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					   Preferences for interventions to
 reduce HIV and STD transmission
online among San Francisco MSM:
            results from one study

                                     February 27, 2010

                     Jen Hecht, STOP AIDS Project
Dan Wohlfeiler, CA STD Control Branch/CA STD/HIV
                         Prevention Training Center
                            Coco Auerswald,UCSF
                       H. Fisher Raymond, SFDPH
            Funded by California HIV/AIDS Research Program
What we’ll cover here
•   Focus groups and surveys of MSM in San
    Francisco – implications for practice

•   Introduce you to a national survey

•   Show you ads from our upcoming survey
Our goal
 To come up with interventions that customers want
 to participate in (or may benefit from even if they
 don’t participate in them),

 that website/venue owners want to implement,

 that public health believes will work,

 and that don’t depend on ongoing funding.
Background for WHERE study
•   We’re not successful enough at reducing
    transmission among MSM
•   Many of us don’t want formal prevention
    efforts
•   We asked MSM:
    •   which interventions they currently use,
    •   what they would like to see, and
    •   whether they would use new strategies
   Percentage of MSM using HIV-
   prevention services or programs
  during past 12 months, by venue –
        US NHBS, 2003-2005
50

40

30

20

10

  0
          HIV/AIDS CBO              Bar, Club,             LGBT Health              Pride event
                                    Bathhouse                Center

           Free Condoms         Individual-level interventions         Group-level intervention


 Sanchez T, Finlayson T, Drake A, Behel S, Cribbin M, Dinenno E, Hall T, Kramer S, Lansky A; Centers
for Disease Control and Prevention (CDC). Human immunodeficiency virus (HIV) risk, prevention, and
testing behaviors--United States, National HIV Behavioral Surveillance System: men who have sex with
            men, November 2003-April 2005. MMWR Surveill Summ. 2006 Jul 7;55(6):1-16.
Networks and risk
•   Sexual networks are connections between
    people based on sexual relationships
•   HIV risk is both about individual factors –
    such as condom use – and location in a
    network
•   Prevention needs to address both
•   The internet – and other venues where men
    go to find partners– have qualities we can
    leverage to reduce risk
What networks can look like
online (and what they can do)
What SF focus groups said about
this:
   “Everybody’s just a little bit away from
    everybody else…if you’re not being careful, it
    can lead to a serious infection.”
   “Six degrees of separation”
   “You’re not only sleeping with him, but with
    everybody he has ever slept with”
Six focus groups from WHERE
study
Held in Summer 2008:
 STOP AIDS staff

 HIV-positive MSM

 MSM under 30

 MSM who only reported safe sex

 MSM who reported high risk sex

 MSM of color
Do you agree or disagree?
   It’s easy to find a hook-up in San Francisco.
   It’s easy to find a boyfriend in San Francisco.
   I find out more about an apartment I’m
    renting, or a car I’m buying, than I do about a
    new sex partner.
Key themes
   Conversations about HIV status with potential
    partners often aren’t happening
   Many men prefer talking about level of risk to
    HIV status
   High degree of agreement that people lied
    when looking for new partners. (“Isn’t the
    whole point of going on Craigslist being able
    to lie?”)
The lies we tell
   I’m “clean.”
   I got tested yesterday.
   This is my first time.
   I’m single.
Conversations about risk are
easier than HIV status
“…in earlier years, it was positive vs. negative,
  and now it’s more – barebacking vs. non-
  barebacking.”
  (High risk MSM)
Automatic reminders to get tested
with a link to sites
“It’s not invasive…and also the ability to find
   somewhere near you, if you decide to take
   action on that message..I think that having
   that piece built into it is very important.”
Implications
Guys will disclose information if it doesn’t limit
 their chances of getting laid
Guys want control, not big-brother
Guys liked the idea of “looking for safe sex
 only”
Guys like anonymity on hookup sites (vs. links
 to Facebook, etc)
SF Consumers’ Preferences for Search Options on One
                     Website
                      n = 67
0.4

0.3

0.2

0.1
  0
-0.1

-0.2

-0.3
                                      Favorite             Least Favorite
-0.4

-0.5




                                                                                 HIV iffy only
                                                                     HIV- only
                                                         HIV+ only
       protected only




                                          specific sex
                        unprotected




                                                                                                 name/contact
                                                                                                   list screen
                            only



                                             acts
                                 Cruising Site Links , n=90
                                       Good Idea/ Bad Idea
                                       Would Use/ Would Not Use




Print Lab Slip    find STD/       Outreach       Health           Cruising Tips FB / Myspace meth/ other
                 HIV Test site     Worker       Resources                         contact     drug info
Differences between groups
   High levels of indifference about many
    interventions
   Guys were more likely to say they liked an
    idea than to say they would use it
   Negative guys liked “looking for protected
    only” more than positive guys
   Few people said they’d use outreach –
    highest risk guys were least likely
Preference for online outreach
        0.5
        0.4
        0.3
        0.2
        0.1
          0
        -0.1
        -0.2
        -0.3
        -0.4
        -0.5


                                    high risk




                                                           positive
               overall




                                                negative
                         low risk




                                                             HIV
                                                  HIV
    Preference for “no pnp” option
                         0.5
                         0.4
                         0.3
                         0.2
                         0.1
                          0
                        -0.1
                        -0.2
                        -0.3
                        -0.4
                        -0.5




                                                    high risk




                                                                           positive
                               overall




                                                                negative
                                         low risk




                                                                             HIV
                                                                  HIV
High risk men – more likely to use meth – less likely to check
“no pnp.” May suggest that guys are being honest.
Next steps
Getting in touch with website owners…can
  you help?
• Find out which interventions webmasters
  want to support and are willing to
  implement,
• Which interventions STD and HIV
  directors want to invest in
• Which interventions guys around the
  country say they’ll actually use.
•   Conversations with webmasters are ongoing
How we’ll do it
   Online national survey funded by amfAR
     Webmasters – 12 completed to date;
      launched November 2009
     STD and HIV directors -- 60 completed to
      date; launched November 2009
     3500 website users -- launching shortly
THANKS
   All the men that participated
   Tom Kennedy and STOP AIDS staff and
    volunteers
   Willi McFarland
   Alberto Currotto
   Bill Woods
                      Thank you!
Contact info:
Dan Wohlfeiler, dwohlfei@cdph.ca.gov
Jen Hecht, jhecht@stopaids.org

				
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posted:9/21/2011
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