Internet-based HIV Research Articles

Adolescent Abstinence and Unprotected Sex in CyberSenga, an Internet-Based HIV Prevention Program: Randomized Clinical Trial of Efficacy

ContextCost-effective, scalable programs are urgently needed in countries deeply affected by HIV.MethodsThis parallel-group RCT was conducted in four secondary schools in Mbarara, Uganda. Participants were 12 years and older, reported past-year computer or Internet use, and provided informed caregiver permission and youth assent. The intervention, CyberSenga, was a five-hour online healthy sexuality program. Half of the intervention group was further randomized to receive a booster at four-months post-intervention. The control arm received ‘treatment as usual’ (i.e., school-delivered sexuality programming). The main outcome measures were: 1) condom use and 2) abstinence in the past three months at six-months' post-intervention. Secondary outcomes were: 1) condom use and 2) abstinence at three-month's post-intervention; and 6-month outcomes by booster exposure. Analyses were intention to treat.ResultsAll 416 eligible youth were invited to participate, 88% (n = 366) of whom enrolled. Participants were randomized to the intervention (n = 183) or control (n = 183) arm; 91 intervention participants were further randomized to the booster. No statistically significant results were noted among the main outcomes. Among the secondary outcomes: At three-month follow-up, trends suggested that intervention participants (81%) were more likely to be abstinent than control participants (74%; p = 0.08), and this was particularly true among youth who were abstinent at baseline (88% vs. 77%; p = 0.02). At six-month follow-up, those in the booster group (80%) reported higher rates of abstinence than youth in the intervention, no booster (57%) and control (55%) groups (p = 0.15); they also reported lower rates of unprotected sex (5%) compared to youth in the intervention, no booster (24%) and control (21%) groups (p = 0.21) among youth sexually active at baseline.ConclusionsThe CyberSenga program may affect HIV preventive behavior among abstinent youth in the short term and, with the booster, may also promote HIV preventive behavior among sexually active youth in the longer term.Trial Registration NCT00906178.

P5.025 Development and Comparative Evaluation of an Innovative HIV Self-Testing Smartphone Application, an Internet-Based and a Paper-Based Instructional Programme in South Africa

BackgroundSouth Africa has about 11% of the total population living with HIV, the largest to date for any country. Facility-based HIV testing has reached only 50% South Africans because of...

Usability and Navigability of an HIV/AIDS Internet Intervention for Adolescents in a Resource-Limited Setting

Use of the Internet is growing in Sub-Saharan Africa. Evidence of computer and Internet effectiveness for reduction in risk behaviors associated with HIV shown in US settings has yet to be replicated in Africa. We describe the development, usability, and navigability testing of an Internet-based HIV prevention program for secondary school students in Uganda, called CyberSenga. For this work, we used four data collection activities, including observation of (a) computer skills and (b) navigation, (c) focus group discussions, and (d) field assessments to document comprehension and usability of program content. We document limited skills among students, but youth with basic computer skills were able to navigate the program after instruction. Youth were most interested in activities with more interaction. Field testing illustrated the importance of using a stand-alone electrical source during program delivery. This work suggests that delivery of Internet-based health promotion content in Africa requires attention to user preparedness and literacy, bandwidth, Internet connection, and electricity.

Evaluation of Bro Online: an Internet-based HIV prevention initiative for gay and bisexual men

The objective of this study is to evaluate the effectiveness of Bro Online, an Internet-based HIV health prevention intervention encouraging a condom culture among gay and bisexual men, in achieving its short-term outcomes (member profiles promoting condom use, members having knowledge of high-risk behaviour and how to reduce risk and members having better access to condoms) and medium-term outcome (being a social space with a norm of condom use). The study design is a programme theory-based evaluation using evaluative rubrics. The method used involves review of Bro Online user profiles, existing site management and Google analytic data, and online survey of data completed by 91 members. The findings show that overall Bro Online achieved mixed results for the four evaluated outcomes with one very good, two good and one poor outcome rating. We conclude that Bro Online is a promising HIV prevention intervention. Development of the website to strengthen the intervention is recommended. Further evaluation will contribute to building the HIV prevention evidence.

LBP-1.02 Acceptability and appeal of internet-based STI and HIV testing among a sample of gay men and clients attending STI clinics in British Columbia

BackgroundSeveral jurisdictions globally have implemented internet-based STI and HIV testing with good uptake and reach into untested populations. In British Columbia, a similar program is under development to offer online...

The Future of Internet-Based HIV Prevention: A Report on Key Findings from the Men’s INTernet (MINTS-I, II) Sex Studies

The Internet and other new media have changed how men who have sex with men (MSM) find and interact with sexual partners. This social phenomenon, paired with growing evidence that use of the Internet increases MSM’s risk for HIV infection, makes it crucial that innovative technology-based HIV prevention interventions are developed for this population. In this commentary we explain why technology-based HIV prevention interventions are urgently needed; we then highlight findings from some of the first Internet-based HIV prevention for MSM studies that show the potential for future interventions; we next discuss ways for interventionists to conceptualize new media as a tool for HIV prevention; and finally we discuss emerging trends for technology-based HIV-prevention research.

The role of critical self-reflection of assumptions in an online HIV intervention for men who have sex with men.

The Men's INTernet Study II included a randomized controlled trial to develop and test an Internet-based HIV prevention intervention for U.S men who use the Internet to seek sex with men. In 2008, participants (n = 560) were randomized to an online, interactive, sexual risk-reduction intervention or to a wait list null control. After 3 months, participants in both conditions reported varying degrees of change in sexual beliefs or behaviors. Using content analysis and logistic regression, this mixed-methods study sought to understand why these changes occurred. Level of critical self-reflection of assumptions appeared to facilitate the labeling of sexual beliefs and behaviors as risky, which in turn encouraged men to commit to and enact change. New HIV prevention interventions should include activities in their curriculum that foster critical self-reflection on assumptions.

Reducing HIV risk behavior of men who have sex with men through persuasive computing: results of the Men's INTernet Study-II.

The primary objective of this study was to develop and test a highly interactive Internet-based HIV prevention intervention for men who have sex with men (MSM). MSM remain the group at highest risk for HIV/AIDS in the United States and similar countries. As the Internet becomes popular for seeking sex, online interventions to reduce sexual risk are critical. Given previous studies, a secondary objective was to demonstrate that good retention is possible in online trials. A randomized controlled trial with 3-month, 6-month, 9-month, and 12-month follow-up design was employed. In 2008, 650 participants were randomized to an online, interactive sexual risk reduction intervention or to a waitlist null control. Retention was 76-89% over 12 months. At 3-month follow-up, results showed a 16% reduction in reported unprotected anal intercourse risk among those in the treatment condition versus control [95% confidence interval (95% CI) of rate ratio: 0.70-1.01]. No meaningful differences were observed at 12-month follow-up. Internet-based, persuasive computing programs hold promise as an effective new approach to HIV prevention for MSM, at least in the short term. Further, online trials can be conducted with acceptable retention provided strong retention protocols are employed. Four directions for future research are identified.

A randomized controlled study to evaluate the efficacy of an Internet-based intervention in reducing HIV risk behaviors among men who have sex with men in Hong Kong

A randomized controlled study evaluated an Internet-based HIV behavioral intervention for men who have sex with men (MSM). Hong Kong Chinese men aged ≥18 having engaged in oral or anal MSM behaviors in the last six months were randomly allocated into the intervention (n=140) and the control groups (n=140). Participants were interviewed anonymously at the baseline and after six months. Interventions included periodic HIV information dissemination, monitoring of risk behaviors and interactive feedback, online peer counseling and provision of a hotline. The control group only received some educational materials. Efficacy of the intervention was not supported as no statistically significant between-group differences in background characteristics, HIV risk behaviors and perceptions were observed both at the baseline and after the 6-month period. Effectiveness of online interventions should not be taken for granted and evidence-based approach is warranted.

HIV Risk and the Internet: Results of the Men’s INTernet Sex (MINTS) Study

This study assessed the feasibility of online recruitment of high-risk Latino men who have sex with men (MSM) for HIV prevention survey research and investigated the relationship between Internet use and unsafe sex. Participants (N = 1,026) were Internet-using Latino MSM living in the U.S. recruited using online banner advertisements. Respondents completed a cross-sectional, online survey in English or Spanish. Sample characteristics reflected national statistics within 5%. Nearly all (99%) reported having used the Internet to seek sex with another man. Two-thirds of respondents reported having unprotected anal sex with > or =1 man in the last year, 57% of these with multiple partners. Participants reported engaging in anal sex and unprotected anal sex with nearly twice as many men first met online versus offline, but risk proportions did not differ. Internet-based HIV prevention research is possible even with geographically-dispersed minority populations. Efficiency appears the primary risk associated with meeting partners online.

An Online Needs Assessment of a Virtual Community: What Men Who Use the Internet to Seek Sex with Men Want in Internet-Based HIV Prevention

As part of a study to develop effective Internet-based HIV prevention interventions for Men who use the Internet to seek Sex with Men (MISM), we sought information from the target population on; (a) acceptability of sexually explicit media; (b) interest in specific content areas; and (c) identification of credible sources of information. A cross-sectional stratified Internet-based survey design was employed. Between September and November 2005, we recruited 2,716 MISM through Gay.com stratified across race/ethnicity to ensure adequate racial/ethnic diversity. Sixteen Likert-type items assessed acceptability of sexual explicitness, 24 items identified topics for inclusion, and two assessed sources of information. There was near universal acceptability for highly sexually explicit education. Over 75% reported high interest in 10 sexual health topics. HIV positive MISM and MISM engaged in unprotected anal sex with multiple male partners reported significantly less interest in HIV prevention specific content. Differences across age, race/ethnicity and education were identified. Idiosyncratic searches and gay sites were frequently cited sources of information; however blogs, government, and media sites were not. It is acceptable for web-based HIV prevention for MISM to be highly sexually explicit and to provide detailed content relevant to men's sexual health. Since demographic differences in acceptability and content were minor, it is appropriate for interventions to target across demographics. Interventions to re-engage men engaging in high risk and HIV + MISM should be considered. Leading health agencies should review whether their web information is retrievable, credible and useful to those most at risk.

Conducting Internet-Based HIV/STD Prevention Survey Research: Considerations in Design and Evaluation

The aim of this paper is to advance rigorous Internet-based HIV/STD Prevention quantitative research by providing guidance to fellow researchers, faculty supervising graduates, human subjects' committees, and review groups about some of the most common and challenging questions about Internet-based HIV prevention quantitative research. The authors represent several research groups who have gained experience conducting some of the first Internet-based HIV/STD prevention quantitative surveys in the US and elsewhere. Sixteen questions specific to Internet-based HIV prevention survey research are identified. To aid rigorous development and review of applications, these questions are organized around six common criteria used in federal review groups in the US: significance, innovation, approach (broken down further by research design, formative development, procedures, sampling considerations, and data collection); investigator, environment and human subjects' issues. Strategies promoting minority participant recruitment, minimizing attrition, validating participants, and compensating participants are discussed. Throughout, the implications on budget and realistic timetabling are identified.

Sex and the Internet: Gay men, risk reduction and serostatus

Access to the Internet has increased dramatically over the past decade as has its use for meeting sexual partners (e‐dating), particularly among gay men. Between June 2002 and January 2004, 128 gay/bisexual men living in London were interviewed one‐to‐one about their experience of e‐dating, sexual risk and HIV prevention. The men were recruited both online (through the Internet) and offline (in clinics and the community); 32 men were HIV‐positive, 59 HIV‐negative, while 13 had never had an HIV test. A key finding was that both identity as well as anonymity are vital to e‐dating. Through a process of online filtering and sero‐sorting, HIV‐positive men are able to meet other positive men for anal sex without condoms. While this does not present a risk of HIV transmission to an uninfected person it does have implications for the potential transmission of other STIs such as syphilis and LGV. Through e‐dating, HIV‐positive gay men can also avoid abuse, discrimination and sexual rejection. Our findings do not support the suggestion that the attraction of e‐dating is that it affords absolute anonymity. We found that the gradual expression of identity is vital for e‐dating among gay men. Internet‐based HIV prevention campaigns need to take account of the different ways in which gay reflexively manage aspects of their identity online Résumé Dans cet article, l'auteur explore le contexte dans lequel la femme risque d'attraper le virus du Sida dans la ville de Chiang Mai en Thaïlande. Il examine le comportement sexuel des hommes et des femmes, leur attitude vis‐à‐vis des métiers du sexe et la perception du risque d'attraper le VIH. Ses conclusions sont tirées des données recueillies au milieu des années 90, au plus fort de l'épidémie. Les hommes et les femmes qui participèrent à cette recherche soulignèrent un certain nombre de thèmes importants. Tout d'abord, certains hommes continuaient à avoir des rapports sexuels non protégés avec des professionnelles du sexe. Deuxièmement, au lieu d'avoir recours aux professionnelles du sexe, les hommes, étant donné leur crainte du Sida, étaient conduits à chercher des partenaires sexuels parmi leurs amies et connaissances car ces personnes étaient censées ne présenter aucun danger par rapport à l'éventuelle transmission du virus. Troisièmement, les femmes qui participèrent à cette recherche ignoraient en grande partie cette extension du réseau sexuel au delà du milieu professionnel du sexe proprement dit. Enfin, la sexualité des femmes était en grande partie méconnue de ceux chargés de promouvoir la politique de santé publique; les participants hommes et femmes n'en tenaient pas compte non plus, ce qui mettait les femmes en danger d'attraper le VIH. Resumen En este artículo examino en qué contexto las mujeres corren el riesgo de contraer VIH valorando la conducta sexual de hombres y mujeres, las actitudes hacia el trabajo sexual y la percepción de riesgo de HIV en la ciudad tailandesa de Chiang Mai. Los resultados se basan en datos recopilados durante mediados de los noventa cuando la epidemia estaba en su punto más álgido. Los hombres y mujeres que participaron en este estudio destacaron una serie de cuestiones importantes. En primer lugar, algunos hombres seguían teniendo sexo arriesgado con las trabajadoras sexuales. En segundo lugar, el miedo a contraer VIH motivaba a los hombres a buscar amigas y conocidas en lugar de trabajadoras sexuales para sus encuentros amorosos porque pensaban que así estaban seguros de no infectarse. En tercer lugar, las mujeres de este estudio desconocían en gran medida la expansión de la red sexual más allá del trabajo sexual. Por último, la sexualidad de las mujeres en general no era reconocida en las respuestas de salud pública o por los participantes masculinos y femeninos, con lo que corrían el riesgo de contraer VIH.

Providing HIV Education and Outreach via Internet Chat Rooms to Men who Have Sex with Men

This article describes a pilot project that provided Internet-based outreach and HIV educational information to Men Who Have Sex with Men (MSM). The project provided services via chat rooms designated for MSM who meet there anonymously for sexual encounters. Services were designed to support behavior changes as well as serving a gateway function for additional services at the host agency. The experiences of the project suggest that the target population may engage in high-risk sexual activity more than what was initially assumed; and that Internet outreach provides a relevant means of conducting outreach to this group.