Hookups or health promotion? An exploratory study of a chat room-based HIV prevention intervention for men who have sex with men

A Systematic Review of Implementation Research on Determinants and Strategies of Effective HIV Interventions for Men Who Have Sex with Men in the United States

Men who have sex with men (MSM) are disproportionately affected by HIV, accounting for two-thirds of HIV cases in the United States despite representing ∼5% of the adult population. Delivery and use of existing and highly effective HIV prevention and treatment strategies remain suboptimal among MSM. To summarize the state of the science, we systematically review implementation determinants and strategies of HIV-related health interventions using implementation science frameworks. Research on implementation barriers has focused predominantly on characteristics of individual recipients (e.g., ethnicity, age, drug use) and less so on deliverers (e.g., nurses, physicians), with little focus on system-level factors. Similarly, most strategies target recipients to influence their uptake and adherence, rather than improving and supporting implementation systems. HIV implementation research is burgeoning; future research is needed to broaden the examination of barriers at the provider and system levels, as well as expand knowledge on how to match strategies to barriers-particularly to address stigma. Collaboration and coordination among federal, state, and local public health agencies; community-based organizations; health care providers; and scientists are important for successful implementation of HIV-related health innovations.

Outcomes From a Randomized Trial of a Bilingual mHealth Social Media Intervention to Increase Care Engagement Among Young Gay, Bisexual, and Other Men Who Have Sex With Men and Transgender Women With HIV

BACKGROUND

The North Carolina Community Research Partnership developed, implemented, and tested weCare, a 12-month bilingual mHealth social media intervention designed to reduce missed HIV care appointments and increase viral suppression among racially/ethnically diverse gay, bisexual, and other men who have sex with men (GBMSM) and transgender women living with HIV by harnessing established social media platforms (i.e., Facebook, texting, and dating apps).

METHODS

We randomized 198 GBMSM and transgender women (mean age = 26) living with HIV to the weCare intervention (n = 100) or usual-care (n = 98) group. Inclusion criteria included being newly diagnosed or not in care. Participants completed structured assessments at baseline and 6-month postintervention follow-up (18 months after baseline data collection). HIV care appointment and viral load data were abstracted from each participant's electronic health record at baseline and follow-up. Follow-up retention was 85.5%.

RESULTS

Among participants, 94% self-identified as cisgender men, 6% as transgender, 64% as African American/Black, and 13% as Latine. Participants in both groups significantly reduced missed HIV care appointments and increased viral suppression at follow-up compared with baseline. However, there were no significant differences between weCare and usual-care participants for either outcome at follow-up.

CONCLUSIONS

An intervention effect was not identified for our two primary outcomes. Several factors may have influenced the lack of significant differences between weCare and usual-care participants at follow-up, including intervention implementation (e.g., staffing changes and lack of fidelity to the intervention as originally designed by the partnership), data collection (e.g., data collection time points and retention strategies), and clinical (e.g., contamination) factors.

Advancing community-engaged research during the COVID-19 pandemic: Insights from a social network analysis of the trans-LINK Network

Collaboration across sectors is critical to address complex health problems, particularly during the current COVID-19 pandemic. We examined the ability to collaborate during the pandemic as part of a baseline evaluation of an intersectoral network of healthcare and community organizations established to improve the collective response to transgender (trans) persons who have been sexually assaulted (the trans-LINK Network). A validated social network analysis survey was sent to 119 member organizations in Ontario, Canada. Survey respondents were asked, ‘Has COVID-19 negatively affected your organization’s ability to collaborate with other organizations on the support of trans survivors of sexual assault?’ and ‘How has COVID-19 negatively affected your organization’s ability to collaborate within the trans-LINK Network?’. Data were analyzed using descriptive statistics. Seventy-eight member organizations participated in the survey (response rate = 66%). Most organizations (79%) indicated that the pandemic had affected their ability to collaborate with others in the network, citing most commonly, increased workload (77%), increased demand for services (57%), and technical and digital challenges (50%). Survey findings were shared in a stakeholder consultation with 22 representatives of 21 network member organizations. Stakeholders provided suggestions to prevent and address the challenges, barriers, and disruptions in serving trans survivors experienced during the pandemic, which were organized into themes. Seven themes were generated and used as a scaffold for the development of recommendations to advance the network, including: increase communication and knowledge exchange among member organizations through the establishment of a network discussion forum and capacity building group workshops; enhance awareness of network organizations by developing a member-facing directory of member services, their contributions, and ability to provide specific supports; strengthen capacity to provide virtual and in-person services and programs through enhanced IT support and increased opportunities for knowledge sharing and skill development; and adopt a network wide syndemic approach that addresses co-occurring epidemics (COVID-19 + racism, housing insecurity, transphobia, xenophobia) that impact trans survivors of sexual assault.

Cardiovascular Disease Prevention Education Using a Virtual Environment in Sexual-Minority Men of Color With HIV: Protocol for a Sequential, Mixed Method, Waitlist Randomized Controlled Trial

BACKGROUND

It is estimated that 70% of all deaths each year in the United States are due to chronic conditions. Cardiovascular disease (CVD), a chronic condition, is the leading cause of death in ethnic and racial minority males. It has been identified as the second most common cause of death in persons with HIV. By the year 2030, it is estimated that 78% of persons with HIV will be diagnosed with CVD.

OBJECTIVE

We propose the first technology-based virtual environment intervention to address behavioral, modifiable risk factors associated with cardiovascular and metabolic comorbidities in sexual-minority men of color with HIV.

METHODS

This study will be guided using social cognitive theory and the Technology Acceptance Model. A sequential, mixed method, waitlist controlled randomized control feasibility trial will be conducted. Aim 1 is to qualitatively explore perceptions of cardiovascular risk in 15 participants. Aim 2 is to conduct a waitlist controlled comparison to test if a virtual environment is feasible and acceptable for CVD prevention, based on web-based, self-assessed, behavioral, and psychosocial outcomes in 80 sexual-minority men of color with HIV.

RESULTS

The study was approved by the New York University Institutional Review Board in 2019, University of Texas Health Science Center at Houston in 2020, and by the Yale University Institutional Review Board in February 2022. As of April 2022, aim 1 data collection is 87% completed. We expect to complete data collection for aim 1 by April 30, 2022. Recruitment for aim 2 will begin mid-May 2022.

CONCLUSIONS

This study will be the first online virtual environment intervention for CVD prevention in sexual-minority men of color with HIV. We anticipate that the intervention will be beneficial for CVD prevention education and building peer social supports, resulting in change or modification over time in risk behaviors for CVD.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05242952; https://clinicaltrials.gov/ct2/show/NCT05242952.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/38348.

Examining LGBTI+ inclusive sexual health education from the perspective of both youth and facilitators: a systematic review

OBJECTIVES

To critically appraise and synthesise the evidence in relation to both the receipt and delivery of LGBTI+ (Lesbian, Gay, Bisexual, Transgender, Intersex) inclusive sexual health education.

DESIGN

A systematic review and narrative synthesis.

DATA SOURCES

A systematic search of three online databases (EMBASE, PsychINFO and SocINDEX) from January 1990 to May 2021 was conducted.

ELIGIBILITY CRITERIA

Studies included were (1) peer-reviewed; (2) English; (3) quantitative, qualitative and mixed methods; that evaluated (4) inclusive sexual health in an educational or online setting and (5) focused on training or educating. Studies were excluded if (1) the population was not LGBTI+ inclusive; (2) the studies did not focus on original data or (3) the study was not available in full text.

DATA EXTRACTION AND SYNTHESIS

The studies that met the inclusion criteria were assessed using the Critical Appraisal Skills Programme tool. A narrative synthesis was then completed employing content analysis focusing on the results section of each article.

RESULTS

Of the 5656 records retrieved, 24 studies met the inclusion criteria. The majority of studies noted that both LGBTI+ youth and those who facilitate sexual health education are turning to online sources of information. Current sexual health education programmes operate mainly from a heterosexual perspective, creating a sense of exclusion for LGBTI+ youth. This is compounded by a lack of training, or provision of an inclusive curricula, resulting in facilitators feeling ill equipped or inhibited by their personal biases.

CONCLUSIONS

LGBTI+ youth are not experiencing inclusive and comprehensive sexual health education. In parallel, educators report poor access to information, training and resources remain the primary reasons. There is a need to standardise sexual health curricula, making them LGBTI+ inclusive and incorporate holistic aspects of health such as pleasure and healthy relationships. Online approaches should be considered in the future, as they represent equality of access for both sexual health education professionals and LGBTI+ youth alike.

How current and potential pre-exposure prophylaxis (PrEP) users experience, negotiate and manage stigma: disclosures and backstage processes in online discourse

Research on stigma as a barrier to pre-exposure prophylaxis (PrEP) uptake for reducing risk of HIV infection has focused on the experience of stigma-othering, shaming and blaming and the associated negative social consequences of this stigmatisation. This study expands this focus to examine how current and potential users of PrEP discuss their experiences of stigmatisation, in addition to their anticipation, preparation and management of stigmatising encounters. The corpus of testimonial blog posts from the "My PrEP Experience" website, reader comments on those posts, and information available through hyperlinks in the posts and comments, were subjected to a qualitative textual analysis. Findings revealed stigmatising labels and perceptions identified in other PrEP and HIV-related stigma research. Findings also revealed the active seeking and sharing of strategies for coping with and challenging stigma, including the creative re-appropriation of negative labels and calls for advocacy. The discussion considers how the described preparation and management strategies can inform future efforts to reduce stigma and encourage PrEP uptake.

Leveraging Social Networks and Technology for HIV Prevention and Treatment With Transgender Women

Transgender women ("trans women") are disproportionately impacted by HIV; yet there are few interventions tailored for trans women. This study employed qualitative methods to better understand how trans women's social networks and technology-based networking platforms may be leveraged in developing health promotion strategies for this high-priority population. Qualitative data from five focus groups (N = 39) revealed three key themes: (1) Social network structure and composition; (2) Technology use patterns; and (3) Accessing transgender health resources online. Participants used technology to establish affiliation with other trans women, build networks of support, and exchange health information and advice. Policymakers and practitioners can invest in the knowledge and expertise of trans women in using technology to organize health resources and support the development of peer-led, technology-based HIV prevention and care interventions.

A Framework for Using eHealth Interventions to Overcome Medical Mistrust Among Sexual Minority Men of Color Living with Chronic Conditions

The purpose of this paper is to present a stepwise, multi-construct, innovative framework that supports the use of eHealth technology to reach sexual minority populations of color to establish trustworthiness and build trust. The salience of eHealth interventions can be leveraged to minimize the existing paradigm of medical mistrust among sexual minority populations of color living with chronic illnesses. These interventions include virtual environments and avatar-led eHealth videos, which address psychosocial and structural-level challenges related to mistrust. Our proposed framework addresses how eHealth interventions enable technology adoption and usage, anonymity, co-presence, self-disclosure, and social support and establish trustworthiness and build trust.

The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development

BACKGROUND

Men who have sex with men (MSM) experience significant inequalities in health and well-being. They are the group in the UK at the highest risk of acquiring a human immunodeficiency virus (HIV) infection. Guidance relating to both HIV infection prevention, in general, and individual-level behaviour change interventions, in particular, is very limited.

OBJECTIVES

To conduct an evidence synthesis of the clinical effectiveness of behaviour change interventions to reduce risky sexual behaviour among MSM after a negative HIV infection test. To identify effective components within interventions in reducing HIV risk-related behaviours and develop a candidate intervention. To host expert events addressing the implementation and optimisation of a candidate intervention.

DATA SOURCES

All major electronic databases (British Education Index, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Educational Resource Index and Abstracts, Health and Medical Complete, MEDLINE, PsycARTICLES, PsycINFO, PubMed and Social Science Citation Index) were searched between January 2000 and December 2014.

REVIEW METHODS

A systematic review of the clinical effectiveness of individual behaviour change interventions was conducted. Interventions were examined using the behaviour change technique (BCT) taxonomy, theory coding assessment, mode of delivery and proximity to HIV infection testing. Data were summarised in narrative review and, when appropriate, meta-analysis was carried out. Supplemental analyses for the development of the candidate intervention focused on post hoc realist review method, the assessment of the sequential delivery and content of intervention components, and the social and historical context of primary studies. Expert panels reviewed the candidate intervention for issues of implementation and optimisation.

RESULTS

Overall, trials included in this review (n = 10) demonstrated that individual-level behaviour change interventions are effective in reducing key HIV infection risk-related behaviours. However, there was considerable clinical and methodological heterogeneity among the trials. Exploratory meta-analysis showed a statistically significant reduction in behaviours associated with high risk of HIV transmission (risk ratio 0.75, 95% confidence interval 0.62 to 0.91). Additional stratified analyses suggested that effectiveness may be enhanced through face-to-face contact immediately after testing, and that theory-based content and BCTs drawn from 'goals and planning' and 'identity' groups are important. All evidence collated in the review was synthesised to develop a candidate intervention. Experts highlighted overall acceptability of the intervention and outlined key ways that the candidate intervention could be optimised to enhance UK implementation.

LIMITATIONS

There was a limited number of primary studies. All were from outside the UK and were subject to considerable clinical, methodological and statistical heterogeneity. The findings of the meta-analysis must therefore be treated with caution. The lack of detailed intervention manuals limited the assessment of intervention content, delivery and fidelity.

CONCLUSIONS

Evidence regarding the effectiveness of behaviour change interventions suggests that they are effective in changing behaviour associated with HIV transmission. Exploratory stratified meta-analyses suggested that interventions should be delivered face to face and immediately after testing. There are uncertainties around the generalisability of these findings to the UK setting. However, UK experts found the intervention acceptable and provided ways of optimising the candidate intervention.

FUTURE WORK

There is a need for well-designed, UK-based trials of individual behaviour change interventions that clearly articulate intervention content and demonstrate intervention fidelity.

STUDY REGISTRATION

The study is registered as PROSPERO CRD42014009500.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

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.

weCARE: A Social Media-Based Intervention Designed to Increase HIV Care Linkage, Retention, and Health Outcomes for Racially and Ethnically Diverse Young MSM

Estimates suggest that only about 30% of all individuals living with HIV in the U.S. have achieved viral suppression. Men who have sex with men (MSM), particularly racial/ethnic minority young MSM, are at increased risk for HIV infection and may have even lower viral suppression rates. HIV testing rates among MSM are low, and when tested, racial/ethnic minority young MSM have disproportionately lower rates of retention in care and viral suppression compared to other subgroups. This article describes the design and development of weCare, our social media-based intervention to improve care linkage and retention and health outcomes among racially and ethnically diverse MSM, ages 13-34, living with HIV that will be implemented and evaluated beginning in late 2016. The intervention harnesses established social media that MSM between these ages commonly use, including Facebook, text messaging, and established GPS-based mobile applications (apps). We are using community-based participatory research (CBPR) to enhance the quality and validity of weCare, equitably involving community members, organization representatives, healthcare providers, clinic staff, and academic researchers.

Online discussion effects on intention to participate in genetic research: A longitudinal experimental study

OBJECTIVE

The National Human Genome Research Institute has emphasised community engagement and public dialogue in the U.S. on issues related to genetics. This study examines how online discussions among the U.S. public directly or indirectly influence psychosocial constructs of the Theory of Planned Behavior, including intention to take part in genetic research.

DESIGN

After completing the baseline questionnaire, participants (n = 3754) were randomly assigned to one of the following three groups: the discussion group, the pre-/post-only group and the End-of-Project group. The discussion group (n = 1824) was invited and participated in up to three online discussions, which were held from November 2008 to May 2009.

MAIN OUTCOME MEASURES

Behavioural intention, beliefs, attitudes, subjective norm and perceived behavioural control variables were assessed.

RESULTS

The most interesting finding was that those participating in online discussions had fewer negative beliefs about volunteering for genetic research, which in turn contributed to more positive attitudes, increased injunctive and descriptive norms and enhanced behavioural control. These relationships, then, were associated with higher intention to participate in genetic research.

CONCLUSION

These findings suggest that continuous public discussions seem to positively affect volunteer intention for genetic research through ameliorating fears of negative consequences.

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.

Evaluating the Internet as a sexually transmitted disease risk environment for teens: findings from the communication, health, and teens study

BACKGROUND

Few studies have examined the association between sexual health risks and online sex-seeking among teenagers. The purpose of this study was to assess the associations between meeting sex partners online and a range of sexual risk behaviors and outcomes among adolescents.

METHODS

Participants aged 13 to 19 years were recruited from a publicly funded teen clinic in Florida. After obtaining informed consent/assent, 273 participants completed an audio computer-assisted self-interview that included questions on demographics, sexual behavior, sexually transmitted disease (STD) history, and online sex-seeking behaviors and experiences. Participants also provided urine samples for chlamydia and gonorrhea testing. Data were analyzed using logistic regression to identify the association between having an online sex partner and sexual behaviors/outcomes.

RESULTS

After adjusting for significant bivariate correlates, teens reporting online sex partners were more likely to be male, be multiracial, have a history of same-sex sexual activity, report a higher number of vaginal sex partners, and report a lower age at first vaginal sex. However, teens with online sex partners were no more likely to have ever had an STD or a current biological STD.

CONCLUSIONS

This study is one of the first to correlate biological STD results to online sexual partnering data in a youth population. Although meeting a sex partner online was not associated with past or current STDs, it was associated with other sexual risk behaviors. Future research is needed to examine the complex nature of online sexual partnering among adolescents and to develop intervention approaches.

The role of sexually explicit material in the sexual development of same-sex-attracted Black adolescent males

Sexually explicit material (SEM) (including Internet, video, and print) may play a key role in the lives of Black same-sex sexually active youth by providing the only information to learn about sexual development. There is limited school- and/or family-based sex education to serve as models for sexual behaviors for Black youth. We describe the role SEM plays in the sexual development of a sample of Black same-sex attracted (SSA) young adolescent males ages 15-19. Adolescents recruited from clinics, social networking sites, and through snowball sampling were invited to participate in a 90-min, semi-structured qualitative interview. Most participants described using SEM prior to their first same-sex sexual experience. Participants described using SEM primarily for sexual development, including learning about sexual organs and function, the mechanics of same-gender sex, and to negotiate one's sexual identity. Secondary functions were to determine readiness for sex; to learn about sexual performance, including understanding sexual roles and responsibilities (e.g., "top" or "bottom"); to introduce sexual performance scripts; and to develop models for how sex should feel (e.g., pleasure and pain). Youth also described engaging in sexual behaviors (including condom non-use and/or swallowing ejaculate) that were modeled on SEM. Comprehensive sexuality education programs should be designed to address the unmet needs of young, Black SSA men, with explicit focus on sexual roles and behaviors that may be inaccurately portrayed and/or involve sexual risk-taking (such as unprotected anal intercourse and swallowing ejaculate) in SEM. This work also calls for development of Internet-based HIV/STI prevention strategies targeting young Black SSA men who may be accessing SEM.

A critical review of "Internet addiction" criteria with suggestions for the future

AIMS

In the last 5 years a deluge of articles on the topic of Internet addiction (IA) has proposed many candidate symptoms as evidence of this proposed disease. We critically reviewed the current approach to the measurement and identification of this new excessive behavior syndrome.

METHODS

Three popular models of IA were discussed: Griffith’s components model; Young’s Internet Addiction Test (IAT); and the criteria by Tao et al. (2010). We selected these models because they are widely cited and propose specific criteria for IA disorder. Our approach is not meant to provide an exhaustive review, but to discuss and critique the most salient trends in the field.

RESULTS

The models of Internet addiction share some criteria, including feeling a loss of control over Internet use; ensuing psychological, social, or professional conflict or problems; and preoccupation when not using the Internet. Other criteria inconsistently mentioned include: mood management, tolerance, withdrawal, and craving/anticipation. The models studied here share the assumption that the Internet can produce a qualitative shift to a diseased state in humans.

CONCLUSIONS

We critically discussed the above criteria and concluded that the evidence base is currently not strong enough to provide support for an Internet addiction disorder. Future research areas are suggested: (1) Focusing on common impaired dimensions, (2) exploring neuroimaging as a model building tool, and (3) identifying shifts in the rewarding aspects of Internet use. Given the lack of consensus on the subject of Internet addiction, a focus on problem behaviors appears warranted.

A systematic review of sexual health interventions for adults: narrative evidence

Recent work has explored the intersection between sexual health (as construed by the World Health Organization and others) and public health domains of action in the United States of America. This article reports the narrative results of a systematic review of sexual health intervention effects on public health-relevant outcomes. To qualify, interventions had to be based on the principles (1) that sexual health is intrinsic to individuals and their overall health and (2) that relationships reflecting sexual health must be positive for all parties concerned. Outcomes were classed in domains: knowledge, attitudes, communication, health care use, sexual behavior, and adverse events. We summarized data from 58 studies (English language, adult populations, 1996-2011) by population (adults, parents, sexual minorities, vulnerable populations) across domains. Interventions were predominantly individual and small-group designs that addressed sexual behaviors (72%) and attitudes/norms (55%). They yielded positive effects in that 98% reported a positive finding in at least one domain; 50% also reported null effects. The most consistently positive effects on behaviors and adverse events were found for sexual minorities, vulnerable populations, and parental communication. Whether via direct action or through partnerships, incorporating principles from existing sexual health definitions in public health efforts may help improve sexual health.

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.

HIV knowledge and risks among Vietnamese men who have sex with men travelling abroad

Rapid economic and social development in Vietnam has resulted in increased opportunities for travel and new potential routes of HIV transmission. We conducted a cross-sectional study examining demographics, knowledge, and sexual risk behaviour amongst 100 Vietnamese men who have sex with men who traveled abroad in the previous 12 months. Men who have sex with men surveyed were mostly university-educated, single, and under 30. Most travel (73%) was within Southeast Asia and was undertaken for tourism (51%) or for work (29%). Casual sex with a foreign partner occurred on 39% of trips. Only four were reported to have involved in unsafe sex with a casual partner. Four reported illicit drug use. Alcohol was widely consumed. Multivariate analysis showed that two variables, travelling alone (OR = 5.26, p < 0.001) and a university education (OR = 4.05, p = 0.004), were significantly associated with casual sex abroad. More HIV prevention education on the risks of sex while travelling abroad is needed for men who have sex with men in Vietnam.

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.

Drinking settings, alcohol consumption, and sexual risk behavior among gay men

We sought to 1) describe the settings or groups of settings where men who have sex with men (MSM) consume alcohol in 16 U.S. metropolitan statistical areas (MSA); and 2) investigate whether certain drinking settings or groups of settings are associated with higher levels of alcohol consumption, problem drinking, and sexual risk behavior. Latent class analysis was used to develop our measure of drinking settings. The final latent class model consisted of four distinct classes which captured the typical settings where MSM consumed alcohol: "home" "social," "bar/social," and "general" drinkers (i.e., drinks in all settings). Regression models showed that "general" drinkers were more likely than "social" drinkers to engage in frequent heavy drinking. Compared to 'social' drinkers, general drinkers were also more likely to engage in unprotected anal intercourse (UAIMP) and UAIMP with men met in bars and other venues (e.g., private parties, bath houses) while intoxicated. Assessment of drinking settings may be a means of identifying MSM who are at greater risk for frequent, heavy drinking and related sexual risk behavior.

Interventions using new digital media to improve adolescent sexual health: a systematic review

New digital media (e.g., the Internet, text messaging, and social networking sites [SNS]) have dramatically altered the communication landscape, especially for youth. These communication platforms present new tools for engaging youth in sexual health promotion and risk reduction. We searched eight public databases across multiple disciplines for all peer-reviewed studies published between January 2000 and May 2011 that empirically evaluated the impact of digital media-based interventions on the sexual health knowledge, attitudes, and/or behaviors of adolescents aged 13-24 years. Of 942 abstracts, 10 met inclusion criteria. Seven studies were conducted in the United States. Eight described Web-based interventions, one used mobile phones, and one was conducted on an SNS. Two studies significantly delayed initiation of sex, and one was successful in encouraging users of an SNS to remove sex references from their public profile. Seven interventions significantly influenced psychosocial outcomes such as condom self-efficacy and abstinence attitudes, but at times the results were in directions unexpected by the study authors. Six studies increased knowledge of HIV, sexually transmitted infections, or pregnancy. This area of research is emerging and rapidly changing. More data from controlled studies with longer (>1 year) follow-up and measurement of behavioral outcomes will provide a more robust evidence base from which to judge the effectiveness of new digital media in changing adolescent sexual behavior.

HealthMpowerment.org: feasibility and acceptability of delivering an internet intervention to young Black men who have sex with men

Young Black men who have sex with men (BMSM) are disproportionately affected by HIV/AIDS in the USA and continue to experience rapidly increasing HIV incidence. We designed a tailored, theory-based interactive HIV/STI prevention website for young BMSM, called HealthMpowerment.org (HMP) and conducted a small pilot trial comparing HMP to currently available HIV/STI websites. We present findings demonstrating feasibility and acceptability of delivering the intervention to the target population of young BMSM. Retention rates were 90% and 78% at one- and three-month follow-ups, respectively. Evaluation immediately after the intervention's completion revealed that participants who used the HMP website reported high levels of user satisfaction and interest and low levels of website difficulty and frustration. At the end of the intervention, there was a trend in increased behavioral intentions to use condoms and engage in preparatory condom use behaviors in the intervention group compared to the control group (p=0.10). We observed a reduction in mean scores on the CES-D scale among those in the intervention group that was not seen in the control group at the one-month follow-up, though this was not statistically significant. Feedback from exit interviews with study participants suggested that HMP is relevant to the prevention needs of young BMSM. Overall, the findings support the acceptability and feasibility of delivering this prevention program to a group that has few interventions despite bearing a significant burden of the epidemic. Future trials, combining Internet and mobile phone technologies, are planned to test HMP among larger and more diverse populations of young BMSM.

Internet use, recreational travel, and HIV risk behaviors in men who have sex with men

Previous studies have documented higher rates of HIV risk behavior in gay and bisexual men traveling for leisure. Most of these studies collected data in high-risk tourist areas known for promoting alcohol and other substance use. The present study sampled a broader range of men by collecting data at a Gay Pride celebration, and asking participants about vacation experiences over the past 12 months. We also collected information about men's use of the Internet to find sexual partners before they traveled. Overall, two-thirds of participants reported recreational travel in the previous year. Of these men, 17% reported having sex with a new partner during their most recent vacation. Forty-three percent of the respondents were sexually active during their vacation. Sexually-active participants reported a mean of 2.01 unprotected anal sex acts during their brief vacation stay (M = 6.2 days). Close to half of the sexually-active men reported having sex with a partner of unknown HIV status. Alcohol and drug use were associated with unprotected sex. Men who used the Internet to set up dates prior to travel reported significantly more sexual partners and were significantly more likely to report having sex with a new partner. Many gay and bisexual men on vacation report behaviors that may place their health at risk, including substance use and unprotected sexual activity. Interventions designed to reduce risk behaviors in this population are needed.

The Treatment Advocacy Program: a randomized controlled trial of a peer-led safer sex intervention for HIV-infected men who have sex with men

OBJECTIVE

Primary care may be an effective venue for delivering behavioral interventions for sexual safety among HIV-positive men who have sex with men (MSM); however, few studies show efficacy for such an approach. We tested the efficacy of the Treatment Advocacy Program (TAP), a 4-session, primary-care-based, individual counseling intervention led by HIV-positive MSM "peer advocates" in reducing unprotected sex with HIV-negative or unknown partners (HIV transmission risk).

METHOD

We randomized 313 HIV-positive MSM to TAP or standard care. HIV transmission risk was assessed at baseline, 6 months, and 12 months (251 participants completed all study waves). We conducted intent-to-treat analyses using general estimating equations to test the interaction of group (TAP vs. standard care) by follow-up period.

RESULTS

At study completion, TAP participants reported greater transmission risk reduction than did those receiving standard care, χ2(2, N = 249) = 6.6, p = .04. Transmission risk among TAP participants decreased from 34% at baseline to about 20% at both 6 and 12 months: Transmission risk ranged from 23% to 25% among comparison participants.

CONCLUSIONS

TAP reduced transmission risk among HIV-positive MSM, although results are modest. Many participants and peer advocates commented favorably on the computer structure of the program. We feel that the key elements of TAP-computer-based and individually tailored session content, delivered by peers, in the primary care setting-warrant further exploration.

A nursing virtual intervention: real-time support for managing antiretroviral therapy

Based on a philosophy of empowerment, we developed the HIV Treatment, Virtual Nursing Assistance and Education intervention to equip persons living with HIV for managing their daily antiretroviral therapies. In this article, we describe the project and the process of developing it, which was carried out in three phases: (1) development of the intervention's clinical content, (2) generation of a multimedia presentation, and (3) implementation of our Web application via computer interface. The HIV Treatment, Virtual Nursing Assistance and Education consists of four interactive sessions at the computer, animated by a virtual nurse that takes the individual through the learning process about the capabilities necessary for taking the treatment. This information and strategies provided by the virtual nurse are specifically adapted to the participant, according to the responses he/she supplies. The virtual intervention approach, still experimental, is intended to be complementary with the actual clinical follow-up and has been developed in the context of reorganizing services and of the scarcity of resources. While we anticipate direct positive outcomes among the HIV clientele, it is also highly probable that this virtual support application will have ramifications among different clienteles who must also contend with the daily challenges of their health conditions.

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.

HealthMpowerment.org: development of a theory-based HIV/STI website for young black MSM

Black men who have sex with men (BMSM) are disproportionately affected by the HIV epidemic, yet few prevention interventions have been developed specifically for them. Recent studies suggest that the Internet is a promising intervention delivery avenue. We describe results from our formative work in developing a theory-based online HIV/STI prevention intervention for young BMSM including focus groups, semistructured interviews, and usability testing. The Intervention, HealthMpowerment.org , was created based on the Institute of Medicine's integrated model of behavior change with extensive input from young BMSM. Key interactive Web site features include live chats, quizzes, personalized health and "hook-up/sex" journals, and decision support tools for assessing risk behaviors. Creating an interactive HIV/sexually transmitted infection web site for BMSM was a complex process requiring many adjustments based on iterative feedback throughout all development stages. Preliminary satisfaction, content acceptability, and usability findings support the use of the Internet to deliver risk reduction messages to young BMSM.

Online and offline sexual health-seeking patterns of HIV-negative men who have sex with men

To inform health information targeting, we used cross-sectional data from 2577 HIV-negative MSM to identify groups of men who access similar sources. Offline, more men reported talking to a physician about HIV than about having sex with men; fewer than half attended a safer sex workshop. Online, men sought information primarily through Internet search engines, GLBT websites, or health websites. A latent class analysis identified four groups of health seekers: minimal health seekers, those who accessed online sources only, those who sought information mostly from health professionals, and those who sought information from diverse sources. Minimal health seekers, 9% of the sample, were the group of greatest concern. They engaged in unprotected anal sex with multiple partners but infrequently testing for HIV or sought sexual health information. By encouraging health seeking from diverse sources, opportunities exist to increase men's knowledge of HIV/STI prevention and, when necessary, access to medical care.

Internet sex ads for MSM and partner selection criteria: the potency of race/ethnicity online

The explosive growth in Internet use by MSM to find sexual partners has been noted in the research literature. However, little attention has been given to the impact of participating in this online sexual marketplace for MSM of color, despite race/ethnicity as a frequently used selection criterion in personal ads or profiles. Six focus group discussions [n=50], and 35 in-depth qualitative interviews were conducted with African American, Latino, Asian and Pacific Islander MSM in Los Angeles, which included discussion of their use of Internet sites to meet/interact with other MSM. Men reported race/ethnicity as a pervasive and powerful factor in facilitating or derailing Internet-mediated sexual encounters. The racialized interactions that MSM of color reported ranged from simple expressions of race-based preferences to blatantly discriminatory/hostile interactions and often demeaning race-based sexual objectification. Experiences of rejection and a perceived hierarchy of value in the sexual market based on race had definite costs for these MSM using these online sites. Furthermore, the private and solitary nature of seeking partners online meant that there was little to buffer the corrosive aspects of those negative experiences. These online dynamics have implications for the power balance in Internet-mediated sexual liaisons, including sexual decision-making and sexual risk.

Efficacy of a web-based intervention to reduce sexual risk in men who have sex with men

To the extent that men who have sex with men (MSM) use the Internet, it serves as a promising medium for behavioral intervention. The present study sought to investigate the efficacy of a web-based skills training and motivational intervention in a randomized trial (N = 112) conducted completely online. After a detailed assessment, MSM were randomly assigned to an online intervention or a control website. The experimental intervention consisted of risk assessment and feedback, motivational exercises, skills training, and education while the control intervention focused on relaxation skills. Follow-up data were collected 3 months later and analyzed with repeated-measures MANOVA. Although both groups evidenced across-the-board reductions in unprotected sex, perhaps due to the detailed assessment, the experimental group showed greater reductions with the riskiest partners, those of positive or unknown serostatus. Thus, this study gives preliminary evidence that a brief web-based intervention offering cognitive behavioral skills training and motivational enhancement can effectively reduce sexual risk in MSM.

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

OBJECTIVES

Chat room-based prevention interventions for human immunodeficiency virus (HIV) are being implemented to reduce the risk of HIV exposure, infection, and re-infection among men who have sex with men (MSM).

METHODS

Our community-based participatory research partnership implemented a chat room-based intervention known as Cyber-Based Education and Referral/Men for Men (CyBER/M4M). We collected both quantitative and qualitative data to describe the characteristics of chat-room participants ("chatters") and their HIV risks and prevention needs, and to document intervention delivery.

RESULTS

Of the 1,851 chatters who participated in the 18-month intervention, 210 completed the online assessment. The mean age was 30 years. Although the majority self-identified as gay, 25.8% self-identified as bisexual. More than half self-identified as white and one-third as black or African American. A total of 8.6% reported being HIV-positive and 14.8% reported never having been tested for HIV. Grounded theory analysis of transcripts from chat-room instant-message discussions identified 13 thematic categories related to chatter characteristics, prevention needs, and intervention delivery. Chatters were looking for sexual partners, were not open about their orientation, lacked basic information about HIV, had questions about how to be tested, and perceived a lack of general community resources to meet their needs. Furthermore, CyBER educators had to understand and respect the online culture, build trust, and deliver well-crafted and focused messages.

CONCLUSIONS

Chat room-based interventions hold promise to systematically reach Internet communities of MSM, a group that is particularly at risk for infection with HIV and other sexually transmitted diseases.

In the dark: young men's stories of sexual initiation in the absence of relevant sexual health information

A growing body of research has investigated the effectiveness of abstinence-only sexual education. There remains a dearth of research on the relevant sexual health information available to young men who have sex with men (YMSM). Drawing on a mixed-methods study with 526 YMSM, this study explores how and where YMSM receive relevant information on sexual health/behavior. Findings indicate that information related to gay men's sexuality is not readily available from family, friends, or schools. At initiation of anal intercourse, respondents generally had limited information about HIV and sexually transmitted infections (STIs). In some cases, this resulted in the perception that activities such as unprotected sex were "low risk." Many mentioned they first learned about anal sex during their sexual debut, describing painful and/or unpleasant experiences. Some relied on older/more experienced partners, the Internet, and pornography for information. Findings are discussed in relation to how providers can help YMSM build solid foundations of sexual education to protect them from STI and HIV infection.

Reaching and retaining high-risk HIV/AIDS clients through the Internet

The Internet is a popular way for people to meet casual sex partners. However, online outreach remains largely unexplored to promote voluntary counseling and testing for HIV. The Student Health Action Coalition's HIV testing program (SHAC-HIV) targets high-risk clients through tailored Internet outreach via chat rooms, social networking sites, and online forums. The SHAC-HIV model also demonstrates that nontraditional testing sites can provide low-cost, client-centered, high-quality services to support increased demand for HIV-testing services. Within the clinic, SHAC-HIV's testing model includes four major components: (a) reliance on a team of well-trained health sciences student volunteers; (b) rapid oral-fluid HIV tests; (c) universal, consent-based testing with client-centered health education and counseling; and (d) coordinated referrals for follow-up testing, treatment, and care. This approach reaches high-risk clients as well as undiagnosed infections. In 2007, there were nine confirmed positive results out of 389 tests, yielding a 2.3% positivity rate. This positivity percentage is higher than any other nontraditional testing site in North Carolina. This article describes the SHAC-HIV outreach and voluntary counseling and testing program with the aim of encouraging adoption of the model by other nontraditional testing sites.

Barebacking: a review of the literature

This article synthesizes the peer-reviewed literature about barebacking, an HIV risk behavior that is generally understood as intentional unprotected anal intercourse between men where HIV transmission is a possibility. Of the 42 academic reports identified in the Anglophone literature, the greatest attention is given to U.S. publications and empirical projects. The variable nomenclature about barebacking is recognized and it is concluded that although epidemiological data suggest prevalence of barebacking varies across regions, time, and serostatus, the majority of men who have sex with men (MSM) do not intentionally seek out condomless anal sex. Findings show that macro-, meso-, interpersonal-, and intrapersonal level factors, such as homonegativity, community norms, partner intimacy, and drug use, converge to influence the likelihood that an individual will bareback. A conceptual framework to examine the reciprocal and dynamic relationships sustaining barebacking is proposed. In examining the theoretical and methodological limitations of the research about barebacking, the atheoretical nature of the studies, failure to report analyses conducted, and suboptimal measures are included among the study constraints. Furthermore, in research to date, the majority of participants have been white, urban, and gay-identified; thus, more research is needed to capture the viewpoints of diverse MSM communities. There has also been an overly individualistic focus on barebacking which needs to be tempered by greater consideration of the impact of macro- and meso-level factors upon MSM's behavior. With respect to programmatic responses, more culturally bound strategies are called for.

PowerON: the use of instant message counseling and the Internet to facilitate HIV/STD education and prevention

OBJECTIVE

In recent years, Internet-based or online counseling has emerged as an effective way to assess psychological disorders and discuss destructive behaviors with individuals or groups of individuals. This study explores the application of online counseling to HIV/STD risk-taking behavior among men who have sex with men (MSM).

METHODS

PowerON, an organization that provides sexual health information to MSM exclusively online, used instant message technology to counsel MSM in real time through computer-mediated means. A sample of 279 transcripts of instant message exchanges between PowerON counselors and Gay.com users were recorded and qualitatively analyzed.

RESULTS

Approximately 43% of the instant message sessions discussed information about HIV/STD testing. Risk-taking behaviors were addressed in 39% of the sessions. Information about HIV/STDs and general counseling were given in 23% and 18% of the counseling sessions, respectively.

CONCLUSION

The data showed these instant message sessions to be a potentially feasible forum for HIV/STD counseling.

PRACTICE IMPLICATIONS

Information ordinarily disseminated at health clinics could be successfully distributed through the Internet to MSM.

Sexual and alcohol risk behaviours of immigrant Latino men in the South-eastern USA

Little is known about the intersections of immigration, masculinity and sexual risk behaviours among recently arrived Latino men in the USA. Nine immigrant Latino men from three urban housing communities in the South-eastern USA used photovoice to identify and explore their lived experiences. From the participants' photographs and words, thirteen themes emerged within four domains. The immigration experience and sociocultural norms and expectations of masculinity were factors identified decreasing Latino men's sense of power and increasing stress, which lead to sexual risk. Latino community strengths and general community strengths were factors that participants identified as promoting health and preventing risk. These themes influenced the development of a conceptual model to explain risk among immigrant Latino men. This model requires further exploration and may prove useful in intervention development.

Frequent and systematic unprotected anal intercourse among men using the Internet to meet other men for sexual purposes in France: results from the "Gay Net Barometer 2006" survey

For men who have sex with men (MSM), the Internet has imposed itself in the past decade as the place to be to meet other men with similar interests for sex or just to surf in search of excitement. This is a biennial study on the MSM in France. Between December 2005 and February 2006, 15,085 MSM completed an online questionnaire on their social and sexual uses of the Internet. Participants in the "The Gay Net Barometer 2006" study responded to questions related to their sexual and sexual risk behaviours. One third of respondents reported at least one event of unprotected anal intercourse while 11.1% reported frequent or systematic unprotected anal intercourse. These sexual risk behaviours were associated with various sociodemographic and sexual variables in addition to the recruitment website. The study suggests Internet users are not a homogeneous group and intervention targeting of them should be based on an in-depth understanding of the sexual cultures operating within websites.

Barebacking among MSM Internet users

This theory-driven study explored the phenomenon barebacking among Men who have Sex with Men (MSM) Internet users. Two hundred and forty men were recruited online and asked to complete a web-based survey. Forty percent of men in this geographically diverse sample reported engaging in bareback sex. Consistent with other research, findings demonstrate that compared with non-barebackers, men who engage in bareback sex are more likely to use alcohol in sexual contexts, use the Internet to meet sex partners, engage in any unsafe sex, and report higher degree of sexual sensation seeking. They are also more likely to report lower perception of safer sex social norms and lower self-efficacy for limiting HIV risk. Lack of concept discrimination between unprotected anal intercourse and barebacking suggests barebacking is a neologism that serves as a manifestation of the changing nature of sexual risk taking among some MSM. Opportunities for reducing the rate of HIV transmission among MSM are suggested.

Sexual risk taking among young internet-using men who have sex with men

OBJECTIVES

We examined the characteristics of young Internet-using men who have sex with men (MSM) and risks associated with seeking sex online, offline, or through both strategies.

METHODS

Data were obtained from MSM aged 18 to 24 years who completed a 45-minute online survey regarding sex and Internet use in the preceding 3 months.

RESULTS

Significantly more Internet-using MSM who had met sexual partners both online and offline (43%) reported unprotected anal intercourse than did those who had met sexual partners exclusively online (29%) or offline (34%). MSM who met sexual partners exclusively offline reported the fewest partners but the greatest proportion of partnerships involving unprotected anal intercourse (49%). Meeting sexual partners both online and offline (odds ratio [OR]=3.38-58.42) and being drunk (OR=1.57) or high (OR=2.24) increased the odds of having more sexual partners. The same factors increased the odds of having unprotected anal intercourse (online and offline sexual partners, OR=1.60; being drunk, OR=1.43; being high, OR=1.61).

CONCLUSIONS

Risky sexual behavior was prevalent among all of the study subgroups. Our findings suggest that online sex seeking is associated with greater numbers of sexual partners but neither promotes nor discourages unprotected anal intercourse. Regardless of where sexual partners met, being drunk and high were significant risks for unprotected anal intercourse.

Cruising in cyber space: comparing Internet chat room versus community venues for recruiting Hispanic men who have sex with men to participate in prevention studies

Difficulties with recruitment of hidden populations, such as Hispanic men who have sex with men (MSM), have hampered HIV prevention research, leading researchers to explore alternative recruitment modalities such as the Internet. In this paper, we compare the efficiency and cost of recruiting HMSM from Internet chat rooms versus community venues and examine the differences between participants recruited from each type of venue. Internet recruitment was more efficient and somewhat less costly than community recruitment. Although the two groups were comparable in most demographic factors and HIV risk behaviors, Internet recruits were more likely to be bisexual, more likely to be HIV seropositive, had a higher level of education, and reported higher levels of psychological distress and lower levels of gay community attachment. Implications of our findings for using Internet chatrooms as recruitment venues are discussed.

Condom acquisition and preferences within a sample of sexually active gay and bisexual men in the southern United States

Health departments, community-based organizations (CBOs), and AIDS service organizations (ASOs) in the United States and abroad distribute large quantities of free condoms to sexually active individuals; however, little is known about where individuals who use condoms actually acquire them. This community-based participatory research (CBPR) study was designed to identify factors associated with the use of free condoms during most recent anal intercourse among self-identifying gay and bisexual men who reported condom use. Data were collected using targeted intercept interviewing during North Carolina Pride Festival events in Fall 2006, using the North Carolina Condom Acquisition and Preferences Assessment (NC-CAPA). Of the 606 participants who completed the assessment, 285 met the inclusion criteria. Mean age of participants was 33 (+/-10.8) years. The sample was predominantly white (80%), 50% reported being single or not dating anyone special, and 38% reported the use of free condoms during most recent anal intercourse. In multivariable analysis, participants who reported using free condoms during most recent anal sex were more likely to report increased age; dating someone special or being partnered; and having multiple male sexual partners in the past 3 months. These participants were less likely to report ever having had a sexually transmitted disease. Despite being in the third decade of the HIV epidemic, little is known about condom acquisition among, and condom preferences of, gay and bisexual men who use condoms. Although more research is needed, our findings illustrate the importance of free condom distribution.

Characteristics of a sample of men who have sex with men, recruited from gay bars and Internet chat rooms, who report methamphetamine use

Crystal methamphetamine is a highly addictive stimulant that initially gained popularity in the western region of the United States and has spread to all regions of the country. This study was designed to identify factors associated with methamphetamine use among men who have sex with men (MSM) in North Carolina. Participants were recruited in five gay bars and in five geographically defined Internet chat rooms concurrently in 2005 to complete a brief assessment of drug use and other risk behaviors. Of the 1189 MSM who completed the assessment, mean age was 29 years. Two thirds self-identified as black/African American or other minorities, and 25% as bisexual. Nearly 6% reported using methamphetamines during the past 30 days. In multivariable analysis, MSM who reported using methamphetamines were more likely to report higher education; health insurance coverage; inconsistent condom use during anal sex within the past 3 months; a history of sexually transmitted disease (STD) infection; positive HIV serostatus; and use of medications designed to treat erectile dysfunction. A lack of data exists on methamphetamine use among MSM in the southeastern United States, particularly in nonurban regions. Because the southeastern United States carries a disproportionate HIV, AIDS, and STD burden, our findings underscore the need for further research and intervention.

Using hepatitis A and B vaccination as a paradigm for effective HIV vaccine delivery

Background: An understanding of vaccine acceptance and uptake is imperative for successful vaccination of populations that will be primary targets for vaccination after a vaccine against HIV is developed and ready for dissemination. Experiences with vaccination against vaccine-preventable hepatitis (VPH) among men who have sex with men (MSM) may offer key insights to inform future HIV vaccination strategies. The purpose of this analysis was to explore what is known currently about vaccination among MSM, using knowledge gained from vaccination against VPH, and to identify important considerations from these experiences that must be explored further as a vaccine against HIV is promoted among MSM. Because cultural and political differences make it difficult to extrapolate findings from studies in one country to another, we have focused our analyses on studies conducted in the USA. Methods: Through a qualitative systematic review of published reports, we identified eight studies that reported correlates of VPH among MSM in the USA. Results: Six major domains of variables associated with vaccination against VPH were identified, including: demographics (e.g. younger age, higher educational attainment); increased vaccine knowledge; increased access to health care; provider recommendation; behaviours (e.g. same-sex behaviour, health-promoting and disease-preventing behaviours); and psychosocial factors (e.g. openness about one’s sexual orientation, reduced barriers to being vaccinated, self-efficacy). Conclusions: Further research is needed to understand vaccination behaviour among MSM and to maximise acceptance and uptake after a vaccine exists. Experiences with VPH provide a real-world model on which to base preliminary assumptions about acceptance and uptake of a vaccine against HIV.

Psychosocial and behavioral correlates of seeking sex partners on the internet among hiv-positive men

BACKGROUND

The Internet is revolutionizing how people access and use information; for some people, the Internet is also redefining interpersonal relationships, including sexual relationships.

PURPOSE

The objective of this study was to extend the understanding of HIV-positive men who use the Internet to meet sex partners.

METHODS

This study examined the use of the Internet for meeting sex partners among 141 sexually active HIV-positive men who completed anonymous surveys.

RESULTS

Results showed that 37% of sexually active HIV-positive men who were using the Internet had gone online to seek potential sex partners in the previous 3 months. Seeking sex partners online was associated with greater likelihood of having HIV-negative sex partners and engaging in unprotected intercourse with HIV-negative or unknown HIV status partners. Multivariate analyses showed that seeking sex partners online was associated with greater education, higher CD4 cell counts, using the Internet for sexual entertainment, and higher Sexual Compulsivity scale scores over and above demographic, health, Internet use, sexual behavior, and other psychosocial characteristics including optimism and depression.

CONCLUSIONS

Results suggest a continued need for interventions targeting HIV transmission risk reduction among HIV-positive men who use the Internet to meet potential sex partners.