reviews, of which 37 reported on program features which were anecdotally or statistically associated with improved program effectiveness and success. Common features of effective interventions were: longer term or repeated implementation; multi-setting and multi-component; parental involvement; culturally/gender/age appropriate; and inclusion of skills-building. SO WHAT?: There is marked consistency of features improving SRH program effectiveness for young people despite the wide variation in interventions reviewed. There is a need to better implement this knowledge in future programs, and our findings provide useful guidance for optimising the design of SRH interventions for young people.

Health status of marginalised young people in unstable accommodation

AIM

More than 26 000 Australians aged 12-24 years experience homelessness, yet data on the health status of homeless youth remain limited. The aim of this study was to describe the health of young people attending a youth health service in Western Sydney who were experiencing homelessness.

METHODS

Retrospective case note review for clients aged 12-25 years attending Youth Health Services in Western Sydney. Extracted data included: homelessness status; demographics; physical health issues; mental health issues; involvement with juvenile justice; and disengagement from education or employment.

RESULTS

Just under half of the 180 clients attending a Youth Health Service in Western Sydney were homeless, and an additional 15 young people who were not currently homeless nominated homelessness as a presenting issue. In comparison with currently domiciled young people, homeless youth were less likely to have a regular general practitioner and more likely to nominate a physical health concern as a presenting issue, although there was no difference between groups in terms of diagnosed mental or physical health conditions. Considered as a whole, the sample showed high rates of acute physical symptoms, physical trauma, psychological distress and self-harm.

CONCLUSIONS

Youth homelessness is associated with risk of both poor physical and mental health. As much of youth homelessness is hidden, health-care providers need to ensure that they inquire about homelessness status, and have an awareness of potentially complex multi-morbidities in the physical and mental health of young marginalised people presenting to health services.

Use of SMS-Based Surveys in the Rapid Response to the Ebola Outbreak in Liberia: Opening Community Dialogue

During an emerging health crisis like the 2014 Ebola outbreak in West Africa, communicating with communities to learn from them and to provide timely information can be a challenge. Insight into community thinking, however, is crucial for developing appropriate communication content and strategies and for monitoring the progress of the emergency response. In November 2014, the Health Communication Capacity Collaborative partnered with GeoPoll to implement a Short Message Service (SMS)-based survey that could create a link with affected communities and help guide the communication response to Ebola. The ideation metatheory of communication and behavior change guided the design of the survey questionnaire, which produced critical insights into trusted sources of information, knowledge of transmission modes, and perceived risks-all factors relevant to the design of an effective communication response that further catalyzed ongoing community actions. The use of GeoPoll's infrastructure for data collection proved a crucial source of almost-real-time data. It allowed for rapid data collection and processing under chaotic field conditions. Though not a replacement for standard survey methodologies, SMS surveys can provide quick answers within a larger research process to decide on immediate steps for communication strategies when the demand for speedy emergency response is high. They can also help frame additional research as the response evolves and overall monitor the pulse of the situation at any point in time.

A web-based personally controlled health management system increases sexually transmitted infection screening rates in young people: a randomized controlled trial

OBJECTIVE

To determine if a web-based personally controlled health management system (PCHMS) could increase the uptake of sexually transmitted infections (STI) screening among a young university population.

METHODS

A non-blinded parallel-group randomized controlled trial was conducted. Participants aged 18-29 years were recruited from a university environment between April and August 2013, and randomized 1:1 to either the intervention group (immediate online PCHMS access) or control group (no PCHMS access). The study outcome was self-reported STI testing, measured by an online follow-up survey in October 2013.

RESULTS

Of the 369 participants allocated to the PCHMS, 150 completed the follow-up survey, and of the 378 in the control group, 225 completed the follow-up survey. The proportion of the PCHMS group who underwent an STI test during the study period was 15.3% (23/150) compared with 7.6% (17/225) in the control group (P = .017). The difference in STI testing rates within the subgroup of sexually active participants (20.4% (23/113) of the PCHMS group compared with 9.6% (15/157) of the control group) was significantly higher (P = .027) than among non-sexually active participants.

DISCUSSION

Access to the PCHMS was associated with a significant increase in participants undergoing STI testing. This is also the first study to demonstrate efficacy of a PCHMS targeting a health concern where susceptibility is generally perceived as low and the majority of infections are asymptomatic.

CONCLUSION

PCHMS interventions may provide an effective means of increasing the demand for STI testing which, combined with increased opportunistic testing by clinicians, could reduce the high and sustained rates of STIs in young people.

A meta-analysis of the effect of new-media interventions on sexual-health behaviours

BACKGROUND AND OBJECTIVES

Direct access to individuals in non-intrusive ways, as well as the technical abilities of new-media to provide tailored information in relatively inexpensive ways, creates a unique opportunity for the delivery of health-related information. The aim of the present research was to examine the effect that new-media-based sexual-health interventions have on sexual-health behaviours in non-clinical populations and to determine the factors that moderate the effect of technology-based sexual-health interventions on sexual--health behaviours.

DATA SOURCES

A systematic literature search of the following databases was conducted: MEDLINE, psycINFO, Global health, and EMBASE, using terms that captured three subject areas-'Sexual-health', 'New Technology' and 'Intervention'.

STUDY ELIGIBILITY CRITERIA

Randomised controlled trial, or a quasi-experiment; delivered exclusively via new-media; included sexual risk behaviour change as an outcome measure and delivered to non-clinical groups.

RESULTS

Twelve studies tested the effect of new-media interventions on condom use, whereas nine tested the effect on sexually transmitted disease testing. Results indicated that new-media interventions led to significant increases in both outcomes; however, these effects were not homogeneous. Moderation analyses revealed that interactivity of the intervention, target population and study design influenced the efficacy of interventions on both sexual-health outcomes, whereas intervention duration influenced sexually transmitted infection testing.

CONCLUSIONS AND IMPLICATIONS

Interventions aiming to improve condom use are more successful when an interactive component is used. Further research needs to be conducted to reach specific at-risk populations.

After the clinic? Researching sexual health technology in context

There is great interest in what testing, pharmaceutical, information and social media technology can do for sexual health. Much programmatic and research activity is focused on assessing how these technologies can be used to best effect. Less obvious are analyses that place technology into historical, political and real-world settings. Developing an 'in-context' analysis of sexual health technology, this paper draws on interviews with leading community advocates, researchers and clinicians in Australia, Canada and the UK and looks across examples, including social media, rapid HIV testing, pre-Exposure Prophylaxis for HIV and polymerase chain reaction Chlamydia testing. The analysis is framed by studies of techno-society and the dialectics of sex-affirmative advocacy with biomedical authority and attends to: the rationalistic and affective dimensions of the imaginary associated with technology; the role of technology in the re-spatialisation and re-temporalisation of the sexual health clinic; and the re-invention of technology in its real-world contexts. This in-context approach is important for: the effective implementation of new technology; strengthening the social science contribution to the field; and enriching social theory in general on life in techno-societies.

HIV behavioural interventions targeted towards older adults: a systematic review

Background

The increasing number of people living with HIV aged 50 years and older has been recognised around the world yet non-pharmacologic HIV behavioural and cognitive interventions specifically targeted to older adults are limited. Evidence is needed to guide the response to this affected group.

Methods

We conducted a systematic review of the available published literature in MEDLINE, Embase and the Education Resources Information Center. A search strategy was defined with high sensitivity but low specificity to identify behavioural interventions with outcomes in the areas of treatment adherence, HIV testing uptake, increased HIV knowledge and uptake of prevention measures. Data from relevant articles were extracted into excel.

Results

Twelve articles were identified all of which originated from the Americas. Eight of the interventions were conducted among older adults living with HIV and four for HIV-negative older adults. Five studies included control groups. Of the included studies, four focused on general knowledge of HIV, three emphasised mental health and coping, two focused on reduced sexual risk behaviour, two on physical status and one on referral for care. Only four of the studies were randomised controlled trials and seven – including all of the studies among HIV-negative older adults – did not include controls at all. A few of the studies conducted statistical testing on small samples of 16 or 11 older adults making inference based on the results difficult. The most relevant study demonstrated that using telephone-based interventions can reduce risky sexual behaviour among older adults with control reporting 3.24 times (95% CI 1.79-5.85) as many occasions of unprotected sex at follow-up as participants. Overall however, few of the articles are sufficiently rigorous to suggest broad replication or to be considered representative and applicable in other settings.

Conclusions

More evidence is needed on what interventions work among older adults to support prevention, adherence and testing. More methodological rigourised needed in the studies targeting older adults. Specifically, including control groups in all studies is needed as well as sufficient sample size to allow for statistical testing. Addition of specific bio-marker or validated behavioural or cognitive outcomes would also strengthen the studies.

'Young clean and safe?' Young people's perceptions of risk from sexually transmitted infections in regional, rural and remote Australia

This paper examines young people's perceived vulnerability to sexually transmitted infections (STIs) and their efforts to create a sense of personal safety within an environment in which risks may be high and where STIs are highly stigmatised. The paper reports on findings from research involving both Indigenous and non-Indigenous 16- to 25-year-olds from remote, rural and regional Australia, including communities in the Northern Territory, Western Australia and South Australia. The study used qualitative methods, including body mapping and scenario based interviewing, to explore how young people made decisions about potential sexual partners and how STIs were understood within the context of young people's everyday social worlds. The paper has important implications for the design and implementation of sexual-health education programmes by documenting the stigmatisation of young people with STIs and the protective mechanisms peer groups employ to create perceptions of personal safety.

Young men's views toward the barriers and facilitators of Internet-based Chlamydia trachomatis screening: qualitative study

Background

There is a growing number of Internet-based approaches that offer young people screening for sexually transmitted infections.

Objective

This paper explores young men’s views towards the barriers and facilitators of implementing an Internet-based screening approach. The study sought to consider ways in which the proposed intervention would reach and engage men across ages and socioeconomic backgrounds.

Methods

This qualitative study included 15 focus groups with 60 heterosexual young men (aged 16-24 years) across central Scotland, drawn across age and socioeconomic backgrounds. Focus groups began by obtaining postcode data to allocate participants to a high/low deprivation category. Focus group discussions involved exploration of men’s knowledge of chlamydia, use of technology, and views toward Internet-based screening. Men were shown sample screening invitation letters, test kits, and existing screening websites to facilitate discussions. Transcripts from audio recordings were analyzed with "Framework Analysis".

Results

Men’s Internet and technology use was heterogeneous in terms of individual practices, with greater use among older men (aged 20-24 years) than teenagers and some deprivation-related differences in use. We detail three themes related to barriers to successful implementation: acceptability, confidentiality and privacy concerns, and language, style, and content. These themes identify ways Internet-based screening approaches may fail to engage some men, such as by raising anxiety and failing to convey confidentiality. Men wanted screening websites to frame screening as a serious issue, rather than using humorous images and text. Participants were encouraged to reach a consensus within their groups on their broad design and style preferences for a screening website; this led to a set of common preferences that they believed were likely to engage men across age and deprivation groups and lead to greater screening uptake.

Conclusions

The Internet provides opportunities for re-evaluating how we deliver sexual health promotion and engage young men in screening. Interventions using such technology should focus on uptake by age and socioeconomic background. Young people should be engaged as coproducers of intervention materials and websites to ensure messages and content are framed appropriately within a fast-changing environment. Doing so may go some way to addressing the overall lower levels of testing and screening among men compared with women.

Chlamydia screening in young people as an outcome of a HEADSS; Home, Education, Activities, Drug and alcohol use, Sexuality and Suicide youth psychosocial assessment tool

AIMS AND OBJECTIVES

To identify the percentage of young people presenting to a primary healthcare service targeting homeless youth, in Melbourne, Australia, who, based on youth-specific Home, Education, Activities, Drug and alcohol use, Sexuality and Suicide (HEADSS) psychosocial assessment tool, were screened for the sexually transmitted infection Chlamydia and tested positive.

BACKGROUND

Homeless young people are at high risk of poor health outcomes including sexual health. Chlamydia prevalence is highest in 16-24 years. Youth psychosocial assessment tools such as the HEADSS can engage young people and provide comprehensive health assessment that identifies health risks.

DESIGN

A retrospective audit.

METHODS

One hundred consecutive client files of youth who presented to a primary healthcare service for the first time were selected. Client data were collected at the health services' inner city drop-in clinic and clinical refuge outreach (CRO). HEADSS assessments were made on new presentations to identify those at risk of Chlamydia. These young people were then offered screening for Chlamydia using a first-pass urine sample.

RESULTS

One hundred HEADSS assessments were audited, of which 15 were incomplete. Of the 85 completed HEADSS assessments, 43 were tested and 11 had Chlamydia-positive results.

CONCLUSION

Comprehensive youth assessment tools, such as the HEADSS, can provide a valuable resource in identifying sexual health risks such as Chlamydia. In turn, skilled nursing staff can provide opportunistic screening. Early identification and treatment for Chlamydia can reduce the spread and sequela of this highly infectious STI.

RELEVANCE TO CLINICAL PRACTICE

Youth health nurses can enhance their nursing practice in working with young people at risk of homelessness and improve their health outcomes by employing youth-specific assessments.

A randomised controlled trial using mobile advertising to promote safer sex and sun safety to young people

Mobile phone text messages (SMS) are a promising method of health promotion, but a simple and low cost way to obtain phone numbers is required to reach a wide population. We conducted a randomised controlled trial with simultaneous brief interventions to (i) evaluate effectiveness of messages related to safer sex and sun safety and (ii) pilot the use of mobile advertising for health promotion. Mobile advertising subscribers aged 16-29 years residing in Victoria, Australia (n = 7606) were randomised to the 'sex' or 'sun' group and received eight messages during the 2008-2009 summer period. Changes in sex- and sun-related knowledge and behaviour were measured by questionnaires completed on mobile phones. At follow-up, the sex group had significantly higher sexual health knowledge and fewer sexual partners than the sun group. The sun group had no change in hat-wearing frequency compared with a significant decline in hat-wearing frequency in the sex group. This is the first study of mobile advertising for health promotion, which can successfully reach most young people. Challenges experienced with project implementation and evaluation should be considered as new technological approaches to health promotion continue to be expanded.

A systematic examination of the use of online social networking sites for sexual health promotion

BACKGROUND

In recent years social networking sites (SNSs) have grown rapidly in popularity. The popularity of these sites, along with their interactive functions, offer a novel environment in which to deliver health promotion messages. The aim of this paper is to examine the extent to which SNSs are currently being used for sexual health promotion and describe the breadth of these activities.

METHODS

We conducted a systematic search of published scientific literature, electronic sources (general and scientific search engines, blogs) and SNSs (Facebook, MySpace) to identify existing sexual health promotion activities using SNSs. Health promotion activities were eligible for inclusion if they related to sexual health or behaviour, utilised one or more SNSs, and involved some element of health promotion. Information regarding the source and type of health promotion activity, target population and site activity were extracted.

RESULTS

178 sexual health promotion activities met the inclusion criteria and were included in the review; only one activity was identified through a traditional systematic search of the published scientific literature. Activities most commonly used one SNS, were conducted by not-for-profit organisations, targeted young people and involved information delivery. Facebook was the most commonly used SNS (used by 71% of all health promotion activities identified), followed by MySpace and Twitter. Seventy nine percent of activities on MySpace were considered inactive as there had been no online posts within the past month, compared to 22% of activities using Facebook and 14% of activities using Twitter. The number of end-users and posts in the last seven days varied greatly between health promotion activities.

CONCLUSIONS

SNSs are being used for sexual health promotion, although the extent to which they are utilised varies greatly, and the vast majority of activities are unreported in the scientific literature. Future studies should examine the key factors for success among those activities attracting a large and active user base, and how success might be measured, in order to guide the development of future health promotion activities in this emerging setting.