Building a Technology-Enhanced Social Network Intervention to Promote HIV Testing among Young Men who have Sex

with Men (YMSM)
Jimena Loveluck,
1; MSW

Tiffany Veinot, PhD,

2,3; MLS

José Bauermeister, PhD,

3; MPH

Meico

1,2; Whitlock
Conceptual Model

Carrie

1,3,4 Rheingans

Background and Significance
In the United States, one in every four people infected with HIV is unaware of his or her HIV status. The HIV transmission rate from people who are unaware they are HIV infected is 3.5 times higher than the transmission rate from people who are aware of their HIV infection. Thus it is estimated that this undiagnosed 25% of the HIV-infected population accounts for most new sexual infections per year (approximately 54 to 70% of all new cases). Because reduction in HIV risk behavior is common after HIV diagnosis, there are increasing calls for HIV testing promotion as an HIV prevention strategy. Young men who have sex with men (MSM), particularly those who are African American or Latino, experience a disproportionate burden of new HIV infections (see Figure 1). Unrecognized HIV infection is also most prevalent among African American MSMs between the ages of 18 and 24. Accordingly, programs tailored to the needs of these groups are greatly needed.

Figure 1. Disparity in new HIV infections by age and race/ethnicity

The Theory of Planned Behavior (TPB) proposes that an individual’s behavioral intention to engage in a behavior is the best predictor of actual behavior.

Figure 2. Conceptual model of HIV testing behavior

As shown in our conceptual model (see Figure 2), three psychosocial factors maximize a person’s behavioral intention: (a) an individual’s attitudes toward the behavior, (b) his/her subjective norms ascribed to said behavior, and (c) his/her perceived behavioral control (“self-efficacy”) to carry out the behavior successfully in a specific context.
In this study, we have also extended the TPB model to include the social influence variables, including descriptive norms (i.e., the perceived prevalence of the behavior in young MSM’s social networks), personal norms (i.e., the feeling of moral obligation for one’s own behavior), and anticipated regret (i.e., the anticipation of an emotional reaction following an unintended behavior). We will also assess barriers to testing and external factors which influence TPB variables, as represented by the contextual variables in our model.

Project Description
HARC recently initiated a social network-based HIV testing initiative among MSM in Southeastern Michigan. However, HARC requires locally-relevant data to inform program design, particularly its outreach strategies with young African American and Latino MSMs. Through a research partnership between HARC and researchers at the University of Michigan’s Schools of Public Health and Information, this study aims to ask the following questions:
(1) How do young MSM’s social and sexual networks promote or reduce their intentions to test for HIV? (2) What psychosocial and network factors are associated with young MSM’s HIV testing behaviors? Additionally, this project will examine acceptability and feasibility of using online networks to promote HIV testing and HIV status awareness – a strategy that appears promising for connecting with this population. A key premise of this research is that promotion of HIV status awareness among young MSM, including African Americans, may lead to a reduction in risk behaviors and contribute to curtailing the alarming rise in HIV incidence among young MSM. Community Expert and Partner
The HIV/AIDS Resource Center (HARC) is a private non-profit organization that provides HIV related services to the community through compassionate direct care, prevention and outreach activities. HARC is the only comprehensive AIDS service organization providing these services in Washtenaw, Jackson, Livingston and Lenawee counties.

Methods
In-depth, face-to-face interviews (Phase 1). We will conduct semi-structured, in-depth interviews with 25-30 racially/ethnically diverse young MSMs who may benefit from HARC’s services. Interviews will focus on the participants’ experiences with, attitudes towards, and beliefs about, HIV testing; and the dynamics and characteristics their social and sexual networks. The qualitative interviews will help to uncover new concepts and themes, thus further strengthening the local applicability of our conceptual model. We will also use the qualitative findings to refine the quantitative measures to be used in Phase 2. Web-survey among MSM (Phase 2). We will conduct a survey with 200 young MSM in the Washtenaw County area exploring the correlates of HIV/AIDS testing. Through this survey, we aim to describe the sociodemographic and HIV risk factors of a diverse sample of MSM who have varied HIV/AIDS testing intentions. We also seek to test the associations within our proposed conceptual model, as further developed with qualitative interview data.

Lessons Learned • Collaborative idea development and proposal writing led to close integration of research and programmatic goals. • Rapid changes in technology are a challenge and opportunity for recruitment. • Online networks supplement service catchment areas. • Reconciling community approaches to outreach with academic research procedures. • Simply beginning this project has helped to promote dialogue in the broader community.

Thank you to our collaborators!

1

HIV/AIDS Resource Center, 2 School of Information, 3 School of Public Health, 4 School of Social Work

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