Black social media influencers engage higher percentages of Black gay and bisexual men in online outreach for HIV prevention research relative to paid ads

Beyond Numbers: Opportunities and Challenges Using Qualitative Methods in Social Media Studies of PrEP Discourse

Using pre-exposure prophylaxis (PrEP) discourse as a case study, we examine qualitative and multi-method approaches to analyzing health communication on social media platforms. These platforms have become crucial spaces for health promotion and community discourse, particularly on HIV prevention. Our review of 23 PrEP-focused studies that used social media data documents the different strengths of both methodologies. Qualitative analyses were strong at capturing how platform architecture shaped discourse quality: Reddit's forum structure enabled deeper narratives while X's (formerly Twitter) character constrained discussions. Algorithm-driven platforms' short-form video formats like TikTok emerged as unique media for health communication, enabling creative expression but limiting discourse depth. Multi-method studies dominated the literature (n = 15) yet struggled to meaningfully integrate quantitative metrics with qualitative insights. Frameworks are required that better combine computational approaches with qualitative analysis, while accounting for key challenges of social media data: the transient nature of data, context preservation, and post-authenticity validation.

After the program ends: HIV testing behavior among men who have sex when men after the conclusion of a program providing regular home delivery of HIV self-testing kits

Testing for HIV continues to play a key role in prevention, especially among at-risk populations such as gay, bisexual, and other men who have sex with men (MSM). Incorporating HIV self-testing (HIVST) into testing programs encourages more frequent screening and likely facilitates earlier diagnosis, but little is known about how testing behavior changes after self-testing programs end. In this study, a subset of MSM in the eTest trial who were randomized to receive regular HIVST or clinic testing every three months for 12 months were followed for an additional 12 months. We compared testing rates during the intervention period to this 12-month post-intervention period. Results of a Poisson mixed model showed a significant condition by time interaction (IRR=0.91, SE=0.04, p=.019, %95CI=0.84-0.98). The average marginal predicted probability of testing in a given follow-up among controls was 30.4% during the intervention period and 28.2% post-intervention, versus 70.0% among HIVST condition participants during the intervention period but 23.6% by the end of the post-intervention period. Although regular mail delivery of HIVST increased HIV testing considerably while tests are actively being delivered, testing rates declined to a level similar to those who had not received HIVST after regular delivery stops. These results suggest that regularly delivering HIVST does not encourage longer-term regular testing habits in MSM who typically test infrequently.

A Nationally Representative Analysis of Substance Use and Sexual Health Correlates Associated with HIV and STI Testing among Adolescents

Adolescents in the United States (US) continue to be disproportionately impacted by HIV and STIs. We investigated the associations between sexual health and substance use behaviors with HIV and STI testing among high school students in the US. Cross-sectional weighted stepwise multivariate logistic regression models were conducted to determine the odds of lifetime HIV and STI testing among students, stratified by sex. Drugs and alcohol before sex, condom use during sex, number of sex partners, sex of sexual partners, substance use (e-cigarette, alcohol, and cannabis) frequency, lifetime cocaine use, and lifetime prescription drug misuse were predictors, adjusting for race/ethnicity and age. This analysis used the 2019 and 2021 cycles of the CDC Youth Risk Behavioral Surveillance System (YRBSS) data. Our sample of adolescents (n = 30,909) had a mean age of 16; 51% were male. Females engaging in substance use had increased odds of HIV and STI testing whereas that pattern did not reflect among males. Multiracial male adolescents had increased odds of HIV testing. Females engaging in condomless sex had lower odds of HIV and STI testing. This study highlights the need for tailored HIV and STI testing promotion and ongoing efforts for dismantling barriers to testing services. Furthermore, our study suggests that screenings follow the concurrent nature of sexual health and substance use behaviors of adolescents for integrated HIV/STI testing.