In high-income countries today a significant proportion of people with HIV do not know their infection status. Here are estimates of these proportions in a few high-income countries:
- Canada -- 21%
- France -- 19%
- UK -- 17%
- U.S. -- 13%
Not knowing one's infection status complicates efforts to reduce the spread of HIV and bring more people into care and treatment.
Studies have found that the initiation of potent combination anti-HIV therapy (commonly called ART) as early as possible after HIV infection helps to preserve the immune system and overall health. This means that people who start ART early in the course of HIV disease are at significantly reduced risk for developing serious illness and dying. Furthermore, by continuing to take ART every day, exactly as directed, the amount of HIV in a person's blood falls to very low levels and stays there. This tremendously decreases their risk for transmitting HIV.
Engaging Populations Through Social Media
Social media are important electronic or virtual spaces for some people that allow them to meet friends, build communities and find sexual partners. Therefore, it is important to provide information about HIV prevention education via social media.
Researchers in North Carolina have deployed a program called "CyBER/testing," which they describe as "an intervention designed to promote HIV testing among men who have sex with men and transgender persons who use social media designed for social and sexual networking." They found that implementation of CyBER/testing led to a marked increase in HIV testing.
Researchers conducted their study in two communities of similar population size, several hundred kilometres apart. One community received the intervention (described later) and the other did not. The intervention was delivered 9 am to 5 pm, Monday through Friday in 2013 and 2014. In justifying this time deployed online, the researchers cited other studies that found the majority of people who are engaged in social media on the weekend and late at night are also online (on social media) during the weekday.
The researchers chose the following social media platforms in which to intervene:
According to the study team, in each social media platform, a health educator created a public profile and did the following:
- posted about HIV on his profile
- posted about the importance of HIV testing
- made users aware of his availability to answer questions about HIV testing, including the testing process, and provide the locations of testing sites
- posted about "additional opportunities" for testing, including non-clinical sites such as events at bars and clubs
These profiles and posts were available to anyone who chose to view them. The health educator communicated with clients via instant messaging.
Researchers asked online volunteers who viewed the health educator's profile to participate in the study and offered a small amount of money ($10 US) for participants who completed surveys. These surveys -- validated in a previous study -- collected information about participants so that researchers could assess their sexual, drug-using and HIV testing behaviours.
A total of 1,292 people chose to participate in the study. On average, participants were 40 years old and while many (about 50%) identified as gay, 36% identified as bisexual and 13% identified as straight. About 2% identified as transgender.
Participants were randomly assigned to receive the intervention or no intervention.
Immediately after participants were recruited, researchers enquired about their past HIV testing behaviour to find out whether they had ever been tested for HIV. The researchers found that there was no initial, or baseline, difference in past HIV testing rates between participants who were assigned to receive the intervention and those who were not.
However, after the intervention, testing rates changed significantly in one group -- those who received the intervention. The rates of HIV testing were as follows:
- initial proportion ever tested for HIV -- 35%
- proportion at end of study tested for HIV -- 64%
- initial proportion ever tested for HIV -- 39%
- proportion at end of study tested for HIV -- 42%
When researchers adjusted their findings -- taking into account sexual orientation, ethno-racial identity, specific social media platforms -- they found that people who received the intervention were almost three-fold more likely to engage in HIV testing compared to people who did not receive the intervention.
The researchers stated that their intervention had "several positive characteristics," which they listed as follows:
- "The intervention was implemented among users in [virtual communities], at a time when many of them may be thinking about sex."
- The health educator "had a presence within social media and was available as needed." He responded when users needed him "based on their priorities."
- The project's intervention reached men who have sex with men "who may be more difficult to reach in physical spaces." This is particularly important "given that nearly half of the [participants] self-identified as bisexual or straight." The researchers stated that such men might not necessarily be reached and educated through "gay-oriented venues."
- The researchers also noted that their intervention was relatively "easy to implement, and only required a trained health educator with Internet access." Therefore, this type of intervention may be of interest to other health departments and agencies that wish to enhance interest and access to HIV testing and education.
It is noteworthy that more than 75% of participants declined compensation for the study.
Now and for the Future
The research team stated that the results from its study might be "transferrable to current ... GPS-based mobile 'hook-up' applications such as Radar, Grindr, Jack'd and Scruff."
Furthermore, the researchers added: "The next generation of global messaging apps [such as WhatsApp and WeChat] are predicted to have advertising capabilities that potentially may be harnessed for health promotion."
In concluding their report, the research team said that its study "highlights the value of using existing social media to address the unique challenges faced by [some] communities to increase HIV testing and support sexual health."
- Rhodes SD, McCoy TP, Tanner A, et al. Using social media to increase HIV testing among gay and bisexual men, other MSM, and transgender persons: outcomes from a randomized community trial. Clinical Infectious Diseases. 2016; in press.
- Rhodes SD, Vissman AT, Stowers J, et al. A CBPR partnership increases HIV testing among men who have sex with men (MSM): outcome findings from a pilot test of the CyBER/testing Internet intervention. Health Education & Behavior. 2011 Jun;38(3):311-20.
- Sun CJ, Stowers J, Miller C, et al. Acceptability and feasibility of using established geosocial and sexual networking mobile applications to promote HIV and STD testing among men who have sex with men. AIDS and Behavior. 2015 Mar;19(3):543-52.
- Supervie V, Lacombe JM, Marty L, et al. How far are we from early cART for all? A nationwide population-based study in France. Conference on Retroviruses and Opportunistic Infections, 22-25 February 2016, Boston, MA. Abstract 1043.
- Skingsley A, Yin Z, Kirwan P, et al. HIV in the UK -- Situation report 2015: data to end 2014. November 2015. Public Health England, London.
- HIV in the United States: At a glance. Centers for Disease Control and Prevention. 29 September 2015.
- Sullivan PS, Jones JS, Baral SD. The global north: HIV epidemiology in high-income countries. Current Opinion in HIV/AIDS. 2014 Mar;9(2):199-205