HIV and Sexuality Stigma Reduction Through Engagement in Online Forums: Results from the HealthMPowerment Intervention

Bauermeister, José A.; Muessig, Kathryn E.; LeGrand, Sara; Flores, Dalmacio Dennis; Choi, Seul Ki; Dong, Willa; Sallabank, Gregory; Hightow-Weidman, Lisa

doi:10.1007/s10461-018-2256-5

Cited by 65 publications

(78 citation statements)

References 29 publications

(31 reference statements)

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“…To date, most research on digital health interventions among PLHIV remains focused on high-income country settings, with a few exceptions [ 57 - 61 ]. A 2016 South African study examined the feasibility and acceptability of a web-based social media platform, MXit, to support YLHIV aged 12 to 25 years.…”

Section: Discussionmentioning

confidence: 99%

A Social Media–Based Support Group for Youth Living With HIV in Nigeria (SMART Connections): Randomized Controlled Trial

Dulli¹,

Ridgeway²,

Packer³

et al. 2020

J Med Internet Res

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Background Youth living with HIV (YLHIV) enrolled in HIV treatment experience higher loss to follow-up, suboptimal treatment adherence, and greater HIV-related mortality compared with younger children or adults. Despite poorer health outcomes, few interventions target youth specifically. Expanding access to mobile phone technology, in low- and middle-income countries (LMICs) in particular, has increased interest in using this technology to improve health outcomes. mHealth interventions may present innovative opportunities to improve adherence and retention among YLHIV in LMICs. Objective This study aimed to test the effectiveness of a structured support group intervention, Social Media to promote Adherence and Retention in Treatment (SMART) Connections, delivered through a social media platform, on HIV treatment retention among YLHIV aged 15 to 24 years and on secondary outcomes of antiretroviral therapy (ART) adherence, HIV knowledge, and social support. Methods We conducted a parallel, unblinded randomized controlled trial. YLHIV enrolled in HIV treatment for less than 12 months were randomized in a 1:1 ratio to receive SMART Connections (intervention) or standard of care alone (control). We collected data at baseline and endline through structured interviews and medical record extraction. We also conducted in-depth interviews with subsets of intervention group participants. The primary outcome was retention in HIV treatment. We conducted a time-to-event analysis examining time retained in treatment from study enrollment to the date the participant was no longer classified as active-on-treatment. Results A total of 349 YLHIV enrolled in the study and were randomly allocated to the intervention group (n=177) or control group (n=172). Our primary analysis included data from 324 participants at endline. The probability of being retained in treatment did not differ significantly between the 2 study arms during the study. Retention was high at endline, with 75.7% (112/163) of intervention group participants and 83.4% (126/161) of control group participants active on treatment. HIV-related knowledge was significantly better in the intervention group at endline, but no statistically significant differences were found for ART adherence or social support. Intervention group participants overwhelmingly reported that the intervention was useful, that they enjoyed taking part, and that they would recommend it to other YLHIV. Conclusions Our findings of improved HIV knowledge and high acceptability are encouraging, despite a lack of measurable effect on retention. Retention was greater than anticipated in both groups, likely a result of external efforts that began partway through the study. Qualitative data indicate that the SMART Connections intervention may have contributed to retention, adherence, and social support in ways that were not captured quantitatively. Web-based delivery of support group interventions can permit people to access information and other group members privately, when convenient, and without travel. Such digital health interventions may help fill critical gaps in services available for YLHIV. Trial Registration ClinicalTrials.gov NCT03516318; https://clinicaltrials.gov/ct2/show/NCT03516318

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Section: Discussionmentioning

confidence: 99%

A Social Media–Based Support Group for Youth Living With HIV in Nigeria (SMART Connections): Randomized Controlled Trial

Dulli¹,

Ridgeway²,

Packer³

et al. 2020

J Med Internet Res

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“…Participants assigned to healthMpowerment, a mobile phone optimized, internet-based intervention, demonstrated a 38% reduction in condomless anal intercourse compared to the control group. Furthermore, intervention participants reported decreases in perceived HIV stigma over time [90].…”

Section: Introductionmentioning

confidence: 99%

HIV Prevention Interventions for Adolescents

Hosek

Pettifor

2019

Curr HIV/AIDS Rep

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Purpose of Review: The goal of this paper is to review recent data on biomedical, behavioral and structural HIV prevention interventions for adolescents and young adults. Recent Findings: While it is accepted that HIV prevention interventions must take an integrated approach to achieve maximum effectiveness, to date, there have been limited, rigorously evaluated combination prevention interventions for adolescents. There are currently a range of effective biomedical, behavioral and structural approaches that can be integrated into prevention packages to address the prevention needs of adolescents, including oral PrEP, male circumcision, rapid HIV testing, numerous behavioral interventions and structural interventions such as cash transfers and community mobilization to address gender-based violence. Summary: There is still a need for rigorously evaluated, innovative combination prevention packages for adolescents. Prevention approaches must take into account the context of young people’s lives and address the multiple levels of influence on their lives including parents, partners and communities.

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“…The HMP 2.0 intervention features tailored content and study measures across these 4 dimensions of stigma and also categorizes a fifth dimension of challenging stigma , that is, the acts of naming, confronting, resisting, or otherwise countering stigmatizing experiences, beliefs, narratives, practices, and perceptions [ 13 , 65 ]. In the HMP 1.0 trial, 75% of all participant-contributed stigma-related content could be categorized as challenging stigma , underscoring its importance within this virtual space [ 67 ] and its potential role in fostering resilience and resisting stigma and discrimination [ 50 , 65 ]. In applying the Stigma Framework, we categorize these 5 dimensions of stigma across content about race and ethnicity, gender, sexuality, and HIV.…”

Section: Methodsmentioning

confidence: 99%

“…The social support features of HMP 1.0 were the most frequently used intervention components, and engagement with these features was associated with improved HIV care outcomes [ 31 ]. We also found associations between engaging with stigma-related content and both psychosocial and physical health outcomes [ 31 , 65 - 67 ].…”

Section: Introductionmentioning

confidence: 99%

Increasing HIV Testing and Viral Suppression via Stigma Reduction in a Social Networking Mobile Health Intervention Among Black and Latinx Young Men and Transgender Women Who Have Sex With Men (HealthMpowerment): Protocol for a Randomized Controlled Trial

Muessig¹,

Golinkoff²,

Hightow-Weidman³

et al. 2020

JMIR Res Protoc

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Background Stigma and discrimination related to sexuality, race, ethnicity, and HIV status negatively impact HIV testing, engagement in care, and consistent viral suppression (VS) among young Black and Latinx men who have sex with men and transgender women who have sex with men (YBLMT). Few interventions address the effects of intersectional stigma among youth living with HIV and those at risk for HIV within the same virtual space. Objective Building on the success of the HealthMpowerment (HMP) mobile health (mHealth) intervention (HMP 1.0) and with the input of a youth advisory board, HMP 2.0 is an app-based intervention that promotes user-generated content and social support to reduce intersectional stigma and improve HIV-related outcomes among YBLMT. The primary objective of this study is to test whether participants randomized to HMP 2.0 report improvement in HIV prevention and care continuum outcomes compared with an information-only control arm. We will also explore whether participant engagement, as measured by paradata (data collected as users interact with an mHealth intervention, eg, time spent using the intervention), mediates stigma- and HIV care–related outcomes. Finally, we will assess whether changes in intersectional stigma and improvements in HIV care continuum outcomes vary across different types of social networks formed within the intervention study arms. Methods We will enroll 1050 YBLMT aged 15 to 29 years affected by HIV across the United States. Using an HIV-status stratified, randomized trial design, participants will be randomly assigned to 1 of the 3 app-based conditions (information-only app-based control arm, a researcher-created network arm of HMP 2.0, or a peer-referred network arm of HMP 2.0). Behavioral assessments will occur at baseline, 3, 6, 9, and 12 months. For participants living with HIV, self-collected biomarkers (viral load) are scheduled for baseline, 6, and 12 months. For HIV-negative participants, up to 3 HIV self-testing kits will be available during the study period. Results Research activities began in September 2018 and are ongoing. The University of Pennsylvania is the central institutional review board for this study (protocol #829805) with institutional reliance agreements with the University of North Carolina at Chapel Hill, Duke University, and SUNY Downstate Health Sciences University. Study recruitment began on July 20, 2020. A total of 205 participants have been enrolled as of November 20, 2020. Conclusions Among a large sample of US-based YBLMT, this study will assess whether HMP 2.0, an app-based intervention designed to ameliorate stigma and its negative sequelae, can increase routine HIV testing among HIV-negative participants and consistent VS among participants living with HIV. If efficacious and brought to scale, this intervention has the potential to significantly impact the disproportionate burden of HIV among YBLMT in the United States. Trial Registration ClinicalTrials.gov NCT03678181; https://clinicaltrials.gov/ct2/show/study/NCT03678181. International Registered Report Identifier (IRRID) DERR1-10.2196/24043

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HIV and Sexuality Stigma Reduction Through Engagement in Online Forums: Results from the HealthMPowerment Intervention

Cited by 65 publications

References 29 publications

A Social Media–Based Support Group for Youth Living With HIV in Nigeria (SMART Connections): Randomized Controlled Trial

A Social Media–Based Support Group for Youth Living With HIV in Nigeria (SMART Connections): Randomized Controlled Trial

HIV Prevention Interventions for Adolescents

Increasing HIV Testing and Viral Suppression via Stigma Reduction in a Social Networking Mobile Health Intervention Among Black and Latinx Young Men and Transgender Women Who Have Sex With Men (HealthMpowerment): Protocol for a Randomized Controlled Trial

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