The emergence of ethical issues in the provision of online sexual health outreach for gay, bisexual, two-spirit and other men who have sex with men: perspectives of online outreach workers

Web-Based Service Provision of HIV, Viral Hepatitis, and Sexually Transmitted Infection Prevention, Testing, Linkage, and Treatment for Key Populations: Systematic Review and Meta-analysis

BACKGROUND

Despite the growth of web-based interventions for HIV, viral hepatitis (VH), and sexually transmitted infections (STIs) for key populations, the evidence for the effectiveness of these interventions has not been reported.

OBJECTIVE

This study aimed to inform the World Health Organization guidelines for HIV, VH, and STI prevention, diagnosis, and treatment services for key populations by systematically reviewing the effectiveness, values and preferences, and costs of web-based outreach, web-based case management, and targeted web-based health information for key populations (men who have sex with men, sex workers, people who inject drugs, trans and gender-diverse people, and people in prisons and other closed settings).

METHODS

We searched CINAHL, PsycINFO, PubMed, and Embase in May 2021 for peer-reviewed studies; screened abstracts; and extracted data in duplicate. The effectiveness review included randomized controlled trials (RCTs) and observational studies. We assessed the risk of bias using the Cochrane Collaboration tool for RCTs and the Evidence Project and Risk of Bias in Non-randomized Studies of Interventions tools for non-RCTs. Values and preferences and cost data were summarized descriptively.

RESULTS

Of 2711 records identified, we included 13 (0.48%) articles in the effectiveness review (3/13, 23% for web-based outreach; 7/13, 54% for web-based case management; and 3/13, 23% for targeted web-based health information), 15 (0.55%) articles in the values and preferences review, and 1 (0.04%) article in the costs review. Nearly all studies were conducted among men who have sex with men in the United States. These articles provided evidence that web-based approaches are as effective as face-to-face services in terms of reaching new people, use of HIV, VH, and STI prevention services, and linkage to and retention in HIV care. A meta-analysis of 2 RCTs among men who have sex with men in China found increased HIV testing after web-based outreach (relative risk 1.39, 95% CI 1.21-1.60). Among men who have sex with men in the United States, such interventions were considered feasible and acceptable. One cost study among Canadian men who have sex with men found that syphilis testing campaign advertisements had the lowest cost-per-click ratio on hookup platforms compared with more traditional social media platforms.

CONCLUSIONS

Web-based services for HIV, VH, and STIs may be a feasible and acceptable approach to expanding services to key populations with similar outcomes as standard of care, but more research is needed in low-resource settings, among key populations other than men who have sex with men, and for infections other than HIV (ie, VH and STIs).

Sociodemographic and Psychological Predictors of Seeking Health Information Online among GB2M in Ontario: Findings from the #iCruise Project

Objectives

The current study examines the experiences of gay, bisexual, two-spirit and other men who have sex with men (GB2M) who use networking applications and their engagements with online sexual health outreach workers disseminating healthcare information through these digital spaces.

Methods

The iCruise study was a longitudinal mixed-methods study across Ontario, Canada which collected data on online sexual health information seeking behaviors.

Results

Results offer insight into differences in information seeking behaviors among diverse groups of queer men.

Conclusions

Implications for the dissemination of health information based on the results of information seeking patterns is discussed as well.

A Qualitative Study of Community-Based HIV/AIDS Prevention Interventions, Programs, and Projects for Rural and Remote Regions in Canada: Implementation Challenges and Lessons Learned

CONTEXT

Fifteen percent to 20% of the Canadian and American populations live outside urban areas, and despite growing regional HIV/AIDS-related health disparities, there is little published research specific to rural or remote (rural/remote) HIV/AIDS prevention programming.

OBJECTIVE

To document implementation challenges, lessons learned, and evaluation approaches of promising and proven HIV/AIDS prevention programs and interventions developed and delivered by organizations with rural/remote catchment areas in Canada to provide a foundation for information sharing among agencies.

DESIGN

Qualitative study design, using a community-based participatory research approach. We screened Canadian community-based organizations with an HIV/AIDS prevention mandate to determine whether they offered services for rural/remote populations and invited organizational representatives to participate in semistructured telephone interviews. Interviews were audio-recorded and transcribed. Content analysis was used to identify categories in the interview data.

SETTING

Canada, provinces (all except Prince Edward Island), and territories (all except Nunavut).

PARTICIPANTS

Twenty-four community-based organizations.

RESULTS

Screening calls were completed with 74 organizations, of which 39 met study criteria. Twenty-four (62%) interviews were conducted. Populations most frequently served were Indigenous peoples (n = 13 organizations) and people who use drugs (n = 8 organizations) (categories not mutually exclusive). Key lessons learned included the importance of involving potential communities served in program development; prioritizing community allies/partnerships; building relationships; local relevancy and appropriateness; assessing community awareness or readiness; program flexibility/adaptability; and addressing stigma. Evaluation activities were varied and used for funder reporting and organizational learning.

CONCLUSIONS

Rural/remote HIV/AIDS programs across Canada expressed similar challenges and lessons learned, suggesting that there is potential for knowledge exchange, and development of a community of practice. Top-down planning and evaluation models may fail to capture program achievements in rural/remote contexts. The long-term engagement practices that render rural/remote programs promising do not always conform to planning and implementation requirements of limited funding.

E-health. Patterns of use and perceived benefits and barriers among people living with HIV and their physicians. Part 2: Health apps and smart devices

OBJECTIVES

To evaluate patterns of use and perceived benefits and barriers to health/wellness applications (apps) and smart devices among people living with HIV (PLHIV) and their physicians.

METHODS

Online multicenter observational survey (October 15-19, 2018).

RESULTS

Study participation was accepted by 229 physicians and 838/1377 PLHIV followed in 46 centers, of which 325 (39%) responded online. Overall, 83/288 (29%) PLHIV had already downloaded at least one app: these 'downloaders' were younger (OR0.96±0.01, P=0.004), educated to at least university entry level (OR2.27±0.86, P=0.03), and more frequently used geolocation-based dating websites (OR3.00±1.09, P=0.002). However, 227/314 (72%) PLHIV claimed they were ready to use an app recommended by a physician. For the 60/83 PLHIV who answered, the ideal app would be a vaccination tracker (76%) to better communicate with their physician (68%). However, 96/277 (42%) physicians were unable to answer this question and for 94/227 (41%) of them, the ideal patient app would be for schedule management. Although PLHIV used smart devices, 231/306 (75%) would want to report the data to their physicians and 137/225 (61%) of physicians would welcome this exchange. The main physician-side barrier to this exchange was concerns over data security.

CONCLUSION

mHealth apps and smart devices have failed to garner adoption by PLHIV. There is a case for good-quality health data sharing and exchange if PLHIV are provided with appropriately secure tools and physicians are backed up by adapted legislation.

Sexualized drug use in virtual space: A scoping review of how gay, bisexual and other men who have sex with men interact online

The purpose of this article is to review the scope of the current literature on sexualized drug use (SDU) among gay, bisexual and other men who have sex with men (GBMSM), particularly in online spaces. Over the last decade, there has been a rapid emergence of online venues for GBMSM to interact for sexual purposes. These spaces have also been infused with various substances that influence or shape the sexual interactions among GBMSM. Employing a scoping review methodology, we explored the interplay between GBMSM, SDU, and online dating and hookup apps. This scoping review presents four themes emerging from the literature: the connection between social networking apps (SNAs) and SDU, the planning and coordination of sex parties, accessing drugs through SNAs, and the coded language that emerges on SNAs. These findings synthesize the important relationship between GBMSM and SDUs, and identify the implications for health promotion.

Imagining Online Sexual Health Outreach: A Critical Investigation into AIDS Service Organizations Workers' Notions of 'Gay Community'

This paper examines how online outreach workers within AIDS Service Organizations (ASOs) discursively imagine notions of "gay community" and the tensions between inequities in varying conceptions of "community" that operate in providers' and managers' sexual health online outreach. Through a Foucauldian Discourse Analysis (FDA) of interview data from a community-based research project examining sexual health outreach among gay, bisexual, and queer (GBQ) men, we provide an analysis that problematizes notions of a unitary "gay community" while illustrating how certain privileged subjects are deemed ideal for inclusion and representation within both online and ASO communities. Moreover, we interrogate how online medical health regimes constitute the ideal neoliberal gay male subject who self-responsibilizes and individualizes his sexual health while erasing inequities relating to social location and intersecting identities. Our analysis highlights how homonormative politics infiltrates GBQ sexual health programming and the ways in which understandings of the "self" and gay subjectivities are constituted through biopolitical apparatuses and online sexual health surveillance. We argue that it is necessary to move online sexual health outreach beyond specifically focusing on the needs of white GBQ men by bringing a greater awareness to the continual exclusions which operate within GBQ "communities".

Providing Online-Based Sexual Health Outreach to Gay, Bisexual, and Queer Men in Ontario, Canada: Qualitative Interviews with Multisectoral Frontline Service Providers and Managers

The Internet is a common tool for gay, bisexual, and other men who have sex with men (MSM) to find sexual partners and sexual health information. Given persistently high human immunodeficiency virus (HIV) infection rates among MSM, it is important to examine the role of online outreach for MSM as part of HIV prevention and care. We provide an overview of the unique perspectives of online sexual health outreach, delivered through AIDS Service Organizations (ASOs) through sociosexual Internet sites and mobile applications. Data were drawn from the qualitative arm of the community-based Cruising Counts study conducted across Ontario from December 2013 to January 2014. ASO online outreach providers and managers (n = 22) were recruited to complete a 1-h in-person/telephone interview to explore in-depth their experiences with, and perspectives on, delivering online outreach services for MSM in Ontario. Thematic analyses were conducted inductively using NVivo 10. Service providers suggested a high demand for online outreach services for MSM. Strengths and advantages of online outreach over face-to-face outreach included anonymity, instant access to services, peer model, and accessing hard-to-reach populations of MSM. Barriers included consistent quality of service, collaborations between companies that own online technologies and outreach service agencies, budgetary and staff capacity issues, and uncertainty of best practices and evaluation parameters for online outreach. Findings from these interviews can inform service providers, policy makers, and researchers on how online sexual health outreach can play a greater role in HIV prevention by better acknowledging and addressing the opportunities and barriers experienced by service providers working with MSM communities online.