A Randomized Trial of an Online Risk Reduction Intervention for Young Black MSM

Abstract

HealthMpowerment.org (HMP), is a mobile optimized, online intervention to reduce sexual risk behaviors among HIV-positive and HIV-negative young Black men who have sex with men (BMSM) by providing information and resources, fostering social support, and including gamebased elements. A randomized controlled trial with 474 young BMSM compared HMP to an information-only control website. The rate of self-reported condomless anal intercourse (CAI) at 3-months was 32% lower in the intervention group compared to the control group (IRR 0.68, 95% CI: 0.43, 0.93), however this effect was not sustained at 12 months. Among HIV-positive participants, the rate of CAI at 3-month follow-up was 82% lower among participants with detectable viral loads in the intervention group compared to the control group (IRR 0.18, 95% CI: 0.04, 0.32). In a secondary analysis, when we limited to those who used HMP for over 60 minutes during the 3-month intervention period (n=50, 25.8%), we estimated 4.85 (95% CI: 2.15, 7.53) fewer CAI events than we would have expected in control participants, had they used the intervention at the same rate as the intervention group. Findings suggest that exposure to an online intervention can reduce the rate of CAI among young BMSM, at least in the short term. Given the stronger effect seen among those participants who complied with HMP, additional intervention engagement strategies are warranted.

A Systematic Review of eHealth Interventions Addressing HIV/STI Prevention Among Men Who Have Sex With Men

“…Several studies focused on HIV/STI prevention knowledge and attitudes [47,56,67,86,87], HIV disclosure [60,62,79,[87][88][89], gonorrhea and chlamydial infection and treatment [90], or pre-exposure prophylaxis uptake [57,91] and adherence [92,93]. Reback et al (2012) had an additional outcome regarding the frequency of methamphetamine use among MSM [50], and Hightow-Weidman et al (2019) investigated the intention to use a condom, attitudes toward safe sexual behaviours, condom use self-efficacy, depressive symptoms, social support and social isolation [49]. Other outcomes of interest included level of internalized homonegativity among MSM [61,94], initiation of antiretroviral therapy (ART) among HIV + MSM [89], shame-related sexual stigma [77], health-related quality of life [52], HBV vaccination [63], Human Papillomavirus (HPV) vaccination knowledge, attitudes and beliefs [83], or HPV vaccine initiation and completion [85], and HIV-related self-efficacy [52,55].…”

“…All studies targeted MSM in accordance with the inclusion criteria. Several studies focused on specific parts of the MSM population such as rural MSM [46,47], black MSM [48,49], methamphetamine-using MSM [50,51], HIV + MSM [52][53][54] and young MSM [55][56][57][58]. Study sample size ranged from 41 [59] to 3092 men [60].…”

“…The length of follow-up ranged from immediate after intervention [61] to 12 months [49,58,[62][63][64] with the average retention rate of 79.8% (ranging from 46.0 [65] to 100% [66][67][68][69]). Four studies measured pre and post-evaluations in different participants [70][71][72][73].…”

“…For black MSM, Hightow-Weidman et al (2019) conducted a web-based RCT called HealthMpowerment.org among 474 black MSM [49]. This intervention group participated in live chats with experts, interactive quizzes, individualized health, "hook up/sex" journals and decision support tools, while the control group received only general HIV/ STI information.…”

“…This intervention group participated in live chats with experts, interactive quizzes, individualized health, "hook up/sex" journals and decision support tools, while the control group received only general HIV/ STI information. Authors found that the intervention could reduce 32% risk of condomless anal intercourse (RR = 0.68, 95% CI 0.43, 0.93) but this outcome was not maintained after 12 months [49]. Another RTC was perfomed in black MSM by Fernandez et al, where the intervention group was provided a tailored website and live chat to interact with, motivate, reinforce and challenge the participants.…”