What Men Who Use the Internet to Seek Sex With Men Want, HIV Prevention
What Men Who Use the Internet to Seek Sex With Men Want, 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.
In the US, Men who have Sex with Men (MSM) continue to be disproportionately over-represented in the HIV epidemic. MSM are 22 times at greater risk for HIV than the general population, while male-male sex is an identified risk factor in about half of all new infections (Centers for Disease Control and Prevention 2006). Two national alerts have prioritized the need for intensive, renewed prevention efforts targeting MSM (Centers for Disease Control and Prevention 2001a, b), while researchers have expressed alarm at reversals in risk behavior, sexually transmitted infections (STIs), and HIV (Gross 2003). Among the greatest recent changes in the risk activity of MSM has been the use of the Internet to meet sexual partners. A recent meta-analysis found that at least 40% of MSM now go online seeking men for sex (Liau et al. 2006) while 14% of Men who use the Internet to seek Sex with Men (MISM) seek their partners only by going online (Rosser et al. 2007a). Online sex seeking among MSM has been reliably associated with greater numbers of partners, higher likelihood of meeting HIV-positive (HIV+) partners, more receptive anal sex, and greater methamphetamine use (Benotsch et al. 2004; Liau et al. 2006; Rosser et al. 2007a). HIV risk in the online environment appears driven by increasing efficiency of meeting sexual partners. In a study conducted by our research team (Rosser et al. 2007a), MISM report a higher number of unprotected anal intercourse (UAI) male partners in Internet-mediated liaisons than offline liaisons, although the proportion of UAI male partners to total partners remains constant.
Accessing quality health information online is problematic. In a meta-analysis, Eysenbach et al. (2002) found a quality issue with health information found on the Internet. The 5,941 evaluated health websites had one or more problems with authority, accuracy, readability, comprehensiveness, or design. In addition to the issue with the caliber of Internet health information, people view on average only 1.9 pages per search (Fallows 2005), and only 25% of searchers for online health information consistently check the source, date and accuracy of the information they find (Fox 2006). Relying on health information on the Internet may lead to injury. Fox (2006) reported that 3% of information searchers (about three million adults) either know of someone who was, or were themselves, harmed by following information found on the Internet. In HIV prevention, any discussion of harm must address sexual explicitness. At the extremes, harm may include being so explicit that some participants are offended, or so non-explicit that the information is unhelpful, misleading or ambiguous.
Online HIV risk reduction interventions have only recently begun to be developed and tested (Bowen et al. 2007; Davidovich et al. 2006; Kok et al. 2006). HIV prevention needs assessments of the target population are essential to inform such interventions, including the issue of sexual explicitness. Specifically, by recruiting a diverse sample, and analyzing the needs of both the sample and its subgroups (e.g., older versus younger; high-risk versus low-risk takers; HIV+ versus HIV-), we can tailor interventions to the needs of the community.
Need assessments are based in the community health assumption that it is respectful, empowering and necessary to enlist the community's knowledge when designing interventions to ensure that the resulting product addresses the health need(s) of the population in an informed, culturally sensitive manner. However, the concept of virtual community health is still new (Rosser 2007b); for example, we could find no published needs assessments conducted with MISM specific to designing Internet-based HIV prevention interventions. To address this gap, we conducted an online needs assessment to inform four questions: (1) To what degree should Internet-based HIV prevention interventions include sexually explicit materials? (2) What content areas are of most interest? (3) Do subgroups of MISM differ significantly on issues of acceptability of sexual explicitness and content priorities? and (4) What sources of information are most credible and desired?
Abstract and Introduction
Abstract
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.
Introduction
In the US, Men who have Sex with Men (MSM) continue to be disproportionately over-represented in the HIV epidemic. MSM are 22 times at greater risk for HIV than the general population, while male-male sex is an identified risk factor in about half of all new infections (Centers for Disease Control and Prevention 2006). Two national alerts have prioritized the need for intensive, renewed prevention efforts targeting MSM (Centers for Disease Control and Prevention 2001a, b), while researchers have expressed alarm at reversals in risk behavior, sexually transmitted infections (STIs), and HIV (Gross 2003). Among the greatest recent changes in the risk activity of MSM has been the use of the Internet to meet sexual partners. A recent meta-analysis found that at least 40% of MSM now go online seeking men for sex (Liau et al. 2006) while 14% of Men who use the Internet to seek Sex with Men (MISM) seek their partners only by going online (Rosser et al. 2007a). Online sex seeking among MSM has been reliably associated with greater numbers of partners, higher likelihood of meeting HIV-positive (HIV+) partners, more receptive anal sex, and greater methamphetamine use (Benotsch et al. 2004; Liau et al. 2006; Rosser et al. 2007a). HIV risk in the online environment appears driven by increasing efficiency of meeting sexual partners. In a study conducted by our research team (Rosser et al. 2007a), MISM report a higher number of unprotected anal intercourse (UAI) male partners in Internet-mediated liaisons than offline liaisons, although the proportion of UAI male partners to total partners remains constant.
Accessing quality health information online is problematic. In a meta-analysis, Eysenbach et al. (2002) found a quality issue with health information found on the Internet. The 5,941 evaluated health websites had one or more problems with authority, accuracy, readability, comprehensiveness, or design. In addition to the issue with the caliber of Internet health information, people view on average only 1.9 pages per search (Fallows 2005), and only 25% of searchers for online health information consistently check the source, date and accuracy of the information they find (Fox 2006). Relying on health information on the Internet may lead to injury. Fox (2006) reported that 3% of information searchers (about three million adults) either know of someone who was, or were themselves, harmed by following information found on the Internet. In HIV prevention, any discussion of harm must address sexual explicitness. At the extremes, harm may include being so explicit that some participants are offended, or so non-explicit that the information is unhelpful, misleading or ambiguous.
Online HIV risk reduction interventions have only recently begun to be developed and tested (Bowen et al. 2007; Davidovich et al. 2006; Kok et al. 2006). HIV prevention needs assessments of the target population are essential to inform such interventions, including the issue of sexual explicitness. Specifically, by recruiting a diverse sample, and analyzing the needs of both the sample and its subgroups (e.g., older versus younger; high-risk versus low-risk takers; HIV+ versus HIV-), we can tailor interventions to the needs of the community.
Need assessments are based in the community health assumption that it is respectful, empowering and necessary to enlist the community's knowledge when designing interventions to ensure that the resulting product addresses the health need(s) of the population in an informed, culturally sensitive manner. However, the concept of virtual community health is still new (Rosser 2007b); for example, we could find no published needs assessments conducted with MISM specific to designing Internet-based HIV prevention interventions. To address this gap, we conducted an online needs assessment to inform four questions: (1) To what degree should Internet-based HIV prevention interventions include sexually explicit materials? (2) What content areas are of most interest? (3) Do subgroups of MISM differ significantly on issues of acceptability of sexual explicitness and content priorities? and (4) What sources of information are most credible and desired?