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Use of Technology to Address Substance Use in the Context of HIV: A Systematic Review

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Substance users are at elevated risk for HIV. HIV researchers, particularly at the intersection of HIV and substance use, have requested new methods to better understand and address this important area. New technologies, such as social media and mobile applications, are increasingly being used as research tools in studies on HIV and substance use. These technologies have the potential to build on existing recruitment methods, provide new and improved intervention methods, and introduce novel ways of monitoring and predicting new HIV cases. However, little work has been done to review and broadly explore the types of studies being conducted on the use of technologies to address HIV and substance use. This systematic literature review identified studies on this topic between 2005 and 2015. We identified 33 studies on this topic after excluding studies that did not fit inclusion criteria. Studies were either observational (n = 24) or interventional (n = 9), with the majority being pilot studies exploring the feasibility of using these new technologies to study HIV and substance use. We discuss the implications of this work along with limitations and recommendations for future research on this topic.
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Use of Technology to Address Substance Use in the Context
of HIV: A Systematic Review
Sean D. Young
&Dallas Swendeman
&Ian W. Holloway
&Cathy J. Reback
Uyen Kao
Published online: 16 October 2015
#Springer Science+Business Media New York 2015
Abstract Substance users are at elevated risk for HIV. HIV
researchers, particularly at the intersection of HIV and sub-
stance use, have requested new methods to better understand
and address this important area. New technologies, such as
social media and mobile applications, are increasingly being
used as research tools in studies on HIV and substance use.
These technologies have the potential to build on existing
recruitment methods, provide new and improved intervention
methods, and introduce novel ways of monitoring and
predicting new HIV cases. However, little work has been done
to review and broadly explore the types of studies being con-
ducted on the use of technologies to address HIV and sub-
stance use. This systematic literature review identified studies
on this topic between 2005 and 2015. We identified 33 studies
on this topic after excluding studies that did not fit inclusion
criteria. Studies were either observational (n=24) or interven-
tional (n=9), with the majority being pilot studies exploring
the feasibility of using these new technologies to study HIV
and substance use. We discuss the implications of this work
along with limitations and recommendations for future re-
search on this topic.
Keywords Technologies .HIV .Substance use .Social
media .Mobile apps
Substance use is strongly linked to HIV, making it an impor-
tant area of concern for HIV researchers. The HIV Cost and
Service Utilization Study (HSCUS) in the U.S. revealed that
40 % of individuals living with HIV disclosed they used ille-
gal drugs in the past year [1]. Globally, it is believed that more
than 3 million injection drug users are HIV positive [2].
Thirty-two percent (32 %) of all frequent non-injection drug
users and 40 % of MSM who are injection drug users in the
U.S. are HIV positive [3].
Two populations, both independent and overlapping, that are
at high risk for HIV acquisition and transmission are men who
have sex with men (MSM) and substance users. MSM are
disproportionately at risk for contracting HIV [4]. In
particular, African American and Latino MSM are at
increased risk for HIV [5]. According to a CDC study focused
on MSM, 28 % of non-Latino Blacks and 18 % of Latinos were
infected compared to 16 % of non-Latino White MSM [6].
Taken together, it is important to address the increased risk for
HIV among MSM, especially African Americans and Latinos.
Technology usage in the past decade has increased signif-
icantly among the general population as well as more specif-
ically among groups with and at high risk for HIV [7,8].
This article is part of the Topical Collection on HIV and Technology
*Sean D. Young
UCLA Department of Family Medicine, University of California
Institute for Prediction Technology, 10880 Wilshire Blvd Suite 1800,
Los Angeles, CA 90049, USA
UCLA Department of Psychiatry and Biobehavioral Sciences,
UCLA Center for HIV Identification, Prevention, and Treatment
Services, Los Angeles, CA, USA
Department of Social Welfare, UCLA Luskin School of Public
Affairs, Los Angeles, CA, USA
Friends Research Institute, Inc., David Geffen School of Medicine,
Integrated Substance Abuse Programs, Semel Institute for
Neuroscience and Human Behavior, University of California, Los
Angeles, Los Angeles, CA, USA
UCLA Department of Family Medicine, UCLA Center for HIV
Identification, Prevention, and Treatment Services, Los Angeles, CA,
Curr HIV/AIDS Rep (2015) 12:462471
DOI 10.1007/s11904-015-0295-3
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Such initiatives can facilitate real-time problem solving between patients and health care providers when medication, health, or other issues arise; remind clients to take medications, attend appointments, and take care of their health; and demonstrate that "somebody cares" [7,15,16]. More recently, mHealth initiatives have aimed to address substance use as well as optimize and expand treatment for substance use and HIV [17][18][19][20][21][22]. Notably, there is a paucity of evidence of mobile phone use for health and mHealth interventions for Indigenous people living with or at risk of HIV, including those using drugs [10]. ...
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Background: Indigenous leaders continue to be concerned about high rates of HIV and barriers to HIV treatment among young Indigenous people involved in substance use. Growing evidence suggests that using mobile phones for health (mHealth) may be a powerful way to support connection with health services, including HIV prevention and treatment. Objective: This study examined the patterns of mobile phone ownership and use among young Indigenous people who have used drugs living with or vulnerable to HIV and explored the acceptability of mHealth to support access to health care in this population. Methods: The Cedar Project is a cohort study involving young Indigenous people who have used drugs in Vancouver and Prince George, British Columbia. This mixed methods exploratory study involved 131 Cedar Project participants enrolled in our WelTel mHealth program. At enrollment, participants completed a questionnaire related to mobile phone use and interest in mHealth. Data were linked to Cedar Project questionnaires and serodata. We present comparative statistics (quantitative) and results of a rapid thematic analysis (qualitative) related to mobile phone patterns and interest in receiving mHealth. Results: Less than half of the participants (59/130; 45.4%) reported owning a phone. Among those with a phone, the majority owned a smartphone (46/59; 78%). Most participants with a phone reported having an unlimited texting plan (39/55; 71%), using the internet on their phone (44/59; 75%), and texting daily (44/55; 80%). A majority reported that using a mobile phone for health would be invaluable (120/130; 92.3%). There were no differences in mHealth acceptance between participants who owned a phone and those who did not (P>.99). All but one participant living with HIV felt using a mobile phone would be helpful for their health, while a small proportion of HIV-negative participants remained unsure (1.9% vs 11.7%; P=.047). In response to open-ended questions asking why using a mobile phone may be helpful for health, participants identified a diverse set of anticipated benefits: (1) connection for emotional, mental, and spiritual support, (2) connection to family, (3) staying in touch and/or being reachable, (4) overcoming current barriers to phone use, (5) convenience, privacy, and safety, and (6) access to health care and emergency services. Conclusions: We observed high acceptance and interest in using mobile phone technology for health despite low rates of personal mobile phone connectivity among young Indigenous people who have used drugs living with and vulnerable to HIV in British Columbia, Canada. Mobile phones were viewed as a way to support connections and relationships that are seen as critical to health and well-being among young Indigenous people in this study. Findings may be useful for health care providers preparing to scale up mHealth programs to support HIV prevention and treatment in this population.
... The use of technology has shown promising results in promoting sexual health or adherence to ART in different settings, including resource-limited settings [126] [127]. Web-based applications provide an opportunity to reach a large audience at any time and provide information on health and available services. ...
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The purpose of this publication is to provide guidance on implementing HIV, hepatitis C (HCV) and hepatitis B (HBV) programmes for people who use stimulant drugs and who are at risk of contracting these viruses. It aims to: • Increase awareness of the needs and issues faced by the affected groups, including the intersectionality among different key populations • Provide implementation guidance to help establish and expand access to core HIV and hepatitis prevention, treatment, care and support services
... Advancements in prevention science and technology science in conjunction with the ubiquity of mobile devices among youths provide prevention researchers with innovative tools to develop and test scalable mHealth solutions to drug use and STI/HIV. Although technologybased [50] and clinic-based [51] interventions have been used in isolation in prior drug abuse and STI/HIV prevention research, efforts to understand how technology can be leveraged in youth-centered community health clinic settings-an ideal setting evidenced by youths' frequent visits-in combination with clinician engagement to reinforce prevention and risk reduction strategies is warranted. The results from the present study suggest both youths' and clinicians' high acceptance of the S4E preventive intervention and high feasibility in the context of the clinic workflow. ...
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Background: Drug abuse and sexually transmitted infections (STIs), including the human immunodeficiency virus (HIV), remain significant public health concerns in the United States. Youth are at disproportionate risk of drug use and STIs/HIV, yet interventions aimed at improving STI and HIV testing and reducing STI/HIV risk behaviors through technology-based engagement in clinic settings are limited. The purpose of this study was to examine the feasibility and acceptability of Storytelling 4 Empowerment (S4E), a multilevel mobile-health drug abuse and STI/HIV preventive application (app) for clinic settings. We also explored uptake of STI/HIV testing among youth immediately post-intervention. Method: Employing community-based participatory research principles and a multi-method research design, we developed a clinician-facing app, and examined the feasibility and acceptability of S4E among clinicians (n = 6) and youth (n = 20) in an urban youth-centered community health clinic. S4E aimed to improve clinician-youth risk communication and youths' drug use and STI/HIV knowledge, self-efficacy, and refusal skills. We also explored youths' uptake of STI and HIV testing. Quantitative data were analyzed by computing mean scores and proportions, and qualitative analyses followed the tenets of content analysis. Results: Among eligible participants, 86.9% of youth and 85.7% of clinicians enrolled in the study, suggesting the feasibility of recruiting participants from the targeted clinic. Most clinicians identified as non-Hispanic white (83%) and female (66.7%). Among the youth, 70% identified as non-Hispanic white, followed by 30% African American, and 50% identified as female with a mean age of 19.6 (SD = 1.5, Range = 16-21). The quantitative findings suggest that the acceptability of S4E is high, as indicated by the Client Satisfaction Questionnaire (mean score = 25.2, SD: 4.8). Immediately post-intervention, all youth who reported past 90-day condomless sex or having never been tested for STIs or HIV in their lifetime, were tested for both STIs and HIV. Qualitative themes revealed four overarching themes, including S4E: (1) faciliated timely, targeted, and tailored prevention and risk reduction strategies; (2) shaped clinician and youth communication and interaction during the clinic visit; (3) may have improved uptake of STI/HIV testing and increased STI/HIV knowledge and self-efficacy; and (4) had high feasibiliy and acceptability among youth and clninicans. Conclusions: Findings suggest the feasibility and acceptability of S4E in an urban community-based health clinic setting. A next important step is to examine the efficacy of S4E in a randomized controlled trial design.
... [16][17][18] Increasingly, more widespread access to, and use of, internet-based and text-messaging technologies has led to the development of new interventions and the adaptation of existing HIV-related interventions for e-health delivery. [19][20][21] However, uptake of e-health interventions is slow. 22 In addition, development of e-health interventions for PLH has primarily focused on men who have sex with men, young adults, and adolescents. ...
Background: E-health may expand access to effective behavioral interventions for women living with HIV (WLH), and others living with a highly stigmatized medical condition. Introduction: Theory may help us to understand e-health program uptake. This mixed methods study examined theoretical applications of the Technology Readiness and Acceptance Model (TRAM) to predict willingness to take part in an e-health videoconferencing group program (i.e., participants interacting with each other in real time via videoconferencing) among a group of WLH. Materials and methods: Women were recruited from HIV/AIDS clinics in an urban area of the southeastern United States. Each participant completed a structured interview. Data were analyzed using a parallel convergent mixed methods design. Results: Participants (N = 91) had a mean age of 43 years and were primarily African American (66%). Despite limited experience with videoconferencing (14.3%), many (71%) reported willingness to attend an intervention via video group for WLH. Qualitative analysis revealed that the constructs of the TRAM (Innovativeness, Optimism, Discomfort, Insecurity, Perceived Usefulness, or Perceived Ease-of-Use) were evident; however, additional mediating factors specific to WLH emerged, including group readiness and HIV-related privacy concerns. Discussion: Group readiness and privacy concerns may be important considerations when applying the TRAM to technology-based group programs for highly stigmatized populations, including WLH. Conclusions: Existing theoretical frameworks may be useful in understanding the willingness of people to take part in group-based e-health interventions, but may need to be modified to account for the role of stigma in e-health program update.
... Entre otras ventajas se encuentra el bajo costo en comparación con las intervenciones tradicionales o cara a cara, el anonimato de los participantes, se incrementa y facilita el reclutamiento y monitoreo de la conducta. [4][5][6][7] Se han realizado diversas investigaciones para demostrar la efectividad de las IPBTC, la gran mayoría han estado dirigidas a prevenir y disminuir el consumo de alcohol en jóvenes 8 , existe poca evidencia de intervenciones dirigidas al uso de drogas ilícitas en esta población, quizá por la baja prevalencia que han mostrado en anteriores encuestas nacionales. También existen revisiones sistemáticas, como la de Bhochibhoya et al. 8 , que señala que la mayoría de las intervenciones estuvieron basadas en la teoría de norma social y el modelo de creencias en salud, no obstante, algunos estudios no reportaron el uso de teoría, y utilizan la técnica de entrevista motivacional con retroalimentación por Internet, en su gran mayoría. ...
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El consumo de drogas psicoactivas se asocia con la pérdida de 28 millones de años de vida sana. En México la demanda entre adolescentes se incrementó al doble en los últimos cinco años. Es de vital importancia evitar que los jóvenes se inicien en el consumo de drogas, o bien, retrasar la edad de inicio para el consumo de drogas legales. Las acciones de prevención deben estar ajustadas a las prácticas culturales de los adolescentes, por lo que una alternativa son las Intervenciones de Prevención Basadas en las Tecnologías de Comunicación (IPBTC) ya que ofrecen ventajas como bajo costo, anonimato de los participantes, además de facilitar el reclutamiento y el monitoreo de la conducta. Con base en lo anterior se realizó una revisión sistemática para dar respuesta a las preguntas: ¿cuáles son las características de las IPBTC mediante el uso de ordenadores (Intervenciones por ordenador IO) y telefonía móvil (Intervenciones por telefonía móvil ITM)? y sí; ¿han sido efectivas para prevenir y/o disminuir el consumo de sustancias psicoactivas en adolescentes escolarizados? En este sentido, se evaluaron 21 estudios realizados en diversos países y los resultados en general muestran efectividad en la reducción de la frecuencia y cantidad de consumo de alcohol y otras drogas.
... Mobile phone apps are also being used to assist with self-management of both physical (Kamel Boulos, Brewer, Karimkhani, Buller, & Dellavalle, 2014) and mental health conditions (Donker et al., 2013), which could assist clients with comorbid illnesses and symptoms. Also, intervention methods such as use of social media sites, text-messaging services, and mobile phone apps have been found to be helpful for outreach and intervention with substance users at risk for HIV (Young, Swendeman, Holloway, Reback, & Kao, 2015). Additionally, internet-based programs have been found to increase social support for people with mental illnesses (Lal & Adair, 2014) and for people with chronic medical problems (Rollman, Belnap, & Rotondi, 2014). ...
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Due to social determinants of health, people living in poverty are at high risk for having comorbid substance use and medical disorders, yet are also the least able to afford and access the care needed to adequately address their health. There has been a recent call for providing integrated care for behavioral and physical health problems, yet there are challenges to fully integrating the two systems. In this article, several suggestions for improving the current system of care for low-income individuals are presented. Suggestions are derived from components of the chronic care model, the model underlying most conceptions of integrated care, and include increasing the use of technology and interdisciplinary teams to supplement assessment and intervention.
... Technology-delivered interventions for substance use have been found to be feasible and acceptable to PLWH and people at risk for acquiring HIV. 117 Telephone-based cognitive-behavioral therapy shows promise for decreasing depressive symptoms and the use of mobile apps may improve social support, particularly for geographically isolated and socially marginalized PLWH (Table 2). 116,118 ...
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The nature of the HIV epidemic in the United States and Canada has changed with a shift towards rural areas. Socioeconomic factors, geography, cultural context, and evolving epidemics of injection drug use are coalescing to move the epidemic into locations where populations are dispersed and healthcare resources are limited. Rural-urban differences along the care continuum demonstrate the implications of this sociogeographic shift. Greater attention is needed to build a more comprehensive understanding of the rural HIV epidemic in the United States and Canada, including research efforts, innovative approaches to care delivery, and greater community engagement in prevention and care.
Aims: Assess whether the Harnessing Online Peer Education (HOPE) social media-based support group can engage patients on opioids at risk for misuse/overdose to discuss risk reduction strategies. Methods: Fifty-one patients on chronic opioid therapy and risk factors for aberrant medication-taking behaviors were randomized to a HOPE intervention or control (Facebook) group. Results: Compared to control group participants, intervention participants had almost 10 times higher posting engagement (n = 411 posts versus 45; 73% versus 52% of participants). Participants discussed coping, pain, medication and non-medication treatments, and other opioid and addiction-related topics. Discussion: Results suggest that a HOPE online community might serve as an effective behavioral intervention tool among chronic pain patients on opioid therapy.
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Background: Addiction is one of the most rapidly growing epidemics that currently plagues nations around the world. In the United States, it has cost the government more than US $700 billion a year in terms of health care and other associated costs and is also associated with serious social, physical, and mental consequences. Increasing efforts have been made to tackle this issue at different levels, from primary prevention to rehabilitation across the globe. With the use of digital technology rapidly increasing, an effort to leverage the consumer health information technologies (CHITs) to combat the rising substance abuse epidemic has been underway. CHITs are identified as patient-focused technological platforms aimed to improve patient engagement in health care and aid them in navigating the complex health care system. Objective: This review aimed to provide a holistic and overarching view of the breadth of research on primary prevention of substance abuse using CHIT conducted over nearly past five decades. It also aimed to map out the changing landscape of CHIT over this period. Methods: We conducted a scoping review using the Arksey and O'Malley's modified methodological framework. We searched 4 electronic databases (PubMed, Cochrane, Scopus, and EMBASE). Papers were included if the studies addressed the use of CHIT for primary prevention of substance abuse and were published in English between 1809 and 2018. Studies that did not focus solely on primary prevention or assessed additional comorbid conditions were eliminated. Results: Forty-two papers that met our inclusion criteria were included in the review. These studies were published between 1970 and 2018 and were not restricted by geography, age, race, or sex. The review mapped studies using the most commonly used CHIT platforms for substance abuse prevention from mass media in the 1970s to mobile and social media in 2018. Moreover, 191 studies that were exclusively focused on alcohol prevention were excluded and will be addressed in a separate paper. The studies included had diverse research designs although the majority were randomized controlled trials (RCT) or review papers. Many of the RCTs used interventions based on different behavioral theories such as family interactions, social cognitive theories, and harm-minimization framework. Conclusions: This review found CHIT platforms to be efficacious and cost-effective in the real-world settings. We also observed a gradual shift in the types and use of CHIT platforms over the past few decades and mapped out their progression. In addition, the review detected a shift in consumer preferences and behaviors from face-to-face interactions to technology-based platforms. However, the studies included in this review only focused on the aspect of primary prevention. Future reviews could assess the effectiveness of platforms for secondary prevention and for prevention of substance abuse among comorbid populations.
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Self-monitoring by mobile phone applications offers new opportunities to engage patients in self-management. Self-monitoring has not been examined thoroughly as a self-directed intervention strategy for self-management of multiple behaviors and states by people living with HIV (PLH). PLH (n = 50), primarily African American and Latino, were recruited from 2 AIDS services organizations and randomly assigned to daily smartphone (n = 34) or biweekly Web-survey only (n = 16) self-monitoring for 6 weeks. Smartphone self-monitoring included responding to brief surveys on medication adherence, mental health, substance use, and sexual risk behaviors, and brief text diaries on stressful events. Qualitative analyses examine biweekly open-ended user-experience interviews regarding perceived benefits and barriers of self-monitoring, and to elaborate a theoretical model for potential efficacy of self-monitoring to support self-management for multiple domains. Self-monitoring functions include reflection for self-awareness, cues to action (reminders), reinforcements from self-tracking, and their potential effects on risk perceptions, motivations, skills, and behavioral activation states. Participants also reported therapeutic benefits related to self-expression for catharsis, nonjudgmental disclosure, and in-the-moment support. About one-third of participants reported that surveys were too long, frequent, or tedious. Some smartphone group participants suggested that daily self-monitoring was more beneficial than biweekly due to frequency and in-the-moment availability. About twice as many daily self-monitoring group participants reported increased awareness and behavior change support from self-monitoring compared with biweekly Web-survey only participants. Self-monitoring is a potentially efficacious disruptive innovation for supporting self-management by PLH and for complementing other interventions, but more research is needed to confirm efficacy, adoption, and sustainability.
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Fifty-two non-treatment-seeking methamphetamine-using men who have sex with men were enrolled in Project Tech Support, an open-label pilot study to evaluate whether exposure to theory-based [social support theory (SST), social cognitive theory (SCT), and health belief model (HBM)] text messages could promote reductions in HIV sexual risk behaviors and/or methamphetamine use. Multivariable analyses revealed that increased relative exposure to HBM or SCT (vs. SST) text messages was associated with significant reductions in the number of HIV serodiscordant unprotected (i.e., without a condom) anal sex partners, engagement in sex for money and/or drugs, and frequency of recent methamphetamine use; additionally, increased relative exposure to HBM (vs. SCT or SST) messages was uniquely associated with reductions in the overall number of non-primary anal sex partners (all p ≤ 0.05, two-tailed). Pilot data demonstrated that text messages based on the principles of HBM and SCT reduced sentinel HIV risk and drug use behaviors in active methamphetamine users.
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Given the popularity of social media among young men who have sex with men (YMSM), and in light of YMSM's elevated and increasing HIV rates, we tested the feasibility, acceptability and preliminary efficacy of a live chat intervention delivered on Facebook in reducing condomless anal sex and substance use within a group of high risk YMSM in a pre-post design with no control group. Participants (N = 41; 18-29 years old) completed up to eight one-hour motivational interviewing and cognitive behavioral skills-based online live chat intervention sessions, and reported on demographic, psychosocial, and behavioral characteristics at baseline and immediately post-intervention. Analyses indicated that participation in the intervention (n = 31) was associated with reductions of days of drug and alcohol use in the past month and instances of anal sex without a condom (including under the influence of substances), as well as increases in knowledge of HIV-related risks at 3-month follow-up. This pilot study argues for the potential of this social media-delivered intervention to reduce HIV risk among a most vulnerable group in the United States, in a manner that was highly acceptable to receive and feasible to execute. A future randomized controlled trial could generate an intervention blueprint for providers to support YMSM's wellbeing by reaching them regardless of their geographical location, at a low cost.
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Recruiting hidden populations into online research remains challenging. In this manuscript, we report lessons learned from our efforts to recruit methamphetamine-using men who have sex with men. Between July and October 2012, we implemented a four-phase recruitment strategy to enroll a total of 343 methamphetamine-using MSM into an online survey about recent substance use, sexual behavior, and various psychosocial measures. The four phases were implemented sequentially. During phase one, we placed advertisements on mobile applications, and during phase two, we placed advertisements on traditional websites formatted for browsers. During phase three, we used e-mail to initiate snowball recruitment, and during phase four, we used social media for snowball recruitment. Advertisements on mobile devices and websites formatted for browsers proved to be expensive options and resulted in few eligible participants. Our attempts to initiate a snowball through e-mail also proved unsuccessful. The majority (n¼320) of observations in our final dataset came from our use of social media. However, participant fraud was a concern, requiring us to implement a strong participant verification protocol. For maximum recruitment and cost-effectiveness, researchers should use social media for recruitment provided they employ strong participant verification protocols.
Geosocial networking applications (GSN apps) represent important virtual contexts in which gay, bisexual, and other men who have sex with men (MSM) seek affiliation. These apps allow users to create and view public profiles, send photos, and text messages, and connect with other users based on shared interests and geographic proximity. The present study examined substance use homophily among a sample of 295 MSM recruited via a popular GSN app. Comparisons of social network members met via GSN app versus elsewhere and associations between both individual and network characteristics and recent binge drinking, marijuana use, and illicit substance use were explored using bivariate tests of association and multivariate logistic regression analyses. High rates of recent binge drinking (59 %), marijuana use (37 %), and illicit substance use (27 %) were observed among participants. GSN app use greater than 1 year and showing naked chest or abs in a profile picture were positively associated with recent illicit substance use. In multivariate analyses, the strongest predictors of binge drinking (AOR 3.81; 95 % CI 1.86-7.80), marijuana use (AOR 4.12; 95 % CI 2.22-7.64), and illicit substance use (AOR 6.45; 95 % CI 3.26-12.79) were the presence of a social network member who also engaged in these behaviors. Social network interventions that target binge drinking, marijuana use, and illicit substance use may be delivered via GSN apps to reduce the prevalence of substance use and related risks among MSM in these virtual contexts.
The changing landscape of HIV prevention in the United States underscores the need to improve our ability to efficiently reach HIV-positive men who have sex with men (MSM) who engage in behaviors that could transmit HIV. We examined the prevalence of anal intercourse (AI) without condoms with HIV-negative or unknown serostatus partners ("at-risk partners") among 1319 HIV-positive adult male members of a sexual networking Web site for MSM. Sexual behaviors and substance use were measured over a 60-day recall period. Logistic regression was used to identify correlates of insertive and receptive AI without condoms with at-risk partners. Approximately 25% of the men had been diagnosed as having HIV 12 months or less before study enrollment. Overall, 32% of men engaged in AI without condoms with at-risk partners. Multiple logistic regression identified behavioral predictors of insertive AI without condoms with at-risk partners, including HIV diagnosis within the last 12 months, sex with multiple male partners, substance use in conjunction with sex, and use of phosphodiesterase type 5 inhibitors. Receptive AI without condoms with at-risk partners was associated with younger age (19-24 years), residing outside metropolitan cities, substance use in conjunction with sex, and having multiple male partners. High levels of sexual risk were found among these MSM. Increased Internet-based HIV prevention marketing efforts and prevention strategies should be considered to efficiently reach HIV-positive MSM who engage in serodiscordant AI without condoms.
Previous research with men who have sex with men (MSM) has found that substance use with sex is strongly associated with HIV acquisition and poor adherence to HIV treatments. Although some studies have assessed male couples’ use of substances with unprotected anal sex, little is known on whether differences in their relationship dynamics are associated with their usage. Current HIV prevention initiatives underscore the importance of studying male couples’ relationship dynamics. Using dyadic data from 28 HIV-positive and 58 HIV-discordant male couples, this analysis sought to: (1) describe, by substance type, whether neither, one, or both partners in the couple used a particular substance with sex within their relationship or outside of the relationship, respectively, and (2) assess, by substance type, whether relationship characteristic differences existed between these three groups of couples with respect to substance use with sex within and outside the relationship. Data from 86 dyads came from a cross-sectional, Internet study. Multivariate multinomial regression models were employed to achieve the aims. Except for alcohol, most did not use substances with sex. Within the relationship, those who used with sex varied by substance type; outside the relationship, most couples had only one partner who used with sex regardless of substance type. Several relationship characteristic differences were noted between the groups of couples. Within the relationship, marijuana and erectile dysfunction medication (EDM) use with sex was associated with having less tangible resources; for outside the relationship, these were associated with perceiving to have greater quality of alternatives. In general, amyl nitrates and party drug use with sex were associated with viewing the main partner as being less dependable for trustworthiness. Marijuana and party drug use with sex within the relationship and EDM use with sex outside the relationship were negatively associated with being able to communicate constructively. Mixed results were noted for relationship satisfaction. Additional research is urgently needed for prevention and promotion of healthy relationships for male couples who use substances with sex.
Background Social media technologies offer new approaches to HIV prevention and promotion of testing. We examined the efficacy of the Harnessing Online Peer Education (HOPE) social media intervention to increase HIV testing among men who have sex with men (MSM) in Peru. Methods In this cluster randomised controlled trial, Peruvian MSM from Greater Lima (including Callao) who had sex with a man in the past 12 months, were 18 years of age or older, were HIV negative or serostatus unknown, and had a Facebook account or were willing to create one (N=556) were randomly assigned (1:1) by concealed allocation to join intervention or control groups on Facebook for 12 weeks. For the intervention, Peruvian MSM were trained and assigned to be HIV prevention mentors (peer-leaders) to participants in Facebook groups. The interventions period lasted 12 weeks. Participants in control groups received an enhanced standard of care, including standard offline HIV prevention available in Peru and participation in Facebook groups (without peer leaders) that provided study updates and HIV testing information. After accepting a request to join the groups, continued participation was voluntary. Participants also completed questionnaires on HIV risk behaviours and social media use at baseline and 12 week follow-up. The primary outcome was the number of participants who received a free HIV test at a local community clinic. The facebook groups were analysed as clusters to account for intracluster correlations. This trial is registered with, number NCT01701206. Findings Of 49 peer-leaders recruited, 34 completed training and were assigned at random to the intervention Facebook groups. Between March 19, 2012, and June 11, 2012, and Sept 26, 2012, and Dec 19, 2012, 556 participants were randomly assigned to intervention groups (N=278) or control groups (N=278); we analyse data for 252 and 246. 43 participants (17%) in the intervention group and 16 (7%) in the control groups got tested for HIV (adjusted odds ratio 2·61, 95% CI 1·55–4·38). No adverse events were reported. Interpretation Development of peer-mentored social media communities seemed to be an efficacious method to increase HIV testing among high-risk populations in Peru. Results suggest that the HOPE social media intervention could improve HIV testing rates among MSM in Peru.
Mobile health (mHealth) interventions to promote antiretroviral therapy (ART) adherence have shown promise; however, among persons living with HIV who abuse methamphetamine (MA), effective tailoring of content to match the expressed needs of this patient population may be necessary. This study aimed (1) to understand patient perspectives of barriers and facilitators of ART adherence among people with HIV who use MA, and (2) to obtain feedback on the thematic content of an mHealth intervention in order to tailor the intervention to this subgroup. Two separate focus groups, each with 10 HIV+/MA+ individuals, were conducted. Transcribed audio recordings were qualitatively analyzed to identify emergent themes. Inter-rater reliability of themes was high (mean Kappa = .97). Adherence barriers included MA use, misguided beliefs about ART adherence, memory and planning difficulties, social barriers and perceived stigma, and mental heath issues. Facilitators of effective ART adherence were cognitive compensatory strategies, promotion of well-being, health-care supports, adherence education, and social support. Additionally, the focus groups generated content for reminder text messages to be used in the medication adherence intervention. This qualitative study demonstrates the feasibility of using focus groups to derive patient-centered intervention content to address the health challenge at hand in targeted populations.