HIV Prevention is 215 Feet Away: Developing Geosocial Networking Interventions for Young Gay, Bisexual and Other Men Who Have Sex With Men

Abstract

HIV continues to rise among young gay, bisexual and other men who have sex with men (YMSM) despite current prevention efforts. Increasingly, YMSM are using smartphone applications (“apps”) to communicate with friends, meet romantic partners and seek information about health. A growing number of apps for YMSM contain a geosocial networking component, allowing users to send text messages, photos and pin drops to other users according to geographic proximity. These apps are becoming increasingly specialized for targeted subpopulations of MSM and attract millions of users worldwide. Our research team used the geolocation feature of a popular app to recruit a probability sample of YMSM (ages 18-24; N = 195) in Southern California. Participants completed an anonymous online survey on a variety of topics, including sexual health and technology use. YMSM in our study were single (87%), educated (85% college degree or higher), gay-identified (87%) and largely out to family and friends (94%). Over three-quarters had used the app to meet a sexual partner and 29% indicated their primary reason for using the app was to “hook up.” However, YMSM also used the app to connect to the gay community (65%), make new friends (80%) and kill time when bored (86%). Eighty-eight percent of users logged onto the app daily (50% logged on five or more times a day); 46% used at least one other gay geosocial networking app and 70% indicated willingness to receive HIV prevention information via smartphone. Results indicate that geosocial networking apps represent a prime opportunity for discreet, targeted outreach for YMSM. Possible functionality could include geolocation-based HIV test finders, automated behavioral and biomedical prevention reminders, gay-specific content on health and well-being and network-based health promotion. Future community-based research with YMSM and smartphone app companies on optimal design and functionality of geosocial networking interventions for YMSM is needed.

Future Directions and Funding Priorities for HIV and Technology-Based Research at NIDA and NIMH

Abstract

Technology-based HIV research has expanded dramatically over the past decade. Technology allows for greater reach, anonymity, tailoring, dissemination and implementation of interventions and services in diverse contexts and settings. Technology also allows for the efficient collection of data in real time, collection across multiple random timepoints, and collection of social network interaction data. While technology presents opportunities, there also are a number of challenges to address as well as investigate through research (e.g. ethics, data security and confidentiality, costs, keeping ahead of changing technology). The National Institute of Mental Health (NIMH) and the National Institute on Drug Abuse (NIDA) have a history of supporting technology-based HIV research and have continued interest in funding research that integrates and takes advantage of innovative and emerging technologies. Both NIMH and NIDA have a number of current funding opportunity announcements (FOAs) and initiatives to harness the power of technology to prevent HIV, provide HIV care and services, and improve the health outcomes of those living with HIV

Policy Panel: Opportunities and Challenges Related to Using Technology-based Interventions for HIV Prevention and Care

Abstract

The purpose of the policy panel session was to gather experts in health technology development, HIV service delivery, and law and policy to discuss the benefits and challenges of providing technology-based HIV prevention and care, with a particular focus on health information security and privacy protection. The key discussion questions were: What are the primary concerns of clients regarding privacy and to what extent do clients have control over their private health information? What are the necessary precautions that clients can take to ensure that their health information is kept private? How can technology companies who interact with researchers and healthcare providers improve their privacy protections for clients?

Each panelist provided their unique perspective and experience on the topic. While no final standards (beyond HIPAA) or best practices were explored, the panelists and members of the audience expressed strong concerns about the sharing of protected health information and the overriding importance of helping clients to fully understand their risks when they are providing information through digital means. All agreed that privacy of client records must be paramount whether it involves the development of a mobile-based application that allows people to share their STD results with other dating partners or health-related information that clients take away from an agency (e.g., written referrals, lab results). With the rapid growth of technology and digital data, protection of client information remains an increasing challenge for researchers, healthcare providers, policy-makers, and other technology companies. More attention on consumer education, health and technology literacy, and increased transparency of protection policies is needed.

Using Text Messaging to Reduce Methamphetamine Use and Sexual Risk Behaviors and Increase ART Adherence among Men Who Have Sex with Men

Abstract

Methamphetamine use among MSM is deeply integrated into socio-sexual networks including physical risk venues such as circuit parties, sex clubs, and bathhouses and digital spaces such as cell phone applications, websites, and digital chat rooms to “hook up” for sex. Thus, methamphetamine use is highly associated with HIV infection due specifically to concomitant high-risk sexual behaviors that occur while using the drug. Text-messaging is a feasible and sustainable approach for targeting high-risk, methamphetamine-using MSM; particularly, those who fail to attend face-to-face or site-based interventions. A real-time text-messaging intervention capitalizes on a communication channel to which this population will attend at the exact time they are most likely to make high-risk sexual decisions. In the Stage I (N = 52) open label pilot study there were significant decreases in frequency of methamphetamine use and unprotected sex while on methamphetamine (both p < .01), and a significant increase in self-reported abstinence from methamphetamine use (13.3% vs. 48.9%; p < .001) from baseline to follow-up. Additionally, participants reported reductions of unprotected anal intercourse with HIV-positive partners (p < .01); with HIV-negative partners, participants reported fewer insertive and receptive episodes (both p < .05). The Stage II randomized controlled trial, which will begin enrollment in February 2014, will assess the impact of the theory-based text-messaging intervention on reductions in methamphetamine use and HIV sexual risk behavior and, for the HIV-infected participants, simultaneously increases in HIV antiretroviral treatment/adherence, and determine the cost effectiveness of the text-messaging intervention. Participants will receive text messages that are personally tailored to fit their risk profile. Participants will be randomized into one of three conditions: Group 1: culturally relevant theory-based text messages interactively transmitted by peer health educators; or, Group 2: the same culturally relevant theory-based text messages transmitted by automation; or, Group 3: assessment-only control with no theoretically based text messages.

How Technology Reduces the Risk-Taking of Homeless Youth

Abstract

Background Homeless youth are at extreme risk for HIV/AIDS. Their risk taking behaviors have consistently been linked to their engagement with risk-taking peer networks. Modern communication technologies such as social media, cell phones, and email have changed what it means to be homeless. Youth today are not limited to connecting only with other high-risk youth, in person on the streets. Now, technology-using youth are able to connect to pro-social networks comprised of family and friends who are not involved in the high-risk activities of street life.

Methods Results from two different NIMH-funded studies of homeless youth in Los Angeles are presented (social network survey n = 136; survey of technology using patterns n = 201).

Results 83.5% of homeless youth report using the internet at least once per week and 62% of youth own a cell phone. Youth who connect with family via the internet are 3.1 times less likely to report trading sex for food, money, drugs or a place to stay. And youth who connect to family are 2.5 times more likely to report getting tested for HIV in the previous six months. 22% of youth report having a home-based, condom-using peer who they communicate with via internet or phone and having such a peer is associated with a 3.5 times increase in safer sex behavior. Youth who connect with friends from home via the internet are 2.0 times more likely to report recent HIV testing.

Conclusions Modern communication technologies, particularly social media platforms, email and cell phones provide new avenues for interventions with homeless youth. Social media-based and smart phone-based apps which help connect youth to HIV prevention services could reach the vast majority of homeless youth. Moreover, using these platforms to help youth reconnect to home-based peers and family seems a particularly promising route for reducing HIV/AIDS related risk behaviors.