C-CHANGE
C-Channel:
Issue 41 | MAY 2012
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Internet-based Interventions to Reduce HIV Risk for Men Who Have Sex with Men

Of Interest…

C-Change worked with the Government of Kenya and other partners on the rollout of the Voluntary Medical Male Circumcision (VMMC) program and development of the VMMC Communication Toolkit (available in Luo, Kiswahili, Teso, Turkana, and English). A case study details the successful collaboration, which included implementation of a communication strategy, establishment of task forces as VMMC champions, high-level advocacy, and development of VMMC communication materials that were concept tested and pretested with local audiences.

This issue highlights six recent articles on internet-based communication interventions to reduce HIV risk for men who have sex with men (MSM). The first summarizes the findings of an expert consultation on the use of new media for HIV-prevention messaging for MSM; the second reports findings for a pilot chat-room intervention; the third details a theory-based, text-messaging intervention to reduce methamphetamine use and high-risk sexual behaviors among out-of-treatment MSM; and the fourth describes a theory-based, interactive website for African American MSM. The next two articles draw from the Men's INTernet Study, describing high retention rates for interactive interventions, noting ways to conceptualize new media as HIV-prevention tools, and outlining emerging trends for technology-based HIV-prevention research. Additional articles on text messaging can be found in C-Channel 33 and C-Channel 24.

C-Change conducted five studies in Jamaica on vulnerable populations subject to stigma and discrimination and considered at-risk for HIV: men who have sex with men [MSM] and sex workers, as well as younger men and women engaged in cross-generational relationships. HIV-related stigma and discrimination occur when an individual who is HIV-positive or associated with the disease is denied dignity, respect, and/or human rights. Findings from these studies will assist implementers to shape HIV prevention and communication programming for these populations.

 

In this issue

Internet-based Interventions to Reduce HIV Risk for Men Who Have Sex with Men

1. Reaching men who have sex with men for HIV prevention messaging with new media
ONLINE FULL TEXT

2. Utilizing internet chat rooms to prevent HIV risk behaviors among MSM
ONLINE FULL TEXT

3. Text messaging risk reduction intervention for methamphetamine-using MSM
ONLINE FULL TEXT

4. HealthMpowerment.org: Internet intervention to young black MSM

5. Reducing HIV risk behavior of MSM through persuasive computing
ONLINE FULL TEXT

6. A report on findings from the Men's INTernet (MINTS-I, II) Sex Studies


1. Reaching men who have sex with men for HIV prevention messaging with new media: Recommendations from an expert consultation

Authors: Lewis M1; Uhrig J1; Ayala G2; Stryker J3
Institutions: 1 RTI International, Research Triangle Park, NC; 2 Global Forum on MSM and HIV, Oakland; US Centers for Disease Control and Prevention, Atlanta
Source: Annals of the Forum for Collaborative HIV Research 2011,13(3): 1-16.

ABSTRACT

We report on the results of an expert consultation held by the Centers for Disease Control and Prevention (CDC) on the use of the Internet and new media to deliver HIV prevention messaging to men who have sex with men (MSM). Experts from government, academia, community-based AIDS service organizations (CBOs/ASOs), and the private sector participated in discussions to examine the strengths and weaknesses of specific channels, technologies, and Websites for delivering HIV prevention messages; and how the issues raised could inform the development of electronic materials to educate, and support choices for different risk reduction strategies. Analysis of the meeting discussion suggested that consultants viewed the Internet and other new media as having great potential to reach MSM with HIV prevention messages. Key themes related to flexibility, reach, visual appeal, engagement, interactivity, and community building were discussed with emphasis given to optimizing the impact and effectiveness via message timing and linking to other resources or data. Several challenges were noted, including structural barriers and the need to deliver HIV content in the context of MSM health issues. Implications for health promotion practice are discussed.

To link the full text of this article online, click here. Access the journal website here.

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

Authors:Rhodes S1; Hergenrather K2; Duncan J3; Vissman A1; Miller C1; Wilkin A1; Stowers J4; Eng E5
Institutions:1 Wake Forest University School of Medicine; 2 Department of Counseling/Human Organizational Studies, George Washington University; 3 AIDS Care Services, Winston-Salem; 4 Triad Health Project, Greensboro, NC; 5 School of Public Health, UNC at Chapel Hill
Source: Public Health Reports 2010, 125(S1): 29-37.

ABSTRACT

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.

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3. Developing a text messaging risk reduction intervention for methamphetamine-using MSM: Research note

Authors: Reback C1; Ling D1; Shoptaw S2; Rohde J3
Institutions: 1 Friends Research Institute, Inc., Los Angeles; 2 Department of Family Medicine, University of California at Los Angeles; Office of AIDS Programs and Policy, Los Angeles County Department of Public Health
Source: Open AIDS Journal 2010, 4:116-122. doi. 10.2174/1874613601004030116.

ABSTRACT

Men who have sex with men (MSM) who use methamphetamine experience high risks for HIV infection due to sexual transmission behaviors often engaged in when under the influence of methamphetamine. Methamphetamine-using MSM use various forms of information technology (IT) communication such as instant messaging, social networking sites, and websites to facilitate a sexual and/or drug "hook up." Given the acceptability of IT communication in their daily lives, an IT intervention represents an appropriate strategy to reach and intervene with out-of-treatment, methamphetamine-using MSM. The aim of this study was to conduct formative work to develop a text messaging intervention to reduce methamphetamine use and high-risk sexual behaviors among out-of-treatment MSM, which involved conducting focus groups, community partners' meetings, and a pre-test intervention. These activities culminated in the development of a two-week, text-messaging intervention that delivered real-time electronic correspondence based on the behavioral change theories of Social Support Theory, Health Belief Model, and Social Cognitive Theory. The focus groups, community meetings, and pre-test were used to identify the IT communication device, the text messages that best support risk reduction and healthier behavioral choices, and logo, flyer and website development. The input and feedback from the target population and community partners were critical to the successful development of a culturally appropriate intervention. The knowledge gleaned from the formative work of this study will be vitally helpful in designing future IT studies.

To link to the full text of this article online, click here. Access the journal website here.

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4. HealthMpowerment.org: Feasibility and acceptability of delivering an internet intervention to young black men who have sex with men

Authors: Hightow-Weidman L1; Pike E1; Fowler B2; Matthews D3; Kibe J2; McCoy R2; Adimora A1
Institutions: 1 School of Medicine, UNC at Chapel Hill; 2 Communication for Health Applications and Interventions Core, UNC at Chapel Hill; 3 Department of Health Behavior and Health Education, UNC at Chapel Hill
Source: AIDS Care 24 Jan 2012 online. doi: 10.1080/09540121.2011.647677.

ABSTRACT

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.

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

Authors: Rosser B; Oakes J; Konstan J; Hooper S; Horvath K; Danilenko G; Nygaard K, Smolenski D
Institution: HIV/STI Intervention and Prevention Studies, University of Minnesota School of Public Health
Source: AIDS 2010, 24(13):2099-2107.

ABSTRACT

OBJECTIVE: 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.
DESIGN: A randomized controlled trial with 3-month, 6-month, 9-month, and 12-month follow-up design was employed.
METHODS: In 2008, 650 participants were randomized to an online, interactive sexual risk reduction intervention or to a waitlist null control.
RESULTS: 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.
CONCLUSION: 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.

To link to the full text of this article online, click here. Access the journal website here.

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6. The future of internet-based HIV prevention: A report on key findings from the Men's INTernet (MINTS-I, II) Sex Studies

Authors: Rosser B; Wilkerson J; Smolenski D; Oakes J; Konstan J; Horvath K; Kilian G; Novak D; Danilenko G; Morgan R
Institution: HIV/STI Intervention and Prevention Studies, University of Minnesota School of Public Health
Source: AIDS and Behavior 2011, 15(S1): 91-100. doi: 10.1007/s10461-011-9910-5.

ABSTRACT

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.

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This publication is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of C-Change, and do not necessarily reflect the views of USAID or the United States Government.

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