A pilot intervention utilizing Internet chat rooms to prevent HIV risk behaviors among men who have sex with men

Patient-Centered Approaches for Designing Destigmatizing Sexual Pain-Related Web-Based Platforms: Qualitative Study

BACKGROUND

Sexual pain is a common but neglected disorder that affects approximately 3% to 18% of women and an unmeasured number of gender-diverse people worldwide. Despite its wide prevalence, many people feel reluctant to visit conventional health care services or disclose their symptoms due to the fear of stigmatization. To alleviate this stigma, various web-based interventions have been developed to complement and, in some cases, replace conventional sexual health interventions. However, the way these web-based interventions are developed could inadvertently reproduce, perpetuate, or exacerbate stigma among end user patients.

OBJECTIVE

The purpose of this study was to understand patients' perspectives on how sexual pain-related web platforms can be designed to alleviate stigma or prevent the unintended effects of stigma among patients who use web-based interventions.

METHODS

Individual semistructured interviews were conducted among 16 participants with lived experiences of painful sex in a large urban city in Western Canada. Participants were recruited via social media platforms, newsletters, and a provincial health volunteer website. Using a sample sexual pain website to provide context, participants were interviewed about their experiences of stigma and how they think web platforms could be designed to address stigma. The interviews were conducted via Zoom (Zoom Technologies Inc) and analyzed using thematic analysis.

RESULTS

The findings revealed 4 overarching themes that represented participants' perspectives on designing web platforms that may alleviate or prevent the unintended effects of stigma. These findings suggested the design of inclusive web platforms, having a nonprovocative and calming user interface, having features that facilitate connections among users and between users and providers, and displaying personal testimonials and experiences of sexual pain.

CONCLUSIONS

This study highlighted patient-centered design approaches that could serve as a reference guide in developing web platforms that alleviate or prevent the unintended effects of stigma, particularly among nonheterosexual and gender-diverse people. While this study was conducted in the context of sexual pain, the results might also apply to web platforms on other potentially stigmatizing health-related disorders or conditions.

Tough Talks COVID-19 Digital Health Intervention for Vaccine Hesitancy Among Black Young Adults: Protocol for a Hybrid Type 1 Effectiveness Implementation Randomized Controlled Trial

BACKGROUND

Interventions for increasing the uptake of COVID-19 vaccination among Black young adults are central to ending the pandemic. Black young adults experience harms from structural forces, such as racism and stigma, that reduce receptivity to traditional public health messaging due to skepticism and distrust. As such, Black young adults continue to represent a priority population on which to focus efforts for promoting COVID-19 vaccine uptake.

OBJECTIVE

In aims 1 and 2, the Tough Talks digital health intervention for HIV disclosure will be adapted to address COVID-19 vaccine hesitancy and tailored to the experiences of Black young adults in the southern United States (Tough Talks for COVID-19). In aim 3, the newly adapted Tough Talks for COVID-19 digital health intervention will be tested across the following three southern states: Alabama, Georgia, and North Carolina.

METHODS

Our innovative digital health intervention study will include qualitative and quantitative assessments. A unique combination of methodological techniques, including web-based surveys, choose-your-own-adventures, digital storytelling, user acceptability testing, and community-based participatory approaches, will culminate in a 2-arm hybrid type 1 effectiveness implementation randomized controlled trial, wherein participants will be randomized to the Tough Talks for COVID-19 intervention arm or a standard-of-care control condition (N=360). Logistic regression will be used to determine the effect of the treatment arm on the probability of vaccination uptake (primary COVID-19 vaccine series or recommended boosters). Concurrently, the inner and outer contexts of implementation will be ascertained and catalogued to inform future scale-up. Florida State University's institutional review board approved the study (STUDY00003617).

RESULTS

Our study was funded at the end of April 2021. Aim 1 data collection concluded in early 2022. The entire study is expected to conclude in January 2025.

CONCLUSIONS

If effective, our digital health intervention will be poised for broad, rapid dissemination to reduce COVID-19 mortality among unvaccinated Black young adults in the southern United States. Our findings will have the potential to inform efforts that seek to address medical mistrust through participatory approaches. The lessons learned from the conduct of our study could be instrumental in improving health care engagement among Black young adults for several critical areas that disproportionately harm this community, such as tobacco control and diabetes prevention.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05490329; https://clinicaltrials.gov/ct2/show/NCT05490329.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41240.

A Systematic Literature Review of Community-Based Participatory Health Research with Sexual and Gender Minority Communities

Purpose:

The objective was to review sexual and gender minority (SGM) health research studies to gain an understanding of how the community-based participatory research (CBPR) framework has been operationalized.

Methods:

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct a review of all SGM health research studies published in the past 10 years that cited a CBPR approach (PROSPERO Registration No. CRD42016036608). CINAHL, PubMed, and PsycINFO databases were systematically searched in October 2020. Dimensions of community involvement (e.g., shared decision-making; flexibility to community needs and priorities) and the strength of evidence for each dimension were rated using guidance from the Agency of Healthcare Research and Quality.

Results:

The 48 eligible articles identified reported a range of 0–11 (out of 13) community elements. Seven studies reported zero elements. Qualitative studies (n=28; 58.3%) had an average quality score of 2.32 (range: 1.43–2.5). The 15 (31.3%) cross-sectional studies had an average quality score of 2.08 (range: 1.64–2.27).

Conclusion:

Adhering to the CBPR framework is challenging. The benefits of striving toward its principles, however, can move us toward transformative and sustainable social change within SGM communities.

Implementation and evaluation of a culturally grounded group-based HIV prevention programme for men who have sex with men in Ghana

This study examined the feasibility and acceptability of an evidence-based HIV prevention programme for men who have sex with men (MSM) in Ghana through a participatory approach. The programme involved 57 self-identified adult cisgender MSM and led by a community-based organisation in collaboration with local nurses. We used an explanatory mixed-method design to evaluate the programme. We computed descriptive statistics, relative frequency, and paired proportionate analysis for the survey data and subjected the focus groups data to summative content analysis. Five key themes from the qualitative data indicated strong evidence of the acceptability and efficacy of the programme among MSM. The programme contributed to building social support networks, a sense of social justice among MSM, and facilitated the development of personalised HIV prevention menus by the participants. We observed increases in HIV testing (from 4% to 17%) and increases in the relative frequency of condom use for anal, oral, and vaginal sex. The programme served as an example of a successfully implemented culturally grounded intervention that has the potential to increase HIV and STI awareness and prevention among MSM in Ghana and other highly stigmatised environments.

HIV prevention and treatment interventions for black men who have sex with men in Canada: a protocol for a scoping systematic review

INTRODUCTION

Globally, rates of HIV are disproportionately high among black men who have sex with men (MSM). In Canada, race, gender and sexuality have been investigated as separate factors that influence quality of care within and progression along the HIV care continuum. Traditional compartmental approaches to synthesising the HIV care continuum literature do not sufficiently account for intersectional experiences and marginalisation of Black MSM (BMSM). Moreover, there is limited research outlining access to and quality of care as specific barriers to progression along the care continuum among BMSM in Canada.

OBJECTIVES

The primary objective of this scoping review is to assess the state of the science regarding the influence of access to and quality of HIV care continuum outcomes for BMSM in Canada.

METHODS AND ANALYSIS

We will conduct a systematic search of published literature of quantitative and qualitative studies published on Canadian BMSM's healthcare and HIV status. The searches will be conducted through MEDLINE, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, the NHUS Economic Development Database, Global Health, APA PsychInfo, PubMed and Web of Science.

ELIGIBILITY CRITERIA

Eligible studies will include data on black MSM living with or without HIV in Canada and must be published after 1983 in either English or French. Screening and data extraction will be conducted in duplicate. Any discrepancies that arise will be resolved by consulting a third author. The findings will subsequently be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.

ETHICS AND DISSEMINATION

Ethics approval is not required as secondary published data will be used. Our findings will be disseminated as peer-reviewed manuscripts, at conferences, student rounds and could be of interest to government health agencies and HIV/AIDS service organisations.

Innovative Self-Confidence Webinar Intervention for Depression in the Workplace: A Focus Group Study and Systematic Development

Brief face-to-face self-confidence workshops were effective in reducing depression among the public. Technological advances have enabled traditional face-to-face interventions to be adapted using unique technology-mediated platforms. This article details the formative development of a self-confidence web-based seminar (webinar) intervention for workplace depression. The first section discusses a qualitative study that explores the feasibility and acceptability of adapting the self-confidence workshops into a webinar platform on employees in the workplace. The second section describes the systematic development of this new webinar intervention informed by the qualitative study findings, a published systematic review, and previous face-to-face self-confidence workshops. The qualitative study involves three focus groups (n = 10) conducted in a small organization. Three themes were identified relevant to the running of the new self-confidence webinars in the workplace: personal (content, time and duration preference, features of the webinar, individual participation, personalization), interpersonal (stigma from others, engagement with participants/presenter, moderated interaction), and organizational (endorsement from management, work demand). For the intervention development, the format, structure, features, and content of the self-confidence webinar intervention are described. Features such as file sharing, virtual whiteboard, live chat, and poll are explained with the intervention primarily based on cognitive behavior therapy and coping flexibility concepts.

Provision of online HIV-related information to gay, bisexual and other men who have sex with men: a health literacy-informed critical appraisal of Canadian agency websites

Background HIV risk and prevention information is increasingly complex and poses challenges for gay, bisexual and other men who have sex with men (GBMSM) seeking to find, understand and apply this information. A directed content analysis of Canadian HIV websites to see what information is provided, how it is presented and experienced by users, was conducted.

METHODS

Eligible sites provided information relevant for GBMSM on HIV risk or prevention, were from community or government agencies, and were aimed at the public. Sites were found by using a Google search using French and English search terms, from expert suggestions and a review of links. Eligibility and content for review was determined by two reviewers, and coded using a standardised form. Reading grade level and usability scores were assessed through Flesch-Kincaid and LIDA instruments.

RESULTS

Of 50 eligible sites, 78% were from community agencies and 26% were focussed on GBMSM. Overall, fewer websites contained information on more recent biomedical advances (e.g. pre-exposure prophylaxis, 10%) or community-based prevention strategies (e.g. seroadaptive positioning, 10%). Many sites had high reading levels, used technical language and relied on text and prose. And 44% of websites had no interactive features and most had poor usability scores for engageability.

CONCLUSIONS

Overall, less information about emerging topics and a reliance on text with high reading requirements was observed. Our study speaks to potential challenges for agency website operators to maintain information relevant to GBMSM which is up-to-date, understandable for a range of health literacy skills and optimises user experience.

Exploring and Prioritization of Mobile-Based Self-Management Strategies for HIV Care

OBJECTIVE

Appropriate mobile-based self-management strategies can be as new approaches to decelerate the HIV infection progression and improve the quality of life. This study aims at (i) identifying in the literature mobile-based self-management strategies for HIV care and (ii) prioritizing those from the point of view of infectious diseases specialists. This study provides some clues to design useful mobile-based self-management tools for HIV patients, from the point of view of practitioners.

METHODS

This mixed methods study was done in two main phases. In the first phase, a review was conducted in: PubMed, Web of Science, Science Direct, Scopus, and Ovid. In this manner, related studies published between 2010 and 2017 and in the English language were reviewed. In the second phase, identified mobile-based self-management strategies were scored and prioritized by 23 participants. Frequency distribution and mean reports were calculated using SPSS statistical software.

RESULTS

By detailed reviewing of 24 related articles, the HIV mobile-based self-management strategies were identified in 47 categories and subcategories. According to the findings, "enhance the quality of life" was the main self-management strategy addressed by reviewed studies. However, "antiretroviral therapy and medication adherence" was reported at a higher rate to be a more helpful strategy than "enhance the quality of life".

CONCLUSION

In this study, helpful HIV mobile-based self-management strategies were identified that can be used to guide self-management interventions which have the potential to improve the healthcare services for people living with HIV.

Testing the Efficacy of a Social Networking Gamification App to Improve Pre-Exposure Prophylaxis Adherence (P3: Prepared, Protected, emPowered): Protocol for a Randomized Controlled Trial

Background

HIV prevalence is high among young men who have sex with men (YMSM) and young transgender women who have sex with men (YTWSM), particularly among minorities. Despite its proven efficacy and safety, the uptake of and adherence to pre-exposure prophylaxis (PrEP) among YMSM and YTWSM is currently limited. To date, evidence-based interventions to promote and sustain PrEP adherence have been limited and not shown to be highly efficacious. Given the widespread adoption of smartphones, mobile apps can be utilized to increase PrEP adherence for many YMSM and YTWSM.

Objective

The study consists of a formative research phase to develop an app-based intervention, P3 (Prepared, Protected, emPowered), to increase PrEP adherence, and a randomized controlled trial (RCT) to test its efficacy. P3 is a mobile app built on an established health platform, which includes social networking and game-based components to encourage PrEP adherence among YMSM and YTWSM. P3+ includes all P3 features plus adherence counseling delivered via two-way text messaging (short message service, SMS) through the app.

Methods

The formative research phase includes usability testing to assess users’ comprehension of P3’s educational content, understanding and use of intervention features, and overall impressions of app functionality, followed by app refinements. A subsequent field trial will identify and resolve any remaining technical challenges. A three-arm RCT (P3, P3+, and standard of care) will then be conducted at 6 iTech subject recruitment venues to assess intervention efficacy and to conduct a comparison of costs to deliver the 2 intervention arms.

Results

This is an ongoing research project with initial results from the formative work expected in 2020 and those from the RCT in 2021.

Conclusions

P3 aims to provide an engaging, interactive experience that is highly appealing for the target population, leveraging technology already heavily integrated into the lives of young people, and thus meeting users’ needs in a familiar, stimulating way. If efficacious, P3 could be a sustainable, easily disseminated, lower-cost PrEP intervention for YMSM and YTWSM. Further, the research aims to determine the processes that are essential to developing and implementing future health-related gamification interventions.

Trial Registration

ClinicalTrials.gov NCT03320512; https://clinicaltrials.gov/ct2/show/NCT03320512 (Archived by WebCite at http://www.webcitation.org/74OVZkICl)

International Registered Report Identifier (IRRID)

DERR1-10.2196/10448

Empowering With PrEP (E-PrEP), a Peer-Led Social Media-Based Intervention to Facilitate HIV Preexposure Prophylaxis Adoption Among Young Black and Latinx Gay and Bisexual Men: Protocol for a Cluster Randomized Controlled Trial

Background

Young black and Latinx, gay, bisexual, and other men who have sex with men (YBLGBM, aged 18-29 years) have among the highest rates of new HIV infections in the United States and are not consistently reached by existing prevention interventions. Preexposure prophylaxis (PrEP), an oral antiretroviral regimen taken daily by HIV-uninfected individuals to prevent HIV acquisition, is highly efficacious in reducing HIV acquisition and could help stop the HIV epidemic in YBLGBM. Use of social media (eg, Facebook, Twitter, online dating sites) is ubiquitous among young people, providing an efficient avenue to engage YBLGBM to facilitate PrEP adoption.

Objective

Our overall goal was to develop and pilot test a theoretically grounded, social media–based, peer-led intervention to increase PrEP uptake in YBLGBM. We used diffusion of innovation and information-motivation-behavioral skills frameworks to (1) identify potential factors associated with interest in and adoption of PrEP among YBLGBM; (2) develop Empowering with PrEP (E-PrEP), a social media–based, peer-led intervention to increase PrEP uptake in YBLGBM; and (3) pilot test the feasibility and acceptability of E-PrEP, and determine its preliminary efficacy for increasing adoption of PrEP by YBLGBM. We describe the development and protocol for E-PrEP.

Methods

Using a participatory research approach, we partnered with YBLGBM intervention development partners to develop a social media–based behavioral intervention to facilitate PrEP uptake, which involved an online messaging campaign disseminated by YBLGBM peer leaders to their existing online networks. We designed the 6-week campaign to provide education about PrEP, increase motivation to use PrEP, and facilitate access to PrEP. We then conducted a cluster-randomized trial of E-PrEP compared with an attention-matched general health control condition (E-Health) among YBLGBM aged 18 to 29 years to assess E-PrEP’s feasibility, acceptability, preliminary efficacy for increasing self-reported intention to use PrEP, PrEP uptake, and impact on knowledge and attitudes about PrEP at 12-week follow-up (6 weeks after the end of the online campaign).

Results

From October 2016 to March 2017, we developed, pretested, and refined E-PrEP with 6 YBLGBM intervention development partners. From May to June 2017, we recruited, enrolled, and randomly assigned 10 peer leaders (n=5 for each condition). The 10 peer leaders then recruited and enrolled 152 participants from their existing online networks (range 3-33 per peer leader), during June and July 2017. Intervention follow-up was completed after 12 weeks, in November 2017, with analyses underway.

Conclusions

We hypothesize that, compared with E-Health, participants randomly assigned to E-PrEP will be more likely to express intention to use PrEP and greater PrEP uptake, and will also show changes in potential mediators of PrEP uptake (knowledge, attitudes, stigma, and access). A Web-based biobehavioral intervention model such as E-PrEP could be rapidly scaled even with limited resources and have significant population-level impact.

Trial Registration

ClinicalTrials.gov NCT03213366; https://clinicaltrials.gov/ct2/show/NCT03213366 (Archived by WebCite at http://www.webcitation.org/71onSdcXY)

Registered Report Identifier

RR1-10.2196/11375

What Do Patients Talk About? A Qualitative Analysis of Online Chat Sessions with Health Care Specialists During a "Virtual" Cardiac Rehabilitation Program

INTRODUCTION

Cardiac rehabilitation programs (CRPs) are effective at reducing cardiovascular disease (CVD) risk, yet attendance in these programs remains low due to geographic constraints. In a previously conducted randomized trial we demonstrated that a virtual CRP (vCRP) delivered over the Internet reduced risk for CVD. The current investigation has reviewed the online chat sessions between participants and healthcare providers (HCP) to describe the content of discussions during the vCRP intervention.

MATERIALS AND METHODS

Participants were recruited from two geographically isolated areas in British Columbia, Canada without in-person CRP or a cardiologist serving the area. The vCRP, among other elements, included scheduled one-on-one chat sessions with a dietician, exercise specialist, and nurse to mimic standard CRP consultations. The chat sessions were reviewed for content and themes. Multiple chat sessions between participants and a single care provider were also analyzed to describe how chat content progressed through multiple sessions.

RESULTS

A total of 38 participants participated in the vCRP intervention. From the 122 chat sessions between participants and HCP during the vCRP, the main themes identified were Managing Health and Lifestyle, Continuity of Care, and Getting Care from a Distance. Within each theme, sub-themes were also identified.

CONCLUSIONS

The vCRP chat sessions fulfilled the role of face-to-face consultations with HCP that are standard in hospital-based CRP and addressed patient concerns, facilitating remote patient-provider interaction and covering topics on exercise, diet, and positive behavior changes to limit risk factors for future heart problems.

Comparing men who have sex with men and transgender women who use Grindr, other similar social and sexual networking apps, or no social and sexual networking apps: Implications for recruitment and health promotion

Objective

Researchers and public health professionals have increased their attention to GPS-based social and sexual networking applications (apps) tailored to gay, bisexual, other men who have sex with men (MSM) and transgender women. These populations continue to be disproportionately affected by HIV in the United States, therefore these apps, in particular Grindr, have become an important sampling venue for the recruitment of HIV-related research participants. As such, it is essential to identify differences among app users to avoid potential sampling bias. This paper seeks to identify differences in MSM and transgender women who use Grindr and those who use other similar apps.

Methods

A community-based participatory research (CBPR) approach was used to recruit participants online who then completed a 25-item anonymous survey. Five domains were assessed: sociodemographics, HIV testing, sexual risk, substance abuse, and use of GPS-based social and sexual networking apps.

Results

457 participants completed surveys. There were significant differences in the sociodemographic characteristics by app use, including age, race/ethnicity, sexual orientation, and outness. After adjusting for the sociodemographic characteristics associated with app use, there were significant differences in HIV risk and substance use between the groups.

Conclusion

This paper is the first to report on findings that compare MSM and transgender women who report using Grindr to MSM and transgender women who report using other similar apps. GPS-based social and sexual networking apps may offer a valuable recruitment tool for future HIV research seeking to recruit populations at increased risk for HIV or those living with HIV for therapeutic trials. Because of the differences identified across users of different apps, these findings suggest that if researchers recruited participants from just one app, they could end up with a sample quite different than if they had recruited MSM and transgender women from other apps.

Online interventions to address HIV and other sexually transmitted and blood-borne infections among young gay, bisexual and other men who have sex with men: a systematic review

Introduction

Globally, young gay, bisexual and other men who have sex with men (gbMSM) continue to experience disproportionately high rates of HIV and other sexually transmitted and blood‐borne infections (STBBIs). As such, there are strong public health imperatives to evaluate innovative prevention, treatment and care interventions, including online interventions. This study reviewed and assessed the status of published research (e.g. effectiveness; acceptability; differential effects across subgroups) involving online interventions that address HIV/STBBIs among young gbMSM.

Methods

We searched Medline, Embase, PsycINFO, CINAHL, and Google Scholar to identify relevant English‐language publications from inception to November 2016. Studies that assessed an online intervention regarding the prevention, care, or treatment of HIV/STBBIs were included. Studies with <50% gbMSM or with a mean age ≥30 years were excluded.

Results

Of the 3465 articles screened, 17 studies met inclusion criteria. Sixteen studies assessed interventions at the “proof‐of‐concept” phase, while one study assessed an intervention in the dissemination phase. All of the studies focused on behavioural or knowledge outcomes at the individual level (e.g. condom use, testing behaviour), and all but one reported a statistically significant effect on ≥1 primary outcomes. Twelve studies described theory‐based interventions. Twelve were conducted in the United States, with study samples focusing mainly on White, African‐American and/or Latino populations; the remaining were conducted in Hong Kong, Peru, China, and Thailand. Thirteen studies included gay and bisexual men; four studies did not assess sexual identity. Two studies reported including both HIV+ and HIV− participants, and all but one study included one or more measure of socio‐economic status. Few studies reported on the differential intervention effects by socio‐economic status, sexual identity, race or serostatus.

Conclusion

While online interventions show promise at addressing HIV/STBBI among young gbMSM, to date, little emphasis has been placed on assessing: (i) potential differential effects of interventions across subgroups of young gbMSM; (ii) effectiveness studies of interventions in the dissemination phase; and (iii) on some “key” populations of young gbMSM (e.g. those who are: transgender, from low‐income settings and/or HIV positive). Future research that unpacks the potentially distinctive experiences of particular subgroups with “real world” interventions is needed.

Engaged for Change: A Community-Engaged Process for Developing Interventions to Reduce Health Disparities

The science underlying the development of individual, community, system, and policy interventions designed to reduce health disparities has lagged behind other innovations. Few models, theoretical frameworks, or processes exist to guide intervention development. Our community-engaged research partnership has been developing, implementing, and evaluating efficacious interventions to reduce HIV disparities for over 15 years. Based on our intervention research experiences, we propose a novel 13-step process designed to demystify and guide intervention development. Our intervention development process includes steps such as establishing an intervention team to manage the details of intervention development; assessing community needs, priorities, and assets; generating intervention priorities; evaluating and incorporating theory; developing a conceptual or logic model; crafting activities; honing materials; administering a pilot, noting its process, and gathering feedback from all those involved; and editing the intervention based on what was learned. Here, we outline and describe each of these 13 steps.

Network support, technology use, depression, and ART adherence among HIV-positive MSM of color

Depression is associated with poor antiretroviral therapy (ART) adherence among people living with HIV/AIDS. This relationship may be moderated by an individual's social network characteristics. Our study sought to examine social network correlates of treatment adherence among HIV-positive men recruited from social service agencies throughout Los Angeles County (N = 150) to inform technology-driven social support interventions for this population. We administered egocentric social network and computer-assisted survey interviews focused on demographic characteristics, health history, depressive symptoms, and ART adherence, where adherence was assessed by the number of reasons participants missed taking their medication, if ever. Significant univariate correlates of adherence were included in a multivariable regression analysis, where the moderating effect of having a network member who reminds participants to take their HIV medication on the relationship between depression and adherence was tested. Over 60% of participants reported clinically significant depressive symptoms; this was significantly associated with lower adherence among those without someone in their social network to remind them about taking their HIV medication, even after adjusting for covariates in an ordinary least squares regression (adjusted mean difference b = -1.61, SE = 0.42, p = 0.0003). Having a network member who reminds participants to take their ART medication significantly ameliorated the negative association between depression and treatment adherence, especially for those reporting greater depressive symptoms (p = 0.0394). Additionally, participants demonstrated high rates of technology use to communicate with social network members. In order to achieve the aims of the National HIV/AIDS Strategy, innovative interventions addressing mental health to improve ART adherence are needed. Network strategies that leverage technology may be helpful for improving ART adherence among HIV-positive men with comorbid depressive symptoms.

Barriers to Access and Adoption of Pre-Exposure Prophylaxis for the Prevention of HIV Among Men Who Have Sex With Men (MSM) in a Relatively Rural State

Biomedical intervention approaches, including antiretroviral pre-exposure prophylaxis (PrEP), have been demonstrated to reduce HIV incidence among several at-risk populations and to be cost effective. However, there is limited understanding of PrEP access and uptake among men who have sex with men (MSM) residing in relatively rural states. Twenty semistructured interviews were conducted (August-November 2016) to assess opinions of and perceived barriers to accessing and adopting PrEP among MSM residing in Oklahoma. Participants perceived substantial barriers to accessing PrEP including a stigmatizing environment and less access to quality, LGBT-sensitive medical care. Overall, geographic isolation limits access to health providers and resources that support sexual health for Oklahoma MSM. Addressing stigma situated across ecological levels in an effort to increase adoption of PrEP by MSM residing in rural states remains necessary. Without this, social determinants may continue to negatively influence PrEP adoption and sexual health outcomes.

Using Facebook as a Platform to Direct Young Black Men Who Have Sex With Men to a Video-Based HIV Testing Intervention: A Feasibility Study

OBJECTIVE

A randomized control pilot study was conducted with Black men who have sex with men (BMSM; N = 42) aged 18-30 years to examine the feasibility of implementing a video intervention delivered using Facebook to motivate HIV testing.

METHODS

At baseline, participants were unaware of their HIV status and had not tested for HIV in the past 6 months, residing in Los Angeles County. The intervention content included topics such as social influence, HIV knowledge, stigma, HIV positive knowledge, and benefits of knowing one's HIV status.

FINDINGS

Logistic regression revealed that those receiving the video intervention were 7 times more likely to have tested for HIV than those in the control group at 6-week follow-up (odds ratio [OR] = 7.00, 95% confidence interval [1.72, 28.33], p = .006).

CONCLUSION

Data suggest that the intervention was feasible for motivating HIV testing.

HIV-Prevention Opportunities With GPS-Based Social and Sexual Networking Applications for Men Who Have Sex With Men

The goal of this study was to gain insight on the sexual health needs of men who have sex with men (MSM) who use GPS-based social and sexual networking mobile applications (apps) and the future utility of app-based interventions. A health educator promoted HIV-testing resources in four popular apps used by MSM. Content analysis was used to identify salient themes that emerged from the conversations. Four major themes were identified: (1) soliciting sexual encounters, (2) relationship building, (3) HIV and STI-testing inquiries, and (4) seeking other sexual health information. The results suggest the intervention's social media-based strategy, respect for community culture, and unobtrusive approach was advantageous in establishing credibility and rapport with app users. These results highlight a need for convenient and discreet methods to access accurate sexual health information and suggest that apps provide an alternative, non-traditional venue for sexual health education in addition to HIV testing promotion.

HIV Testing Among Internet-Using MSM in the United States: Systematic Review

Regular HIV testing enables early identification and treatment of HIV among at-risk men who have sex with men (MSM). Characterizing HIV testing needs for Internet-using MSM informs development of Internet-facilitated testing interventions. In this systematic review we analyze HIV testing patterns among Internet-using MSM in the United States who report, through participation in an online study or survey, their HIV status as negative or unknown and identify demographic or behavioral risk factors associated with testing. We systematically searched multiple electronic databases for relevant English-language articles published between January 1, 2005 and December 16, 2014. Using meta-analysis, we summarized the proportion of Internet-using MSM who had ever tested for HIV and the proportion who tested in the 12 months preceding participation in the online study or survey. We also identified factors predictive of these outcomes using meta-regression and narrative synthesis. Thirty-two studies that enrolled 83,186 MSM met our inclusion criteria. Among the studies reporting data for each outcome, 85 % (95 % CI 82-87 %) of participants had ever tested, and 58 % (95 % CI 53-63 %) had tested in the year preceding enrollment in the study, among those for whom those data were reported. Age over 30 years, at least a college education, use of drugs, and self-identification as being homosexual or gay were associated with ever having tested for HIV. A large majority of Internet-using MSM indicated they had been tested for HIV at some point in the past. A smaller proportion-but still a majority-reported they had been tested within the year preceding study or survey participation. MSM who self-identify as heterosexual or bisexual, are younger, or who use drugs (including non-injection drugs) may be less likely to have ever tested for HIV. The overall findings of our systematic review are encouraging; however, a subpopulation of MSM may benefit from targeted outreach. These findings indicate unmet needs for HIV testing among Internet-using MSM and identify subpopulations that might benefit from targeted outreach, such as provision of HIV self-testing kits.

The Use of Technology to Advance HIV Prevention for Couples

The majority of HIV prevention studies and programs have targeted individuals or operated at the community level. This has also been the standard approach when incorporating technology (e.g., web-based, smartphones) to help improve HIV prevention efforts. The tides have turned for both approaches: greater attention is now focusing on couple-based HIV prevention and using technology to help improve these efforts for maximizing reach and potential impact. To assess the extent that technology has been used to help advance HIV prevention with couples, a literature review was conducted using four databases and included studies that collected data from 2000 to early 2015. Results from this review suggest that technology has primarily been used to help advance HIV prevention with couples as a tool for (1) recruitment and data collection and (2) intervention development. Challenges and limitations of conducting research (e.g., validity of dyadic data) along with future directions for how technology (e.g., mHealth, wearable sensors) can be used to advance HIV prevention with couples are then discussed. Given the growing and near ubiquitous use of the Internet and smartphones, further efforts in the realm of mHealth (e.g., applications or "apps") and eHealth are needed to develop novel couple-focused HIV-preventive interventions.

Project SMART: Preliminary Results From a Test of the Efficacy of a Swedish Internet-Based HIV Risk-Reduction Intervention for Men Who Have Sex With Men

In Sweden, 57 % of HIV transmission occurs among MSM, and other sexually transmitted infections are increasing, supporting the need for innovative interventions. The Internet is a potentially useful HIV-prevention platform, but there is a lack of such programs in Sweden. The purpose of this exploratory study was to test the efficacy of the Internet-based SMART intervention to decrease HIV sexual risks in Swedish MSM. The intervention was adapted from the Wyoming Rural AIDS Prevention Project to the Swedish context, which was guided by the Information-Motivation-Behavioral (IMB) skills model and consisted of six sessions. A total of 112 men responded to a pretest questionnaire and were randomly assigned to the SMART intervention or to a waitlist group. Fifty-four men dropped out, leaving a final sample of 58 participants. Twenty-five were assigned to the SMART intervention and 33 to a waitlist group. One month post intervention, the number of casual anal sex partners significantly decreased (t = 2.19, p = .04). Compared with the waitlist group, men in the intervention group increased their HIV knowledge (β = 0.70, p = .01), their belief of condom use as an act of responsibility (β = 1.19, p = .04), their willingness to use a condom with every new partner all the time (β = 1.39, p = .03), and their confidence in using condoms in challenging situations (β = 1.65, p = .02). Condom use was not analyzed due to the small sample size. Despite the small sample, high drop-out, and short follow-up, the study provides support for the efficacy of the Internet interventions, the SMART intervention specifically, for reducing the proportion of casual anal sex partners and improving the three cognitive components of the IMB model for Swedish MSM.

Social innovation for the promotion of health equity

The role of social innovations in transforming the lives of individuals and communities has been a source of popular attention in recent years. This article systematically reviews the available evidence of the relationship between social innovation and its promotion of health equity. Guided by Fair Foundations: The VicHealth framework for health equity and examining four types of social innovation--social movements, service-related social innovations, social enterprise and digital social innovations--we find a growing literature on social innovation activities, but inconsistent evaluative evidence of their impacts on health equities, particularly at the socio-economic, political and cultural level of the framework. Distinctive characteristics of social innovations related to the promotion of health equity include the mobilization of latent or unrealised value through new combinations of (social, cultural and material) resources; growing bridging social capital and purposeful approaches to linking individual knowledge and experience to institutional change. These have implications for health promotion practice and for research about social innovation and health equity.

Community-Based Participatory Research Studies on HIV/AIDS Prevention, 2005-2014

The recent literature on community-based participatory research (CBPR) approaches to preventing HIV infection in diverse communities was systematically reviewed as part of the planning process for a new study. Published HIV prevention studies that employed CBPR methods were identified for the period January 1, 2005 to April 30, 2014 using PubMed databases and MeSH term and keyword searches. A total of 44 studies on CBPR and HIV or AIDS prevention were identified, of which 3 focused on adolescents, 33 on adults, and 8 on both adolescents and adults. A variety of at-risk populations were the focus of the studies including men who have sex with men, African American or Hispanic men, and African American or Hispanic women. Few studies focused on Asian/Pacific Islander or American Indian populations in the U.S. Six studies employed CBPR methods to address HIV prevention in church settings. Many of the studies were limited to formative research (ethnographic research, in-depth interviews of key informants, or focus groups). Other studies had a pre-/post-test design, quasi-experimental, or randomized design. Additional CBPR studies and faith-based interventions are needed with adequate sample sizes and rigorous study designs to address lack of knowledge of HIV and inadequate screening in diverse communities to address health disparities.

Online Outreach Services Among Men Who Use the Internet to Seek Sex With Other Men (MISM) in Ontario, Canada: An Online Survey

BACKGROUND

Men who use the Internet to seek sex with other men (MISM) are increasingly using the Internet to find sexual health information and to seek sexual partners, with some research suggesting HIV transmission is associated with sexual partnering online. Aiming to "meet men where they are at," some AIDS service organizations (ASOs) deliver online outreach services via sociosexual Internet sites and mobile apps.

OBJECTIVE

To investigate MISM's experiences and self-perceived impacts of online outreach.

METHODS

From December 2013 to January 2014, MISM aged 16 years or older were recruited from Internet sites, mobile apps, and ASOs across Ontario to complete a 15-minute anonymous online questionnaire regarding their experience of online outreach. Demographic factors associated with encountering online outreach were assessed using backward-stepwise multivariable logistic regression (P<.05 was considered significant).

RESULTS

Of 1830 MISM who completed the survey, 8.25% (151/1830) reported direct experience with online outreach services. Encountering online outreach was more likely for Aboriginal versus white MISM, MISM from Toronto compared with MISM from either Eastern or Southwestern Ontario, and MISM receiving any social assistance. MISM who experienced online outreach felt the service provider was friendly (130/141, 92.2%), easy to understand (122/140, 87.1%), helpful (115/139, 82.7%), prompt (107/143, 74.8%), and knowledgeable (92/134, 68.7%); half reported they received a useful referral (49/98, 50%). Few MISM felt the interaction was annoying (13/141, 9.2%) or confusing (18/142, 12.7%). As a result of their last online outreach encounter, MISM reported the following: better understanding of (88/147, 59.9%) and comfort with (75/147, 51.0%) their level of sexual risk; increased knowledge (71/147, 48.3%); and feeling less anxious (51/147, 34.7%), better connected (46/147, 31.3%), and more empowered (40/147, 27.2%). Behaviorally, they reported using condoms more frequently (48/147, 32.7%) and effectively (35/147, 23.8%); getting tested for HIV (43/125, 34.4%) or STIs (42/147, 28.6%); asking for their partners' HIV statuses (37/147, 25.2%); and serosorting (26/147, 17.7%). Few MISM reported no changes (15/147, 10.2%) and most would use these services again (98/117, 83.8%). Most MISM who did not use online outreach said they did not need these services (1074/1559, 68.89%) or were unaware of them (496/1559, 31.82%).

CONCLUSIONS

This is the first online outreach evaluation study of MISM in Canada. Online outreach services are a relatively new and underdeveloped area of intervention, but are a promising health promotion strategy to provide service referrals and engage diverse groups of MISM in sexual health education.

Social Media and HIV: A Systematic Review of Uses of Social Media in HIV Communication

BACKGROUND

Social media, including mobile technologies and social networking sites, are being used increasingly as part of human immunodeficiency virus (HIV) prevention and treatment efforts. As an important avenue for communication about HIV, social media use may continue to increase and become more widespread.

OBJECTIVE

The objective of this paper is to present a comprehensive systematic review of the current published literature on the design, users, benefits, and limitations of using social media to communicate about HIV prevention and treatment.

METHODS

This review paper used a systematic approach to survey all literature published before February 2014 using 7 electronic databases and a manual search. The inclusion criteria were (1) primary focus on communication/interaction about HIV/acquired immunodeficiency syndrome (AIDS), (2) discusses the use of social media to facilitate communication, (3) communication on the social media platform is between individuals or a group of individuals rather than the use of preset, automated responses from a platform, (4) published before February 19, 2014, and (5) all study designs.

RESULTS

The search identified 35 original research studies. Thirty studies had low or unclear risk of at least one of the bias items in the methodological quality assessment. Among the 8 social media platform types described, short message service text messaging was most commonly used. Platforms served multiple purposes including disseminating health information, conducting health promotion, sharing experiences, providing social support, and promoting medication adherence. Social media users were diverse in geographic location and race/ethnicity; studies commonly reported users aged 18-40 years and users with lower income. Although most studies did not specify whether use was anonymous, studies reported the importance of anonymity in social media use to communicate about HIV largely due to the stigma associated with HIV. The ability to share and receive information about HIV was the most commonly reported benefit of social media use and the most common challenges were related to technology. Measures of frequency of use, satisfaction, and effects of use varied across studies.

CONCLUSIONS

Using social media to bridge communication among a diverse range of users, in various geographic and social contexts, may be leveraged through pre-existing platforms and with attention to the roles of anonymity and confidentiality in communication about HIV prevention and treatment. More robust research is needed to determine the effects of social media use on various health and social outcomes related to HIV.

Using Social Media for Actionable Disease Surveillance and Outbreak Management: A Systematic Literature Review

OBJECTIVE

Research studies show that social media may be valuable tools in the disease surveillance toolkit used for improving public health professionals' ability to detect disease outbreaks faster than traditional methods and to enhance outbreak response. A social media work group, consisting of surveillance practitioners, academic researchers, and other subject matter experts convened by the International Society for Disease Surveillance, conducted a systematic primary literature review using the PRISMA framework to identify research, published through February 2013, answering either of the following questions: Can social media be integrated into disease surveillance practice and outbreak management to support and improve public health?Can social media be used to effectively target populations, specifically vulnerable populations, to test an intervention and interact with a community to improve health outcomes?Examples of social media included are Facebook, MySpace, microblogs (e.g., Twitter), blogs, and discussion forums. For Question 1, 33 manuscripts were identified, starting in 2009 with topics on Influenza-like Illnesses (n = 15), Infectious Diseases (n = 6), Non-infectious Diseases (n = 4), Medication and Vaccines (n = 3), and Other (n = 5). For Question 2, 32 manuscripts were identified, the first in 2000 with topics on Health Risk Behaviors (n = 10), Infectious Diseases (n = 3), Non-infectious Diseases (n = 9), and Other (n = 10).

CONCLUSIONS

The literature on the use of social media to support public health practice has identified many gaps and biases in current knowledge. Despite the potential for success identified in exploratory studies, there are limited studies on interventions and little use of social media in practice. However, information gleaned from the articles demonstrates the effectiveness of social media in supporting and improving public health and in identifying target populations for intervention. A primary recommendation resulting from the review is to identify opportunities that enable public health professionals to integrate social media analytics into disease surveillance and outbreak management practice.

The Role of Social Network Technologies in Online Health Promotion: A Narrative Review of Theoretical and Empirical Factors Influencing Intervention Effectiveness

Background

Social network technologies have become part of health education and wider health promotion—either by design or happenstance. Social support, peer pressure, and information sharing in online communities may affect health behaviors. If there are positive and sustained effects, then social network technologies could increase the effectiveness and efficiency of many public health campaigns. Social media alone, however, may be insufficient to promote health. Furthermore, there may be unintended and potentially harmful consequences of inaccurate or misleading health information. Given these uncertainties, there is a need to understand and synthesize the evidence base for the use of online social networking as part of health promoting interventions to inform future research and practice.

Objective

Our aim was to review the research on the integration of expert-led health promotion interventions with online social networking in order to determine the extent to which the complementary benefits of each are understood and used. We asked, in particular, (1) How is effectiveness being measured and what are the specific problems in effecting health behavior change?, and (2) To what extent is the designated role of social networking grounded in theory?

Methods

The narrative synthesis approach to literature review was used to analyze the existing evidence. We searched the indexed scientific literature using keywords associated with health promotion and social networking. The papers included were only those making substantial study of both social networking and health promotion—either reporting the results of the intervention or detailing evidence-based plans. General papers about social networking and health were not included.

Results

The search identified 162 potentially relevant documents after review of titles and abstracts. Of these, 42 satisfied the inclusion criteria after full-text review. Six studies described randomized controlled trials (RCTs) evaluating the effectiveness of online social networking within health promotion interventions. Most of the trials investigated the value of a “social networking condition” in general and did not identify specific features that might play a role in effectiveness. Issues about the usability and level of uptake of interventions were more common among pilot studies, while observational studies showed positive evidence about the role of social support. A total of 20 papers showed the use of theory in the design of interventions, but authors evaluated effectiveness in only 10 papers.

Conclusions

More research is needed in this area to understand the actual effect of social network technologies on health promotion. More RCTs of greater length need to be conducted taking into account contextual factors such as patient characteristics and types of a social network technology. Also, more evidence is needed regarding the actual usability of online social networking and how different interface design elements may help or hinder behavior change and engagement. Moreover, it is crucial to investigate further the effect of theory on the effectiveness of this type of technology for health promotion. Research is needed linking theoretical grounding with observation and analysis of health promotion in online networks.

General practice and the Internet revolution. Use of an Internet social network to communicate information on prevention in France

The popularity of social networks and the huge number of exchanges have made them immensely important for the communication of information. This French study explored prevention in hereditary breast cancer using a social Internet network to communicate information. The principal objective was to inform French women aged from 20 to 50 years, using the social network Facebook, about the warning signs of breast cancer in cases of a predisposition to the disease due to a genetic mutation. The secondary objectives were to inform people about screening. An information page entitled "hereditary breast cancer: and if I was concerned?" was distributed in 3 different ways: from friend to friend, via groups of persons, and by targeted advertising. Four articles and 11 messages were distributed over 27 days. The total number of visits for this period amounted to 1019. A total of 81 percent of the Internauts were women and 55 percent of the visitors were aged between 25 and 44 years. Other information campaigns concerning public health issues could be conducted using this tool. A legal framework is necessary to preserve the quality of the medical information provided. This new means of communication, used for prevention purposes, will add to other frequently used methods of communication.

Acceptability and feasibility of using established geosocial and sexual networking mobile applications to promote HIV and STD testing among men who have sex with men

This study is the first published multi-app study, of which we are aware, to evaluate both the acceptability and feasibility of providing sexual health information and HIV/STD testing referrals via established geosocial and sexual networking apps for MSM. Data were collected using an online survey and through four apps (A4A Radar, Grindr, Jack'd, and Scruff). Two-thirds (64 %) found apps to be an acceptable source for sexual health information. MSM who found apps as acceptable were more likely non-white, not sure of their current HIV status, and have low HIV testing self-efficacy. One-quarter (26 %) of informational chats with the health educator resulted in users requesting and being referred to local HIV/STD testing sites. There were significant differences in the number and types of interactions across apps. Established apps designed for MSM may be both an acceptable and feasible platform to promote HIV/STD testing. Future research should evaluate interventions that leverage this technology.

Community-academic partnerships in HIV-related research: a systematic literature review of theory and practice

Introduction

Community involvement in HIV research has increased over recent years, enhancing community-academic partnerships. Several terms have been used to describe community participation in research. Clarification is needed to determine whether these terms are synonymous or actually describe different research processes. In addition, it remains unclear if the role that communities play in the actual research process follows the recommendations given in theoretical frameworks of community-academia research.

Objectives

The objective of this study is to review the existing terms and definitions regarding community-academic partnerships and assess how studies are implementing these in relation to conceptual definitions.

Methods

A systematic literature review was conducted in PubMed. Two reviewers independently assessed each article, applying the following inclusion criteria: the article must be published in English before 2013; it must provide an explicit definition and/or defining methodology for a term describing research with a community component; and it has to refer to HIV or AIDS, reproductive health and/or STDs. When disagreements about the relevance of an article emerged, a third reviewer was involved until concordance was reached. Data were extracted by one reviewer and independently verified by a second. Qualitative data were analyzed using MaxQDA for content and thematic analyses while quantitative data were analyzed using descriptive statistics. Community feedback on data analysis and presentation of results was also incorporated.

Results

In total, 246 articles were retrieved, 159 of which fulfilled the inclusion criteria. The number of studies that included community participation in the field of HIV research increased between 1991 and 2012, and the terms used to describe these activities have changed, moving away from action research (AR) to participatory action research (PAR), community-based research (CBR) and community-based participatory research (CBPR), with the latter being the most commonly used term. While definitions of all terms had common characteristics (e.g. participation of community in research process), they varied with regard to the emphasis placed on these characteristics. The nature of community participation in reviewed studies differed considerably from that described in theoretical models.

Conclusions

This study indicates the increase of participatory approaches in HIV research and underlines the need for clarification of terms and a framework providing orientation to community-academia partnerships.

HealthMpowerment.org: Building Community Through a Mobile-Optimized, Online Health Promotion Intervention

BACKGROUND

Both young Black men who have sex with men as well as young Black transgender women (YBMSM/TW) continue to experience a significant increase in HIV incidence. HealthMpowerment.org (HMP) is a mobile phone-optimized, online intervention for both YBMSM/TW to build community and facilitate supportive relationships.

METHODS

To assess the feasibility, acceptability, and preliminary outcomes, a 1-month pilot trial of HMP among 15 YBMSM/TW was conducted.

RESULTS

Retention was 100%. Mean age was 26 years, 60% were HIV-infected, 87% earned <$21,000, and 67% were uninsured. Despite the small sample size and limited intervention length, statistically significant improvements were seen in social support (p = .012), social isolation (p = .050), and depressive symptoms (p = .045).

CONCLUSION

The HMP pilot trial demonstrated feasibility and acceptability. Given the burden of the epidemic among YBMSM/TW, there is an imperative to develop, test, and scale up culturally appropriate interventions to both prevent HIV acquisition and limit onward transmission.

Internet use associated with HIV testing in adults in a national sample: Findings from the National Health Interview Survey, 2009

BACKGROUND

Routine Human Immunodeficiency Virus (HIV) testing is a CDC recommendation. Little is known about health information technology (HIT) use and HIV testing.

PURPOSE

To assess the relationship between HIT use and HIV screening and determine whether self-perceived HIV risk modifies this association.

METHODS

Data from the National Health Interview Survey were analyzed. The survey response rate was 65.4%. The outcome was self-report of HIV testing (Y/N). Independent variables were HIT use, self-perceived HIV risk, and socio-demographics. HIT use is defined as internet or chat room use for health information. Logistic regression tested the association between HIV testing and HIT. Crude and adjusted models are reported.

RESULTS

Of participants with data on HIV testing (n = 26,745), 40% reported being HIV tested, 52% used internet, and 4.2% used chat rooms. Internet and chat users had greater odds ratios for HIV testing (OR 1.8 95% CI (1.7, 1.9) and OR 1.7 95% CI (1.4, 2.0), respectively). Adjusting for covariates, internet use remained associated with HIV testing OR 1.4 95% CI (1.2, 1.7), but chat use did not. Self-perceived HIV risk did not modify this model.

CONCLUSION

Internet use was associated with higher odds of HIV testing in the general population. Promotion of HIV testing via online sources may benefit screening efforts.

If you build it will they come? Addressing social isolation within a technology-based HIV intervention for young black men who have sex with men

The rate of HIV infections among young black men who have sex with men (YBMSM) continues to rise at an alarming pace. YBMSM are particularly vulnerable to social isolation and a lack of social support due to experiences with racism and homophobia, which may have implications for sexual risk behaviors. The purpose of this study was to explore perceptions of social isolation and sense of community among YBMSM, the need for and receptivity to social networking features designed to reduce social isolation and build community within an Internet- and mobile phone-based primary and secondary HIV prevention intervention for YBMSM and to identify strategies to develop these features. Focus groups were conducted with 22 YBMSM aged 20-30 years at three sites in North Carolina. Data from the focus groups were thematically analyzed using NVivo. Feelings of social isolation and lack of a sense of community were strongly endorsed by participants with homophobia, lack of opportunities for social engagement, and a focus on sex rather than friendship in interpersonal relationships with other YBMSM cited as contributing factors. Participants were receptive to a social networking intervention designed to reduce social isolation and build community. Recommendations offered by participants to increase acceptability and usability of such features included: availability of information about healthy relationships, the ability to connect with other YBMSM and health care providers, and ensuring the site had ongoing facilitation by the study team as well as monitoring for inappropriate content. The development of a social networking feature of an HIV prevention intervention may present an opportunity to reduce social isolation, build community, and reduce risky sexual behaviors among YBMSM. The findings from this study are being used to inform the development of a social networking feature for an existing Internet- and mobile phone-based primary and secondary HIV prevention intervention for YBMSM.

Gay and bisexual men's use of the Internet: research from the 1990s through 2013

We document the historical and cultural shifts in how gay and bisexual men have used the Internet for sexuality between the 1990s and 2013-including shifting technology as well as research methods to study gay and bisexual men online. Gay and bisexual men have rapidly taken to using the Internet for sexual purposes: for health information seeking, finding sex partners, dating, cybersex, and pornography. Men have adapted to the ever-evolving technological advances that have been made in connecting users to the Internet-from logging on via dial-up modem on a desktop computer to geo-social-sexual networking via handheld devices. In kind, researchers have adapted to the Internet to study gay and bisexual men. Studies have carefully considered the ethics, feasibility, and acceptability of using the Internet to conduct research and interventions. Much of this work has been grounded in models of disease prevention, largely as a result of the ongoing HIV/AIDS epidemic. The need to reduce HIV in this population has been a driving force to develop innovative research and Internet-based intervention methodologies. The Internet, and specifically mobile technology, is an environment gay and bisexual men are using for sexual purposes. These innovative technologies represent powerful resources for researchers to study and provide outreach.

Feasibility of using social networking technologies for health research among men who have sex with men: a mixed methods study

This study aims to assess the feasibility and acceptability of using social networking as a health research platform among men who have sex with men (MSM). Fifty-five MSM (primarily African American and Latino) were invited to join a "secret" group on the social networking website, Facebook. Peer leaders, trained in health education, posted health-related content to groups. The study and analysis used mixed (qualitative and quantitative) methods. Facebook conversations were thematically analyzed. Latino and African American participants voluntarily used social networking to discuss health-related knowledge and personal topics (exercise, nutrition, mental health, disease prevention, and substance abuse) with other group participants (N=564 excerpts). Although Latinos comprised 60% of the sample and African Americans 25.5%, Latinos contributed 82% of conversations and African Americans contributed only 15% of all conversations. Twenty-four percent of posts from Latinos and 7% of posts from African Americans were related to health topics. Results suggest that Facebook is an acceptable and engaging platform for facilitating and documenting health discussions for mixed methods research among MSM. An understanding of population differences is needed for crafting effective online social health interventions.

Preventing HIV infection in women

Although the number of new infections has declined recently, women still constitute almost half of the world's 34 million people with HIV infection, and HIV remains the leading cause of death among women of reproductive age. Prevention research has made considerable progress during the past few years in addressing the biological, behavioral, and social factors that influence women's vulnerability to HIV infection. Nevertheless, substantial work still must be performed to implement scientific advancements and to resolve many questions that remain. This article highlights some of the recent advances and persistent gaps in HIV prevention research for women and outlines key research and policy priorities.

Feasibility of recruiting peer educators for an online social networking-based health intervention

OBJECTIVE

This study aims to determine the feasibility of recruiting peer leaders to deliver a community-based health intervention using social media.

METHOD

We recruited sixteen African American and Latino men who have sex with men (MSM) as peer leaders for either an HIV prevention or general health intervention using social media. Inclusion criteria required that peer leaders were African American or Latino MSM health communication experts experienced using social media. To receive certification, peer leaders attended 3 training sessions on using social media for public health. Questionnaires asking about health knowledge and comfort using social media to discuss health-related topics were provided at baseline and post-training to ensure that peer leaders were qualified post-training. Repeated measures ANOVA models and χ2 tests tested for differences in peer leader knowledge and comfort using social media pre- and post-training.

RESULTS

After training, peer leaders were significantly more comfortable using social media to discuss sexual positions. There were no significant differences pre- and post-training on other comfort or knowledge measures, as at baseline, almost all peer leaders were already comfortable using social media.

CONCLUSION

Results suggest that peer leaders can be recruited who are qualified to conduct health interventions without needing additional training. The discussed training plan can further ensure that any unqualified peer leaders will be prepared after training. To our knowledge, this is the first study to suggest that peer leaders can be recruited as peer health educators to communicate using social media.

Queer as F**k: reaching and engaging gay men in sexual health promotion through social networking sites

Background

A growing number of health promotion interventions are taking advantage of the popularity and interactivity of new social media platforms to foster and engage communities for health promotion. However, few health promotion interventions using social networking sites (SNS) have been rigorously evaluated. "Queer as F**k"(QAF) began as pilot project in 2010 to deliver sexual health promotion via short "webisodes" on SNS to gay men. Now in its fifth season, QAF is among the few published examples internationally to demonstrate the sexual health promotion potential of SNS.

Objective

The objective of this evaluation is to assess reach, interactivity, and engagement generated by QAF to inform future health interventions and evaluations using SNS.

Methods

We undertook a mixed method process evaluation using an uncontrolled longitudinal study design that compared multiple measurements over time to assess changes in reach and engagement. We adapted evaluation methods from the health promotion, information systems, and creative spheres. We incorporated online usage statistics, interviews informed by user diary-scrapbooks, and user focus groups to assess intervention reach and engagement.

Results

During Series 1-3 (April 2010 to April 2011), 32 webisodes were posted on the QAF Facebook and YouTube pages. These webisodes attracted over 30,000 views; ranging from 124-3092 views per individual episode. By April 2011, the QAF Facebook page had 2929 predominantly male fans. Interview and focus group participants supported the balance of education and entertainment. They endorsed the narrative "soap opera" format as an effective way to deliver sexual health messages in an engaging, informative, and accessible manner that encouraged online peer discussion of sexual health and promoted community engagement.

Conclusions

QAF offers a successful example of exploiting the reach, interactivity, and engagement potential of SNS; findings from this process evaluation provide a model to inform the delivery and evaluation of future health promotion interventions on SNS.

A virtual community: concerns of patients with pulmonary hypertension

Pulmonary Hypertension (PH) is a complex disorder characterized by elevated pressures in the pulmonary artery that cause right heart failure and eventually leads to death. Treatment regimens can be complex and mortality is high. The purpose of this study was to determine how people with PH are using an online Discussion Board. Qualitative descriptive methodology was used to analyze a convenience sample of self-identified patients with PH. Internet posts to an online Discussion Board from January 1, 2010 to December 31, 2010 were analyzed for common themes. Five hundred forty-nine individuals with PH posted to the Discussion Board. Four themes emerged: Uncertainty and Concern, Guidance and Validation, Support, and Refocusing Life. People with PH are using the Internet to answer questions about PH and seeking support. Future research needs to be conducted to further explore the needs and concerns of people with PH to provide tailored interventions.

African American adolescents meeting sex partners online: closing the digital research divide in STI/HIV prevention

Minority adolescents are affected disproportionately by HIV and STIs, and the Internet is a popular venue to meet sex partners. Little is known about the risks of this behavior for minority adolescents. The majority of studies that have examined sexual risk behavior online or STI/HIV prevention programs online have been among adult MSM. In this study, data from 1,045 African American youth found that 6% met sex partners online and in chat rooms. Odds ratios, adjusting for gender, found this behavior was associated with alcohol (AOR = 2.33, 95% CI [1.1, 4.7]) and drug use (AOR = 3.45, 95% CI [1.9, 6.1]), unprotected vaginal (AOR = 4.71, 95% CI [1.9, 8.4]) and anal sex (AOR = 4.77, 95% CI [1.3,17.1]) in the last 90 days, more lifetime vaginal (AOR = 3.65, 95% CI [2.0, 6.8]) and anal sex (AOR = 2.74, 95% CI [1.5, 4.8]), greater sexual sensation seeking (AOR = 2.92, 95% CI [1.5, 5.7]) and greater depression (AOR = 2.06, 95% CI [1.2, 3.6]. A final multiple logistic regression analyses found that male gender (AOR = 3.13, 95% CI [1.7, 5.8]), drug use at last sex (AOR = 2.41, 95% CI [1.3, 4.5]), lifetime history of vaginal (AOR = 2.90, 95% CI [1.5, 5.5]) and anal sex (AOR = 2.09, 95% CI [1.2, 3.6]), and cocaine use (AOR = 8.53, 95% CI [2.7, 27.3]) were independently associated with having sex with a partner met online. Meeting sex partners online is associated with a variety of risks among African American youth; however, the Internet may be an opportunity for intervention.

Technology use and reasons to participate in social networking health websites among people living with HIV in the US

Online social media and mobile technologies hold potential to enhance adherence to antiretroviral therapy (ART), although little is known about the current use of these technologies among people living with HIV (PLWH). To address this gap in understanding, 312 PLWH (84% male, 69% White) US adults completed an online survey in 2009, from which 22 persons accepted an invitation to participate in one of two online focus groups. Results showed that 76% of participants with lower ART adherence used social networking websites/features at least once a week. Their ideal online social networking health websites included one that facilitated socializing with others (45% of participants) and ones with relevant HIV informational content (22%), although privacy was a barrier to use (26%). Texting (81%), and to a lesser extent mobile web-access (51%), was widely used among participants. Results support the potential reach of online social networking and text messaging intervention approaches.

eHealth interventions for HIV prevention

The rapidly changing media landscape and proliferation of new technologies creates vast new opportunities for HIV prevention. The fast growth of the relatively new eHealth field is a testament to the excitement and promise of these new technologies. eHealth interventions in HIV prevention tested to date include computer- and Internet-based interventions; chat room interventions; text messaging interventions; and social media. The current article provides a brief review of these types of interventions in HIV prevention, including their unique advantages and evidence of efficacy. Implications for future research in the eHealth HIV prevention field are discussed.

Changes in gay men's participation in gay community life: implications for HIV surveillance and research

Successful antiretroviral treatments, achievements in gay acceptance and human rights, and internet use have prompted changes in gay socialising which create potential challenges for engaging with gay men for HIV surveillance and research. We used data from the Australian behavioural surveillance and explored (i) the relationship between community engagement and HIV related practices, and (ii) time trends in gay men's engagement with the gay community. Analyses were conducted using log-binomial regression and chi-square test for trend. The proportion of men who socialized mainly with gay men declined and the Internet use to connect with sex partners increased over time. Gay social engagement was associated with HIV positive serostatus, unprotected anal intercourse with regular partners and a high frequency of HIV/STI testing. Our findings indicate a shift in how gay men socialise and find partners. We discuss the challenges for ongoing engagement with gay men for behavioural surveillance and HIV research.

[Attitudes toward online HIV/sexually-transmitted infection prevention programs and Internet user profiles among men who have sex with men]

OBJECTIVES

To describe the attitudes of men who have sex with men (MSM) toward online HIV/sexually-transmitted infection (STI) prevention programs and to identify and characterize user profiles with regard to their attitudes toward online prevention programs.

METHOD

A survey in gay venues or via the internet was completed by 2,044 participants from Madrid, Barcelona, Bilbao and San Sebastián (Spain). The survey explored socio-demographic variables, sexual behavior and other risk behaviors associated with HIV infection, as well as attitudes toward online prevention programs. The statistical analysis included factor analysis and non-hierarchical cluster analysis.

RESULTS

Most MSM had positive attitudes towards online HIV/STI prevention programs. Factor analysis revealed two factors: online prevention aimed at interaction and online prevention aimed at information. Based on these factors, three user profiles were identified: users oriented toward informative and interactive online prevention (53.5%), users oriented toward interactive online prevention (25.9%) and users were not oriented toward online prevention (20.7%). On characterizing these profiles, we observed a significant presence of men who were not interested in online prevention among those with a lower educational level, bisexual men and HIV-positive men. Conversely, those most receptive to online prevention were men self-identified as gay, those with a bachelors degree, those who had been tested for HIV and those who were HIV-negative.

CONCLUSION

The internet can facilitate sexual health promotion among MSM. Characterization of user profiles offers the possibility of segmenting prevention programs and of combining online and offline strategies.

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.

HIV prevention and care in the digital age

OBJECTIVES

To describe the technologic advances in the digital media, including computers, mobile phones, and the Internet, that have greatly expanded opportunities to deliver evidence-based HIV education, prevention, and treatment programs.

METHODS

This article examines the use of digital media in the United States and its potential role in HIV prevention and care.

RESULTS

Although the "digital divide" is shrinking, access varies by age, race/ethnicity, and education. The Internet is an important medium for delivering universal and targeted HIV education and prevention, especially for men who have sex with men, who report going online to seek health information online and for social and sexual networking. Online and off-line behavioral interventions using digital media range from computerized multimedia interventions that take into account individual behaviors to brief untailored video interventions. Numerous Web sites facilitate access to care by providing a variety of services, including location of and linkage to HIV testing and treatment sites. HIV treatment and adherence programs that use online medical records text messaging, paging, and tablet computer-based counseling tools are also being developed.

CONCLUSIONS

HIV prevention and care programs using digital media have great potential to cost-effectively meet the complex needs of diverse and often underserved populations living with or at high risk of HIV.

A CBPR partnership increases HIV testing among men who have sex with men (MSM): outcome findings from a pilot test of the CyBER/testing internet intervention

The Internet has emerged as an important tool for the delivery of health promotion and disease prevention interventions. Our community-based participatory research (CBPR) partnership developed and piloted CyBER/testing, a culturally congruent intervention designed to promote HIV testing among men who have sex with men (MSM) within existing Internet chat rooms. Using a quasi-experimental, single-group study design, cross-sectional data were collected from chat room participants, known as "chatters," at pretest (n = 346) and posttest (n = 315). Extant profile data also were collected to describe the demographics of the online population. The intervention significantly increased self-reported HIV testing among chatters overall, increasing rates from 44.5% at pretest to nearly 60% at posttest (p < .001). Furthermore, chatters who reported having both male and female sexual partners had nearly 6 times the odds of reporting HIV testing at posttest. Findings suggest that chat room-based HIV testing intervention may increase testing among MSM who may be difficult to reach in traditional physical spaces.

Boys must be men, and men must have sex with women: a qualitative CBPR study to explore sexual risk among African American, Latino, and White gay men and MSM

Men who have sex with men (MSM) continue to be disproportionately affected by HIV and sexually transmitted diseases. This study was designed to explore sexual risk among MSM using community-based participatory research (CBPR). An academic-community partnership conducted nine focus groups with 88 MSM. Participants self-identified as African American/Black (n=28), Hispanic/Latino (n=33), White (n=21), and biracial/ethnic (n=6). The mean age was 27 years (range=18-60 years). Grounded theory was used. Twelve themes related to HIV risk emerged, including low knowledge of HIV and sexually transmitted diseases, particularly among Latino MSM and MSM who use the Internet for sexual networking; stereotyping of African American MSM as sexually "dominant" and Latino MSM as less likely to be HIV infected; and the eroticization of "barebacking." Twelve intervention approaches also were identified, including developing culturally congruent programming using community-identified assets, harnessing social media used by informal networks of MSM, and promoting protection within the context of intimate relationships. A community forum was held to develop recommendations and move these themes to action.