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Simple outreach on dating websites increases HIV testing rate
Roger Pebody, 2016-04-05 11:10:00
A simple online outreach intervention – in which a health
educator engaged in conversation and responded to questions about HIV testing
on dating and hook-up websites for men who have sex with men – significantly
increased the HIV testing rate, according to data from a randomised controlled trial published in Clinical Infectious
These kinds of interventions are widely implemented, but
until now there has been little data to show whether they are effective or not.
This is the first randomised trial of such an intervention.
The intervention was developed in partnership with community
organisations and involved a health educator having a presence in chat rooms on
Adam4Adam, BlackGayChat, Craigslist and Gay.com.
On each site, the health educator created a profile and
publicised his availability to answer questions about HIV testing, including
providing details of local services and of testing opportunities in bars and
other community spaces. He could answer questions about transmission risks,
symptoms and the testing process. Men using the sites could choose to begin a
conversation by sending the health educator a private message.
“The intervention was based on empowerment education, social
cognitive theory, and natural helping,” say the authors. It was more fully described
in a previous publication. The health educator was skilled in building
relationships with social media users, maintaining boundaries, being patient,
having a sense of humour, and networking with other organisations, particularly
those offering HIV testing.
The intervention was provided over a period of a year, only between 9am and 5pm, Monday to Friday. These aren’t the busiest moments for hook-up
websites, but many health organisations only provide such interventions during
The study was conducted in four geographically distinct
communities in the United States, in 2013 and 2014. In two of the communities,
on the four websites, the intervention was provided. In the two control
communities, no interventions were provided. Because each community was at
least 200 miles away from the other ones and the sites are used to arrange
face-to-face hook-ups, the researchers judged that people in control
communities would be unlikely to be exposed to the intervention.
A cross-sectional survey was done with users on each site in
each community before the intervention was delivered, with the survey repeated
after the intervention period. Numbers completing each survey were quite small,
with approximately 150 people taking part in each community in each survey.
Overall, 1292 men took part in all surveys.
Most participants were in their thirties or forties;
three-quarters were white; one third reported recent sex with a woman as well
as a man.
Before the intervention was provided, there was no
difference in HIV testing rates between the communities – around 36% had tested
for HIV within the previous year.
After the intervention, 64% of those in intervention
communities had tested in the previous year, compared with 42% of those in
control communities. After adjustment for confounding factors, those in
intervention communities were three times more likely to have tested (odds
ratio 2.9, 95% confidence interval: 1.8-4.7).
The researchers note some features of the intervention – it
is simple and cheap to deliver, requiring only a trained health educator and an
internet connection; it can easily be replicated and delivered at a greater
scale; it reaches men when they may already be thinking about sex; it reaches
men who may not use gay bars, including bisexual men.
This randomised study examined an intervention delivered on websites. In a separate
study the same researchers have also demonstrated that it is feasible and
acceptable to provide a similar intervention on geosocial networking apps such
as Grindr, A4A Radar, Jack’d and Scruff.