%0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e64497 %T Investigating Social Network Peer Effects on HIV Care Engagement Using a Fuzzy-Like Matching Approach: Cross-Sectional Secondary Analysis of the N2 Cohort Study %A Shrader,Cho-Hee %A Duncan,Dustin T %A Driver,Redd %A Arroyo-Flores,Juan G %A Coudray,Makella S %A Moody,Raymond %A Chen,Yen-Tyng %A Skaathun,Britt %A Young,Lindsay %A del Vecchio,Natascha %A Fujimoto,Kayo %A Knox,Justin R %A Kanamori,Mariano %A Schneider,John A %K social network analysis %K HIV %K social media %K social environment %K sexual and gender minorities %K African Americans %K social network %K social networking %K public health %K HIV care %K health center %K peer referral sampling %K neighborhoods and networks %K N2 %K Facebook %K sexual health %K mobile phone %K fuzzy %K innovation %K digital health %K mHealth %K eHealth %K surveillance %K mobile health %D 2025 %7 8.5.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Social network data are essential and informative for public health research and implementation as they provide details on individuals and their social context. For example, health information and behaviors, such as HIV-related prevention and care, may disseminate within a network or across society. By harmonizing egocentric and digital networks, researchers may construct a sociocentric-like “fuzzy” network based on a subgroup of the population. Objective: We aimed to generate a more complete sociocentric-like “fuzzy” network by harmonizing alternative sources of egocentric and digital network data to examine relationships between participants in the Neighborhoods and Networks (N2) cohort study. Further, we examined network peer effects of the status-neutral HIV care continuum cascade. Methods: Data were collected from January 2018 to December 2019 in Chicago, Illinois, United States, from a community health center and via peer referral sampling as part of the N2 cohort study, comprised of Black sexually minoritized men and gender expansive populations. Participants provided sociodemographics, social networks, sexual networks, mobile phone contacts, and Facebook friends list data. Lab-based information about the HIV care continuum cascade was also collected. We used an experimental approach to develop and test a fuzzy matching algorithm to construct a more complete network across social, sexual, phone, and Facebook networks using R and Excel. We calculated social network centrality measures for each of these networks and then described the HIV care continuum within the context of each network. We then used Spearman correlation and a network autocorrelation model to examine social network peer effects with HIV status and care engagement. Results: A total of 412 participants resulted in 2054 network connections (ties) across the confidant and sexual partner social networks (participants=387; ties=445), peer referral network (participants=412; ties=362), phone contacts (participants=273; ties=362), and Facebook network (participants=144; ties=1383), reaching the entire study sample in one fully connected “fuzzy” network. Results from the individual networks’ autocorrelation model suggest there are no peer effects on status-neutral HIV care engagement. Results from the final fuzzy-like sociocentric network autocorrelation model, adjusted for HIV serostatus, suggest that participants who were proximate to network members engaged in HIV care were significantly more likely to be engaged in care (ρ=0.128, SE 0.064; P=.045). Conclusions: Using alternative sources of network data allowed us to fuzzy match a more complete network: fuzzy matching may identify hidden ties among participants that were missed by examining alternative sources of network data separately. Although sociocentric studies require significant resources to implement, more complete sociocentric-like networks may be generated using a fuzzy match approach that leverages egocentric, peer referral, and digital networks. Enriching offline networks with digital network data may provide insights into characteristics and norms that egocentric approaches may not be able to capture. International Registered Report Identifier (IRRID): RR2-10.2196/48548 %R 10.2196/64497 %U https://publichealth.jmir.org/2025/1/e64497 %U https://doi.org/10.2196/64497 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e66772 %T Sexual Response Problems and Their Correlates Among Older Adults From the Sexual Well-Being (SWELL) Study in China: Multicenter Cross-Sectional Study %A Liang,Bingyu %A Xu,Chen %A Wang,Bingyi %A Li,Xinyi %A Peng,Xin %A Wang,Ying %A Li,Hui %A Lu,Yong %A Shen,Xiaopei %A Ouyang,Lin %A Wu,Guohui %A Yu,Maohe %A Liu,Jiewei %A Meng,Xiaojun %A Cai,Yong %A Zou,Huachun %K dysfunction %K sexual health %K sexual well-being %K sexually active %K sexual activity %K well-being %K correlate %K sex partner relationship %K gerontology %K geriatrics %K older adults %K elder %K elderly %K older person %K aging %K China %K cross-sectional study %D 2025 %7 1.5.2025 %9 %J JMIR Aging %G English %X Background: Sexual response problems among older adults are not an inevitable consequence of aging but rather a response to sexual health. However, there is a lack of recent and multicenter data on this issue in China. Objective: This study aims to assess the prevalence of sexual response problems and their correlates among older adults. Methods: A multicenter cross-sectional study on sexual well-being was conducted among individuals aged more than 50 years in China between June 2020 and December 2022. Data on sociodemographics, physical health, psychological health, and sexual response problems were collected through face-to-face interviews. We included sexually active older adults who reported either vaginal, oral, or anal sex in the past 12 months for this study. Sexual response problems included a lack of interest or enjoyment in sex; feeling anxious, having pain, or no excitement during sex; no desire or orgasms; and the lack of lubrication in sex. The stepwise logistic regression models were used to examine the correlates of sexual response problems. Results: A total of 1317 sexually active older adults (842 men, 475 women) were included. Older women reported a higher prevalence of sexual response problems than older men (52.0% [247/475] vs 43.1% [363/842]). Common factors associated with at least one of the sexual response problems included living in rural areas (men: adjusted odds ratio [aOR]=0.31, 95% CI 0.22‐0.43; women: aOR=0.29, 95% CI 0.19‐0.43) and abnormal BMI (aOR=men: 1.52, 95% CI1.11‐2.07; women: aOR=2.19, 95% CI 1.47‐3.28). Among older men, sleep quality (aOR=1.87, 95% CI 1.30‐2.68), emotional connection with sex partners during sexual intercourse (aOR=0.69, 95% CI 0.50‐0.96), frequently experienced fatigue (aOR=2.47, 95% CI 1.59‐3.90), anxiety (aOR=4.26, 95% CI 1.12‐21.27), and seeking professional help for sex life (aOR=1.58, 95% CI 1.14‐2.21) were associated with sexual response problems. Among older women, sexual response problems were associated with a lack of physical exercise (aOR=1.69, 95% CI 1.13‐2.54), poor sex-partner relationships (aOR=1.70, 95% CI 1.12‐2.60), and depressive symptoms (aOR=3.18, 95% CI 1.18‐10.24). Conclusions: Sexual response problems are common among older adults. These problems were associated with adverse physical health, mental health, and poor sex-partner relationships. These findings highlight the importance for health care providers to take into account the physical and psychological health of older adults, as well as the quality of their relationships with sexual partners when diagnosing and addressing sexual response problems. %R 10.2196/66772 %U https://aging.jmir.org/2025/1/e66772 %U https://doi.org/10.2196/66772 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e66897 %T Assessment of Heterosexual-Identified Men Who Have Sex With Men and Men of Diverse Sexual Identities: Protocol for an International, Multilingual, Online, Comparative Sexuality Study %A Eaton,Andrew D %A Scheadler,Travis R %A Rowe,Megan %A Rao,Salem %A Kwan,Sandra %A Beer,Oliver W J %A Shuper,Paul A %A Curtis,Tyrone J %A Busch,Adam %A Vandervoort,Daniel %A McInroy,Lauren B %+ Faculty of Social Work, Saskatoon Campus, University of Regina, 111-116 Research Dr, Saskatoon, SK, S7N 3R3, Canada, 1 3066647371, andrew.eaton@uregina.ca %K heterosexual-identified men who have sex with men %K sexuality %K survey %K interviews %K structural equation modeling %K interpretive phenomenology %D 2025 %7 30.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sexuality is multidimensional and complex, and involves identity development, attraction, and behavior. Heterosexual-identified men who have sex with men (H-MSM) experience sexual identity and behavior discordance, yet it is unknown how H-MSM compare to concordant heterosexual men and gay, bisexual, and queer (GBQ+) men in terms of sexuality constructs. Objective: This study aims to survey adult cisgender men in Canada, the United States, and the United Kingdom to gain greater insights into how demographics, identity development, attraction, behavior, technology use, relationship negotiation and communication skills, and pre-exposure prophylaxis and life satisfaction relate to each other, and then to interview H-MSM for an in-depth follow-up on survey concepts. Methods: Purposive sampling will be used to recruit men via online and offline venues. Data collection will be multifaceted and include an online questionnaire for adult cisgender men and a subsequent interview for H-MSM. The survey will be available in English, French, and Spanish. Structural equation modeling, underpinned by hegemonic masculinity and sexual script theories, will be performed to test the relationships among survey variables. Interpretive phenomenology will be employed on the qualitative data to consider how unique sociocultural factors influence the sexuality and experiences of H-MSM, allowing for similarities and differences across participants to be identified and explored. Results: Data collection began on November 26, 2024, and as of February 2025, data collection remains ongoing. We expect to conclude data collection and data cleaning by mid-summer 2025. Data analysis will begin in fall 2025. Our findings will provide a more nuanced understanding of the identity development, attraction, behavior, relationship negotiation, and technology use of H-MSM in comparison with GBQ+ men and concordant heterosexual men. Conclusions: This research aims to broaden the scope of existing literature and support advancements in interventions and knowledge to support the overall health and well-being of H-MSM. An examination of potential differences among H-MSM, concordant heterosexual men, and GBQ+ men aims to improve the understanding of H-MSM as a distinct population, without dismissing them as closeted GBQ+ men. This study aims to provide key insights into avenues for research and practice with men whose sexuality and sexual behaviors may be outside of commonly accepted norms. International Registered Report Identifier (IRRID): DERR1-10.2196/66897 %M 40306626 %R 10.2196/66897 %U https://www.researchprotocols.org/2025/1/e66897 %U https://doi.org/10.2196/66897 %U http://www.ncbi.nlm.nih.gov/pubmed/40306626 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e59519 %T Use of Behavior Change Techniques in Digital HIV Prevention Programs for Adolescents and Young People: Systematic Review %A Mo,Phoenix Kit-han %A Xie,Luyao %A Lee,Tsz Ching %A Li,Angela Yuen Chun %+ Center for Health Behaviours Research, JC School of Public Health and Primary Care, Chinese University of Hong Kong, No. 30-32 Ngan Shing Street, Hong Kong, China (Hong Kong), 852 22528765, phoenix.mo@cuhk.edu.hk %K HIV %K prevention %K adolescent %K young adult %K behavior change techniques %D 2025 %7 28.4.2025 %9 Review %J JMIR Public Health Surveill %G English %X Background: HIV infections have caused severe public health and economic burdens to the world. Adolescents and young people continue to constitute a large proportion of newly diagnosed HIV cases. Digital health interventions have been increasingly used to prevent the rising HIV epidemic. Behavior change techniques (BCTs) are intervention components designed to modify the underlying processes that regulate behavior. The BCT taxonomy offers a systematic approach to identifying, extracting, and coding these components, providing valuable insights into effective intervention strategies. However, few reviews have comprehensively identified the use of BCTs in digital HIV interventions among adolescents and young people. Objective: This study aimed to synthesize existing evidence on the commonly used BCTs in effective digital HIV prevention programs targeting adolescents and young people. Methods: In total, 4 databases (PubMed, Embase, Cochrane Library, and APA PsycINFO) were searched, and studies from January 2008 to November 2024 were screened. Reference lists of relevant review studies were reviewed to identify any additional sources. Eligible randomized controlled trials with 1 of 3 HIV prevention outcomes (ie, HIV knowledge, condom-use self-efficacy, and condom use) were included. Basic study characteristics, intervention strategies, and study results were extracted and compared for data analysis. For the included interventions, BCTs were identified according to the BCT taxonomy proposed by Abraham and Michie in 2008, and the frequencies of BCTs used in these interventions were counted. Results: Searches yielded 383 studies after duplicates were removed, with 34 (8.9%) publications finally included in this review. The most frequently used BCTs included prompting intention formation (34/34, 100%), providing information about behavior-health link (33/34, 97%), providing information on consequences (33/34, 97%), and providing instruction (33/34, 97%). Interventions with significant improvements in HIV knowledge (11/34, 32%) more frequently used BCTs with a provision nature, such as providing information about behavior-health link (11/11, 100%), information on consequences (11/11, 100%), encouragement (10/11, 91%), and instruction (10/11, 91%). Those with significant increases in condom-use self-efficacy (7/34, 20%) used BCTs toward initiating actions, such as prompts for intention formation (7/7, 100%), barrier identification (7/7, 100%), and practice (5/7, 71%). In addition, studies showing significant improvements in condom use (14/34, 41%) included BCTs focused not only on provision and initiation but also on behavioral management and maintenance, such as use follow-up prompts (5/14, 36%), relapse prevention (4/14, 29%), prompt self-monitoring of behavior (3/14, 21%), and prompt review of behavioral goals (3/14, 21%). Conclusions: This is the first systematic review that examined the use of BCTs in digital HIV prevention interventions for adolescents and young adults. The identified BCTs offer important reference for developing more effective digital interventions, with implications for enhancing their HIV knowledge, condom-use self-efficacy, and condom use in youth. %M 40293783 %R 10.2196/59519 %U https://publichealth.jmir.org/2025/1/e59519 %U https://doi.org/10.2196/59519 %U http://www.ncbi.nlm.nih.gov/pubmed/40293783 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e70594 %T Are Dating App Algorithms Making Men Lonely and Does This Present a Public Health Concern? %A Balki,Eric %+ Faculty of Health and Medicine, Department of Health, Lancaster University, Innovation One, Sir John Fisher Dr, Bailrigg, Lancaster, LA1 4AT, United Kingdom, 44 1524 593763, e.balkhi@lancaster.ac.uk %K dating apps %K mental health %K men %K algorithm %K anxiety %K depression %K loneliness %D 2025 %7 7.4.2025 %9 Viewpoint %J JMIR Form Res %G English %X During the pandemic, dating apps emerged as essential platforms connecting users amid social isolation, experiencing rapid growth in engagement and profile creation. This paper examines the evolution of these apps, highlighting their shift from facilitating offline encounters to promoting match accumulation for revenue. In particular, the study investigates gender disparities, addictive behaviors, and algorithmic match throttling that disproportionately impact men’s psychological well-being. Drawing on evidence linking dating app use to increased depression and anxiety, the analysis calls for regulatory intervention to eliminate pay-for-advantage models and ensure fair, healthy user experiences, thereby mitigating adverse public health outcomes. %M 40193188 %R 10.2196/70594 %U https://formative.jmir.org/2025/1/e70594 %U https://doi.org/10.2196/70594 %U http://www.ncbi.nlm.nih.gov/pubmed/40193188 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69828 %T Evaluating a Digital Health Tool Designed to Improve Low Sexual Desire in Women: Mixed-Methods Implementation Science Study %A Brotto,Lori A %A Stephenson,Kyle R %A Marshall,Nisha %A Balvan,Mariia %A Okara,Yaroslava %A Mahar,Elizabeth A %+ Department of Obstetrics and Gynaecology, University of British Columbia, 2775 Laurel Street, Department of Gynaecology, Vancouver, BC, V5Z1M9, Canada, 1 6048754111 ext 68898, lori.brotto@ubc.ca %K implementation science %K sexual interest/arousal disorder (SIAD) %K sexuality %K internet interventions %K online therapy %K telehealth %K online interventions %K web-based therapeutic programs/interventions %K online CBT/MBT treatment %K female sexual dysfunction %K eHealth %D 2025 %7 25.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexual health difficulties affect up to 30% of women, with desire and arousal problems being the most prevalent. While cognitive behavioral therapy and mindfulness-based therapy are effective treatments, access is limited by barriers such as specialist shortages, cost, and embarrassment. Web-based interventions offer a potential solution by providing self-paced, cost-effective treatments. eSense, a digital health program, offers cognitive behavioral therapy and mindfulness-based therapy skills targeted to women with low sexual desire, and previous trials find eSense to be highly feasible and efficacious. Objective: The goal of the present implementation science study was to use the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance of Implementation) framework to assess the integration of eSense into several sexual health clinics. We chose the RE-AIM framework because it addresses both dissemination (eg, reach) and implementation of an intervention. Methods: A total of 14 specialty clinics participated, and we report on the reported experiences of those clinics in implementing eSense. We also examined responses from 12 women on waitlists to receive sex therapy or sexual medicine care. Results: Per clinic outcomes, all aspects of implementation (reach, effectiveness, adoption, implementation, and maintenance) were in the moderate to high range for clinics, reporting that offering eSense helped them overcome negative feelings associated with their long clinic waitlists. The majority expressed a need for eSense and could see how it overcame the limitations of traditional therapy. Nearly all expressed a wish to continue offering eSense to patients after the implementation study was complete. One caveat was that half of the clinics noted cost as a key issue for future implementation, and one-third noted that the administrative burden of implementing eSense as a standard of care may be challenging. For individual users, the majority expressed an interest in knowing more about eSense and a desire to use eSense, though most of these did not complete the program in its entirety. Users experienced a significant improvement in sex-related distress with no clinically meaningful change in other outcomes and a high level of satisfaction with eSense. Most also reported doing things differently in their sexual lives after participating in eSense. Conclusions: We found that eSense demonstrates potential as a digital intervention for sexual difficulties for women, particularly concerning its moderate implementation outcomes and also because of its ability to reduce sexual distress. Future studies should address the barriers identified for broader adoption of eSense in clinical settings. Trial Registration: ClinicalTrials.gov NCT05168371; https://clinicaltrials.gov/study/NCT05168371 %M 40132194 %R 10.2196/69828 %U https://www.jmir.org/2025/1/e69828 %U https://doi.org/10.2196/69828 %U http://www.ncbi.nlm.nih.gov/pubmed/40132194 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60369 %T Telemedicine Use During the COVID-19 Pandemic in 8 Countries From the International Sexual Health and Reproductive Health Consortium: Web-Based Cross-Sectional Survey Study %A Tan,Rayner Kay Jin %A Hensel,Devon %A Ivanova,Olena %A Bravo,Raquel Gomez %A Olumide,Adesola %A Adebayo,Emmanuel %A Cleeve,Amanda %A Gesselman,Amanda %A Shah,Sonam Jyoti %A Adesoba,Helen %A Marley,Gifty %A Tang,Weiming %+ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01 MD1, Singapore, 117549, Singapore, 65 91878576, rayner.tan@nus.edu.sg %K COVID-19 %K telemedicine %K sexual and reproductive health %K pandemic %K web-based survey %K sexual health %K reproductive health %K communication technology %K medical education %K contraception %K abortion %K health care delivery %K care %K chronic condition %D 2025 %7 4.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Telemedicine is an important way to fill in the access gap to in-person health care services during challenging times like pandemics. Objective: This study aimed to investigate the role that telemedicine played during the COVID-19 pandemic by multicountry comparison of the use of telemedicine prior to and during the pandemic. Methods: This study analyzes data from the second wave of the International Sexual Health and Reproductive Health study. This included data collected between April 2021 and July 2022 in 8 countries, including Armenia (n=296), Egypt (n=889), Germany (n=138), Moldova (n=311), Nigeria (n=205), Portugal (n=951), Singapore (n=13), and Spain (n=54). This study covered sociodemographics, sexual and reproductive health (SRH), and telemedicine use. Descriptive statistics and multilevel modeling were used to assess the factors influencing the use of telemedicine. Results: Overall, 2857 participants were recruited. Approximately 57.6% (n=1646) of participants had never used telemedicine prior to COVID-19 measures, while 45.9% (n=1311) of participants required health care but reported not using telemedicine services following the introduction of COVID-19 measures. In high-income countries, the most common mode reported was audio-based telemedicine services, with 283 (71.8%) and 417 (73.5%) participants doing so before and during COVID-19, respectively. This was followed by text-based telemedicine services, with 152 (38.6%) and 173 (30.5%) participants doing so before and during COVID-19, respectively. In low- to middle-income countries, many participants also reported using audio-based telemedicine services, with 288 (35.3%) and 237 (40.8%) participants doing so before and during COVID-19, respectively. This was followed by chat-based telemedicine services, with 265 (32.4%) and 217 (37.3%) participants doing so before and during COVID-19, respectively. Multilevel modeling revealed that those who were older (adjusted odds ratio [aOR] 0.99, 95% CI 0.99-1.00) and were in countries with a higher gross domestic product per capita (aOR 0.99, 95% CI 0.98-1.00) were less likely to have ever used telemedicine. Participants who were of male sex assigned at birth (aOR 0.79, 95% CI 0.65-0.96) were less likely to use telemedicine during the pandemic. Participants who perceived that they were worse off financially were more likely to have switched to telemedicine during COVID-19 (aOR 1.39, 95% CI 1.02-1.89) and were more likely to report having a poor or fair experience of telemedicine services (aOR 1.75, 95% CI 1.34-2.29). When sexual orientation was included in the model, nonheterosexual individuals were more likely to ever use telemedicine prior to COVID-19 (aOR 1.35, 95% CI 1.08-1.69), more likely to have used telemedicine during COVID-19 (aOR 1.58, 95% CI 1.24-2.02), and more likely to have switched to telemedicine during COVID-19 (aOR 1.55, 95% CI 1.09-2.21). Conclusions: Telemedicine played a key role in addressing health care needs during the COVID-19 pandemic. Age, sex, economic status, and sexual orientation influenced its use. %M 40053813 %R 10.2196/60369 %U https://www.jmir.org/2025/1/e60369 %U https://doi.org/10.2196/60369 %U http://www.ncbi.nlm.nih.gov/pubmed/40053813 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66702 %T A Comparison of Mobile Social Media Promotion and Volunteer-Driven Strategies for Community Organizations Recruiting Men Who Have Sex with Men for HIV Testing in Zhejiang Province, China: Cross-Sectional Study Based on a Large-Scale Survey %A He,Lin %A Jiang,Shaoqiang %A Jiang,Tingting %A Chen,Wanjun %A Zheng,Jinlei %A Wang,Hui %A Chai,Chengliang %+ , Zhejiang Provincial Center for Disease Control and Prevention, 3399 Bin Sheng Road, Binjiang District, Hangzhou, 310051, China, 86 87115193, chlchai@cdc.zj.cn %K men who have sex with men %K MSM %K internet %K recruit %K HIV testing %K community organization %K strategy %K China %K mobile phone %D 2025 %7 13.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: China has recently implemented a strategy to promote and facilitate community organization involvement in HIV prevention among men who have sex with men (MSM). Although community-based strategies have been shown to increase HIV testing uptake, the relative effectiveness of mobile social media promotion compared with volunteer-driven recruitment remains underexplored. Limited research has investigated how these strategies differentially affect MSM who have not undergone previous HIV testing. Objective: This study aimed to compare the differences between a mobile social media promotion strategy and a volunteer-driven strategy for community organizations to recruit MSM for HIV testing. Methods: A cross-sectional study was conducted from July to December 2023 among MSM in Zhejiang Province, China. Participants aged 16 years with an HIV-negative or unknown status were recruited either through a mobile social media promotion strategy or through a volunteer-driven strategy by a community organization. They completed a questionnaire that collected information on demographics, sexual behavior, and HIV testing history. All participants were tested for HIV after completing the questionnaire. A multivariate logistic regression model was used to identify factors associated with recruitment through mobile social media promotion. Results: The study included 4600 MSM, of whom 3035 (66%) were recruited through the mobile social media strategy. Overall, 1.4% (66/4600) of participants tested positive for HIV, and 18.8% (865/4600) underwent HIV testing for the first time. Recruitment via the mobile social media promotion strategy was significantly associated with several factors: having only gay sexual partners (adjusted OR [aOR] 1.23, 95% CI 1.05-1.45), having more than 2 sexual partners in the past 3 months (aOR 1.74, 95% CI 1.42-2.11), frequently using rush poppers during sex (aOR 1.39, 95% CI 1.14-1.99), having a history of sexually transmitted infections (aOR 1.56, 95% CI 1.02-2.39), having awareness of pre-exposure prophylaxis (aOR 1.42, 95% CI 1.19-1.71), having awareness of postexposure prophylaxis (PEP; aOR 1.49, 95% CI 1.24-1.79), using mail-in HIV self-testing kits (aOR 2.02, 95% CI 1.77-2.31), testing HIV-positive (aOR 2.02, 95% CI 1.10-3.72), and first-time HIV testing (aOR 1.28, 95% CI 1.09-1.52). Conclusions: Community organizations play a critical role in expanding HIV testing and identifying undiagnosed individuals infected with HIV. Compared to the volunteer-driven outreach, mobile social media promotion strategies had a higher proportion of first-time testers and a higher rate of HIV positivity. We recommend prioritizing mobile social media strategies in regions with limited LGBTQ+ organizations or HIV health services to increase HIV testing coverage and interventions among MSM. %M 39946712 %R 10.2196/66702 %U https://www.jmir.org/2025/1/e66702 %U https://doi.org/10.2196/66702 %U http://www.ncbi.nlm.nih.gov/pubmed/39946712 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e63428 %T The Effects of MyChoices and LYNX Mobile Apps on HIV Testing and Pre-Exposure Prophylaxis Use by Young US Sexual Minority Men: Results From a National Randomized Controlled Trial %A Biello,Katie B %A Mayer,Kenneth H %A Scott,Hyman %A Valente,Pablo K %A Hill-Rorie,Jonathan %A Buchbinder,Susan %A Ackah-Toffey,Lucinda %A Sullivan,Patrick S %A Hightow-Weidman,Lisa %A Liu,Albert Y %+ Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Box G-S121-2, Providence, RI, 02912, United States, 1 4018633082, katie_biello@brown.edu %K HIV testing %K adolescents %K sexual minority men %K mobile apps %K pre-exposure prophylaxis %K youths %K randomized controlled trial %K sexual minority %K United States %K efficacy %K LYNX %K MyChoices %K sociodemographic %K behavioral health %K HIV prevention %K HIV infection %K HIV care %K transmission %K public health %K mHealth %K mobile phones %D 2025 %7 5.2.2025 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Young sexual minority men have among the highest rates of HIV in the United States; yet, the use of evidence-based prevention strategies, including routine HIV testing and pre-exposure prophylaxis (PrEP), remains low. Mobile apps have enormous potential to increase HIV testing and PrEP use among young sexual minority men. Objective: This study aims to assess the efficacy of 2 theory- and community-informed mobile apps—LYNX (APT Mobility) and MyChoices (Keymind)—to improve HIV testing and PrEP initiation among young sexual minority men. Methods: Between October 2019 and May 2022, we implemented a 3-arm, parallel randomized controlled trial in 9 US cities to test the efficacy of the LYNX and MyChoices apps against standard of care (SOC) among young sexual minority men (aged 15-29 years) reporting anal sex with cisgender male or transgender female in the last 12 months. Randomization was 1:1:1 and was stratified by site and participant age; there was no masking. The co-primary outcomes were self-reported HIV testing and PrEP initiation over 6 months of follow-up. Results: A total of 381 young sexual minority men were randomized. The mean age was 22 (SD 3.2) years. Nearly one-fifth were Black, non-Hispanic (n=67, 18%), Hispanic or Latino men (n=67, 18%), and 60% identified as gay (n=228). In total, 200 (53%) participants resided in the Southern United States. At baseline, participants self-reported the following: 29% (n=110) had never had an HIV test and 85% (n=324) had never used PrEP. Sociodemographic and behavioral characteristics did not differ by study arm. Compared to SOC (n=72, 59%), participants randomized to MyChoices (n=87, 74%; P=.01) were more likely to have received at least 1 HIV test over 6 months of follow-up; those randomized to LYNX also had a higher proportion of testing (n=80, 70%) but it did not reach the a priori threshold for statistical significance (P=.08). Participants in both MyChoices (n=23, 21%) and LYNX (n=21, 20%) arms had higher rates of starting PrEP compared to SOC (n=19, 16%), yet these differences were not statistically significant (P=.52). Conclusions: In addition to facilitating earlier treatment among those who become aware of their HIV status, given the ubiquity of mobile apps and modest resources required to scale this intervention, a 25% relative increase in HIV testing among young sexual minority men, as seen in this study, could meaningfully reduce HIV incidence in the United States. Trial Registration: ClinicalTrials.gov NCT03965221; https://clinicaltrials.gov/study/NCT03965221 %M 39908084 %R 10.2196/63428 %U https://publichealth.jmir.org/2025/1/e63428 %U https://doi.org/10.2196/63428 %U http://www.ncbi.nlm.nih.gov/pubmed/39908084 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e55275 %T Evaluating Reaction Videos of Young People Watching Edutainment Media (MTV Shuga): Qualitative Observational Study %A Baker,Venetia %A Mulwa,Sarah %A Khanyile,David %A Arnold,Georgia %A Cousens,Simon %A Cawood,Cherie %A Birdthistle,Isolde %+ Faculty of Epidemiology and Population Health, The London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom, 44 020 7636 8636, venetia.baker1@lshtm.ac.uk %K mass media %K edutainment %K adolescents %K sexual health %K HIV prevention %K participatory research %D 2025 %7 31.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Mass media campaigns, particularly edutainment, are critical in disseminating sexual health information to young people. However, there is limited understanding of the authentic viewing experience or how viewing contexts influence engagement with media campaigns. Reaction videos, a popular format in web-based culture in which users film themselves reacting to television shows, can be adapted as a research method for immediate and unfiltered insights into young people’s engagement with edutainment media. Objective: We explored how physical and social context influences young people’s engagement with MTV Shuga, a dramatic television series based on sexual health and relationships among individuals aged 15 to 25 years. We trialed reaction videos as a novel research method to investigate how young people in South Africa experience the show, including sexual health themes and messages, in their viewing environments. Methods: In Eastern Cape, in 2020, purposively selected participants aged 18 to 24 years of an evaluation study were invited to take part in further research to video record themselves watching MTV Shuga episodes with their COVID-19 social bubble. To guide the analysis of the visual and audio data, we created a framework to examine the physical setting, group composition, social dynamics, coinciding activities, and viewers’ spoken and unspoken reactions to the show. We identified patterns within and across groups to generate themes about the nature and role of viewing contexts. We also reflected on the utility of the method and analytical framework. Results: In total, 8 participants recorded themselves watching MTV Shuga episodes in family or friendship groups. Viewings occurred around a laptop in the home (living room or bedroom) and outside (garden or vehicle). In same-age groups, viewers appeared relaxed, engaging with the content through discussion, comments, empathy, and laughter. Intergenerational groups experienced discomfort, with older relatives’ presence causing embarrassment and younger siblings’ distractions interrupting the engagement. Scenes featuring physical intimacy prompted some viewers to hide their eyes or leave the room. While some would prefer watching MTV Shuga alone to avoid the self-consciousness experienced in group settings, others valued the social experience and the lively discussions it spurred. This illustrates varied preferences for consuming edutainment and the factors influencing these preferences. Conclusions: The use of reaction videos for research captured real-time verbal and nonverbal reactions, physical environments, and social dynamics that other methods cannot easily measure. They revealed how group composition, dynamics, settings, and storylines can maximize engagement with MTV Shuga to enhance HIV prevention education. The presence of parents and the camera may alter young people’s behavior, limiting the authenticity of their viewing experience. Still, reaction videos offer a unique opportunity to understand audience engagement with media interventions and promote participatory digital research with young people. %M 39889281 %R 10.2196/55275 %U https://formative.jmir.org/2025/1/e55275 %U https://doi.org/10.2196/55275 %U http://www.ncbi.nlm.nih.gov/pubmed/39889281 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63114 %T Adolescent Youth Survey on HIV Prevention and Sexual Health Education in Alabama: Protocol for a Web-Based Survey With Fraud Protection Study %A Budhwani,Henna %A Yigit,Ibrahim %A Bruce,Josh %A Bond,Christyenne Lily %A Johnson,Andrea %+ , Institute on Digital Health and Innovation, College of Nursing, Florida State University, Innovation Park, Research Building B, 2010 Levy Ave, RM B3400, Tallahassee, FL, 32310, United States, 1 8506443296, hbudhwani@fsu.edu %K HIV knowledge %K PrEP %K pre-exposure prophylaxis %K adolescents %K teenagers %K transgender %K MSM %K men who have sex with men %K south %K bot protection %K bots %K fraud protection %K survey protocol %D 2025 %7 29.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Alabama, the undiagnosed HIV rate is over 20%; youth and young adults, particularly those who identify as sexual and gender minority individuals, are at elevated risk for HIV acquisition and are the only demographic group in the United States with rising rates of new infections. Adolescence is a period marked by exploration, risk taking, and learning, making comprehensive sexual health education a high-priority prevention strategy for HIV and sexually transmitted infections. However, in Alabama, school-based sexual health and HIV prevention education is strictly regulated and does not address the unique needs of sexual and gender minority teenagers. Objective: To understand knowledge gaps related to sexual health, HIV prevention, and pre-exposure prophylaxis (PrEP), we conducted the Alabama Youth Survey with individuals aged 14-17 years. In the survey, we also evaluated young sexual and gender minority individuals’ preferences related to prevention modalities and trusted sources of health information. Methods: Between September 2023 and March 2024, we conducted a web-based survey with 14- to 17-year-olds who are assigned male at birth, are sexually attracted to male youth, and lived in Alabama. Half of the study’s participants were recruited through community partners, the Magic City Acceptance Academy and Magic City Acceptance Center. The other half were recruited on the web via social media. A 7-step fraud and bot detection protocol was implemented and applied to web-based recruitment to reduce the likelihood of collecting false information. Once data are ready, we will compute frequencies for each measure and construct summary scores of scales, such as HIV and PrEP knowledge, to determine internal consistency. Using multivariable logistic regression, we will examine associations between personal characteristics of survey respondents and key constructs using SPSS 29 (IBM Corp) or SAS 9.4 (SAS Institute). Results: Analyses are ongoing (N=206) and will conclude in June 2025. Preliminary results include a sample mean age of 16.21 (SD 0.88) years; about a quarter identified as transgender or gender nonconforming, with 6% stating their gender as a transgender woman. A total of 30% self-reported their race as African American or Black; 12% were Hispanic or Latinx. More than half reported being sexually active in the past 6 months. Primary data analyses will be completed in mid-2025. If findings are promising, results will be used as preliminary data to support the development of an intervention to address knowledge gaps and prevention preferences. Conclusions: If the study is successful, it will yield information on HIV knowledge, PrEP awareness, PrEP preferences, and related outcomes among sexual and gender minority teenagers in Alabama, an underserved, hard-to-reach, but also high-priority population for public health efforts to Ending the HIV Epidemic. International Registered Report Identifier (IRRID): DERR1-10.2196/63114 %M 39880394 %R 10.2196/63114 %U https://www.researchprotocols.org/2025/1/e63114 %U https://doi.org/10.2196/63114 %U http://www.ncbi.nlm.nih.gov/pubmed/39880394 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e58912 %T Pervasive Games for Sexual Health Promotion: Scoping Literature Review %A Rubio,Claudio %A Besoain,Felipe %+ Department of Interactive Visualization and Virtual Reality, Faculty of Engineering, University of Talca, 2 norte #685, Talca, 3460000, Chile, 56 2201687 ext 2687, fbesoain@utalca.cl %K serious games %K promotion %K ubiquitous technologies %K healthy behaviors %K HIV %K sexually transmitted infection %K STI %K scoping review %K mobile phone %D 2025 %7 15.1.2025 %9 Review %J JMIR Serious Games %G English %X Background: Serious games play a fundamental role in promoting safe sexual behaviors. This medium has great potential for promoting healthy behaviors that prevent potential risk factors, such as sexually transmitted infections, and promote adherence to sexual health treatments, such as antiretroviral therapy. The ubiquity of mobile devices enhances access to such tools, increasing the effectiveness of video games as agents of change. Objective: In this scoping review, we aimed to (1) identify the extent to which pervasive games have been used in the field of sexual health, (2) determine the theories used in the design and evaluation of pervasive games for sexual health, (3) identify the methods used to evaluate pervasive games for sexual health, and (4) explore the reported benefits of using pervasive games for sexual health. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) methodology, we conducted a comprehensive literature search in the Web of Science, Scopus, IEEE Xplore, and ACM databases for articles published between January 1, 2000, and August 4, 2024. Included articles were published in English between 2000 and 2024 and involved the design, implementation, or evaluation of a ubiquitous video game focused on promoting safe sexual behaviors, with qualitative and/or quantitative results based on theory-based techniques and ubiquitous technologies. Review articles, conference papers, or books without available data or quantitative or qualitative results were excluded. Results: We screened 521 of 612 articles (85.1%) after removing duplicates. After the title and abstract review, 51 (9.8%) articles were assessed for eligibility, and 30 (5.8%) articles meeting the criteria were studied and evaluated in depth. The results suggested that the use of pervasive video games has a positive impact on promoting safe sexual behaviors. This is enhanced by the effectiveness of theory-based techniques and the use of mobile technologies as developmental factors that drive the gaming experience. The results indicated that this domain is a growing field that should not be ignored. Conclusions: The literature showed that pervasive video games have been effective in promoting safe sexual behaviors. Substantial growth has been seen in scientific community interest in researching this domain; nevertheless, there is still much to work on. In this context, we advocate for the standardization of design, implementation, and experimentation as essential phases in creating video game experiences. These 3 fundamental aspects are critical in the development of video game–based studies to ensure the reproducibility of experiments. %M 39813670 %R 10.2196/58912 %U https://games.jmir.org/2025/1/e58912 %U https://doi.org/10.2196/58912 %U http://www.ncbi.nlm.nih.gov/pubmed/39813670 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e66139 %T Awareness of Sexual Partner’s HIV Status Among Men Who Have Sex With Men in China: Cross-Sec. tional Survey Study %A Ma,Qian %A Jiang,Tingting %A Chen,Wanjun %A Jiang,Shaoqiang %A Zheng,Jinlei %A Wang,Hui %A He,Lin %K human immunodeficiency virus %K HIV %K serostatus disclosure %K pre-exposure prophylaxis %K PrEP %K men who have sex with men %K MSM %K web-based survey %K HIV awareness %D 2025 %7 13.1.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Men who have sex with men (MSM) constitute a significant proportion of individuals living with human immunodeficiency virus. Over the past few years, China has implemented various strategies aimed at increasing the rate of HIV testing and reducing HIV transmission among MSM. Among these, the disclosure of HIV serostatus is an effective prevention strategy. Objective: This study aimed to assess HIV serostatus disclosure and identify factors associated with awareness of sexual partners’ HIV status among MSM to provide a scientific basis for promoting HIV testing and reducing HIV transmission. Methods: A cross-sectional study based on a large-scale web-based survey was conducted among MSM in Zhejiang province, China, between July and December 2023. MSM who were HIV-negative or had an unknown HIV status were recruited from the Sunshine Test, a web-based platform that uses location-based services to provide HIV prevention services. Participants were required to complete a questionnaire on demographic characteristics, sexual behavior, rush popper use, awareness of sexual partners’ HIV status, and knowledge of pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP). A multinomial regression model was used to identify the factors associated with awareness of sexual partners’ HIV status. Results: A total of 7629 MSM participated in the study, with 45.2% (n=3451) being aware, 35.4% (n=2701) being partially aware, and 19.4% (n=1477) being unaware of their sexual partner’s HIV status. The multinomial logistic regression analysis revealed the following results. Compared to those who were unaware of their sexual partner’s HIV status, participants who were students (adjusted odds ratio [aOR] 1.43, 95% CI 1.09‐1.86), had a monthly income of more than US $1400 (aOR 1.36, 95% CI 1.03‐1.80), had insertive anal sex (aOR 1.35, 95% CI 1.12‐1.63), had only male sexual partners (aOR 1.53, 95% CI 1.28‐1.82), had 1 sexual partner in the past 3 months (aOR 2.36, 95% CI 2.01‐2.77), had used condoms for the past 3 months (aOR 1.72, 95% CI 1.33‐2.22), had frequently used rush poppers in the past 3 months (aOR 2.27, 95% CI 1.81‐2.86), were aware of HIV PrEP (aOR 2.04, 95% CI 1.68‐2.48), were aware of HIV PEP (aOR 1.69, 95% CI 1.39‐2.06), used mail reagent self-testing (aOR 1.19, 95% CI 1.04‐1.36), and had previously undergone HIV testing (aOR 1.40, 95% CI 1.16‐1.69) were associated with increased odds of being aware of their sexual partner’s HIV status. Conclusions: Overall, 45.2% of MSM who were HIV-negative or had an unknown status were aware of their sexual partners’ HIV status in China. We suggest strengthening targeted interventions through web-based platforms and gay apps to promote the disclosure of HIV serostatus and reduce HIV transmission among MSM. %R 10.2196/66139 %U https://publichealth.jmir.org/2025/1/e66139 %U https://doi.org/10.2196/66139 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e49860 %T Pornography-Watching Disorder and Its Risk Factors Among Young Adults: Cross-Sectional Survey %A Erdős,Csaba %A Kelemen,Oguz %A Pócs,Dávid %A Paulik,Edit %A Papp,András %A Horváth,Edina %A Golan,Arbel %A Széll,Krisztián %+ Department of Public Health, University of Szeged, Albert Szent-Györgyi Medical School, Dóm tér 10, Szeged, H-6720, Hungary, 36 62545119, erdos.csaba@med.u-szeged.hu %K pornography %K Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition %K DSM-5 %K paraphilia %K satisfaction %K sexual disorder %K sexual education %K online survey %K young adults %K online %K risk factor %K cross sectional %K online survey %K pornography-watching disorder %K social media %K web-based questionnaire %K internet use %K public health %K prevention programs %K sexual well-being %D 2025 %7 8.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The widespread availability of internet-based pornography has led to growing concerns about its impact on mental health, particularly among young adults. Despite increasing recognition of problematic pornography use, standardized diagnostic criteria for pornography addiction are lacking. Objective: This study aimed to address this gap by applying adapted DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) criteria to evaluate “pornography-watching disorder” (PWD) in a large sample of young adults in Hungary. The primary objective was to assess the prevalence of PWD among young adults and identify key risk factors associated with its development using DSM-5 criteria adapted for pornography use. It also aimed to advance the understanding of PWD as a potential behavioral addiction. Methods: A cross-sectional web-based survey was conducted between September and December 2018, targeting young adults aged 18-35 years in Hungary. Participants were recruited through social media and the University of Szeged Albert Szent-Györgyi Medical School’s web page. Of the 9397 respondents, 7187 (76.5%) had previously consumed pornography and were included in the analysis. PWD was measured using 10 statements adapted from the DSM-5 substance use disorder criteria. Multivariable binary logistic regression was used to identify significant predictors of PWD. Results: The prevalence of PWD in the sample was 4.4% (n=315). Frequent pornography consumption was a significant risk factor, with weekly users (odds ratio [OR] 0.45, 95% CI 0.33-0.62, P<.001), monthly users (OR 0.18, 95% CI 0.11-0.28, P<.001), and less than monthly users (OR 0.05, 95% CI 0.03-0.10, P<.001) showing significantly lower odds compared with daily users as a reference category. Male sex was associated with a higher risk (OR 0.53, 95% CI 0.39-0.72, P<.001), as were early exposure to pornography (OR 0.94, 95% CI 0.90-0.98, P=.006), paraphilia (OR 3.95, 95% CI 2.37-6.56, P<.001), dissatisfaction with sexual life (OR 0.94, 95% CI 0.90-0.98, P=.006), difficulty forming personal relationships (OR 0.93, 95% CI 0.88-0.98, P=.005), and strong adherence to religious norms (OR 1.12, 95% CI 1.06-1.19, P<.001). Protective factors included adequate sexual education (OR 0.67, 95% CI 0.53-0.87, P=.02) and residing in the capital (OR 0.52, 95% CI 0.30-0.91, P=.02). The use of an anonymous web-based questionnaire likely reduced the influence of stigma, resulting in more accurate self-reporting of sensitive behaviors. Conclusions: This study is among the first to apply DSM-5 criteria to evaluate PWD, providing important insights into its prevalence and associated risk factors in young adults. The findings highlight the need for standardized diagnostic tools for PWD and suggest targeted interventions, particularly for high-risk groups. These results contribute to the ongoing discussion about whether pornography addiction should be recognized as a distinct behavioral disorder. %M 39778200 %R 10.2196/49860 %U https://www.jmir.org/2025/1/e49860 %U https://doi.org/10.2196/49860 %U http://www.ncbi.nlm.nih.gov/pubmed/39778200 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e65713 %T HIV Pre-Exposure Prophylaxis Cascade Stages Among Men Who Have Sex With Men With Sexually Transmitted Infections in China: Multicenter Cross-Sectional Survey Study %A Yang,Xue %A Kang,Wenting %A Zhang,Zhuoer %A Tang,Houlin %A Zhang,Dapeng %A Sun,Lijun %A Li,Zaicun %A Liu,An %K HIV %K men who have sex with men %K MSM %K pre-exposure prophylaxis %K PrEP %K sexually transmitted infection %K STI %D 2024 %7 30.12.2024 %9 %J JMIR Public Health Surveill %G English %X Background: There is limited literature available regarding the knowledge and use of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) with sexually transmitted infections (STIs). Objective: This study’s objective was to explore the HIV PrEP cascade stages (knowledge, willingness to use, and use) among MSM with STIs in China, in order to promote the implementation of PrEP in this population. Methods: A cross-sectional study was conducted using a respondent-driven sampling method in 19 cities in China, from January to August 2022. The study collected data on demographics, behaviors, and PrEP cascade stages from participants who were not infected with HIV and who self-reported being recently infected with STIs. After using chi-square tests or Fisher exact tests to analyze differences in the knowledge of PrEP, willingness to use PrEP, and PrEP use across different variables, multivariate logistic regression was used to analyze the influences of the different variables on PrEP cascade stages. Results: By August 2022, following screening and exclusion, a total of 1329 MSM were included in the study. Among them, 85.55% (n=1137) had heard of PrEP, 81.57% (n=1084) expressed their willingness to use PrEP if engaging in high-risk HIV behaviors, 70.58% (n=938) had consulted a health care professional about PrEP, 62.98% (n=837) reported having used PrEP, and 46.35% (n=616) possessed a basic understanding of PrEP. The results of multivariate logistic regression analyses showed that the same factors significantly influenced both knowledge of PrEP and willingness to take PrEP, including age, education, marital status, income, condom usage, participation in group sex, HIV status of the most recent male sexual partner, and postexposure prophylaxis (PEP) usage. The factors significantly related to the PrEP use included income, engagement in commercial sex, participation in group sex, HIV status of the most recent male sexual partner, new drug usage, and PEP usage. Conclusions: MSM with STIs were engaged with the PrEP cascade stages at a relatively high rate, but they lacked an understanding of PrEP and underestimated HIV risk. The prevalence of having a basic understanding of PrEP was lower than PrEP usage, and this suboptimal awareness could impede PrEP efficacy and lead to risk compensation. %R 10.2196/65713 %U https://publichealth.jmir.org/2024/1/e65713 %U https://doi.org/10.2196/65713 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52651 %T Promoting Comprehensive Sexuality Education in Pakistan Using a Cocreated Social Media Intervention: Development and Pilot Testing Study %A Ahmed,Furqan %A Ahmad,Ghufran %A Eisinger,Katharina %A Khan,Muhammad Asad %A Brand,Tilman %+ Department of Prevention and Evaluation, Leibniz Institute of Prevention Research and Epidemiology-BIPS, Achterstraße 30, Bremen, 28359, Germany, 49 (0)421 21856913, ahmedf@leibniz-bips.de %K digital health interventions %K sexuality education %K social media %K influencer marketing %K community readiness %D 2024 %7 20.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Comprehensive sexuality education (CSE) is a curriculum-based approach to learning and teaching about sexuality that focuses on the cognitive, emotional, physical, and social domains. The United Nations Educational, Scientific, and Cultural Organization (UNESCO) CSE guideline emphasizes gender issues and is firmly rooted in a human rights–based approach to sexuality. A recent cross-sectional community readiness assessment in Islamabad, Pakistan, found that the community is at the denial or resistant stage when it comes to implementing school-based sexuality education. The reluctance was attributed to a lack of understanding and widespread misconceptions about CSE. Objective: This study aims to use the cocreation process to develop, pilot, and evaluate an intervention based on community readiness level to respond to community resistance by introducing CSE content, its anticipated benefits, and addressing prevalent misconceptions through awareness and promotion content for digital social media platforms. Methods: For the development of the intervention (audio-video content), focus group discussion sessions with key stakeholders were held. Two videos were created in partnership with social media influencers and subsequently shared on Facebook, YouTube, and Instagram. A comprehensive process and performance evaluation of the videos and intervention development phase was conducted to evaluate audience exposure, reach, engagement, demographics, retention, and in-depth insights. The videos were uploaded to social media platforms in June and July 2021, and the data used to assess their performance was obtained in February 2022. Results: With a total reach (number of people who have contact with the videos) of 432,457 and 735,563 for the first and second videos, respectively, on all social media platforms, we concluded that social media platforms provide an opportunity to communicate, promote, and engage with important stakeholders to raise awareness and obtain support for CSE. According to the findings, the public is responsive to CSE promotion content developed for social media platforms, with a total engagement (the number of people who participate in creating, sharing, and using the content) of 11,578. The findings revealed that male viewers predominated across all social media platforms. Punjab province had the largest audience share on Instagram (51.9% for the first video, 52.7% for the second) and Facebook (44.3% for the first video and 48.4% for the second). YouTube had the highest audience retention, with viewers watching an average of 151 seconds (45%) of the first video and 163 seconds (38%) of the second. With a net sentiment score of 0.83 (minimum=−3, maximum=5), end-user participation was also positive, and audience feedback highlighted the reasons for positive and negative criticism. Conclusions: To promote sexuality education in Pakistan, it is vital to overcome opposition through sensitizing the society, and digital social media platforms offer a unique, though underused, chance to do so through reliable influencer marketing. %M 39705696 %R 10.2196/52651 %U https://formative.jmir.org/2024/1/e52651 %U https://doi.org/10.2196/52651 %U http://www.ncbi.nlm.nih.gov/pubmed/39705696 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57244 %T Role of HIV Serostatus Communication on Frequent HIV Testing and Self-Testing Among Men Who Have Sex With Men Who Seek Sexual Partners on the Internet in Zhejiang, China: Cross-Sectional Study %A Chen,Wanjun %A Chen,Lin %A Ni,Zhikan %A He,Lin %A Pan,Xiaohong %+ Department of AIDS and STD Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, Zhejiang, 310051, China, 86 057187115190, xhpan@cdc.zj.cn %K human immunodeficiency virus %K HIV %K men who have sex with men %K HIV serostatus communication %K HIV testing %K HIV self-testing %D 2024 %7 14.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Men who have sex with men (MSM) are increasingly using the internet to meet casual sexual partners. Those who do are at higher risk of sexually transmitted diseases. However, little is known about the rates and associations of frequent HIV testing and self-testing among such MSM. Objective: We aimed to examine HIV serostatus communication and perceptions regarding the HIV infection risk of internet-based partners, along with their associations with frequent HIV testing and self-testing. Methods: A cross-sectional study was conducted between May 2018 and April 2019 in Zhejiang Province, China. The study participants were assigned male at birth, were aged 18 years or older, had had casual sex with another male found through the internet in the last 6 months, and were HIV-negative. Information was obtained on HIV-testing behavior, along with demographic characteristics, HIV-related knowledge, internet-based behaviors, sexual behaviors with male partners, HIV serostatus communication, and perceptions regarding the HIV infection risk of internet-based partners. Uni- and multivariate logistic regression models were used to measure the associations of HIV testing and self-testing. Results: The study recruited 281 individuals who had sought casual sexual partners through the internet during the previous 6 months. Of the participants, 61.9% (174/281) reported frequent HIV testing (twice or more frequently) and 50.9% (119/234; 47 with missing values) reported frequent HIV self-testing. MSM who always or usually communicated about the HIV serostatus of internet-based partners in the previous 6 months had 3.12 (95% CI 1.76-5.52) and 2.45 (95% CI 1.42-4.22) times higher odds of being frequently tested or self-tested for HIV, respectively, compared with those who communicated about this issue minimally or not at all. Conclusions: There remains a need to improve the frequency of HIV testing and self-testing among internet-based MSM. HIV serostatus communication should be improved within the context of social networking applications to promote frequent HIV testing among internet-based MSM, especially for those who communicated about this issue minimally or not at all. %M 39541583 %R 10.2196/57244 %U https://formative.jmir.org/2024/1/e57244 %U https://doi.org/10.2196/57244 %U http://www.ncbi.nlm.nih.gov/pubmed/39541583 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e62801 %T Preferences for Starting Daily, On-Demand, and Long-Acting Injectable HIV Preexposure Prophylaxis Among Men Who Have Sex With Men in the United States (2021-2022): Nationwide Online Cross-Sectional Study %A Islek,Duygu %A Sanchez,Travis %A Glick,Jennifer L %A Jones,Jeb %A Rawlings,Keith %A Sarkar,Supriya %A Sullivan,Patrick S %A Vannappagari,Vani %+ Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 4704399053, duyguislek@hotmail.com %K preexposure prophylaxis %K men who have sex with men %K gay %K HIV %K HIV prevention %K United States %K long-acting %K injectable %K sociodemographic %K illicit drug use %K adherence %K sexually transmitted infection %K reproductive health %K sexual behavior %K HIV treatment %D 2024 %7 13.11.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Long-acting (LA) injectable preexposure prophylaxis (PrEP) and on-demand PrEP may improve overall PrEP uptake among men who have sex with men (MSM), but little is understood about the PrEP option preferences of MSM in practical scenarios where they may choose between various PrEP options. Objective: This study aims to examine the preferences for starting various PrEP options among a US nationwide online convenience sample of MSM from September 2021 to February 2022. Methods: Participants reporting no prior HIV diagnosis were provided brief descriptions of each PrEP option and were asked, “If [PrEP option] were available from your local doctor and you could access it for free, would you go to your doctor in the next month to start [PrEP option]?” Those who said “yes” to multiple options were asked to rank them in order of preference. MSM currently taking daily oral (DO) PrEP were asked whether they would switch to on-demand or LA PrEP options. Log binomial models were created to examine the association between willingness to start or switch to on-demand and LA PrEP with various sociodemographic and behavioral factors. Results: In the analytic sample (N=7760), among the participants who did not use any PrEP in the past 12 months (n=5108, 66%), 54% (n=2445) reported willingness to start at least 1 PrEP option and 41% (n=1845) of participants showed interest in starting multiple PrEP options. Overall, the highest willingness was reported for on-demand PrEP (n=2235, 44%), followed by DO PrEP (n=2174, 43%) and LA PrEP (n=1482, 29%). LA PrEP was ranked first among those interested in multiple options. Characteristics associated with ranking LA PrEP as a first option to start PrEP versus DO or on-demand PrEP were region of residence (residing in the West vs Northeast), report of sexually transmitted infection diagnosis in the past year, report of illicit drug use other than marijuana in the past year, and prior awareness of LA PrEP. Among current DO PrEP users (n=2379, 31%), 58% (n=1386) were willing to switch to on-demand or LA PrEP, and LA PrEP was ranked first among participants who were open to switching to both options. Willingness to switch to LA PrEP was higher among those who used illicit drugs other than marijuana in the past year, who heard of LA PrEP prior to the survey, and those who took 15 or less doses of oral PrEP in the last 30 days. Conclusions: LA PrEP was the highest-ranked option among most MSM who were willing to try multiple options or switch from DO PrEP. These findings highlight that LA PrEP might fill coverage gaps among MSM who use illicit drugs, have had a recent sexually transmitted infection diagnosis, and have less than optimal DO PrEP adherence. %M 39536313 %R 10.2196/62801 %U https://publichealth.jmir.org/2024/1/e62801 %U https://doi.org/10.2196/62801 %U http://www.ncbi.nlm.nih.gov/pubmed/39536313 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e63211 %T Awareness and Uptake of HIV Preexposure Prophylaxis and Postexposure Prophylaxis Among College Students With Sexual Experiences: Institutional-Based Cross-Sectional Study %A Xu,Junfang %A Xu,Ke %A Juma,Omar %A Zhang,Xingliang %A Lian,Zhujun %K HIV %K preexposure prophylaxis %K postexposure prophylaxis %K college students %K China %D 2024 %7 6.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Evidence has shown that HIV prevalence among young people, especially college students, has increased disproportionately. Preexposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) are two of the most effective ways to prevent HIV, which are vital for college students with sexual experiences who have sexual risks. Objective: To provide evidence for effective intervention to reduce the risk of HIV infection among young students, this study aimed to analyze the awareness and uptake of HIV PrEP and PEP among college students with sexual experiences. Methods: An institutional-based cross-sectional study design was used to collect data through an electronic questionnaire from college students in 5 colleges located in Zhejiang Province. A total of 21,962 college students were investigated, of which 2605 students with sexual experiences were included in the data analysis with the following information collected: sociodemographic characteristics, awareness and uptake of HIV PrEP and PEP, sexual behaviors, and HIV tests. Binary logistic regression analysis was used to explore the factors on seeking PrEP and PEP. Results: The average age of college students with sexual experiences was 21.25 (SD 2.75) years. Overall, 61.4% (n=1600) of the participants were aware of PrEP, and 53.0% (n=1380) of them were aware of PEP. Moreover, 5.6% (n=146) of them have sought PrEP or/and PEP, and 89.1% (n=2321) have not sought PrEP or PEP. College students who had more than 6 sexual partners, have always had unprotected sex, have subjective perceived risk behavior, and undergo HIV testing were more likely to seek PrEP or/and PEP. The main ways for the participants to learn PrEP and PEP were through school clubs, the internet, and the Centers for Disease Control and Prevention. Moreover, senior students and those who had not undergone an HIV test had a lower likelihood of seeking PrEP and PEP. College students who did not have risky sexual behaviors (odds ratio 0.468, P=.004) and homosexual students (odds ratio 0.318, P=.03) were more likely not to seek PEP. Conclusions: College students with sexual experiences rarely seek PrEP and PEP, with a relatively low awareness of PrEP and PEP. It is very important to increase the knowledge and uptake of PrEP and PEP by educational and behavioral interventions among young students at risk for HIV infection. %R 10.2196/63211 %U https://publichealth.jmir.org/2024/1/e63211 %U https://doi.org/10.2196/63211 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e60012 %T Chemsex Session Typologies and Associated Sociodemographic Factors in Sexual Minority Men: Latent Class Analysis From a Cultural Perspective Using a Cross-Sectional Survey %A Gonzalez-Recio,Paule %A Crossin,Rose %A Donat,Marta %A Palma,David %A Guede Caballero,David %A Moreno-Garcia,Sara %A Guerras,Juan Miguel %A Belza,María José %K chemsex %K sexualized drug use %K sexual minority men %K typologies %K latent class analysis %K social determinants of health %K culture %K party and play %K sociodemographics %K sexual minority %K cross-sectional study %K homogeneity %K SMM %K Spain %K drug use %K Poisson regression %K migrants %K public health %K LGBTQ %K teenagers %K adults %K HIV %K sexual health %K sexual risk behavior %K gay %D 2024 %7 27.9.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Chemsex prevalence is still not well known, and both the lack of homogeneity and cultural component of chemsex practices are usually overlooked. Objective: This study aims to estimate the proportion of sexual minority men (SMM) engaging in chemsex sessions, while understanding the cultural dimension of chemsex, and to analyze distinct session typologies with potential risk differences and the sociodemographic factors associated with engaging in them. Methods: A total of 5711 SMM residing throughout Spain participated in an anonymous web-based survey that assessed chemsex session engagement and characteristics, drug use, and sociodemographic variables. We measured the association of sociodemographic factors with engaging in chemsex sessions by calculating adjusted prevalence ratios, using multivariate Poisson regression analysis. Chemsex typologies were analyzed using latent class analysis, and sociodemographic factors were associated with the different risk classes. Results: Our results determined that 21.1% (1205/5711; 95% CI 20.0%‐22.1%) of SMM engaged in chemsex sessions during their lifetime. Participating in sessions was significantly associated with being a migrant, not having a comfortable financial situation, openly living their sexuality, residing in bigger municipalities, older age, using steroids, and living with HIV (adjusted prevalence ratio: range 1.17-2.01; all P values <.05). Three typologies of sessions with different risks were identified with latent class analysis, with 23.2% of SMM engaging in sessions taking part in higher-risk ones, which was associated with younger age, using steroids, living in bigger municipalities, openly living their sexuality, and living with HIV, compared to SMM engaging in lower-risk sessions (odds ratio: range 2.75-4.99). Conclusions: Chemsex is relatively common among SMM in Spain, but it is important to differentiate typologies of sessions with varying risks, and the proportion of SMM engaging in high-risk sessions is low. Chemsex is highly associated with sociodemographic factors. Chemsex should be prioritized in public health programs, which should consider the different forms of sessions with their varying risks and prevalence, while also considering the cultural dimension inherent to chemsex. %R 10.2196/60012 %U https://publichealth.jmir.org/2024/1/e60012 %U https://doi.org/10.2196/60012 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54215 %T Racial and Ethnic Differences in Mobile App Use for Meeting Sexual Partners Among Young Men Who Have Sex With Men and Young Transgender Women: Cross-Sectional Study %A Risher,Kathryn %A Janulis,Patrick %A McConnell,Elizabeth %A Motley,Darnell %A Serrano,Pedro Alonso %A Jackson,Joel D %A Brown,Alonzo %A Williams,Meghan %A Mendez,Daniel %A Phillips II,Gregory %A Melville,Joshua %A Birkett,Michelle %K young men who have sex with men and young transgender women %K hookup or dating apps %K sexual partners %K race and ethnicity %K race %K ethnicity %K mobile app %K racial bias %K sexual partner %K young %K transgender %K Chicago %K United States %K online %K dating app %K racism %K analysis %K youth %K social network %K hookup %K black %K Hispanic %K Tinder %K Grindr %K Scruff %K sexual mixing patterns %K sexual patterns %K sexual pattern %K sexually transmitted infection %K sexually transmitted infections %D 2024 %7 11.9.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Young men who have sex with men and young transgender women (YMSM-YTW) use online spaces to meet sexual partners with increasing regularity, and research shows that experiences of racism online mimics the real world. Objective: We analyzed differences by race and ethnicity in web-based and mobile apps used to meet sexual partners as reported by Chicago-based YMSM-YTW in 2016‐2017. Methods: A racially and ethnically diverse sample of 643 YMSM-YTW aged 16‐29 years were asked to name websites or mobile apps used to seek a sexual partner in the prior 6 months, as well as provide information about sexual partnerships from the same period. We used logistic regression to assess the adjusted association of race and ethnicity with (1) use of any website or mobile apps to find a sexual partner, (2) use of a “social network” to find a sexual partner compared to websites or mobile apps predominantly used for dating or hookups, (3) use of specific websites or mobile apps, and (4) reporting successfully meeting a sexual partner online among website or mobile app users. Results: While most YMSM-YTW (454/643, 70.6%) used websites or mobile apps to find sexual partners, we found that Black non-Hispanic YMSM-YTW were significantly less likely to report doing so (comparing White non-Hispanic to Black non-Hispanic: adjusted odds ratio [aOR] 1.74, 95% CI 1.10‐2.76). Black non-Hispanic YMSM-YTW were more likely to have used a social network site to find a sexual partner (comparing White non-Hispanic to Black non-Hispanic: aOR 0.20, 95% CI 0.11‐0.37), though this was only reported by one-third (149/454, 32.8%) of all app-using participants. Individual apps used varied by race and ethnicity, with Grindr, Tinder, and Scruff being more common among White non-Hispanic YMSM-YTW (93/123, 75.6%; 72/123, 58.5%; and 30/123, 24.4%, respectively) than among Black non-Hispanic YMSM-YTW (65/178, 36.5%; 25/178, 14%; and 4/178, 2.2%, respectively) and Jack’d and Facebook being more common among Black non-Hispanic YMSM-YTW (105/178, 59% and 64/178, 36%, respectively) than among White non-Hispanic YMSM-YTW (6/123, 4.9% and 8/123, 6.5%, respectively). Finally, we found that while half (230/454, 50.7%) of YMSM-YTW app users reported successfully meeting a new sexual partner on an app, Black non-Hispanic YMSM-YTW app users were less likely to have done so than White non-Hispanic app users (comparing White non-Hispanic to Black non-Hispanic: aOR 2.46, 95% CI 1.50‐4.05). Conclusions: We found that Black non-Hispanic YMSM-YTW engaged with websites or mobile apps and found sexual partners systematically differently than White non-Hispanic YMSM-YTW. Our findings give a deeper understanding of how racial and ethnic sexual mixing patterns arise and have implications for the spread of sexually transmitted infections among Chicago’s YMSM-YTW. %R 10.2196/54215 %U https://publichealth.jmir.org/2024/1/e54215 %U https://doi.org/10.2196/54215 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48453 %T Evaluating the Impact of a Dutch Sexual Health Intervention for Adolescents: Think-Aloud and Semistructured Interview Study %A Metz,Gido %A Thielmann,Rosa R L C %A Roosjen,Hanneke %A Crutzen,Rik %+ Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, PO Box 616, Maastricht, 6200 MD, Netherlands, 31 433882435, g.metz@maastrichtuniversity.nl %K web-based intervention %K eHealth %K engagement %K potential impact %K mixed methods %K evaluation %K acyclic behavior change diagram %K web analytics %K think-aloud method %K web-based %K user %K chlamydia %K behavior change %D 2024 %7 11.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Engagement with and the potential impact of web-based interventions is often studied by tracking user behavior with web analytics. These metrics do provide insights into how users behave, but not why they behave as such. Objective: This paper demonstrates how a mixed methods approach consisting of (1) a theoretical analysis of intended use, (2) a subsequent analysis of actual use, and (3) an exploration of user perceptions can provide insights into engagement with and potential impact of web-based interventions. This paper focuses on the exploration of user perceptions, using the chlamydia page of the Dutch sexual health intervention, Sense.info, as a demonstration case. This prevention-focused platform serves as the main source of sexual and reproductive health information (and care if needed) for young people aged 12-25 years in the Netherlands. Methods: First, acyclic behavior change diagrams were used to theoretically analyze the intended use of the chlamydia page. Acyclic behavior change diagrams display how behavior change principles are applied in an intervention and which subbehaviors and target behaviors are (aimed to be) influenced. This analysis indicated that one of the main aims of the page is to motivate sexually transmitted infection (STI) testing. Second, the actual use of the chlamydia page was analyzed with the web analytics tool Matomo. Despite the page’s aim of promoting STI testing, a relatively small percentage (n=4948, 14%) of the 35,347 transfers from this page were to the STI testing page. Based on these two phases, preliminary assumptions about use and impact were formulated. Third, to further explore these assumptions, a study combining the think-aloud method and semistructured interviews was executed with 15 young individuals aged 16-25 (mean 20, SD 2.5) years. Template analysis was used to analyze interview transcripts. Results: Participants found the information on the Sense.info chlamydia page reliable and would visit it mostly for self-diagnosis purposes if they experienced potential STI symptoms. A perceived facilitator for STI testing was the possibility to learn about the symptoms and consequences of chlamydia through the page. Barriers included an easily overlooked link to the STI testing page and the use of language not meeting the needs of participants. Participants offered suggestions for lowering the threshold for STI testing. Conclusions: The mixed methods approach used provided detailed insights into the engagement with and potential impact of the Sense.info chlamydia page, as well as strategies to further engage end users and increase the potential impact of the page. We conclude that this approach, which triangulates findings from theoretical analysis with web analytics and a think-aloud study combined with semistructured interviews, may also have potential for the evaluation of web-based interventions in general. %M 39259573 %R 10.2196/48453 %U https://formative.jmir.org/2024/1/e48453 %U https://doi.org/10.2196/48453 %U http://www.ncbi.nlm.nih.gov/pubmed/39259573 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e56958 %T Drug Use Behaviors and the Risk of HIV Infection Among Drug Users in China Between 2014 and 2021: Cross-Sectional Study %A Lv,Jiaqi %A Jia,Yangfan %A Yan,Chunhui %A Zhang,Xingliang %A Xu,Ke %A Xu,Junfang %K drug user %K drug-using behavior %K HIV %K behaviors %K behavior %K risky %K sexual %K drug %K drugs %K substance %K STI %K STD %K sexual transmission %K sexually transmitted %K association %K associations %K correlation %K correlations %K sentinel %K surveillance %K sexually transmitted infection %K sexually transmitted disease %D 2024 %7 10.9.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Drug users are a high-risk group for HIV infection and are prominent HIV carriers. Given the emergence of new drugs, we explored current drug-using behaviors, HIV infections, and the correlation between drug-using behaviors and HIV infection risk among drug users from 2014 to 2021. Objective: We aimed to identify the prevalence of HIV infection risk among drug users and explore drug use behaviors based on the updated data, which could provide evidence for the precision of HIV prevention strategies among drug users. Methods: Data were collected from sentinel surveillance of drug users in rehabilitation centers and communities in Hangzhou (2014‐2021), including sociodemographic characteristics, HIV awareness, drug use, risky sexual behaviors, and HIV infection status. Multivariate logistic regression was used to identify the factors influencing HIV infection and risky sexual behaviors among drug users. Results: In total, 5623 drug users (male: n=4734, 84.19%; age: mean 38.38, SD 9.94 years) were included. New drugs dominated among the participants (n=3674, 65.34%). The main mode of drug use was noninjection (n=4756, 84.58%). Overall, for 27.45% (n=1544) of injected drugs in the last month before the investigation, the average daily injection frequency was 3.10 (SD 8.24). Meanwhile, 3.43% of participants shared needles. The incidence of sexual behaviors after drug use was 33.13% (n=1863), with 35.75% (n=666) of them using a condom in the last time. Overall, 116 participants tested positive for HIV antibodies (infection rate=2.06%). New drug users exhibited more postuse sexual behaviors than traditional drug users (odds ratio [OR] 7.771, 95% CI 6.126‐9.856; P<.001). HIV-aware drug users were more likely to engage in risky sexual behaviors (OR 1.624, 95% CI 1.152‐2.291; P=.006). New-type drug users were more likely to engage in unprotected sexual behavior (OR 1.457, 95% CI 1.055‐2.011; P=.02). Paradoxically, drug users with greater HIV awareness were more prone to engaging in unprotected sexual behavior (OR 5.820, 95% CI 4.650‐7.284; P<.001). Women engaged less in unprotected sex than men (OR 0.356, 95% CI 0.190‐0.665; P=.001). HIV rates were higher among injecting drug users (OR 2.692, 95% CI 0.995‐7.287; P=.04) and lower among drug users who used condoms during recent sex than those who did not (OR 0.202, 95% CI 0.076‐0.537; P=.001). Higher education levels were associated with higher HIV infection rates. However, there was no significant correlation between HIV cognition level and HIV infection. Conclusions: New drug types and noninjection were the main patterns in last 7 years. Using new types of drugs, rather than traditional drugs, was associated with an increased risk of HIV infection. Injection drug use was a risk factor for HIV infection. HIV awareness among drug users was high, but the incidence of risky sexual behaviors remained high. Therefore, it is important to promote the behavioral transformation of high-risk populations from cognition to attitude, and then to taking protective measures. %R 10.2196/56958 %U https://publichealth.jmir.org/2024/1/e56958 %U https://doi.org/10.2196/56958 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e59095 %T Characteristics of and Factors Associated With Partner Service Uptake Cascade Among People With Newly Reported HIV/AIDS Diagnoses in Southeastern China in 2022: Cross-Sectional Survey %A Jiang,Jun %A Chen,Lin %A Cheng,Wei %A Chen,Wanjun %A Yang,Jiezhe %A Xu,Yun %A Zhou,Xin %A Pan,Xiaohong %A Chai,Chengliang %+ Zhejiang Provincial Center for Disease and Control and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou, 310051, China, 86 057187115193, chlchai@cdc.zj.cn %K HIV/AIDS %K partner service %K testing %K nonmarital partnership %K heterosexual %K homosexual %K China %D 2024 %7 9.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: HIV notification and testing integrated into partner service (PS) practices among HIV-positive individuals have been proven to be an efficient approach for case finding, although it remains a weak link in China. Although nonmarital sexual activities accounted for a large proportion of newly diagnosed HIV-positive cases in China, little is known about PS uptake and associated factors within nonmarital partnerships. Objective: This study aimed to describe HIV PS utilization and its associated factors among HIV-positive individuals with nonmarital sexual partners. Methods: We recruited newly diagnosed HIV-positive individuals who had nonmarital sexual partners in 2022 in Zhejiang Province and offered them PS. We described the PS uptake cascade within sexual partner categories and analyzed the associated factors with 3 primary outcomes from the participants’ perspective: nonmarital partner enumeration, HIV testing, and HIV positivity. Results: In this study, 3509 HIV-positive individuals were recruited as participants, and they enumerated 2507 nonmarital sex partners (2507/14,556, 17.2% of all nonmarital sex partners) with contact information. Among these, 43.1% (1090/2507) underwent an HIV test, with an HIV-positive rate of 28.3% (309/1090). Heterosexual commercial partners were the least likely of being enumerated (441/4292, 10.3%) and had the highest HIV-positive rate (40/107, 37.4%). At the participant level, 48.1% (1688/3509) of the participants enumerated at least one nonmarital sex partner with contact information, 52.7% (890/1688) had a sex partner tested for HIV, and 31% (276/890) had at least one nonmarital sex partner who tested positive. Multivariate analysis indicated that gender and transmission route were associated with both nonmarital sex partner enumeration and HIV testing. Age and occupation were associated with nonmarital sex partner enumeration and HIV positivity. Compared with participants who had no regular nonmarital sex partner, those who had a regular nonmarital sex partner were more likely to enumerate nonmarital sex partners (adjusted odds ratio [aOR] 3.017, 95% CI 2.560-3.554), have them get tested for HIV (aOR 1.725, 95% CI 1.403-2.122), and have an HIV-positive nonmarital sex partner (aOR 1.962, 95% CI 1.454-2.647). Conclusions: The percentage of partner enumeration was low, and HIV testing rate was moderate among nonmarital partnerships of HIV-positive individuals. More efforts should be made to improve PS practices among HIV-positive individuals and address the gap in partner enumeration, especially for heterosexual commercial nonmarital partnerships. Additionally, enhancing PS operational skills among health care personnel could increase the overall efficiency of PS uptake in China. %M 39250196 %R 10.2196/59095 %U https://publichealth.jmir.org/2024/1/e59095 %U https://doi.org/10.2196/59095 %U http://www.ncbi.nlm.nih.gov/pubmed/39250196 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49362 %T Comparing the Efficacy of 2 WeChat Mini Programs in Reducing Nonmarital Heterosexual Contact by Male Factory Workers: Randomized Controlled Trial %A Zhang,Kechun %A Cao,Bolin %A Fang,Yuan %A Liang,Xue %A Ye,Danhua %A Chen,Ya Qi %A Zhong,Ruilan %A Cao,He %A Hu,Tian %A Li,Ting %A Cai,Yong %A Zou,Huachun %A Wang,Zixin %+ Centre for Health Behaviours Research, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, 30-32 Ngan Shing Street, Hong Kong, China (Hong Kong), 852 22528740, wangzx@cuhk.edu.hk %K nonmarital heterosexual contacts %K male factory workers %K WeChat mini program %K randomized controlled trial %K China %K mobile phone %D 2024 %7 9.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Male factory workers in China are vulnerable to HIV transmission. Commercial and nonmarital noncommercial contacts are the driving forces of heterosexual HIV transmission among male factory workers in China. There is a lack of effective HIV interventions for male factory workers in China. Objective: The primary objective of this randomized controlled trial was to compare the efficacy of an enhanced versus the standard version of a WeChat mini program in reducing sexual intercourse with nonregular female sex partners and female sex workers among male factory workers in Shenzhen, China. Methods: A nonblinded 2-arm parallel randomized controlled trial was conducted between December 2021 and April 2023. Participants were adult male factory workers in Shenzhen who had access to a smartphone and WeChat. Those who had oral or anal sex with a man or self-reported as HIV positive were excluded. A total of 247 participants were randomly assigned to the intervention group (n=125, 50.6%) or the control group (n=122, 49.4%); 221 (89.5%) and 220 (89.1%) completed follow-up surveys at T1 (6 months after completion of the interventions) and T2 (6 months after T1). Participants in the control group had access to the standard WeChat mini program that provided basic HIV-related knowledge and information about local free HIV testing services. Participants in the intervention group had access to the enhanced WeChat mini program. The enhanced mini program covered all the information in the standard mini program. In addition, the enhanced mini program assessed users’ behaviors and invited users to watch different web-based videos on reducing nonmarital sexual contacts and promoting HIV testing based on their behavioral characteristics at months 0 and 1. The videos were developed based on in-depth interviews with male factory workers. Intention-to-treat analysis was used for outcome analyses. Multiple imputation was used to replace missing outcome values at T1 and T2. Results: At T1, fewer participants in the intervention group reported sexual intercourse with a nonregular female sex partner in the past 6 months compared with the control group (1/125, 0.8% vs 8/122, 6.6%; relative risk=0.12, 95% CI 0.02-0.96; P=.02). However, there were no between-group differences in sexual intercourse with a nonregular female sex partner at T2 (10/125, 8% vs 14/122, 11.5%; P=.36) or sexual intercourse with a female sex worker at T1 (2/125, 1.6% vs 2/122, 1.6%; P=.98) or T2 (8/125, 6.4% vs 8/122, 6.6%; P=.96). Conclusions: The enhanced WeChat mini program was more effective than the standard WeChat mini program in reducing sexual intercourse with nonregular female sex partners among male factory workers in the short term but not in the longer term. Improvements should be made to the WeChat mini program before implementation. Trial Registration: ClinicalTrials.gov NCT05811611; https://clinicaltrials.gov/study/NCT05811611 %M 39250213 %R 10.2196/49362 %U https://www.jmir.org/2024/1/e49362 %U https://doi.org/10.2196/49362 %U http://www.ncbi.nlm.nih.gov/pubmed/39250213 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59963 %T Development of an mHealth App by Experts for Queer Individuals’ Sexual-Reproductive Health Care Services and Needs: Nominal Group Technique Study %A Seretlo,Raikane James %A Smuts,Hanlie %A Mokgatle,Mathildah Mpata %+ Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Molotlegi St, Ga-Rankuwa Zone 1, Ga-Rankuwa, Tshwane, 0208, South Africa, 27 012 521 4111, Raikane.seretlo@smu.ac.za %K experts %K mobile health app %K mHealth app %K digital health care %K telemedicine %K digital innovation %K sexual-reproductive health care services and needs %K lesbian, gay, bisexual, transgender, queer, intersex, asexual individuals, and related identities %K LBQTQIA+ %K queer individuals %K nominal group technique %K mobile phone %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Queer individuals continue to be marginalized in South Africa; they experience various health care challenges (eg, stigma, discrimination, prejudice, harassment, and humiliation), mental health issues (eg, suicide and depression), and an increased spread of HIV or AIDS and sexually transmitted illnesses (STIs; chlamydia, gonorrhea, and syphilis). Mobile health (mHealth) apps have the potential to resolve the health care deficits experienced by health care providers when managing queer individuals and by queer individuals when accessing sexual-reproductive health care services and needs, thus ensuring inclusivity and the promotion of health and well-being. Studies have proven that the nominal group technique (NGT) could be used to solve different social and health problems and develop innovative solutions. This technique ensures that different voices are represented during decision-making processes and leads to robust results. Objective: This study aims to identify important contents to include in the development of an mHealth app for addressing the sexual-reproductive health care services and needs of queer individuals. Methods: We invited a group of 13 experts from different fields, such as researchers, queer activists, sexual and reproductive health experts, private practicing health care providers, innovators, and private health care stakeholders, to take part in a face-to-face NGT. The NGT was conducted in the form of a workshop with 1 moderator, 2 research assistants, and 1 principal investigator. The workshop lasted approximately 2 hours 46 minutes and 55 seconds. We followed and applied 5 NGT steps in the workshop for experts to reach consensus. The main question that experts were expected to answer was as follows: Which content should be included in the mHealth app for addressing sexual-reproductive health care services and needs for queer individuals? This question was guided by user demographics and background, health education and information, privacy and security, accessibility and inclusivity, functionality and menu options, personalization and user engagement, service integration and partnerships, feedback and improvement, cultural sensitivity and ethical considerations, legal and regulatory compliance, and connectivity and data use. Results: Overall, experts voted and ranked the following main icons: menu options (66 points), privacy and security (39 points), user engagement (27 points), information hub (26 points), user demographics (20 points), connectivity (16 points), service integration and partnerships (10 points), functionalities (10 points), and accessibility and inclusivity (7 points). Conclusions: Conducting an NGT with experts from different fields, possessing vast skill sets, knowledge, and expertise, enabled us to obtain targeted data on the development of an mHealth app to address sexual-reproductive health care services and needs for queer individuals. This approach emphasized the usefulness of a multidisciplinary perspective to inform the development of our mHealth app and demonstrated the future need for continuity in using this approach for other digital health care innovations and interventions. %M 39167434 %R 10.2196/59963 %U https://formative.jmir.org/2024/1/e59963 %U https://doi.org/10.2196/59963 %U http://www.ncbi.nlm.nih.gov/pubmed/39167434 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e58009 %T Integrating Sexual and Reproductive Health Equity Into Public Health Goals and Metrics: Comparative Analysis of Healthy People 2030’s Approach and a Person-Centered Approach to Contraceptive Access Using Population-Based Data %A Gomez,Anu Manchikanti %A Reed,Reiley Diane %A Bennett,Ariana H %A Kavanaugh,Megan %+ School of Social Welfare, University of California, Berkeley, 120 Haviland Hall MC 7400, Berkeley, CA, 94720-7400, United States, 1 510 642 0722, anugomez@berkeley.edu %K contraception %K public health objectives %K public health metrics %K person-centeredness %K sexual and reproductive health equity %D 2024 %7 20.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Healthy People initiative is a national effort to lay out public health goals in the United States every decade. In its latest iteration, Healthy People 2030, key goals related to contraception focus on increasing the use of effective birth control (contraceptive methods classified as most or moderately effective for pregnancy prevention) among women at risk of unintended pregnancy. This narrow focus is misaligned with sexual and reproductive health equity, which recognizes that individuals’ self-defined contraceptive needs are critical for monitoring contraceptive access and designing policy and programmatic strategies to increase access. Objective: We aimed to compare 2 population-level metrics of contraceptive access: a conventional metric, use of contraceptive methods considered most or moderately effective for pregnancy prevention among those considered at risk of unintended pregnancy (approximating the Healthy People 2030 approach), and a person-centered metric, use of preferred contraceptive method among current and prospective contraceptive users. Methods: We used nationally representative data collected in 2022 to construct the 2 metrics of contraceptive access; the overall sample included individuals assigned female at birth not using female sterilization or otherwise infecund and who were not pregnant or trying to become pregnant (unweighted N=2760; population estimate: 43.9 million). We conducted a comparative analysis to examine the convergence and divergence of the metrics by examining whether individuals met the inclusion criteria for the denominators of both metrics, neither metric, only the conventional metric, or only the person-centered metric. Results: Comparing the 2 approaches to measuring contraceptive access, we found that 79% of respondents were either included in or excluded from both metrics (reflecting that the metrics converged when individuals were treated the same by both). The remaining 21% represented divergence in the metrics, with an estimated 5.7 million individuals who did not want to use contraception included only in the conventional metric denominator and an estimated 3.5 million individuals who were using or wanted to use contraception but had never had penile-vaginal sex included only in the person-centered metric denominator. Among those included only in the conventional metric, 100% were content nonusers—individuals who were not using contraception, nor did they want to. Among those included only in the person-centered metric, 68% were currently using contraception. Despite their current or desired contraceptive use, these individuals were excluded from the conventional metric because they had never had penile-vaginal sex. Conclusions: Our analysis highlights that a frequently used metric of contraceptive access misses the needs of millions of people by simultaneously including content nonusers and excluding those who are using or want to use contraception who have never had sex. Documenting and quantifying the gap between current approaches to assessing contraceptive access and more person-centered ones helps clearly identify where programmatic and policy efforts should focus going forward. %M 39163117 %R 10.2196/58009 %U https://publichealth.jmir.org/2024/1/e58009 %U https://doi.org/10.2196/58009 %U http://www.ncbi.nlm.nih.gov/pubmed/39163117 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57600 %T Assessment of Sexual Violence Risk Perception in Men Who Have Sex With Men: Proposal for the Development and Validation of “G-Date” %A Angelone,D J %A Mitchell,Damon %A Wells,Brooke %A Korovich,Megan %A Nicoletti,Alexandra %A Fife,Dustin %+ Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, United States, 1 856 256 4500 ext 53780, angeloned@rowan.edu %K sexual violence %K risk perception %K laboratory analog %K dating and sexual networking apps %K men who have sex with men %D 2024 %7 19.8.2024 %9 Proposal %J JMIR Res Protoc %G English %X Background: Sexual violence (SV) is a significant problem for sexual minorities, including men who have sex with men (MSM). The limited research suggests SV is associated with a host of syndemic conditions. These factors tend to cluster and interact to worsen one another. Unfortunately, while much work has been conducted to examine these factors in heterosexual women, there is a lack of research examining MSM, especially their SV risk perception. Further, MSM are active users of dating and sexual networking (DSN) mobile apps, and this technology has demonstrated usefulness for creating safe spaces for MSM to meet and engage partners. However, mounting data demonstrate that DSN app use is associated with an increased risk for SV, especially given the higher likelihood of using alcohol and other drugs before sex. By contrast, some researchers have demonstrated that DSN technology can be harnessed as a prevention tool for HIV; unfortunately, no such work has progressed regarding SV. Objective: This study aims to (1) use qualitative and quantitative methods to tailor an existing laboratory paradigm of SV risk perception in women for MSM using a DSN mobile app framework and (2) subject this novel paradigm to a rigorous validation study to confirm its usefulness in predicting SV, with the potential for use in future prevention endeavors. Methods: To tailor the paradigm for MSM, a team of computer scientists created an initial DSN app (G-Date) and incorporated ongoing feedback about the usability, feasibility, and realism of this tool from a representative sample of MSM. We used focus groups and interviews to assist in the development of G-Date, including by identifying relevant stimuli, developing the cover story, and establishing the appropriate study language. To confirm the paradigm’s usefulness, we are conducting an experimental study with web-based and face-to-face participants to determine the content, concurrent, and predictive validities of G-Date. We will evaluate whether certain correlates of SV informed by syndemics and minority stress theories (eg, history of SV and alcohol and drug use) affect the ability of MSM to detect SV risk within G-Date and how paradigm engagement influences behavior in actual DSN app use contexts. Results: This study received funding from the National Institute on Alcohol Abuse and Alcoholism on September 10, 2020, and ethics approval on October 19, 2020, and we began app development for aim 1 immediately thereafter. We began data collection for the aim 2 validation study in December 2022. Initial results from the validation study are expected to be available after December 2025. Conclusions: We hope that G-Date will enhance our understanding of factors associated with SV risk and serve as a useful step in creating prevention programs for this susceptible population. %M 39159453 %R 10.2196/57600 %U https://www.researchprotocols.org/2024/1/e57600 %U https://doi.org/10.2196/57600 %U http://www.ncbi.nlm.nih.gov/pubmed/39159453 %0 Journal Article %@ 2369-2960 %I %V 10 %N %P e52366 %T HIV Incidence and Transactional Sex Among Men Who Have Sex With Men in Ningbo, China: Prospective Cohort Study Using a WeChat-Based Platform %A Hong,Hang %A Shi,Xiaojun %A Liu,Yuhui %A Feng,Wei %A Fang,Ting %A Tang,Chunlan %A Xu,Guozhang %K HIV/AIDS %K incidence %K men who have sex with men %K MSM %K transactional sex %K WeChat %K HIV %K STI %K STD %K sexual %K behavior %K behavioral %K risk %K risky %K risks %K China %K Chinese %K testing %K mHealth %K mobile health %K app %K apps %K applications %K applications %K text message %K text messages %K messaging %K social media %K regression %K sexually transmitted infection %K sexually transmitted disease %D 2024 %7 23.7.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Sexual transmission among men who have sex with men (MSM) has become the major HIV transmission route. However, limited research has been conducted to investigate the association between transactional sex (TS) and HIV incidence in China. Objective: This study aims to investigate HIV incidence and distinguish sociodemographic and sexual behavioral risk factors associated with HIV incidence among MSM who engage in TS (MSM-TS) in China. Methods: We conducted a prospective cohort study using a WeChat-based platform to evaluate HIV incidence among Chinese MSM, including MSM-TS in Ningbo, recruited from July 2019 until June 2022. At each visit, participants completed a questionnaire and scheduled an appointment for HIV counseling and testing on the WeChat-based platform before undergoing offline HIV tests. HIV incidence density was calculated as the number of HIV seroconversions divided by person-years (PYs) of follow-up, and univariate and multivariate Cox proportional hazards regression was conducted to identify factors associated with HIV incidence. Results: A total of 932 participants contributed 630.9 PYs of follow-up, and 25 HIV seroconversions were observed during the study period, resulting in an estimated HIV incidence of 4.0 (95% CI 2.7-5.8) per 100 PYs. The HIV incidence among MSM-TS was 18.4 (95% CI 8.7-34.7) per 100 PYs, which was significantly higher than the incidence of 3.2 (95% CI 2.1-5.0) per 100 PYs among MSM who do not engage in TS. After adjusting for sociodemographic characteristics, factors associated with HIV acquisition were MSM-TS (adjusted hazard ratio [aHR] 3.93, 95% CI 1.29-11.93), having unprotected sex with men (aHR 10.35, 95% CI 2.25-47.69), and having multiple male sex partners (aHR 3.43, 95% CI 1.22-9.64) in the past 6 months. Conclusions: This study found a high incidence of HIV among MSM-TS in Ningbo, China. The risk factors associated with HIV incidence include TS, having unprotected sex with men, and having multiple male sex partners. These findings emphasize the need for developing targeted interventions and providing comprehensive medical care, HIV testing, and preexposure prophylaxis for MSM, particularly those who engage in TS. %R 10.2196/52366 %U https://publichealth.jmir.org/2024/1/e52366 %U https://doi.org/10.2196/52366 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58549 %T A Digital Sexual Health Education Web Application for Resource-Poor Regions in Kenya: Implementation-Oriented Case Study Using the Intercultural Research Model %A Soehnchen,Clarissa %A Burmann,Anja %A Henningsen,Maike %A Meister,Sven %+ Health Informatics, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, Witten, 58455, Germany, 49 2302 9260, clarissa.soehnchen@uni-wh.de %K sexual health education %K Intercultural Research Model %K semistructured interview %K SUS analysis %K user-centered design %D 2024 %7 3.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Developing a digital educational application focused on sexual health education necessitates a framework that integrates cultural considerations effectively. Drawing from previous research, we identified the problem and essential requirements to incorporate cultural insights into the development of a solution. Objective: This study aims to explore the Solution Room of the self-established Intercultural Research Model, with a focus on creating a reusable framework for developing and implementing a widely accessible digital educational tool for sexual health. The study centers on advancing from a low-fidelity prototype (She!Masomo) to a high-fidelity prototype (We!Masomo), while evaluating its system usability through differentiation. This research contributes to the pursuit of Sustainable Development Goals 3, 4, and 5. Methods: The research methodology is anchored in the Solution Room of the self-expanded Intercultural Research Model, which integrates cultural considerations. It uses a multimethod, user-centered design thinking approach, focusing on extensive human involvement for the open web-based application. This includes gathering self-assessed textual user feedback, conducting a System Usability Scale (SUS) analysis, and conducting 4 face-to-face semistructured expert interviews, following COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines. Results: Based on the identified limitations of the low-fidelity prototype, She!Masomo (SUS score 67), which were highlighted through textual user feedback (63/77) and prototype feature comparisons, iterative development and improvement were implemented. This process led to the creation of an enhanced high-fidelity prototype (We!Masomo). The improved effectiveness of the enhanced prototype was evaluated using the qualitative SUS analysis (82/90), resulting in a favorable score of 77.3, compared with the previous SUS score of 67 for the low-fidelity prototype. Highlighting the importance of accessible digital educational tools, this study conducted 4 expert interviews (4/4) and reported e-survey results following the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guideline. The digital educational platform, We!Masomo, is specifically designed to promote universal and inclusive free access to information. Therefore, the developed high-fidelity prototype was implemented in Kenya. Conclusions: The primary outcome of this research provides a comprehensive exploration of utilizing a case study methodology to advance the development of digital educational web tools, particularly focusing on cultural sensitivity and sensitive educational subjects. It offers critical insights for effectively introducing such tools in regions with limited resources. Nonetheless, it is crucial to emphasize that the findings underscore the importance of integrating culture-specific components during the design phase. This highlights the necessity of conducting a thorough requirement engineering analysis and developing a low-fidelity prototype, followed by an SUS analysis. These measures are particularly critical when disseminating sensitive information, such as sexual health, through digital platforms. International Registered Report Identifier (IRRID): RR2-10.1186/s12905-023-02839-6 %M 38959047 %R 10.2196/58549 %U https://formative.jmir.org/2024/1/e58549 %U https://doi.org/10.2196/58549 %U http://www.ncbi.nlm.nih.gov/pubmed/38959047 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e56906 %T Examining HIV Testing Coverage and Factors Influencing First-Time Testing Among Men Who Have Sex With Men in Zhejiang Province, China: Cross-Sectional Study Based on a Large Internet Survey %A He,Lin %A Jiang,Tingting %A Chen,Wanjun %A Jiang,Shaoqiang %A Zheng,Jinlei %A Chen,Weiyong %A Wang,Hui %A Ma,Qiaoqin %A Chai,Chengliang %+ Zhejiang Provincial Center for Disease Control and Prevention, 3399 Bin Sheng Road, Binjiang District, Hangzhou, 310051, China, 86 57187115193, chlchai@cdc.zj.cn %K HIV %K testing %K men who have sex with men %K MSM %K internet %K pre-exposure prophylaxis %K China %K mobile phone %D 2024 %7 14.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Men who have sex with men (MSM) constitute a significant population of patients infected with HIV. In recent years, several efforts have been made to promote HIV testing among MSM in China. Objective: This study aimed to assess HIV testing coverage and factors associated with first-time HIV testing among MSM to provide a scientific basis for achieving the goal of diagnosing 95% of patients infected with HIV by 2030. Methods: This cross-sectional study was conducted between July 2023 and December 2023. MSM were recruited from the “Sunshine Test,” an internet platform that uses location-based services to offer free HIV testing services to MSM by visiting the WeChat official account in Zhejiang Province, China. Participants were required to complete a questionnaire on their demographic characteristics, sexual behaviors, substance use, and HIV testing history. A logistic regression model was used to analyze first-time HIV testing and its associated factors. Results: A total of 7629 MSM participated in the study, with 87.1% (6647) having undergone HIV testing before and 12.9% (982) undergoing HIV testing for the first time. Multivariate logistic regression analysis revealed that first-time HIV testing was associated with younger age (adjusted odds ratio [aOR] 2.55, 95% CI 1.91-3.42), lower education (aOR 1.39, 95% CI 1.03-1.88), student status (aOR 1.35, 95% CI 1.04-1.75), low income (aOR 1.55, 95% CI 1.16-2.08), insertive anal sex role (aOR 1.28, 95% CI 1.05-1.56), bisexuality (aOR 1.69, 95% CI 1.40-2.03), fewer sex partners (aOR 1.44, 95% CI 1.13-1.83), use of rush poppers (aOR 2.06, 95% CI 1.70-2.49), unknown HIV status of sex partners (aOR 1.40, 95% CI 1.17-1.69), lack of awareness of HIV pre-exposure prophylaxis (aOR 1.39, 95% CI 1.03-1.88), and offline HIV testing uptake (aOR 2.08, 95% CI 1.80-2.41). Conclusions: A notable 12.9% (982/7629) of MSM had never undergone HIV testing before this large internet survey. We recommend enhancing HIV intervention and testing through internet-based platforms and gay apps to promote testing among MSM and achieve the target of diagnosing 95% of patients infected with HIV by 2030. %M 38875001 %R 10.2196/56906 %U https://publichealth.jmir.org/2024/1/e56906 %U https://doi.org/10.2196/56906 %U http://www.ncbi.nlm.nih.gov/pubmed/38875001 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e56643 %T Population Percentage and Population Size of Men Who Have Sex With Men in the United States, 2017-2021: Meta-Analysis of 5 Population-Based Surveys %A Bennett,Brady W %A DuBose,Stephanie %A Huang,Ya-Lin A %A Johnson,Christopher H %A Hoover,Karen W %A Wiener,Jeffrey %A Purcell,David W %A Sullivan,Patrick S %+ Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 706 766 1510, brady.bennett@emory.edu %K sexual behavior %K sexual identity %K sexual attraction %K men who have sex with men %K population estimates %K MSM %K men who have sex with other men %K national surveys %K census %K United States %D 2024 %7 11.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Male-to-male sexual transmission continues to account for the greatest proportion of new HIV diagnoses in the United States. However, calculating population-specific surveillance metrics for HIV and other sexually transmitted infections requires regularly updated estimates of the number and proportion of men who have sex with men (MSM) in the United States, which are not collected by census surveys. Objective: The purpose of this analysis was to estimate the number and percentage of MSM in the United States from population-based surveys. Methods: We used data from 5 population-based surveys to calculate weighted estimates of the proportion of MSM in the United States and pooled these estimates using meta-analytic procedures. We estimated the proportion of MSM using sexual behavior–based questions (encompassing anal or oral sex) for 3 recall periods—past 12 months, past 5 years, and lifetime. In addition, we estimated the proportion of MSM using self-reported identity and attraction survey responses. The total number of MSM and non-MSM in the United States were calculated from estimates of the percentage of MSM who reported sex with another man in the past 12 months. Results: The percentage of MSM varied by recall period: 3.3% (95% CI 1.7%-4.9%) indicated sex with another male in the past 12 months, 4.7% (95% CI 0.0%-33.8%) in the past 5 years, and 6.2% (95% CI 2.9%-9.5%) in their lifetime. There were comparable percentages of men who identified as gay or bisexual (3.4%, 95% CI 2.2%-4.6%) or who indicated that they are attracted to other men (4.9%, 95% CI 3.1%-6.7%) based on pooled estimates. Our estimate of the total number of MSM in the United States is 4,230,000 (95% CI 2,179,000-6,281,000) based on the history of recent sexual behavior (sex with another man in the past 12 months). Conclusions: We calculated the pooled percentage and number of MSM in the United States from a meta-analysis of population-based surveys collected from 2017 to 2021. These estimates update and expand upon those derived from the Centers for Disease Control and Prevention in 2012 by including estimates of the percentage of MSM based on sexual identity and sexual attraction. The percentage and number of MSM in the United States is an important indicator for calculating population-specific disease rates and eligibility for preventive interventions such as pre-exposure prophylaxis. %M 38861303 %R 10.2196/56643 %U https://publichealth.jmir.org/2024/1/e56643 %U https://doi.org/10.2196/56643 %U http://www.ncbi.nlm.nih.gov/pubmed/38861303 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56561 %T MyPEEPS Mobile App for HIV Prevention Among Transmasculine Youth: Adaptation Through Community-Based Feedback and Usability Evaluation %A Adedoja,Dorcas %A Kuhns,Lisa M %A Radix,Asa %A Garofalo,Robert %A Brin,Maeve %A Schnall,Rebecca %+ Columbia University School of Nursing, 560 W. 168th Street, New York City, NY, 10032, United States, 1 2123426886, rb897@columbia.edu %K HIV %K mobile app %K transgender men %K transmasculine %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Transgender men and transmasculine youth are at high risk for acquiring HIV. Growing research on transgender men demonstrates increased HIV risk and burden compared with the general US population. Despite biomedical advancements in HIV prevention, there remains a dearth of evidence-based, sexual health HIV prevention interventions for young transgender men. MyPEEPS (Male Youth Pursuing Empowerment, Education, and Prevention around Sexuality) Mobile is a web-based app that builds on extensive formative community–informed work to develop an evidence-based HIV prevention intervention. Our study team developed and tested the MyPEEPS Mobile intervention for 13- to 18-year-old cisgender young men in a national randomized controlled trial, which demonstrated efficacy to reduce sexual risk in the short term—at 3-month follow-up. Trans men and transmasculine youth resonated with basic HIV educational information and sexual scenarios of the original MyPEEPS app for cisgender men, but recognized the app's lack of transmasculine specificity. Objective: The purpose of this study is to detail the user-centered design methods to adapt, improve the user interface, and enhance the usability of the MyPEEPS Mobile app for young transgender men and transmasculine youth. Methods: The MyPEEPS Mobile app for young transgender men was adapted through a user-centered design approach, which included an iterative review of the adapted prototype by expert advisors and a youth advisory board. The app was then evaluated through a rigorous usability evaluation. Results: MyPEEPS Mobile is among the first mobile health interventions developed to meet the specific needs of young transgender men and transmasculine youth to reduce HIV risk behaviors. While many of the activities in the original MyPEEPS Mobile were rigorously developed and tested, there was a need to adapt our intervention to meet the specific needs and risk factors among young transgender men and transmasculine youth. The findings from this study describe the adaptation of these activities through feedback from a youth advisory board and expert advisors. Following adaptation of the content, the app underwent a rigorous usability assessment through an evaluation with experts in human-computer interaction (n=5) and targeted end users (n=20). Conclusions: Usability and adaptation findings demonstrate that the MyPEEPS Mobile app is highly usable and perceived as potentially useful for targeting HIV risk behaviors in young transgender men and transmasculine youth. %M 38814701 %R 10.2196/56561 %U https://formative.jmir.org/2024/1/e56561 %U https://doi.org/10.2196/56561 %U http://www.ncbi.nlm.nih.gov/pubmed/38814701 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e46845 %T Understanding Risk Factors for Oropharyngeal Gonorrhea Among Sex Workers Attending Sexual Health Clinics in 2 Australian Cities: Mixed Methods Study %A Phillips,Tiffany R %A Fairley,Christopher K %A Maddaford,Kate %A McNulty,Anna %A Donovan,Basil %A Guy,Rebecca %A McIver,Ruthy %A Wigan,Rebecca %A Varma,Rick %A Ong,Jason J %A Callander,Denton %A Skelsey,Gabrielle %A Pony,Mish %A O'Hara,Dylan %A Bilardi,Jade E %A Chow,Eric PF %+ Monash University, Wellington Road, Clayton, 3800, Australia, 61 99054000, tiffany.phillips@monash.edu %K case-control %K qualitative %K oral sex %K condoms %K transactional sex %D 2024 %7 20.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The risk factors for oropharyngeal gonorrhea have not been examined in sex workers despite the increasing prevalence of gonorrhea infection. Objective: This study aims to determine the risk factors for oropharyngeal gonorrhea in female and gender-diverse sex workers (including cisgender and transgender women, nonbinary and gender fluid sex workers, and those with a different identity) and examine kissing, oral sex, and mouthwash practices with clients. Methods: This mixed methods case-control study was conducted from 2018 to 2020 at 2 sexual health clinics in Melbourne, Victoria, and Sydney, New South Wales, Australia. We recruited 83 sex workers diagnosed with oropharyngeal gonorrhea (cases) and 581 sex workers without (controls). Semistructured interviews with 19 sex workers from Melbourne were conducted. Results: In the case-control study, the median age of 664 sex workers was 30 (IQR 25-36) years. Almost 30% of sex workers (192/664, 28.9%) reported performing condomless fellatio on clients. Performing condomless fellatio with clients was the only behavior associated with oropharyngeal gonorrhea (adjusted odds ratio 3.6, 95% CI 1.7-7.6; P=.001). Most participants (521/664, 78.5%) used mouthwash frequently. In the qualitative study, almost all sex workers reported kissing clients due to demand and generally reported following clients’ lead with regard to kissing style and duration. However, they used condoms for fellatio because they considered it a risky practice for contracting sexually transmitted infections, unlike cunnilingus without a dental dam. Conclusions: Our study shows that condomless fellatio is a risk factor for oropharyngeal gonorrhea among sex workers despite most sex workers using condoms with their clients for fellatio. Novel interventions, particularly targeting the oropharynx, will be required for oropharyngeal gonorrhea prevention. %M 38767954 %R 10.2196/46845 %U https://publichealth.jmir.org/2024/1/e46845 %U https://doi.org/10.2196/46845 %U http://www.ncbi.nlm.nih.gov/pubmed/38767954 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50656 %T A Machine Learning Model for Identifying Sexual Health Influencers to Promote the Secondary Distribution of HIV Self-Testing Among Gay, Bisexual, and Other Men Who Have Sex With Men in China: Quasi-Experimental Study %A Ni,Yuxin %A Lu,Ying %A Jing,Fengshi %A Wang,Qianyun %A Xie,Yewei %A He,Xi %A Wu,Dan %A Tan,Rayner Kay Jin %A Tucker,Joseph D %A Yan,Xumeng %A Ong,Jason J %A Zhang,Qingpeng %A Jiang,Hongbo %A Dai,Wencan %A Huang,Liqun %A Mei,Wenhua %A Zhou,Yi %A Tang,Weiming %+ Dermatology Hospital of Southern Medical University, 2 Lujing Rd, Yuexiu District, Guangzhou, 510091, China, 86 13302391532, weiming_tang@med.unc.edu %K artificial intelligence %K HIV testing %K key opinion leaders %K machine learning %K men who have sex with men %K self-testing %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Sexual health influencers (SHIs) are individuals actively sharing sexual health information with their peers, and they play an important role in promoting HIV care services, including the secondary distribution of HIV self-testing (SD-HIVST). Previous studies used a 6-item empirical leadership scale to identify SHIs. However, this approach may be biased as it does not consider individuals’ social networks. Objective: This study used a quasi-experimental study design to evaluate how well a newly developed machine learning (ML) model identifies SHIs in promoting SD-HIVST compared to SHIs identified by a scale whose validity had been tested before. Methods: We recruited participants from BlueD, the largest social networking app for gay men in China. Based on their responses to the baseline survey, the ML model and scale were used to identify SHIs, respectively. This study consisted of 2 rounds, differing in the upper limit of the number of HIVST kits and peer-referral links that SHIs could order and distribute (first round ≤5 and second round ≤10). Consented SHIs could order multiple HIV self-testing (HIVST) kits and generate personalized peer-referral links through a web-based platform managed by a partnered gay-friendly community-based organization. SHIs were encouraged to share additional kits and peer-referral links with their social contacts (defined as “alters”). SHIs would receive US $3 incentives when their corresponding alters uploaded valid photographic testing results to the same platform. Our primary outcomes included (1) the number of alters who conducted HIVST in each group and (2) the number of newly tested alters who conducted HIVST in each. We used negative binomial regression to examine group differences during the first round (February-June 2021), the second round (June-November 2021), and the combined first and second rounds, respectively. Results: In January 2021, a total of 1828 men who have sex with men (MSM) completed the survey. Overall, 393 SHIs (scale=195 and ML model=198) agreed to participate in SD-HIVST. Among them, 229 SHIs (scale=116 and ML model=113) ordered HIVST on the web. Compared with the scale group, SHIs in the ML model group motivated more alters to conduct HIVST (mean difference [MD] 0.88, 95% CI 0.02-2.22; adjusted incidence risk ratio [aIRR] 1.77, 95% CI 1.07-2.95) when we combined the first and second rounds. Although the mean number of newly tested alters was slightly higher in the ML model group than in the scale group, the group difference was insignificant (MD 0.35, 95% CI –0.17 to –0.99; aIRR 1.49, 95% CI 0.74-3.02). Conclusions: Among Chinese MSM, SHIs identified by the ML model can motivate more individuals to conduct HIVST than those identified by the scale. Future research can focus on how to adapt the ML model to encourage newly tested individuals to conduct HIVST. Trial Registration: Chinese Clinical Trials Registry ChiCTR2000039632; https://www.chictr.org.cn/showprojEN.html?proj=63068 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-021-11817-2 %M 38656769 %R 10.2196/50656 %U https://publichealth.jmir.org/2024/1/e50656 %U https://doi.org/10.2196/50656 %U http://www.ncbi.nlm.nih.gov/pubmed/38656769 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56206 %T Evaluating the User Experience of a Smartphone-Delivered Sexual Health Promotion Program for Older Adults in the Netherlands: Single-Arm Pilot Study %A Correia de Barros,Ana %A Bergmans,Mariëtte %A Hasanaj,Kreshnik %A Krasniqi,Drianë %A Nóbrega,Catarina %A Carvalho Carneiro,Bruna %A Vasconcelos,Priscila A %A Quinta-Gomes,Ana Luísa %A Nobre,Pedro J %A Couto da Silva,Joana %A Mendes-Santos,Cristina %+ Fraunhofer Portugal AICOS, Rua Alfredo Allen, 455, Porto, 4200-135, Portugal, 351 220430306, ana.barros@fraunhofer.pt %K internet interventions %K mobile health %K mHealth %K older adults %K sexual health %K smartphone %K user experience %K pilot study %K mobile phone %D 2024 %7 3.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Sexual health is an important component of quality of life in older adults. However, older adults often face barriers to attaining a fulfilling sexual life because of issues such as stigma, lack of information, or difficult access to adequate support. Objective: We aimed to evaluate the user experience of a self-guided, smartphone-delivered program to promote sexual health among older adults. Methods: The mobile app was made available to community-dwelling older adults in the Netherlands, who freely used the app for 8 weeks. User experience and its respective components were assessed using self-developed questionnaires, the System Usability Scale, and semistructured interviews. Quantitative and qualitative data were descriptively and thematically analyzed, respectively. Results: In total, 15 participants (mean age 71.7, SD 9.5 years) completed the trial. Participants showed a neutral to positive stance regarding the mobile app’s usefulness and ease of use. Usability was assessed as “Ok/Fair.” The participants felt confident about using the mobile app. To increase user experience, participants offered suggestions to improve content and interaction, including access to specialized sexual health services. Conclusions: The sexual health promotion program delivered through a smartphone in a self-guided mode was usable. Participants’ perception is that improvements to user experience, namely in content and interaction, as well as connection to external services, will likely improve usefulness and acceptance. %M 38568726 %R 10.2196/56206 %U https://humanfactors.jmir.org/2024/1/e56206 %U https://doi.org/10.2196/56206 %U http://www.ncbi.nlm.nih.gov/pubmed/38568726 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53742 %T Patient-Centered Approaches for Designing Destigmatizing Sexual Pain-Related Web-Based Platforms: Qualitative Study %A Abdulai,Abdul-Fatawu %A Naghdali,Hasti %A Noga,Heather %A Yong,Paul J %+ School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada, 1 604 822 7214, fatawu.abdulai@ubc.ca %K stigma %K digital health %K sexual pain %K destigmatizing %K end user patients %D 2024 %7 15.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual pain is a common but neglected disorder that affects approximately 3% to 18% of women and an unmeasured number of gender-diverse people worldwide. Despite its wide prevalence, many people feel reluctant to visit conventional health care services or disclose their symptoms due to the fear of stigmatization. To alleviate this stigma, various web-based interventions have been developed to complement and, in some cases, replace conventional sexual health interventions. However, the way these web-based interventions are developed could inadvertently reproduce, perpetuate, or exacerbate stigma among end user patients. Objective: The purpose of this study was to understand patients’ perspectives on how sexual pain–related web platforms can be designed to alleviate stigma or prevent the unintended effects of stigma among patients who use web-based interventions. Methods: Individual semistructured interviews were conducted among 16 participants with lived experiences of painful sex in a large urban city in Western Canada. Participants were recruited via social media platforms, newsletters, and a provincial health volunteer website. Using a sample sexual pain website to provide context, participants were interviewed about their experiences of stigma and how they think web platforms could be designed to address stigma. The interviews were conducted via Zoom (Zoom Technologies Inc) and analyzed using thematic analysis. Results: The findings revealed 4 overarching themes that represented participants’ perspectives on designing web platforms that may alleviate or prevent the unintended effects of stigma. These findings suggested the design of inclusive web platforms, having a nonprovocative and calming user interface, having features that facilitate connections among users and between users and providers, and displaying personal testimonials and experiences of sexual pain. Conclusions: This study highlighted patient-centered design approaches that could serve as a reference guide in developing web platforms that alleviate or prevent the unintended effects of stigma, particularly among nonheterosexual and gender-diverse people. While this study was conducted in the context of sexual pain, the results might also apply to web platforms on other potentially stigmatizing health-related disorders or conditions. %M 38488844 %R 10.2196/53742 %U https://formative.jmir.org/2024/1/e53742 %U https://doi.org/10.2196/53742 %U http://www.ncbi.nlm.nih.gov/pubmed/38488844 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e44861 %T What Adolescents Say in Text Messages to Motivate Peer Networks to Access Health Care and Sexually Transmitted Infection Testing: Qualitative Thematic Analysis %A Lightfoot,Marguerita %A Campbell,Chadwick %A Maragh-Bass,Allysha C %A Jackson-Morgan,Joi %A Taylor,Kelly %+ School of Public Health, Oregon Health & Science University – Portland State University, 1810 SW 5th Ave., Suite 510, Portland, OR, 97201, United States, 1 503 494 4345, lightfom@ohsu.edu %K adolescents %K clinics %K HIV/STI testing %K intervention %K mobile health %K peer %K screening %K sexually active %K STI %K text messaging %K young adult %D 2024 %7 28.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: While rates of HIV and sexually transmitted infections (STIs) are extremely high among adolescents and young adults in the United States, rates of HIV and STI testing remain low. Given the ubiquity of mobile phones and the saliency of peers for youths, text messaging strategies may successfully promote HIV or STI testing among youths. Objective: This study aimed to understand the types of messages youths believe were motivating and persuasive when asked to text friends to encourage them to seek HIV or STI testing services at a neighborhood clinic. Methods: We implemented an adolescent peer-based text messaging intervention to encourage clinic attendance and increase STI and HIV testing among youths (n=100) at an adolescent clinic in San Francisco, California. Participants were asked to send a text message to 5 friends they believed were sexually active to encourage their friends to visit the clinic and receive STI or HIV screening. Thematic analysis was used to analyze the content of the text messages sent and received during the clinic visit. Member checking and consensus coding were used to ensure interrater reliability and significance of themes. Results: We identified four themes in the messages sent by participants: (1) calls to action to encourage peers to get tested, (2) personalized messages with sender-specific information, (3) clinic information such as location and hours, and (4) self-disclosure of personal clinic experience. We found that nearly all text messages included some combination of 2 or more of these broad themes. We also found that youths were inclined to send messages they created themselves, as opposed to sending the same message to each peer, which they tailored to each individual to whom they were sent. Many (40/100, 40%) received an immediate response to their message, and most participants reported receiving at least 1 positive response, while a few reported that they had received at least 1 negative response. There were some differences in responses depending on the type of message sent. Conclusions: Given the high rates of STI and HIV and low rates of testing among adolescents, peer-driven text messaging interventions to encourage accessing care may be successful at reaching this population. This study suggests that youths are willing to text message their friends, and there are clear types of messages they develop and use. Future research should use these methods with a large, more diverse sample of youths and young adults for long-term evaluation of care seeking and care retention outcomes to make progress in reducing HIV and STI among adolescents and young adults. %M 38416541 %R 10.2196/44861 %U https://www.jmir.org/2024/1/e44861 %U https://doi.org/10.2196/44861 %U http://www.ncbi.nlm.nih.gov/pubmed/38416541 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e47216 %T Efficacy of a Digital Health Preventive Intervention for Adolescents With HIV or Sexually Transmitted Infections and Substance Use Disorder: Protocol for a Randomized Controlled Trial %A Cordova,David %A Bauermeister,José A %A Warner,Sydni %A , %A Wells,Patricia %A MacLeod,Jennifer %A Neilands,Torsten B %A Mendoza Lua,Frania %A Delva,Jorge %A Fessler,Kathryn Bondy %A Smith Jr,Versell %A Khreizat,Sarah %A Boyer,Cherrie %+ School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, 48109, United States, 1 734 763 6201, cordovad@umich.edu %K youth %K mHealth %K HIV %K STI %K illicit drugs %K primary care %K prevention %K public health %K USA %K teens %K drugs %K drug use %K sex %K racial minority %K risk behavior %K engagement %K tool %K substance use disorder %D 2024 %7 19.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: HIV or sexually transmitted infections remain a significant public health concern in the United States, with adolescents affected disproportionately. Adolescents engage in HIV/STI risk behaviors, including drug use and condomless sex, which increase the risk for HIV/STIs. At-risk adolescents, many of whom are racial minorities, experience HIV/STI disparities. Although at-risk adolescents are disproportionately affected by HIV/STI risk behaviors and infections and although the Centers for Disease Control and Prevention recommends routine HIV/STI testing for adolescents, relatively few adolescents report having ever been tested for HIV/STI. With expected increases in health clinic visits as a result of the Affordable Care Act combined with technological advances, health clinics and mobile health (mHealth), including apps, provide innovative contexts and tools to engage at-risk adolescents in HIV/STI prevention programs. Yet, there is a dearth of efficacious mHealth interventions in health clinics to prevent and reduce both condomless sex and drug use and increase HIV/STI testing for at-risk adolescents. Objective: To address this gap in knowledge, we developed a theory-driven, culturally congruent mHealth intervention (hereon referred to as S4E [Storytelling 4 Empowerment]) that has demonstrated feasibility and acceptability in a clinical setting. The next step is to examine the preliminary efficacy of S4E on adolescent HIV/STI testing and risk behaviors. This goal will be accomplished by 2 aims: the first aim is to develop a cross-platform and universal version of S4E. The cross-platform and universal version of S4E will be compatible with both iOS and Android operating systems and multiple mobile devices, aimed at providing adolescents with ongoing access to the intervention once they leave the clinic, and the second aim is to evaluate the preliminary efficacy of S4E, relative to usual care control condition, in preventing or reducing drug use and condomless sex and increasing HIV/STI testing in a clinical sample of at-risk adolescents aged 14-21 years living in Southeast Michigan. Methods: In this study, 100 adolescents recruited from a youth-centered community health clinic will be randomized via blocked randomization with random sequences of block sizes to one of the 2 conditions: S4E mHealth intervention or usual care. Theory-driven and culturally congruent, S4E is an mHealth adaptation of face-to-face storytelling for empowerment, which is registered with the Substance Abuse and Mental Health Services Administration's National Registry of Evidence-Based Programs and Practices. Results: This paper describes the protocol of our study. The recruitment began on May 1, 2018. This study was registered on December 11, 2017, in ClinicalTrials.gov. All participants have been recruited. Data analysis will be complete by the end of March 2024, with study findings available by December 2024. Conclusions: This study has the potential to improve public health by preventing HIV/STI and substance use disorders. Trial Registration: ClinicalTrials.gov NCT03368456; https://clinicaltrials.gov/study/NCT03368456 International Registered Report Identifier (IRRID): DERR1-10.2196/47216 %M 38373025 %R 10.2196/47216 %U https://www.researchprotocols.org/2024/1/e47216 %U https://doi.org/10.2196/47216 %U http://www.ncbi.nlm.nih.gov/pubmed/38373025 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e45647 %T Counseling Supporting HIV Self-Testing and Linkage to Care Among Men Who Have Sex With Men: Systematic Review and Meta-Analysis %A Chen,Siyu %A Fang,Yuan %A Chan,Paul Shing-fong %A Kawuki,Joseph %A Mo,Phoenix %A Wang,Zixin %+ Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, Shatin, NT, Hong Kong, 999077, China (Hong Kong), 852 2252 8740, wangzx@cuhk.edu.hk %K HIV self-testing %K counseling %K linkage to care %K men who have sex with men %K meta-analysis %K mobile phone %D 2024 %7 24.1.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: Counseling supporting HIV self-testing (HIVST) is helpful in facilitating linkage to care and promoting behavior changes among men who have sex with men (MSM). Different levels of counseling support for MSM HIVST users may lead to variance in the linkage to care. Objective: This study aims to synthesize evidence on counseling supporting MSM HIVST users and to conduct a meta-analysis to quantify the proportion of MSM HIVST users who were linked to care. Methods: A systematic search was conducted using predefined eligibility criteria and relevant keywords to retrieve studies from the MEDLINE, Global Health, Web of Science, Embase, APA PsycINFO, and Scopus databases. This search encompassed papers and preprints published between July 3, 2012, and June 30, 2022. Studies were eligible if they reported counseling supporting HIVST or quantitative outcomes for linkage to care among MSM and were published in English. The screening process and data extraction followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The quality of the included studies was assessed by the National Institutes of Health quality assessment tool. Data were extracted using random effects models to combine the proportion of HIVST users who were linked to care. Subgroup analyses and metaregression were conducted to assess whether linkage to care varied according to study characteristics. All analyses were performed with R (version 4.2.1; R Foundation for Statistical Computing) using the metafor package. Results: A total of 55 studies published between 2014 and 2021, including 43 observational studies and 12 randomized controlled trials, were identified. Among these studies, 50 (91%) provided active counseling support and 5 (9%) provided passive counseling support. In studies providing active counseling support, most MSM HIVST users were linked to various forms of care, including reporting test results (97.2%, 95% CI 74.3%-99.8%), laboratory confirmation (92.6%, 95% CI 86.1%-96.2%), antiretroviral therapy initiation (90.8%, 95% CI 86.7%-93.7%), and referral to physicians (96.3%, 95% CI 85%-99.2%). In studies providing passive counseling support, fewer MSM HIVST users were linked to laboratory confirmation (78.7%, 95% CI 17.8%-98.4%), antiretroviral therapy initiation (79.1%, 95% CI 48.8%-93.7%), and referral to physicians (79.1%, 95% CI 0%-100%). Multivariate metaregression indicated that a higher number of essential counseling components, a smaller sample size (<300), and the use of mobile health technology to deliver counseling support were associated with better linkage to care. The quality of the studies varied from fair to good with a low to high risk of bias. Conclusions: Proactively providing counseling support for all users, involving a higher number of essential components in the counseling support, and using mobile health technology could increase the linkage to care among MSM HIVST users. Trial Registration: PROSPERO CRD42022346247; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346247 %M 38265866 %R 10.2196/45647 %U https://publichealth.jmir.org/2024/1/e45647 %U https://doi.org/10.2196/45647 %U http://www.ncbi.nlm.nih.gov/pubmed/38265866 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49962 %T Adolescents and Young Adults Evaluating a Website for Affective-Sexual Information and Education: Multicenter Cross-Sectional Study %A Montero-Pons,Laura %A Rodríguez-Martín,Dolors %A Esquinas,Cristina %A García-Sierra,Rosa %A Manresa-Domínguez,Josep Maria %A Reyes-Lacalle,Azahara %A Cabedo-Ferreiro,Rosa %A Vicente-Hernández,MªMercedes %A Gómez Masvidal,Míriam %A Toran-Monserrat,Pere %A Falguera-Puig,Gemma %+ Sexual and Reproductive Healthcare Santa Coloma de Gramenet, Primary Care Management Metropolitana Nord, Catalan Institute of Health, 49, 53 Major St, Santa Coloma de Gramenet, 08921, Spain, 34 936 932 736, lmontero.ics@gencat.cat %K sex education %K adolescent %K young adult %K internet %K cross-sectional studies %K program evaluation %K gender mainstreaming %D 2023 %7 26.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Today’s young people have long been demanding a paradigm shift in the emotional and sexual education they receive. While for them, affective-sexual and gender diversity is already a reality, the sexual and reproductive health professionals they encounter lack sufficient training. The digital devices and affective-sexual education websites aimed at today’s young people must also be thoroughly evaluated. The website Sexe Joves is a website on sexuality by the Department of Health of the Government of Catalonia (Spain). It is designed for people aged 14 to 25 years. It currently needs to undergo a process of evaluation. Affective-sexual education aimed at young people must stem from their participation and the whole range of sexual and gender diversity in order to reach the entire population equally. Objective: The aim of this study was to evaluate the website Sexe Joves as a source of affective-sexual health information, education, and communication for young people. It takes into account sex, gender identity, sexual orientation, socioeconomic status, and location within Catalonia (urban, semiurban, and rural areas). Methods: This was an observational, descriptive, and cross-sectional study that forms part of a larger mixed methods study. An ad hoc questionnaire was used to collect data. In total, 1830 participants were included. The study was carried out simultaneously in all the territorial administrations of Catalonia. Results: Almost 30% of the sample obtained were young people who experience affective-sexual and gender diversity. Of those surveyed, only 14.2% (n=260) said they were familiar with the website and of these, 6.5% said they used it (n=114). The website content rated most indispensable was on sexual abuse, harassment, and violence, followed by sexually transmitted infections; 70.5% (n=1200) reported that they visit pornographic websites. Conclusions: The results of this study will contribute to the design of new strategies for the website Sexe Joves, a public health resource, in order to improve affective sexual education for young people. International Registered Report Identifier (IRRID): RR2-10.3390/ijerph192416586 %M 37883153 %R 10.2196/49962 %U https://www.jmir.org/2023/1/e49962 %U https://doi.org/10.2196/49962 %U http://www.ncbi.nlm.nih.gov/pubmed/37883153 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45134 %T Moderating Effect of Pre-Exposure Prophylaxis Use on the Association Between Sexual Risk Behavior and Perceived Risk of HIV Among Brazilian Gay, Bisexual, and Other Men Who Have Sex With Men: Cross-Sectional Study %A Blair,Kevin James %A Torres,Thiago S %A Hoagland,Brenda %A Bezerra,Daniel R B %A Veloso,Valdilea G %A Grinsztejn,Beatriz %A Clark,Jesse %A Luz,Paula M %+ South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, 10833 Le Conte Ave, 72-227 CHS, Los Angeles, CA, 90095, United States, 1 6362368515, KBlair@mednet.ucla.edu %K HIV prevention %K men who have sex with men %K pre-exposure prophylaxis %K Latin America %K risk factors %K risk perception %K HIV %K gay %K prevention %K health service %D 2023 %7 5.10.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Gay, bisexual, and other men who have sex with men (MSM) with a higher perceived risk of HIV are more aware of and willing to use pre-exposure prophylaxis (PrEP). PrEP is an effective HIV prevention strategy, but there is a lack of data on how PrEP use might moderate the relationship between sexual risk behavior and perceived risk of HIV. Moreover, most studies measure perceived risk of HIV via a single question. Objective: We estimated the moderating effect of PrEP use on the association between sexual risk behavior and perceived risk of HIV, measured with the 8-item Perceived Risk of HIV Scale (PRHS), among Brazilian MSM. Methods: A cross-sectional, web-based survey was completed by Brazilian Hornet app users aged ≥18 years between February and March 2020. We included data from cisgender men who reported sex with men in the previous 6 months. We evaluated the moderating effect of current PrEP use on the association between sexual risk behavior, measured via the HIV Incidence Risk Index for MSM (HIRI-MSM), and perceived risk of HIV, measured by the PRHS. Higher HIRI-MSM (range 0-45) and PRHS (range 10-40) scores indicate greater sexual behavioral risk and perceived risk of HIV, respectively. Both were standardized to z scores for use in multivariable linear regression models. Results: Among 4344 cisgender MSM, 448 (10.3%) were currently taking PrEP. Current PrEP users had a higher mean HIRI-MSM score (mean 21.0, SD 9.4 vs mean 13.2, SD 8.1; P<.001) and a lower mean PRHS score (mean 24.6, SD 5.1 vs mean 25.9, SD 4.9; P<.001) compared to those not currently taking PrEP. In the multivariable model, greater HIRI-MSM scores significantly predicted increased PRHS scores (β=.26, 95% CI 0.22-0.29; P<.001). PrEP use moderated the association between HIRI-MSM and PRHS score (interaction term β=–.30, 95% CI –0.39 to –0.21; P<.001), such that higher HIRI-MSM score did not predict higher PRHS score among current PrEP users. Conclusions: Our results suggest current PrEP users have confidence in PrEP’s effectiveness as an HIV prevention strategy. PrEP’s effectiveness, positive psychological impact, and the frequent HIV testing and interaction with health services required of PrEP users may jointly influence the relationship between sexual risk behavior and perceived risk of HIV among PrEP users. %M 37796573 %R 10.2196/45134 %U https://publichealth.jmir.org/2023/1/e45134 %U https://doi.org/10.2196/45134 %U http://www.ncbi.nlm.nih.gov/pubmed/37796573 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45695 %T Web-Based STI/HIV Testing Services Available for Access in Australia: Systematic Search and Analysis %A Cardwell,Ethan Trey %A Ludwick,Teralynn %A Fairley,Christopher %A Bourne,Christopher %A Chang,Shanton %A Hocking,Jane S %A Kong,Fabian Y S %+ Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, 3053, Australia, 61 3 9035 3039, t.cardwell@unimelb.edu.au %K STI/HIV testing %K STI/HIV %K self-testing %K sexual health %K web-based STI testing %K web-based STI/HIV testing %D 2023 %7 22.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexually transmitted infection (STI) rates continue to rise in Australia, and timely access to testing and treatment is crucial to reduce transmission. Web-based services have been viewed as a way to improve timely access to STI/HIV testing and have proliferated in recent years. However, the regulation of these services in Australia is minimal, leading to concerns about their quality. The purpose of this review was to systematically identify web-based STI/HIV testing services available in Australia and assess them on aspects of quality, reliability, and accessibility. Objective: We aim to systematically identify and assess web-based STI/HIV testing services available in Australia. Methods: A Google search of Australian web-based services was conducted in March 2022 and repeated in September 2022 using Boolean operators and search terms related to test services (eg, on the internet or home), STIs (eg, chlamydia or gonorrhea), and test type (eg, self-test). The first 10 pages were assessed, and services were categorized as self-testing (ST; test at home), self-sampling (SS; sample at home and return to laboratory), or self-navigated pathology (SNP; specimens collected at pathology center). Website reliability was assessed against the Health on the Net Foundation code of conduct, and service quality was assessed using a scorecard that was developed based on similar reviews, Australian guidelines for in-person services, and UK standards. Additionally, we looked at measures of accessibility including cost, rural access, and time to test results. Results: Seventeen services were identified (8 ST, 2 SS, and 7 SNP). Only 4 services offered recommended testing for all 4 infections (chlamydia, gonorrhea, syphilis, and HIV) including genital, anorectal, and oropharyngeal sites, and 5 offered tests other than those recommended by Australian testing guidelines (eg, Ureaplasma). Nine services (1 SNP, 8 self-test) had no minimum age requirements for access. Reliability scores (scale 0-8) were similar between all services (range 4.75-8.0). Quality weighted scores (scale 0-58) were similar between SNP and SS services (average 44.89, SD 5.56 and 44.75, SD 1.77, respectively) but lower for ST services (22.66, SD 8.93; P=.002). Government-funded services were of higher quality than private services (43.54, SD 6.71 vs 29.43, SD 13.55; P=.03). The cost for services varied between SNP (Aus $0-$595; ie, US $0-$381.96), self-sample (Aus $0; ie, US $0), and ST (Aus $0-$135; ie, US $0-$86.66). The time to test results was much shorter for SNP services (~4 days) than for SS (~12 days) and ST (~14 days). Conclusions: This review identified considerable variability in the quality and reliability of the web-based STI/HIV testing services in Australia. Given the proliferation and use of these services will likely increase, it is imperative that Australia develops national standards to ensure the standard-of-care offered by web-based STI/HIV testing services is appropriate to protect Australian users from the impact of poorly performing and inappropriate tests. %M 37738083 %R 10.2196/45695 %U https://www.jmir.org/2023/1/e45695 %U https://doi.org/10.2196/45695 %U http://www.ncbi.nlm.nih.gov/pubmed/37738083 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41682 %T Community-Engaged Participatory Methods to Address Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning Young People’s Health Information Needs With a Resource Website: Participatory Design and Development Study %A Delmonaco,Daniel %A Li,Shannon %A Paneda,Christian %A Popoff,Elliot %A Hughson,Luna %A Jadwin-Cakmak,Laura %A Alferio,Jack %A Stephenson,Christian %A Henry,Angelique %A Powdhar,Kiandra %A Gierlinger,Isabella %A Harper,Gary W %A Haimson,Oliver L %+ University of Michigan, 105 S State St, Ann Arbor, MI, 48109, United States, 1 734 764 5876, haimson@umich.edu %K lesbian, gay, bisexual, transgender, and queer health %K LGBTQ+ health %K information seeking %K participatory design %K community-based research %K web-based health resources %K lesbian, gay, bisexual, transgender, and queer young people %K LGBTQ+ young people %K mobile phone %D 2023 %7 7.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) young people (aged 15 to 25 years) face unique health challenges and often lack resources to adequately address their health information needs related to gender and sexuality. Beyond information access issues, LGBTQ+ young people may need information resources to be designed and organized differently compared with their cisgender and heterosexual peers and, because of identity exploration, may have different information needs related to gender and sexuality than older people. Objective: The objective of our study was to work with a community partner to develop an inclusive and comprehensive new website to address LGBTQ+ young people’s health information needs. To design this resource website using a community-engaged approach, our objective required working with and incorporating content and design recommendations from young LGBTQ+ participants. Methods: We conducted interviews (n=17) and participatory design sessions (n=11; total individual participants: n=25) with LGBTQ+ young people to understand their health information needs and elicit design recommendations for the new website. We involved our community partner in all aspects of the research and design process. Results: We present participants’ desired resources, health topics, and technical website features that can facilitate information seeking for LGBTQ+ young people exploring their sexuality and gender and looking for health resources. We describe how filters can allow people to find information related to intersecting marginalized identities and how dark mode can be a privacy measure to avoid unwanted identity disclosure. We reflect on our design process and situate the website development in previous critical reflections on participatory research with marginalized communities. We suggest recommendations for future LGBTQ+ health websites based on our research and design experiences and final website design, which can enable LGBTQ+ young people to access information, find the right information, and navigate identity disclosure concerns. These design recommendations include filters, a reduced number of links, conscientious choice of graphics, dark mode, and resources tailored to intersecting identities. Conclusions: Meaningful collaboration with community partners throughout the design process is vital for developing technological resources that meet community needs. We argue for community partner leadership rather than just involvement in community-based research endeavors at the intersection of human-computer interaction and health. %M 37676709 %R 10.2196/41682 %U https://formative.jmir.org/2023/1/e41682 %U https://doi.org/10.2196/41682 %U http://www.ncbi.nlm.nih.gov/pubmed/37676709 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48113 %T An mHealth-Delivered Sexual Harm Reduction Tool (PartyPack) for Men Who Have Sex With Men in Malaysia: Usability Study %A Gautam,Kamal %A Paudel,Kiran %A Jacobs,Jerome %A Wickersham,Jeffrey A %A Ikhtiaruddin,Wan Mohd %A Azwa,Iskandar %A Saifi,Rumana %A Lim,Sin How %A Shrestha,Roman %+ Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Rd, Storrs, CT, 06269, United States, 1 860 486 2834, roman.shrestha@uconn.edu %K chemsex %K party and play %K sexualized drug use %K PartyPack %K harm reduction tool %K men who have sex with men %K Malaysia %K health promotion %K sexual health %K mHealth intervention %K HIV prevention %D 2023 %7 24.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Chemsex—the use of psychoactive drugs to enhance the sexual experience—is an increasing phenomenon globally. Despite the increasing burden and associated harms of chemsex, evidence-based interventions (ie, behavioral and pharmacological) for chemsex users are nonexistent. Objective: In this study, we assessed the usability and acceptability of a mobile health (mHealth)–delivered safer chemsex package (“PartyPack”) as a sexual harm reduction strategy among men who have sex with men in Malaysia—a setting where chemsex is becoming increasingly prevalent. Methods: This study is part of a larger smartphone app-based intervention (ie, JomPrEP; University of Connecticut) designed to improve access to HIV prevention services among Malaysian men who have sex with men. A total of 50 participants were recruited from the Greater Kuala Lumpur region of Malaysia to use the JomPrEP app, which included a feature allowing participants to order PartyPack, for 30 days (March-April 2022). The usability and acceptability of the PartyPack were assessed using self-report, app analytics, and exit interviews (n=20). Results: Overall, 8% (4/50) of participants reported having engaged in chemsex in the past 6 months; however, engagement in condomless sex (34/50, 68%) and group sex (9/50, 18%) was much higher. A total of 43 (86%) participants ordered PartyPack, of which 27 (63%) made multiple orders during the 30 days. Most participants (41/43, 95%) reported being satisfied with the PartyPack order feature in the app, with 91% (39/43) indicating the order and tracking process was easy. Thematic data exploration further revealed important information for understanding (eg, items included in the package, use of mHealth platform to order package, and discreetness of the PartyPack box and order and delivery) and refining the logistical preferences (eg, using branded items and allowing customization during order). Conclusions: Our findings provide strong evidence of the usability and acceptability of a mHealth-delivered safer chemsex package as a potential sexual harm reduction tool among this underserved population. Replication in a study with a larger sample size to test the efficacy of the PartyPack is warranted. %M 37616034 %R 10.2196/48113 %U https://formative.jmir.org/2023/1/e48113 %U https://doi.org/10.2196/48113 %U http://www.ncbi.nlm.nih.gov/pubmed/37616034 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43493 %T Using a Geosocial Networking App to Investigate New HIV Infections and Related Risk Factors Among Student and Nonstudent Men Who Have Sex With Men in Chengdu, China: Open Cohort Study %A Dai,Zhen %A Mi,Guodong %A Yu,Fei %A Chen,Guodong %A Wang,Xiaodong %A He,Qinying %+ Department of Sexually Transmitted Disease, AIDS Prevention and Control, Chengdu Center for Disease Control and Prevention, Longxiang Road 4, Wuhou District, Chengdu, 610041, China, 86 028 87033114, 78004693@qq.com %K geosocial networking app %K GSN app %K young men who have sex with men %K MSM %K HIV %K incidence %K risk factors %K cohort study %K smartphone %K mobile phone %D 2023 %7 28.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In China, condomless sex among men who have sex with men (MSM) is the primary route of HIV infection in young people. Chengdu is a hotspot for reported HIV cases among young people nationwide. Extensive use of geosocial networking (GSN) smartphone apps has dramatically changed the pattern of sexual behavior among young MSM (YMSM). However, data on HIV incidence and the risk behavior of YMSM using the GSN app are still obscure. Objective: This study aims to analyze and understand the HIV incidence and its risk factors among YMSM using GSN apps in Chengdu, China. Methods: An open cohort study was conducted among YMSM aged 18-24 years through a gay GSN smartphone app in Chengdu, China, from July 2018 to December 2020. Every participant completed a web-based questionnaire on sociodemographic characteristics, sexual behaviors, and other related statuses; made a reservation for a web-based HIV testing; and then voluntarily got tested at the designated testing site. At least one additional HIV test was taken via the app during the study period, and participants were evaluated at the end of the study or at the time of HIV seroconversion. By dividing the sum of the observed HIV seroconversions by the observed person-years, HIV incidence was calculated and compared between the student and nonstudent MSM. Univariate and multivariate (Cox proportional hazards regression) analyses were used to discuss the risk factors for new HIV infections. Results: In the study cohort, 24 seroconversions occurred among 625 YMSM who took at least two HIV tests through the app during the study period, contributing to 505 observed person-years. The HIV incidence rate per 100 person-years was 4.75 (95% CI 2.89-6.61) among all MSM, 3.60 (95% CI 1.27-5.93) among student MSM, and 5.88 (95% CI 2.97-8.79) among nonstudent MSM. In addition, the HIV incidence per 100 person-years was 11.11 (95% CI 4.49-17.73) among those who had resided in the area for 6 months or less and 7.14 (95% CI 1.52-12.77) among those with senior high school or less education. Two or more sexual partners (adjusted hazards ratio [HR] 3.63, 95% CI 1.08-12.23) in the preceding 6 months was a risk factor for new HIV infections. Consistent condom use for anal sex (adjusted HR 0.38, 95% CI 0.16-0.88) and insertive anal sex only (adjusted HR 0.10, 95% CI 0.01-0.75) in the preceding 6 months were protective factors for new HIV infections. Conclusions: The rate of new HIV infections among YMSM who actively used GSN smartphone apps was high, especially among migrant nonstudent MSM. Targeted interventions on GSN smartphone apps should be implemented to provide demand-adapted prevention and services to reduce the threat of HIV. %M 37505891 %R 10.2196/43493 %U https://www.jmir.org/2023/1/e43493 %U https://doi.org/10.2196/43493 %U http://www.ncbi.nlm.nih.gov/pubmed/37505891 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45236 %T Prevalence and Trends of Sexual Behaviors Among Young Adolescents Aged 12 Years to 15 Years in Low and Middle-Income Countries: Population-Based Study %A Jing,Zhengyue %A Li,Jie %A Wang,Yi %A Zhou,Chengchao %+ Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, 250012, China, 86 053188381567, zhouchengchao@sdu.edu.cn %K risky sexual behaviors %K early sexual intercourse %K multiple sexual partners %K condom use %K young adolescents %K low and middle-income countries %D 2023 %7 7.6.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Risky sexual behaviors remain significant public health challenges among adolescents. Nearly 90% of adolescents live in low and middle-income countries (LMICs), but few studies have used standardized methodology to monitor the prevalence and trends of sexual behaviors among adolescents in LMICs. Objective: This study aimed to assess the prevalence of sexual behaviors (ever had sexual intercourse, multiple sexual partners, and condom use) among adolescents aged 12 years to 15 years as well as the trends in prevalence between 2003 and 2017. Methods: For this population-based study, we used recent data from the Global School-based Student Health Survey conducted in 69 LMICs from 2003 to 2017 to assess the recent prevalence of sexual behaviors by using complex analysis and a random effects meta-analyses method. Using the chi-square trend test, we also assessed the trends in the prevalence of sexual behaviors in 17 countries that had conducted ≥1 round of surveys from 2003 to 2017. Results: We included 145,277 adolescents aged 12 years to 15 years (64,719/145,277, 44.5% boys) from the 69 LMICs that had conducted ≥1 survey and 80,646 adolescents aged 12 years to 15 years (34,725/80,646, 43.1% boys) from the 17 LMICs that had conducted ≥1 round of surveys. The recent global prevalence of ever had sexual intercourse was 6.9% (95% CI 6.2%-7.6%) and was higher among boys (10.0%, 95% CI 9.1%-11.1%) than girls (4.2%, 95% CI 3.7%-4.7%) and among those aged 14 years to 15 years (8.5%, 95% CI 7.7%-9.3%) than those aged 12 years to 13 years (4%, 95% CI 3.4%-4.7%). Among adolescents who had ever had sex, the recent global prevalence of having multiple sexual partners was 52% (95% CI 50.4%-53.6%) and was higher among boys (58%, 95% CI 56.1%-59.9%) than girls (41.4%, 95% CI 38.9%-43.9%) and among those aged 14 years to 15 years (53.5%, 95% CI 51.6%-55.4%) than those aged 12 years to 13 years (49.7%, 95% CI 45.9%-53.5%). Among adolescents who had ever had sex, the recent global prevalence of condom use was 58.1% (95% CI 56.2%-59.9%) and was higher among girls (59.2%, 95% CI 56.4%-61.9%) than boys (57.7%, 95% CI 55.7%-59.7%) and among those aged 14 years to 15 years (59.9%, 95% CI 58.0%-61.8%) than those aged 12 years to 13 years (51.6%, 95% CI 47.5%-55.7%). Between the earliest and latest surveys, the overall prevalence of ever had sexual intercourse (3.1% decrease) and condom use (2.0% decrease) showed downward trends. The overall prevalence of having multiple sexual partners increased by 2.6%. Conclusions: We provide evidence and important implication for policymakers to develop targeted policy support systems to prevent and reduce risky sexual behaviors among young adolescents in LMICs with a high prevalence of risky sexual behaviors. %M 37285196 %R 10.2196/45236 %U https://publichealth.jmir.org/2023/1/e45236 %U https://doi.org/10.2196/45236 %U http://www.ncbi.nlm.nih.gov/pubmed/37285196 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46514 %T Implementation Cascade of a Social Network–Based HIV Self-testing Approach for Men Who Have Sex With Men: Cross-sectional Study %A Kwan,Tsz Ho %A Chan,Denise Pui Chung %A Wong,Samuel Yeung-shan %A Lee,Shui Shan %+ Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Room 207, Postgraduate Education Centre, Prince of Wales Hospital, Hong Kong, China (Hong Kong), 852 22528862, sslee@cuhk.edu.hk %K community-based testing service %K cross-sectional study %K HIV self-test %K HIV testing %K HIV %K implementation cascade %K men who have sex with men %K social network %K virus transmission %D 2023 %7 26.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: HIV testing is the cornerstone of strategies for achieving the fast-track target to end the AIDS epidemic by 2030. Self-testing has been proven to be an effective health intervention for men who have sex with men (MSM). While social network–based approaches for distributing HIV self-tests are recommended by the World Health Organization, their implementation consists of multiple steps that need to be properly evaluated. Objective: This study aimed to assess the implementation cascade of a social network–based HIV self-test approach for reaching MSM who had never undergone testing in Hong Kong. Methods: This is a cross-sectional study. Seed MSM participants were recruited through different web-based channels, who in turn invited their peers to participate in this study. A web-based platform was set up to support the recruitment and referral process. Participants could request for an oral fluid or a finger-prick HIV self-test, with or without real-time support, after completing a self-administered questionnaire. Referrals could be made upon uploading the test result and passing the web-based training. Characteristics of participants completing each of these steps and their preferences for the type of HIV self-test were evaluated. Results: A total of 463 MSM were recruited, including 150 seeds. Participants recruited by seeds were less likely to have previously been tested for HIV (odds ratio [OR] 1.80, 95% CI 1.06-3.04, P=.03) and have lower confidence in performing self-tests (OR 0.66, 95% CI 0.45-0.99, P=.045). Almost all (434/442, 98%) MSM who completed the questionnaire requested a self-test, of whom 82% (354/434) had uploaded their test results. Participants requesting support were new to self-testing (OR 3.65, 95% CI 2.10-6.35, P<.001) and less confident in carrying out the self-test correctly (OR 0.35, 95% CI 0.22-0.56, P<.001). More than half (216/354, 61%) of the eligible participants initiated the referral process by attempting the web-based training with a passing rate of 93% (200/216). They were more likely to have sought sex partners (OR 2.20, 95% CI 1.14-4.25, P=.02), especially through location-based networking apps (OR 2.13, 95% CI 1.31-3.49, P=.002). They also gave higher usability scores along the implementation cascade (median 81 vs 75, P=.003). Conclusions: The social network approach was effective in diffusing HIV self-tests in the MSM community and reaching nontesters. Support and option to choose a preferable type of self-test are essential to address users’ individual needs when delivering HIV self-tests. A positive user experience throughout the processes along the implementation cascade is vital to transform a tester into a promoter. Trial Registration: ClinicalTrials.gov NCT04379206; https://clinicaltrials.gov/ct2/show/NCT04379206 %M 37099364 %R 10.2196/46514 %U https://www.jmir.org/2023/1/e46514 %U https://doi.org/10.2196/46514 %U http://www.ncbi.nlm.nih.gov/pubmed/37099364 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44961 %T Long-Acting Injectable Cabotegravir for HIV Preexposure Prophylaxis Among Sexual and Gender Minorities: Protocol for an Implementation Study %A Grinsztejn,Beatriz %A Torres,Thiago Silva %A Hoagland,Brenda %A Jalil,Emilia Moreira %A Moreira,Ronaldo Ismerio %A O'Malley,Gabrielle %A Shade,Starley B %A Benedetti,Marcos R %A Moreira,Julio %A Simpson,Keila %A Pimenta,Maria Cristina %A Veloso,Valdiléa Gonçalves %A , %+ Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365 Manguinhos, Rio de Janeiro, 21040360, Brazil, 55 21 38659128, gbeatriz@ini.fiocruz.br %K sexual and gender minorities %K young %K Brazil %K HIV prevention %K injectable preexposure prophylaxis %K injectable PrEP %K cabotegravir %D 2023 %7 19.4.2023 %9 Protocol %J JMIR Public Health Surveill %G English %X Background: Long-acting injectable cabotegravir (CAB-LA) for preexposure prophylaxis (PrEP) has proven efficacious in randomized controlled trials. Further research is critical to evaluate its effectiveness in real-world settings and identify effective implementation approaches, especially among young sexual and gender minorities (SGMs). Objective: ImPrEP CAB Brasil is an implementation study aiming to generate critical evidence on the feasibility, acceptability, and effectiveness of incorporating CAB-LA into the existing public health oral PrEP services in 6 Brazilian cities. It will also evaluate a mobile health (mHealth) education and decision support tool, digital injection appointment reminders, and the facilitators of and barriers to integrating CAB-LA into the existing services. Methods: This type-2 hybrid implementation-effectiveness study includes formative work, qualitative assessments, and clinical steps 1 to 4. For formative work, we will use participatory design methods to develop an initial CAB-LA implementation package and process mapping at each site to facilitate optimal client flow. SGMs aged 18 to 30 years arriving at a study clinic interested in PrEP (naive) will be invited for step 1. Individuals who tested HIV negative will receive mHealth intervention and standard of care (SOC) counseling or SOC for PrEP choice (oral or CAB-LA). Participants interested in CAB-LA will be invited for step 2, and those with undetectable HIV viral load will receive same-day CAB-LA injection and will be randomized to receive digital appointment reminders or SOC. Clinical appointments and CAB-LA injection are scheduled after 1 month and every 2 months thereafter (25-month follow-up). Participants will be invited to a 1-year follow-up to step 3 if they decide to change to oral PrEP or discontinue CAB-LA and to step 4 if diagnosed with HIV during the study. Outcomes of interest include PrEP acceptability, choice, effectiveness, implementation, and feasibility. HIV incidence in the CAB-LA cohort (n=1200) will be compared with that in a similar oral PrEP cohort from the public health system. The effectiveness of the mHealth and digital interventions will be assessed using interrupted time series analysis and logistic mixed models, respectively. Results: During the third and fourth quarters of 2022, we obtained regulatory approvals; programmed data entry and management systems; trained sites; and performed community consultancy and formative work. Study enrollment is programmed for the second quarter of 2023. Conclusions: ImPrEP CAB Brasil is the first study to evaluate CAB-LA PrEP implementation in Latin America, one of the regions where PrEP scale-up is most needed. This study will be fundamental to designing programmatic strategies for implementing and scaling up feasible, equitable, cost-effective, sustainable, and comprehensive alternatives for PrEP programs. It will also contribute to maximizing the impact of a public health approach to reducing HIV incidence among SGMs in Brazil and other countries in the Global South. Trial Registration: Clinicaltrials.gov NCT05515770; https://clinicaltrials.gov/ct2/show/NCT05515770 International Registered Report Identifier (IRRID): PRR1-10.2196/44961 %M 37074775 %R 10.2196/44961 %U https://publichealth.jmir.org/2023/1/e44961 %U https://doi.org/10.2196/44961 %U http://www.ncbi.nlm.nih.gov/pubmed/37074775 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43114 %T Population Size Estimation of Men Who Have Sex With Men in Rwanda: Three-Source Capture-Recapture Method %A Tuyishime,Elysee %A Kayitesi,Catherine %A Musengimana,Gentille %A Malamba,Samuel %A Moges,Hailegiorgis %A Kankindi,Ida %A Escudero,Horacio Ruisenor %A Habimana Kabano,Ignace %A Oluoch,Tom %A Remera,Eric %A Chukwu,Angela %+ Division of Global HIV and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention, 337H+F58, Kigali, Kigali, 28, Rwanda, 250 782723453 ext 2580, obx5@cdc.gov %K population size %K men who have sex with men %K nationwide %K capture-recapture %K RDS %K three-source %K Rwanda %K HIV %D 2023 %7 27.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Globally, men who have sex with men (MSM) continue to bear a disproportionately high burden of HIV infection. Rwanda experiences a mixed HIV epidemic, which is generalized in the adult population, with aspects of a concentrated epidemic among certain key populations at higher risk of HIV infection, including MSM. Limited data exist to estimate the population size of MSM at a national scale; hence, an important piece is missing in determining the denominators to use in estimates for policy makers, program managers, and planners to effectively monitor HIV epidemic control. Objective: The aims of this study were to provide the first national population size estimate (PSE) and geographic distribution of MSM in Rwanda. Methods: Between October and December 2021, a three-source capture-recapture method was used to estimate the MSM population size in Rwanda. Unique objects were distributed to MSM through their networks (first capture), who were then tagged according to MSM-friendly service provision (second capture), and a respondent-driven sampling survey was used as the third capture. Capture histories were aggregated in a 2k–1 contingency table, where k indicates the number of capture occasions and “1” and “0” indicate captured and not captured, respectively. Statistical analysis was performed in R (version 4.0.5) and the Bayesian nonparametric latent-class capture-recapture package was used to produce the final PSE with 95% credibility sets (CS). Results: We sampled 2465, 1314, and 2211 MSM in capture one, two, and three, respectively. There were 721 recaptures between captures one and two, 415 recaptures between captures two and three, and 422 recaptures between captures one and three. There were 210 MSM captured in all three captures. The total estimated population size of MSM above 18 years old in Rwanda was 18,100 (95% CS 11,300-29,700), corresponding to 0.70% (95% CI 0.4%-1.1%) of total adult males. Most MSM reside in the city of Kigali (7842, 95% CS 4587-13,153), followed by the Western province (2469, 95% CS 1994-3518), Northern province (2375, 95% CS 842-4239), Eastern province (2287, 95% CS 1927-3014), and Southern province (2109, 95% CS 1681-3418). Conclusions: Our study provides, for the first time, a PSE of MSM aged 18 years or older in Rwanda. MSM are concentrated in the city of Kigali and are almost evenly distributed across the other 4 provinces. The national proportion estimate bounds of MSM out of the total adult males includes the World Health Organization’s minimum recommended proportion (at least 1.0%) based on 2012 census population projections for 2021. These results will inform denominators to be used for estimating service coverage and fill existing information gaps to enable policy makers and planners to monitor the HIV epidemic among MSM nationally. There is an opportunity for conducting small-area MSM PSEs for subnational-level HIV treatment and prevention interventions. %M 36972131 %R 10.2196/43114 %U https://publichealth.jmir.org/2023/1/e43114 %U https://doi.org/10.2196/43114 %U http://www.ncbi.nlm.nih.gov/pubmed/36972131 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45389 %T Co-designing a Sexual Health App With Immigrant Adolescents: Protocol for a Qualitative Community-Based Participatory Action Research Study %A Meherali,Salima %A Munro,Sarah %A Puinean,Giulia %A Salami,Bukola %A Wong,Josephine Pui-Hing %A Vandermorris,Ashley %A Benoit,James Russell Andrew %A Flicker,Sarah %A Okeke-Ihejirika,Philomina %A Stroulia,Eleni %A Norman,Wendy V %A Scott,Shannon D %+ University of Alberta, 11405 87 Ave NW, Edmonton, AB, T6G 1C9, Canada, 1 780 248 1401, meherali@ualberta.ca %K adolescent health %K health promotion %K immigrants %K information needs %K mHealth %K sexual and reproductive health %K access to care %D 2023 %7 22.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Canada is one of the world’s most ethnically diverse countries, with over 7 million individuals out of a population of 38 million being born in a foreign country. Immigrant adolescents (aged 10 to 19 years) make up a substantial proportion of newcomers to Canada. Religious and cultural practices can influence adolescents’ sexual attitudes and behaviors, as well as the uptake of sexual and reproductive health (SRH) services among this population. Adolescence is a time to establish lifelong healthy behaviors. Research indicates an alarming gap in adolescents’ SRH knowledge, yet there is limited research on the SRH needs of immigrant adolescents in Canada. Objective: The purpose of this study is to actively engage with immigrant adolescents to develop, implement, and evaluate a mobile health (mHealth) intervention (ie, mobile app). The interactive mobile app will aim to deliver accurate and evidence-based SRH information to adolescents. Methods: We will use community-based participatory action research to guide our study. This research project will be conducted in 4 stages based on user-centered co-design principles. In Stage 1 (Empathize), we will recruit and convene 3 adolescent advisory groups in Edmonton, Toronto, and Vancouver. Members will be engaged as coresearchers and receive training in qualitative and quantitative methodologies, sexual health, and the social determinants of health. In Stage 2 (Define and Ideate), we will explore SRH information and service needs through focus group discussions with immigrant adolescents. In Stage 3 (Prototype), we will collaborate with mobile developers to build and iteratively design the app with support from the adolescent advisory groups. Finally, in Stage 4 (Test), we will return to focus group settings to share the app prototype, gather feedback on usability, and refine and release the app. Results: Recruitment and data collection will be completed by February 2023, and mobile app development will begin in March 2023. The mHealth app will be our core output and is expected to be released in the spring of 2024. Conclusions: Our study will advance the limited knowledge base on SRH and the information needs of immigrant adolescents in Canada as well as the science underpinning participatory action research methods with immigrant adolescents. This study will address gaps by exploring SRH priorities, health information needs, and innovative strategies to improve the SRH of immigrant adolescents. Engaging adolescents throughout the study will increase their involvement in SRH care decision-making, expand efficiencies in SRH care utilization, and ultimately improve adolescents' SRH outcomes. The app we develop will be transferable to all adolescent groups, is scalable in international contexts, and simultaneously leverages significant economies of scale. International Registered Report Identifier (IRRID): PRR1-10.2196/45389 %M 36947124 %R 10.2196/45389 %U https://www.researchprotocols.org/2023/1/e45389 %U https://doi.org/10.2196/45389 %U http://www.ncbi.nlm.nih.gov/pubmed/36947124 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e40539 %T A Digital Intervention to Improve Mental Health and Interpersonal Resilience in Young People Who Have Experienced Technology-Assisted Sexual Abuse: Protocol for a Nonrandomized Feasibility Clinical Trial and Nested Qualitative Study %A Bucci,Sandra %A Varese,Filippo %A Quayle,Ethel %A Cartwright,Kim %A Machin,Matthew %A Whelan,Pauline %A Chitsabesan,Prathiba %A Richards,Cathy %A Green,Victoria %A Norrie,John %A Schwannauer,Matthias %+ Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science, The University of Manchester, 2nd Floor, Sochonis Building, Brunswick Street, Manchester, M13 9PL, United Kingdom, 1 01613060422, sandra.bucci@manchester.ac.uk %K technology-assisted sexual abuse %K digital %K young people %K abuse %K eHealth %K mobile health %K mHealth %K mobile phone %D 2023 %7 21.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: No evidence-based support has been offered to young people (YP) who have experienced technology-assisted sexual abuse (TASA). Interventions aimed at improving mentalization (the ability to understand the mental states of oneself and others) are increasingly being applied to treat YP with various clinical issues. Digital technology use among YP is now common. A digital intervention aimed at improving mentalization in YP who have experienced TASA may reduce the risk of revictimization and future harm and make YP more resilient and able to manage distress that might result from TASA experiences. Objective: In this paper, we describe a protocol for determining the feasibility of the i-Minds trial and the acceptability, safety, and usability of the digital intervention (the i-Minds app) and explore how to best integrate i-Minds into existing routine care pathways. Methods: This is a mixed methods nonrandomized study aimed to determine the feasibility, acceptability, safety, and usability of the intervention. Participants aged between 12 and 18 years who report distress associated with TASA exposure will be recruited from the United Kingdom from the National Health Service (NHS) Trust Child and Adolescent Mental Health Services, sexual assault referral centers, and a web-based e-therapy provider. All participants will receive the i-Minds app for 6 weeks. Coproduced with YP and a range of stakeholders, the i-Minds app focuses on 4 main topics: mentalization, TASA and its impact, emotional and mental health, and trauma. A daily prompt will encourage YP to use the app, which is designed to be used in a stand-alone manner alongside routine care. We will follow participants up after the intervention and conduct interviews with stakeholders to explore the acceptability of the app and trial procedures and identify areas for improvement. Informed by the normalization process theory, we will examine barriers and enablers relevant to the future integration of the intervention into existing care pathways, including traditional clinic-based NHS and NHS e-therapy providers. Results: This study was approved by the Research Ethics Board of Scotland. We expect data to be collected from up to 60 YP. We expect to conduct approximately 20 qualitative interviews with participants and 20 health care professionals who referred YP to the study. The results of this study have been submitted for publication. Conclusions: This study will provide preliminary evidence on the feasibility of recruiting YP to a trial of this nature and on the acceptability, safety, and usability of the i-Minds app, including how to best integrate it into existing routine care. The findings will inform the decision to proceed with a powered efficacy trial. Trial Registration: International Standard Randomised Controlled Trial Number Registry (ISRCTN) ISRCTN43130832; https://www.isrctn.com/ISRCTN43130832 International Registered Report Identifier (IRRID): DERR1-10.2196/40539 %M 36943343 %R 10.2196/40539 %U https://www.researchprotocols.org/2023/1/e40539 %U https://doi.org/10.2196/40539 %U http://www.ncbi.nlm.nih.gov/pubmed/36943343 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40503 %T Digital-Assisted Self-interview of HIV or Sexually Transmitted Infection Risk Behaviors in Transmasculine Adults: Development and Field Testing of the Transmasculine Sexual Health Assessment %A Reisner,Sari L %A Pletta,David R %A Pardee,Dana J %A Deutsch,Madeline B %A Peitzmeier,Sarah M %A Hughto,Jaclyn MW %A Quint,Meg %A Potter,Jennifer %+ Brigham and Women's Hospital, 221 Longwood Ave, 5th Floor, Boston, MA, 02115, United States, 1 15712437532, sreisner@bwh.harvard.edu %K transgender %K sexual health %K HIV %K sexually transmitted infection %K STI %K epidemiology %K mobile phone %D 2023 %7 17.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The sexual health of transmasculine (TM) people—those who identify as male, men, or nonbinary and were assigned a female sex at birth—is understudied. One barrier to conducting HIV- and sexually transmitted infection (STI)–related research with this population is how to best capture sexual risk data in an acceptable, gender-affirming, and accurate manner. Objective: This study aimed to report on the community-based process of developing, piloting, and refining a digitally deployed measure to assess self-reported sexual behaviors associated with HIV and STI transmission for research with TM adults. Methods: A multicomponent process was used to develop a digital-assisted self-interview to assess HIV and STI risk in TM people: gathering input from a Community Task Force; working with an interdisciplinary team of content experts in transgender medicine, epidemiology, and infectious diseases; conducting web-based focus groups; and iteratively refining the measure. We field-tested the measure with 141 TM people in the greater Boston, Massachusetts area to assess HIV and STI risk. Descriptive statistics characterized the distribution of sexual behaviors and HIV and STI transmission risk by the gender identity of sexual partners. Results: The Transmasculine Sexual Health Assessment (TM-SHA) measures the broad range of potential sexual behaviors TM people may engage in, including those which may confer risk for STIs and not just for HIV infection (ie, oral-genital contact); incorporates gender-affirming language (ie, genital or frontal vs vaginal); and asks sexual partnership characteristics (ie, partner gender). Among 141 individual participants (mean age 27, SD 5 years; range 21-29 years; n=21, 14.9% multiracial), 259 sexual partnerships and 15 sexual risk behaviors were reported. Participants engaged in a wide range of sexual behaviors, including fingering or fisting (receiving: n=170, 65.6%; performing: n=173, 66.8%), oral-genital sex (receiving: n=182, 70.3%; performing: n=216, 83.4%), anal-genital sex (receptive: n=31, 11.9%; insertive: n=9, 3.5%), frontal-genital sex (receptive: n=105, 40.5%; insertive: n=46, 17.8%), and sharing toys or prosthetics during insertive sex (n=62, 23.9%). Overall barrier use for each sexual behavior ranged from 10.9% (20/182) to 81% (25/31). Frontal receptive sex with genitals and no protective barrier was the highest (21/42, 50%) with cisgender male partners. In total, 14.9% (21/141) of participants reported a lifetime diagnosis of STI. The sexual history tool was highly acceptable to TM participants. Conclusions: The TM-SHA is one of the first digital sexual health risk measures developed specifically with and exclusively for TM people. TM-SHA successfully integrates gender-affirming language and branching logic to capture a wide array of sexual behaviors. The measure elicits sexual behavior information needed to assess HIV and STI transmission risk behaviors. A strength of the tool is that detailed partner-by-partner data can be used to model partnership-level characteristics, not just individual-level participant data, to inform HIV and STI interventions. %M 36930204 %R 10.2196/40503 %U https://publichealth.jmir.org/2023/1/e40503 %U https://doi.org/10.2196/40503 %U http://www.ncbi.nlm.nih.gov/pubmed/36930204 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38491 %T Contraceptive Access and Use Among Undergraduate and Graduate Students During COVID-19: Online Survey Study %A Chen,Emily %A Hollowell,Adam %A Truong,Tracy %A Bentley-Edwards,Keisha %A Myers,Evan %A Erkanli,Alaattin %A Holt,Lauren %A Swartz,Jonas J %+ Department of Obstetrics & Gynecology, Duke University Medical Center, DUMC 3084, Durham, NC, 27710, United States, 1 919 668 7594, jonas.swartz@duke.edu %K COVID-19 %K contraception %K college %K disparities %K LARC %K sexual health %K social media %K health promotion %K telehealth %K health messaging %K health resource %K health disparity %K risk factor %K healthcare access %D 2023 %7 14.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic led to widespread college campus closures in the months of March to June 2020, endangering students’ access to on-campus health resources, including reproductive health services. Objective: To assess contraceptive access and use among undergraduate and graduate students in North Carolina during the COVID-19 pandemic. Methods: We conducted a cross-sectional web-based survey of undergraduate and graduate students enrolled at degree-granting institutions in North Carolina. Participants were recruited using targeted Instagram advertisements. The survey queried several aspects of participants’ sexual behavior, including sex drive, level of sexual experience, number of sexual partners, digital sexual experience, dating patterns, and types of contraception used. Participants were asked to compare many of these behaviors before and after the pandemic. The survey also assessed several sociodemographic factors that we hypothesized would be associated with contraceptive use based on prior data, including educational background, sexual orientation and gender minority status (ie, lesbian, gay, bisexual, transgender, queer), health insurance status, race, ethnicity, degree of sensation seeking, religiosity, and desire to become pregnant. Results: Over 10 days, 2035 Instagram users began our survey, of whom 1002 met eligibility criteria. Of these 1002 eligible participants, 934 completed the survey, for a 93% completion rate. Our respondents were mostly female (665/934, 71%), cisgender (877/934, 94%), heterosexual (592/934, 64%), white (695/934 75%), not Hispanic (835/934, 89%), and enrolled at a 4-year college (618/934, 66%). Over 95% (895/934) of respondents reported that they maintained access to their preferred contraception during the COVID-19 pandemic. In a multivariable analysis, participants who were enrolled in a 4-year college or graduate program were less likely to lose contraceptive access when compared to participants enrolled in a 2-year college (risk ratio [RR] 0.34, 95% CI 0.16-0.71); in addition, when compared to cisgender participants, nonbinary and transgender participants were more likely to lose contraceptive access (RR 2.43, 95% CI 1.01-5.87). Respondents reported that they were more interested in using telehealth to access contraception during the pandemic. The contraceptive methods most commonly used by our participants were, in order, condoms (331/934, 35.4%), oral contraception (303/934, 32.4%), and long-acting reversible contraception (LARC; 221/934, 23.7%). The rate of LARC use among our participants was higher than the national average for this age group (14%). Emergency contraception was uncommonly used (25/934, 2.7%). Conclusions: Undergraduate and graduate students in North Carolina overwhelmingly reported that they maintained access to their preferred contraceptive methods during the COVID-19 pandemic and through changing patterns of health care access, including telehealth. Gender nonbinary and transgender students and 2-year college students may have been at greater risk of losing access to contraception during the first year of the COVID-19 pandemic. %M 36827491 %R 10.2196/38491 %U https://formative.jmir.org/2023/1/e38491 %U https://doi.org/10.2196/38491 %U http://www.ncbi.nlm.nih.gov/pubmed/36827491 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43116 %T Exposure to Pornography and Adolescent Sexual Behavior: Systematic Review %A Pathmendra,Pranujan %A Raggatt,Michelle %A Lim,Megan SC %A Marino,Jennifer L %A Skinner,S Rachel %+ Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Corner Hawkesbury Road and Hainsworth Street, Westmead, 2145, Australia, 61 298450000, ppat9224@uni.sydney.edu.au %K adolescence %K teenager %K sexual debut %K sexual behavior %K risky behavior %K pornography use %K digital media %D 2023 %7 28.2.2023 %9 Review %J J Med Internet Res %G English %X Background: Formative experiences in adolescence lay the foundation for healthy and pleasurable romantic and sexual relationships. Exposure to pornography may affect these experiences. Objective: We aimed to synthesize evidence published in the past decade on the relationship between exposure to pornography and sexual behavior (earlier age of first sex [<16 years], condomless sex, past-year multiple partners [>1], lifetime multiple partners [>1], group sex, sexual aggression including forced sex, paid sex, teenage pregnancy, and history of sexually transmitted infection) in adolescents aged between 10 and 19 years. Methods: We identified 19 eligible studies by searching MEDLINE, PsycINFO, Cochrane, CINAHL, Embase, and Web of Science databases from January 2010 to November 2022. Results: Out of 8 studies that assessed earlier age of first sex, 5 studies, including 1 longitudinal study, found a statistically significant association with exposure to pornography. Given that most studies were cross-sectional or had substantial limitations, causal inference could not be made. Also, exposure to pornography was not measured consistently. The evidence was conflicting or insufficient to draw any conclusions regarding other outcomes. Conclusions: More quantitative research is needed to elucidate the association between pornography exposure and sexual behavior, and sex education should adopt evidence-based approaches to minimize the potential harms from pornography. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021227390; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=227390 %M 36853749 %R 10.2196/43116 %U https://www.jmir.org/2023/1/e43116 %U https://doi.org/10.2196/43116 %U http://www.ncbi.nlm.nih.gov/pubmed/36853749 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43394 %T Risk and Protective Profile of Men Who Have Sex With Men Using Mobile Voluntary HIV Counseling and Testing: Latent Class Analysis %A Chiou,Piao-Yi %A Tsao,Wei-Wen %A Lin,Kuan-Chia %A Fang,Yuan-Yuan %A Lin,Kuan-Yin %A Li,Chia-Lin %+ School of Nursing, College of Medicine, National Taiwan University, No 2-1 Xuzhou Road, Zhongzheng District, Taipei City, 100, Taiwan, 886 2 23123123 ext 288427, purechiou2@gmail.com %K HIV testing %K latent class analysis %K men who have sex with men %K mobile health %K postexposure prophylaxis (PEP) %K preexposure prophylaxis (PrEP) %K risk-taking %K anal sex %K sexual partners %K social networking %D 2023 %7 16.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Mobile voluntary counseling and testing (VCT) for HIV has been carried out to improve the targeting of at-risk populations and HIV case detection for men who have sex with men (MSM). However, the HIV-positive detection rate using this screening strategy has declined in recent years. This may imply unknown changes in risk-taking and protective features jointly influencing the testing results. These changing patterns in this key population remain unexplored. Objective: The aim of this study was to identify the nuanced group classification of MSM who underwent mobile VCT using latent class analysis (LCA), and to compare the difference in characteristics and testing results between subgroups. Methods: A cross-sectional research design and purposive sampling were applied between May 21, 2019, and December 31, 2019. Participants were recruited by a well-trained research assistant through social networking platforms, including the most popular instant messenger app Line, geosocial network apps dedicated to MSM, and online communities. Mobile VCT was provided to participants at an assigned time and place. Demographic characteristics and risk-taking and protective features of the MSM were collected via online questionnaires. LCA was used to identify discrete subgroups based on four risk-taking indicators—multiple sexual partners (MSP), unprotected anal intercourse (UAI), recreational drug use within the past 3 months, and history of sexually transmitted diseases—and three protective indicators—experience of postexposure prophylaxis, preexposure prophylaxis use, and regular HIV testing. Results: Overall, 1018 participants (mean age 30.17, SD 7.29 years) were included. A three-class model provided the best fit. Classes 1, 2, and 3 corresponded to the highest risk (n=175, 17.19%), highest protection (n=121, 11.89%), and low risk and low protection (n=722, 70.92%), respectively. Compared to those of class 3, class 1 participants were more likely to have MSP and UAI within the past 3 months, to be ≥40 years of age (odds ratio [OR] 2.197, 95% CI 1.357-3.558; P=.001), to have HIV-positive results (OR 6.47, 95% CI 2.272-18.482; P<.001), and a CD4 count ≤349/μL (OR 17.50, 95% CI 1.223-250.357; P=.04). Class 2 participants were more likely to adopt biomedical preventions and have marital experience (OR 2.55, 95% CI 1.033-6.277; P=.04). Conclusions: LCA helped derive a classification of risk-taking and protection subgroups among MSM who underwent mobile VCT. These results may inform policies for simplifying the prescreening assessment and more precisely recognizing those who have higher probabilities of risk-taking features but remain undiagnosed targets, including MSM engaging in MSP and UAI within the past 3 months and those ≥40 years old. These results could be applied to tailor HIV prevention and testing programs. %M 36795477 %R 10.2196/43394 %U https://publichealth.jmir.org/2023/1/e43394 %U https://doi.org/10.2196/43394 %U http://www.ncbi.nlm.nih.gov/pubmed/36795477 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43844 %T Development of a Mobile App to Increase the Uptake of HIV Pre-exposure Prophylaxis Among Latino Sexual Minority Men: Qualitative Needs Assessment %A Cantos,Valeria D %A Hagen,Kimberly %A Duarte,Ana Paula %A Escobar,Carolina %A Batina,Isabella %A Orozco,Humberto %A Rodriguez,Josue %A Camacho-Gonzalez,Andres %A Siegler,Aaron J %+ Division of Infectious Diseases, Emory University School of Medicine, 46 Armstrong Street, Atlanta, GA, 30303, United States, 1 404 251 8717, vcantos@emory.edu %K pre-exposure prophylaxis %K PrEP %K Latino %K sexual minority men %K SMM %K mobile health %K mHealth %K HIV prevention %K HIV %K technology %K minority %K men %K development %K biomedical intervention %K mobile technology %K mobile app %K community %K app %K barrier %K mobile phone %D 2023 %7 8.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV disproportionally impacts Latino sexual minority men (SMM). Uptake of pre-exposure prophylaxis (PrEP), an effective biomedical intervention to prevent HIV, is low in this group compared with White SMM. Mobile health technology represents an innovative strategy to increase PrEP uptake among Latino SMM. Objective: We aimed to describe the qualitative process leading to the development of SaludFindr, a comprehensive HIV prevention mobile app aiming to increase PrEP uptake, HIV testing, and condom use by Latino SMM. Methods: We conducted 13 in-depth interviews with Latino SMM living in the Atlanta area to explore their main barriers and facilitators to PrEP uptake and to analyze their opinions of potential SaludFindr app functionalities. To explore potential app functions, we used HealthMindr, an existing HIV prevention app, as a template and added new proposed features intended to address the specific community needs. Results: We identified general PrEP uptake barriers that, although common among non-Latino groups, had added complexities such as the influence of religion and family on stigma. Low perceived PrEP eligibility, intersectional stigma, lack of insurance, cost concerns, and misconceptions about PrEP side effects were described as general barriers. We also identified Latino-specific barriers that predominantly hinder access to existing services, including a scarcity of PrEP clinics that are prepared to provide culturally concordant services, limited availability of Spanish language information related to PrEP access, distrust of peers as credible sources of information, perceived ineligibility for low-cost services owing to undocumented status, fear of immigration authorities, and competing work obligations that prevent PrEP clinic attendance. Health care providers represented a trusted source of information, and 3 provider characteristics were identified as PrEP facilitators: familiarity with prescribing PrEP; being Latino; and being part of lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) group or ally. The proposed app was very well accepted, with a particularly high interest in features that facilitate PrEP access, including a tailored list of clinics that meet the community needs and a private platform to seek PrEP information. Spanish language availability and free or low-cost PrEP care represented the 2 main clinic criteria that would facilitate PrEP uptake. Latino representation in clinic staff and providers; clinic perception as a safe space for undocumented patients; and LGBTQIA+ representation was listed as additional criteria. Only 8 of 47 clinics listed on the Centers for Diseases Control and Prevention PrEP locator website for the Atlanta area fulfilled at least 2 main criteria. Conclusions: This study provides further evidence of the substantial PrEP uptake barriers that Latino SMM face; exposes the urgent need to increase the number of accessible PrEP-providing clinics for Latino SMM; and proposes an innovative, community-driven, and mobile technology–based tool as a future intervention to overcome some of these barriers. %M 36625855 %R 10.2196/43844 %U https://formative.jmir.org/2023/1/e43844 %U https://doi.org/10.2196/43844 %U http://www.ncbi.nlm.nih.gov/pubmed/36625855 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e35116 %T Impacts of GlobalConsent, a Web-Based Social Norms Edutainment Program, on Sexually Violent Behavior and Bystander Behavior Among University Men in Vietnam: Randomized Controlled Trial %A Yount,Kathryn M %A Cheong,Yuk Fai %A Bergenfeld,Irina %A Trang,Quach Thu %A Sales,Jessica M %A Li,Yiman %A Minh,Tran Hung %+ Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, United States, 1 4047278511, kyount@emory.edu %K behavior change communication %K bystander behavior %K campus sexual assault %K educational entertainment (edutainment) %K sexual violence %K social cognitive theory %K social norms theory %K Vietnam %K mobile phone %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Sexual violence against women is prevalent worldwide. Prevention programs that treat men as allies and integrate a bystander framework are emerging in lower income settings, but evidence of their effectiveness is conflicting. Objective: This study aimed to test the impact of GlobalConsent on sexually violent behavior and prosocial bystander behavior among university men in Vietnam. Methods: We used a double-blind, parallel intervention versus control group design with 1:1 randomization at 2 universities. A total of 793 consenting heterosexual or bisexual men aged 18-24 years who matriculated in September 2019 were enrolled and assigned randomly to GlobalConsent or an attention-control adolescent health education (AHEAD) program. GlobalConsent is an adapted, theory-based, 6-module web-based intervention with diverse behavior change techniques and a locally produced serial drama. AHEAD is a customized, 6-module attention-control program on adolescent health. Both the programs were delivered to computers and smartphones over 12 weeks. Self-reported sexually violent behaviors toward women in the prior 6 months and prosocial bystander behaviors in the prior year were measured at 0, 6, and 12 months. Results: More than 92.7% (735/793) of men in both study arms completed at least 1 program module, and >90.2% (715/793) of men completed all 6 modules. At baseline, a notable percentage of men reported any sexually violent behavior (GlobalConsent: 123/396, 31.1%; AHEAD: 103/397, 25.9%) in the prior 6 months. Among men receiving GlobalConsent, the odds of reporting a high level (at least 2 acts) of sexually violent behavior at the endline were 1.3 times the odds at baseline. Among men receiving AHEAD, the corresponding odds ratio was higher at 2.7. The odds of reporting any bystander behavior at endline were 0.7 times the odds at baseline for GlobalConsent, and the corresponding odds ratio for AHEAD was lower at 0.5. Conclusions: Compared with a health attention-control condition, GlobalConsent has sustained favorable impacts on sexually violent behavior and prosocial bystander behavior among matriculating university men in Vietnam, who would otherwise face increasing risks of sexually violent behavior. GlobalConsent shows promise for national scale-up and regional adaptations. Trial Registration: ClinicalTrials.gov NCT04147455; https://clinicaltrials.gov/ct2/show/NCT04147455 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-020-09454-2 %M 36705965 %R 10.2196/35116 %U https://publichealth.jmir.org/2023/1/e35116 %U https://doi.org/10.2196/35116 %U http://www.ncbi.nlm.nih.gov/pubmed/36705965 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e41162 %T Predicting Risky Sexual Behavior Among College Students Through Machine Learning Approaches: Cross-sectional Analysis of Individual Data From 1264 Universities in 31 Provinces in China %A Li,Xuan %A Zhang,Hanxiyue %A Zhao,Shuangyu %A Tang,Kun %+ Vanke School of Public Health, Tsinghua University, No 30 Shuangqing Road, Haidian District, Beijing, 100084, China, 86 13671129425, tangk@mail.tsinghua.edu.cn %K risky sexual behavior %K sexually transmitted infections %K college students %K machine learning %K prediction %K students %K risk factor %K STI %K intervention %K China %K sex %D 2023 %7 25.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Risky sexual behavior (RSB), the most direct risk factor for sexually transmitted infections (STIs), is common among college students. Thus, identifying relevant risk factors and predicting RSB are important to intervene and prevent RSB among college students. Objective: We aim to establish a predictive model for RSB among college students to facilitate timely intervention and the prevention of RSB to help limit STI contraction. Methods: We included a total of 8794 heterosexual Chinese students who self-reported engaging in sexual intercourse from November 2019 to February 2020. We identified RSB among those students and attributed it to 4 dimensions: whether contraception was used, whether the contraceptive method was safe, whether students engaged in casual sex or sex with multiple partners, and integrated RSB (which combined the first 3 dimensions). Overall, 126 predictors were included in this study, including demographic characteristics, daily habits, physical and mental health, relationship status, sexual knowledge, sexual education, sexual attitude, and previous sexual experience. For each type of RSB, we compared 8 machine learning (ML) models: multiple logistic regression (MLR), naive Bayes (BYS), linear discriminant analysis (LDA), random forest (RF), gradient boosting machine (GBM), extreme gradient boosting (XGBoost), deep learning (DL), and the ensemble model. The optimal model for both RSB prediction and risk factor identification was selected based on a set of validation indicators. An MLR model was applied to investigate the association between RSB and identified risk factors through ML methods. Results: In total, 5328 (60.59%) students were found to have previously engaged in RSB. Among them, 3682 (41.87%) did not use contraception every time they had sexual intercourse, 3602 (40.96%) had previously used an ineffective or unsafe contraceptive method, and 1157 (13.16%) had engaged in casual sex or sex with multiple partners. XGBoost achieved the optimal predictive performance on all 4 types of RSB, with the area under the receiver operator characteristic curve (AUROC) reaching 0.78, 0.72, 0.94, and 0.80 for contraceptive use, safe contraceptive method use, engagement in casual sex or with multiple partners, and integrated RSB, respectively. By ensuring the stability of various validation indicators, the 12 most predictive variables were then selected using XGBoost, including the participants’ relationship status, sexual knowledge, sexual attitude, and previous sexual experience. Through MLR, RSB was found to be significantly associated with less sexual knowledge, more liberal sexual attitudes, single relationship status, and increased sexual experience. Conclusions: RSB is prevalent among college students. The XGBoost model is an effective approach to predict RSB and identify corresponding risk factors. This study presented an opportunity to promote sexual and reproductive health through ML models, which can help targeted interventions aimed at different subgroups and the precise surveillance and prevention of RSB among college students through risk probability prediction. %M 36696166 %R 10.2196/41162 %U https://publichealth.jmir.org/2023/1/e41162 %U https://doi.org/10.2196/41162 %U http://www.ncbi.nlm.nih.gov/pubmed/36696166 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e42197 %T Effect of Participative Web-Based Educational Modules on HIV and Sexually Transmitted Infection Prevention Competency Among Medical Students: Single-Arm Interventional Study %A Grant,William %A Adan,Matthew A %A Samurkas,Christina A %A Quigee,Daniela %A Benitez,Jorge %A Gray,Brett %A Carnevale,Caroline %A Gordon,Rachel J %A Castor,Delivette %A Zucker,Jason %A Sobieszczyk,Magdalena E %+ Vagelos College of Physicians & Surgeons, Columbia University, 622 West 168th Street 8th Floor, New York, NY, 10032, United States, 1 201 723 6637, madan@mgh.harvard.edu %K HIV prevention %K medical education %K sexual health education %K pre-exposure prophylaxis %K PrEP %D 2023 %7 24.1.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: The number of new HIV diagnoses in the United States continues to slowly decline; yet, transgender women and men who have sex with men remain disproportionately affected. Key to improving the quality of prevention services are providers who are comfortable broaching the subjects of sexual health and HIV prevention with people across the spectrum of gender identities and sexual orientations. Preservice training is a critical point to establish HIV prevention and sexual health education practices before providers’ practice habits are established. Objective: The study aimed to develop participative web-based educational modules and test their impact on HIV prevention knowledge and awareness in future providers. Methods: Sexual health providers at an academic hospital, research clinicians, community engagement professionals, and New York City community members were consulted to develop 7 web-based educational modules, which were then piloted among medical students. We assessed knowledge of HIV and sexually transmitted infection prevention and comfort assessing the prevention needs of various patients via web-based questionnaires administered before and after our educational intervention. We conducted exploratory factor analysis of the items in the questionnaire. Results: Pre- and postmodule surveys were completed by 125 students and 89 students, respectively, from all 4 years of training. Before the intervention, the majority of students had heard of HIV pre-exposure prophylaxis (122/123, 99.2%) and postexposure prophylaxis (114/123, 92.7%). Before the training, 30.9% (38/123) of the students agreed that they could confidently identify a patient who is a candidate for pre-exposure prophylaxis or postexposure prophylaxis; this increased to 91% (81/89) after the intervention. Conclusions: Our findings highlight a need for increased HIV and sexually transmitted infection prevention training in medical school curricula to enable future providers to identify and care for diverse at-risk populations. Participative web-based modules offer an effective way to teach these concepts. %M 36692921 %R 10.2196/42197 %U https://mededu.jmir.org/2023/1/e42197 %U https://doi.org/10.2196/42197 %U http://www.ncbi.nlm.nih.gov/pubmed/36692921 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37344 %T HIV Prevalence and Risk Factors Among Young Men Who Have Sex With Men in Southwest China: Cross-sectional Questionnaire Study %A Song,Liping %A Yu,Xiangyuan %A Su,Bing %A Geng,Wen Kui %A Lan,Guanghua %A Zhang,Xiangjun %+ Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Avenue, Memphis, TN, 38163, United States, 1 901 448 1763, zxj@nevada.unr.edu %K HIV %K young men who have sex with men %K syphilis %K sexually transmitted infection %K ethnic minority %D 2023 %7 11.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Previous studies showed an increase in HIV prevalence among young men who have sex with men aged 25 years or younger in China. Objective: This study aimed to assess HIV prevalence and associated factors among young men who have sex with men in the Guangxi Zhuang Autonomous Region. Methods: This study was conducted in 4 cities (Guilin, Liuzhou, Beihai, and Nanning) in the Guangxi Zhuang Autonomous Region between June 2014 and May 2016. Participants were reached through web-based and site recruitment approaches. Laboratory tests were performed to detect HIV and syphilis infections. A self-administered questionnaire was used to collect data from 632 eligible young men who have sex with men. Results: The prevalence of HIV and syphilis was 9.3% (59/632) and 11.4% (72/632), respectively. Multivariable logistic analysis showed that ethnic minority (adjusted odds ratio [AOR] for Han Chinese vs other minorities 0.28, 95% CI 0.11-0.71, P=.007), receptive sexual positioning in the past 6 months (AOR 2.94, 95% CI 1.32-6.53, P=.008), current syphilis infection (AOR for individuals without vs those with infection 0.38, 95% CI 0.19-0.75, P=.005), inconsistent condom use in the past 6 months (AOR 1.91, 95% CI 1.06-3.45, P=.03), and psychotropic drug use before last anal intercourse (AOR 16.70, 95% CI 2.34-119.18, P=.005) were independently associated with HIV infection. Conclusions: There is an urgent need to scale up HIV and syphilis interventions in young men who have sex with men. Some subgroups might need specific attention for HIV prevention, including ethnic minority men, individuals with a history of sexually transmitted infections, and individuals who have been engaging in receptive anal sex. %M 36630166 %R 10.2196/37344 %U https://formative.jmir.org/2023/1/e37344 %U https://doi.org/10.2196/37344 %U http://www.ncbi.nlm.nih.gov/pubmed/36630166 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42902 %T Web-Based Harm Reduction Intervention for Chemsex in Men Who Have Sex With Men: Randomized Controlled Trial %A Choi,Edmond Pui Hang %A Choi,Kitty Wai Ying %A Wu,Chanchan %A Chau,Pui Hing %A Kwok,Jojo Yan Yan %A Wong,William Chi Wai %A Chow,Eric Pui Fung %+ School of Nursing, The University of Hong Kong, 5/F, Academic Building, 3 Sassoon Road, Pok Fu Lam, Hong Kong, , China (Hong Kong), 852 3917 6972, h0714919@connect.hku.hk %K chemsex %K drug abuse %K eHealth %K men who have sex with men %K trial %K prevention %K Chinese %D 2023 %7 5.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Men who have sex with men (MSM) who practice chemsex have a higher likelihood of engaging in risky sexual behaviors and higher rates of HIV infection and other sexually transmitted infections (STIs) than those who do not. Objective: This trial aimed to evaluate the effectiveness of a web-based intervention in reducing the sexual harms of chemsex among MSM. Methods: The study was a 2-arm, assessor-blinded, randomized, parallel-group trial with a 3-month follow-up period. The study was conducted in the year 2021 in Hong Kong. Underpinned by the theory of planned behaviors and a harm reduction approach, the intervention consisted of interactive components and knowledge-based information about chemsex. Participants in the control group received brief information and content about sexual violence. The primary outcome was self-efficacy in refusing risky sexual behaviors and chemsex, as measured by the Condom Self-Efficacy Scale (CSES), Self-Efficacy for Sexual Safety (SESS) instrument, and Drug Avoidance Self-Efficacy Scale (DASES). The secondary outcomes included intentions to have chemsex, actual engagement in chemsex, HIV and other STI testing, and condom use in the last 3 months. All outcomes were self-reported. An online structured questionnaire was used to collect data. Results: In total, 316 MSM enrolled in the study. The intervention group demonstrated a significantly larger improvement in condom-use self-efficacy (as measured by CSES scores; time-by-group interaction: β=4.52, 95% CI 2.03-7.02; P<.001), self-efficacy for sexual safety (as measured by SESS scores; time-by-group interaction: β=2.11, 95% CI 0.66-3.56; P=.004), and drug avoidance self-efficacy (as measured by DASES scores; time-by-group interaction: β=6.98, 95% CI 1.75-12.22; P=.009). Regarding the secondary outcomes, participants in the intervention group demonstrated a significantly larger reduction in the likelihood of having engaged in chemsex in the last 3 months (time-by-group interaction: odds ratio [OR]=0.23, 95% CI 0.10-0.53; P=.001) and likelihood of having had the intention to engage in chemsex in the last 3 months (time-by-group interaction: OR=0.37, 95% CI 0.18-0.78; P=.009). Participants in the intervention group also showed a significantly larger increase in the likelihood of having undergone HIV testing in the last 3 months (time-by-group interaction: OR=3.08, 95% CI 1.72-5.54; P<.001). Conclusions: This study suggests that a web-based intervention with a harm reduction approach can enhance the self-efficacy of MSM in refusing risky sexual behaviors and chemsex and improve the uptake of HIV testing. We also provide initial evidence that such interventions can reduce both the intention of MSM to engage in chemsex and their actual engagement in chemsex. Trial Registration: ISRCTN Registry ISRCTN20134522; https://www.isrctn.com/ISRCTN20134522. International Registered Report Identifier (IRRID): RR2-10.1186/s12889-021-10742-8 %M 36602853 %R 10.2196/42902 %U https://publichealth.jmir.org/2023/1/e42902 %U https://doi.org/10.2196/42902 %U http://www.ncbi.nlm.nih.gov/pubmed/36602853 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e31237 %T The Use of HIV Pre- and Postexposure Prophylaxis Among a Web-Based Sample of HIV-Negative and Unknown Status Cisgender and Transgender Sexual Minority Men: Cross-sectional Study %A John,Steven A %A Sizemore,K Marie %A Jimenez,Ruben H %A Jones,S Scott %A Petroll,Andrew E %A Rendina,H Jonathon %+ Health Intervention Sciences Group / Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N Summit Ave, Milwaukee, WI, 53202, United States, 1 414 955 7744, sjohn@mcw.edu %K HIV %K pre-exposure prophylaxis %K postexposure prophylaxis %K sexual minority men %K men who have sex with men %D 2022 %7 16.12.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: HIV disproportionately affects sexual minority men (SMM) in the United States. Objective: We sought to determine past HIV postexposure prophylaxis (PEP) use and current and prior pre-exposure prophylaxis (PrEP) use among a web-based sample of cisgender and transgender men who have sex with men. Methods: In 2019, HIV-negative and unknown status SMM (n=63,015) were recruited via geosocial networking apps, social media, and other web-based venues to participate in a brief eligibility screening survey. Individuals were asked about past PEP use and current and prior PrEP use. We examined associations of demographics, socioeconomic indicators, and recent club drug use with PEP and PrEP use, as well as the association between past PEP use and current and prior PrEP use using generalized linear models and multinomial logistic regression. Statistical significance was considered at P<.001, given the large sample size; 99.9% CIs are reported. Results: Prior PEP use was reported by 11.28% (7108/63,015) of the participants, with current or prior PrEP use reported by 21.95% (13,832/63,015) and 8.12% (5118/63,015), respectively. Nearly half (3268/7108, 46%) of the past PEP users were current PrEP users, and another 39.9% (2836/7108) of the participants who reported past PEP use also reported prior PrEP use. In multivariable analysis, past PEP use was associated with current (relative risk ratio [RRR] 23.53, 99.9% CI 14.03-39.46) and prior PrEP use (RRR 52.14, 99.9% CI 29.39-92.50). Compared with White men, Black men had higher prevalence of past PEP use and current PrEP use, Latino men had higher prevalence of PEP use but no significant difference in PrEP use, and those identifying as another race or ethnicity reported higher prevalence of past PEP use and lower current PrEP use. Past PEP use and current PrEP use were highest in the Northeast, with participants in the Midwest and South reporting significantly lower PEP and PrEP use. A significant interaction of Black race by past PEP use with current PrEP use was found (RRR 0.57, 99.9% CI 0.37-0.87), indicating that Black men who previously used PEP were less likely to report current PrEP use. Participants who reported recent club drug use were significantly more likely to report past PEP use and current or prior PrEP use than those without recent club drug use. Conclusions: PrEP use continues to be the predominant HIV prevention strategy for SMM compared with PEP use. Higher rates of past PEP use and current PrEP use among Black SMM are noteworthy, given the disproportionate burden of HIV. Nonetheless, understanding why Black men who previously used PEP are less likely to report current PrEP use is an important avenue for future research. %M 36306518 %R 10.2196/31237 %U https://publichealth.jmir.org/2022/12/e31237 %U https://doi.org/10.2196/31237 %U http://www.ncbi.nlm.nih.gov/pubmed/36306518 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 12 %P e37395 %T Integrating Enhanced HIV Pre-exposure Prophylaxis Into a Sexually Transmitted Infection Clinic in Lilongwe: Protocol for a Prospective Cohort Study %A Rutstein,Sarah E %A Matoga,Mitch %A Chen,Jane S %A Mathiya,Esther %A Ndalama,Beatrice %A Nyirenda,Naomi %A Bonongwe,Naomi %A Chithambo,Shyreen %A Chagomerana,Maganizo %A Tegha,Gerald %A Hosseinipour,Mina C %A Herce,Michael E %A Jere,Edward %A Krysiak,Robert G %A Hoffman,Irving F %+ Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Chapel Hill, NC, 27599, United States, 1 919 966 2537, srutstein@unc.edu %K pre-exposure prophylaxis %K PrEP %K sexually transmitted infections %K STI %K sub-Saharan Africa %K partner notification %D 2022 %7 5.12.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Pre-exposure prophylaxis (PrEP) reduces HIV acquisition risk by >90% and is a critical lever to reduce HIV incidence. Identifying individuals most likely to benefit from PrEP and retaining them on PrEP throughout HIV risk is critical to realize PrEP’s prevention potential. Individuals with sexually transmitted infections (STIs) are an obvious priority PrEP population, but there are no data from sub-Saharan Africa (SSA) confirming the effectiveness of integrating PrEP into STI clinics. Assisted partner notification may further enhance STI clinic–based PrEP programming by recruiting PrEP users from the pool of named sexual partners of individuals presenting with an incident STI. However, the acceptability, feasibility, and effectiveness of these integrated and enhanced strategies are unknown. Objective: This study aims to describe the implementation outcomes of acceptability, feasibility, and effectiveness (regarding PrEP uptake and persistence) of integrating an enhanced PrEP implementation strategy into an STI clinic in Malawi. Methods: The enhanced PrEP STI study is a prospective cohort study enrolling patients who are eligible for PrEP (aged ≥15 years) who are seeking STI services at a Lilongwe-based STI clinic. Data collection relies on a combination of in-depth interviews, patient and clinic staff surveys, and clinic record review. All enrolled PrEP users will be screened for acute HIV infection and receive quarterly testing for Neisseria gonorrhea, Chlamydia trachomatis, and syphilis. Participants will be asked to name recent sexual partners for assisted notification; returning partners will be screened for PrEP eligibility and, if interested, enrolled into the cohort of PrEP initiators. We will also enroll patients who are eligible for PrEP but choose not to initiate it, from the STI clinic. Patient participants will be followed for 6 months; we will assess self-reported PrEP use, PrEP refills, sexual behaviors, perceived HIV risk, and incident STIs. Clinic staff participants will be interviewed at baseline and at approximately 6 months and will complete surveys examining the perceived acceptability and feasibility of the integrated and enhanced PrEP strategy. Results: Enrollment began in March 2022 and is projected to continue until February 2023, with patient participant follow-up through August 2023. The results of this study are expected to be reported in 2024. Conclusions: This study will generate important evidence regarding the potential integration of PrEP services into STI clinics in SSA and preliminary data regarding the effectiveness of an enhanced intervention that includes assisted partner notification as a strategy to identify potential PrEP users. Furthermore, this trial will provide some of the first insights into STI incidence among PrEP users recruited from an STI clinic in SSA—critical data to inform the use of etiologic STI testing where syndromic management is the current standard. These findings will help to design future PrEP implementation strategies in SSA. Trial Registration: ClinicalTrials.gov NCT05307991; https://clinicaltrials.gov/ct2/show/NCT05307991 International Registered Report Identifier (IRRID): DERR1-10.2196/37395 %M 36469400 %R 10.2196/37395 %U https://www.researchprotocols.org/2022/12/e37395 %U https://doi.org/10.2196/37395 %U http://www.ncbi.nlm.nih.gov/pubmed/36469400 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e33093 %T A Brief Educational Pre-exposure Prophylaxis Intervention in an Infectious Disease Clinic: Protocol for a Case Series Study %A Dalton,Cynthia %A Cornelius,Judith %A Davis,Bernard %+ University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, United States, 1 3364062546, cdalton7777@gmail.com %K PrEP %K men who have sex with men %K protocol %K case series design %K HIV %K pre-exposure prophylaxis %K sexual health %K HIV prevention %K health education %K educational intervention %D 2022 %7 23.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Black men who have sex with men (BMSM) remain the highest group infected with HIV despite treatment with medications known as pre-exposure prophylaxis (PrEP). PrEP in combination with safer sex practices has shown efficacy in preventing HIV infection. Despite awareness campaigns, PrEP uptake remains low among BMSM. While brief educational interventions have value in fast-paced clinical settings with limited appointment times, a brief PrEP educational intervention has not been initiated with BMSM in a fast-paced outpatient infectious disease clinic in North Carolina. Objective: The purpose of this study was to examine the effect of initiating a brief PrEP educational intervention to reduce HIV infection rates in BMSM in a fast-paced infectious disease clinic delivered by a doctoral-prepared nurse practitioner. Methods: This case-series study uses a brief educational intervention to develop and pilot-test a brief PrEP educational uptake intervention with BMSM. The participants met with the nurse practitioner at 3 different time points: baseline, 4 weeks later (first visit), and at the 3-month follow-up (second visit). We used a pretest-posttest design to examine the primary outcomes of PrEP knowledge, medication adherence, and sexually transmitted infection outcomes. Results: Due to the COVID-19 pandemic, the recruitment process was delayed. From November 1, 2019, to August 30, 2021, a total of 7 participants consented to participate in the study. Data analysis will be completed by the end of September 2022. We will submit a manuscript for publication consideration by December 2022. Conclusions: Brief educational interventions delivered in a fast-paced infectious disease clinic have the potential to increase PrEP awareness and knowledge, medication adherence, and decreased rates of sexually transmitted diseases in BMSM. This protocol will contribute to the literature on the development of brief PrEP educational interventions and has the potential to be generalized to other populations (eg, women and adolescents). International Registered Report Identifier (IRRID): RR1-10.2196/33093 %M 36416868 %R 10.2196/33093 %U https://www.researchprotocols.org/2022/11/e33093 %U https://doi.org/10.2196/33093 %U http://www.ncbi.nlm.nih.gov/pubmed/36416868 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e38855 %T A Cost-effectiveness Analysis of a Mobile Phone–Based Integrated HIV-Prevention Intervention Among Men Who Have Sex With Men in China: Economic Evaluation %A Yun,Ke %A Yu,Jiaming %A Liu,Changyang %A Zhang,Xinxin %+ Department of Ophthalmology Laboratory, The Fourth Affiliated Hospital of China Medical University, No. 11 Xinhua Road, Shenyang, 110006, China, 86 024 62035015, zhangxinxin@cmu.edu.cn %K cost-effectiveness %K digital intervention %K men who have sex with men %K mathematical model %D 2022 %7 2.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile phone–based digital interventions have been shown to be a promising strategy for HIV prevention among men who have sex with men (MSM). Objective: This study aimed to evaluate the cost-effectiveness of a mobile phone–based digital intervention for HIV prevention among MSM in China from the perspective of a public health provider. Methods: The cost-effectiveness of the mobile phone–based digital intervention was estimated for a hypothetical cohort of 10,000 HIV-negative MSM who were followed for 1 year. A model was developed with China-specific data to project the clinical impact and cost-effectiveness of two mobile phone–based digital strategies for HIV prevention among MSM. The intervention group received an integrated behavioral intervention that included 1) individualized HIV infection risk assessment, 2) recommendation of centers testing for HIV and other STIs, 3) free online order of condoms and HIV and syphilis self-test kits and 4) educational materials about HIV/AIDS. The control group was only given educational materials about HIV/AIDS. Outcomes of interest were the number of HIV infections among MSM averted by the intervention, intervention costs, cost per HIV infection averted by the mobile phone–based digital intervention, and quality-adjusted life-years (QALYs). Univariate and multivariate sensitivity analyses were also conducted to examine the robustness of the results. Results: It is estimated that the intervention can prevent 48 MSM from becoming infected with HIV and can save 480 QALYs. The cost of preventing 1 case of HIV infection was US $2599.87, and the cost-utility ratio was less than 0. Sensitivity analysis showed that the cost-effectiveness of the mobile phone–based digital intervention was mainly impacted by the average number of sexual behaviors with each sexual partner. Additionally, the higher the HIV prevalence among MSM, the greater the benefit of the intervention. Conclusions: Mobile phone–based digital interventions are a cost-effective HIV-prevention strategy for MSM and could be considered for promotion and application among high-risk MSM subgroups. %M 36322123 %R 10.2196/38855 %U https://www.jmir.org/2022/11/e38855 %U https://doi.org/10.2196/38855 %U http://www.ncbi.nlm.nih.gov/pubmed/36322123 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e37982 %T Social Media Communication and Network Correlates of HIV Infection and Transmission Risks Among Black Sexual Minority Men: Cross-sectional Digital Epidemiology Study %A Young,Lindsay E %A Tang,Jack Lipei %A Nan,Yuanfeixue %+ Annenberg School for Communication and Journalism, University of Southern California, 3502 Watt Way, Los Angeles, CA, 90089, United States, 1 610 331 1930, lindsay.young@usc.edu %K HIV surveillance %K HIV prevention %K digital epidemiology %K social media %K social networks %K sexual minority men %K men who have sex with men %D 2022 %7 20.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, HIV disproportionately affects Black cisgender sexual minority men (BSMM). Although epidemiological and behavioral surveillance are integral to identifying BSMM at risk of HIV infection and transmission, overreliance on self-reported data, inability to observe social contexts, and neglect of populations with limited engagement in health care systems limits their effectiveness. Digital epidemiological approaches drawing on social media data offer an opportunity to overcome these limitations by passively observing in organic settings activities, beliefs, behaviors, and moods that indicate health risks but are otherwise challenging to capture. Objective: The primary aim of this study was to determine whether features of Facebook communication and networks were associated with biological, behavioral, and psychological indicators of HIV infection and transmission risk. Methods: Facebook and survey data were collected from BSMM aged 18 to 35 years living in Chicago (N=310). Participants’ Facebook posts were characterized using 4 culturally tailored topic dictionaries related to aspects of HIV protection and risk among BSMM (sexual health; substance use; sex behavior; and ballroom culture, a salient subculture in lesbian, gay, bisexual, transgender, and queer communities of color). Social network methods were used to capture structural features of BSMM’s Facebook friendships (centrality, brokerage, and local clustering) and Facebook group affiliations. Multivariable regressions revealed relationships between these Facebook features and 5 ground truth indicators of HIV infection and transmission risk (sexually transmitted infection incidence, condomless sex, sex drug use, biomedical prevention, and depression). Results: Although analysis of participants’ Facebook posts revealed that HIV-related topics occupied a small portion of the total messages posted by each participant, significant associations were found between the following HIV risk indicators and Facebook features: Condomless sex, including communication about sexual health (odds ratio [OR] 1.58, 95% CI 1.09-2.29), ballroom culture (OR 0.76, 95% CI 0.63-0.93), and friendship centrality (OR 0.69, 95% CI 0.52-0.92); Sex drug use, including communication about substance use (OR 1.81, 95% CI 1.17-2.79) and friendship centrality (OR 0.73, 95% CI 0.55-0.96) and brokerage (OR 0.71, 95% CI 0.51-0.99); Biomedical prevention, including communication about ballroom culture (OR 0.06, 95% CI 0.01-0.71); and Depression, including communication about sexual health (β=–0.72, 95% CI −1.42 to −0.02), ballroom culture (β=.80, 95% CI 0.27-1.34), friendship centrality (β=−0.90, 95% CI −1.60 to −0.21), and Facebook group affiliations (β=.84, 95% CI 0.25-1.43). Facebook features provided no significant explanatory value for sexually transmitted infection incidence. Conclusions: Finding innovative strategies to detect BSMM at risk of contracting or transmitting HIV is critical to eliminating HIV disparities in this community. The findings suggest that social media data enable passive observance of social and communicative contexts that would otherwise go undetected using traditional HIV surveillance methods. As such, social media data are promising complements to more traditional data sources. %M 36264617 %R 10.2196/37982 %U https://formative.jmir.org/2022/10/e37982 %U https://doi.org/10.2196/37982 %U http://www.ncbi.nlm.nih.gov/pubmed/36264617 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e41602 %T Community-Engaged Intervention Mapping for Cardiovascular Disease Prevention in Black and Latinx Sexual Minority Men With HIV in New York City: Protocol for a Web-Based Mixed Methods Study %A Ramos,S Raquel %A Fraser,Marilyn %A Araya,Faven %A Kim,Hyun Young %A Parrilla,Jon Andre Sabio %A Sy,Kalla Maxine %A Nagpal,Riya Tongson %A Camacho-Rivera,Marlene %A Boutjdir,Mohamed %+ School of Nursing, Yale University, 400 West Campus Dr, Orange, CT, 06477, United States, 1 203 737 2339, raquel.ramos@yale.edu %K intervention mapping %K CVD %K eHealth intervention %K HIV %K sexual minority men %K Black men %K Latinx %K community engagement %K men who have sex with men %K community based %K qualitative %K survey %D 2022 %7 11.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Approximately every 37 seconds, someone in the United States dies of cardiovascular disease (CVD). It has emerged as an important contributor to morbidity among persons with HIV. Black and Latinx sexual minority men are at higher risk of both HIV and CVD when compared to heterosexual, nonethnic or minority men. Persons with HIV have a 1.5 to 2-times risk of having CVD than do HIV-negative persons. Data suggest that by the year 2030, an estimated 78% of persons with HIV will have CVD. The relationship between HIV and CVD in marginalized populations is not well understood because overall awareness of HIV and CVD as comorbid conditions is low, which further heightens risk. This has created a critically pressing issue affecting underrepresented ethnic and racial populations with HIV and requires immediate efforts to mitigate risk. Objective: The purpose of this formative, mixed methods study is to use a community-engaged approach to map a behavioral intervention for CVD prevention in Black and Latinx sexual minority men with HIV in New York City. Methods: Literature reviews focused on behavioral prevention studies using intervention mapping. In Aim 1, we will use qualitative interviews with HIV program managers and community members to understand facilitators and barriers to CVD prevention, chronic illnesses of concern, and early design elements needed for a web-based CVD prevention intervention. In Aim 2, we will conduct qualitative interviews and administer cross-sectional validated surveys with 30 Black and Latinx sexual minority men with HIV. We will assess illness perceptions of chronic conditions, such as HIV, hypertension, and diabetes. A total of 40 participants (program managers and community members) for Aims 1 and 2 will be enrolled to participate. To develop the protocol, we will follow steps 1 through 3 (needs assessment, change objectives, implementation strategy) of intervention mapping, using mixed methods. Results: The study was approved by New York University Institutional Review Board in February 2021 (IRB-FY2021-4772) and also by the Yale University Institutional Review Board in June 2022 (#2000031577). We anticipate completing data collection on or before December 2022. Early analyses suggested concerns about illnesses outside of HIV and associated comorbid conditions, such as COVID-19 and monkeypox. Additionally, we noted a strong interest in using a web-based platform for CVD prevention education. Conclusions: Web-based, behavioral, CVD prevention interventions may be promising modalities to closing the cardiovascular health disparities gap in Black and Latinx sexual minority men with HIV by extending the reach of prevention interventions using community-informed approaches and technological modalities that have been underused in this population. International Registered Report Identifier (IRRID): RR1-10.2196/41602 %M 36130735 %R 10.2196/41602 %U https://www.researchprotocols.org/2022/10/e41602 %U https://doi.org/10.2196/41602 %U http://www.ncbi.nlm.nih.gov/pubmed/36130735 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e35648 %T Relative Effectiveness of Social Media, Dating Apps, and Information Search Sites in Promoting HIV Self-testing: Observational Cohort Study %A Stafylis,Chrysovalantis %A Vavala,Gabriella %A Wang,Qiao %A McLeman,Bethany %A Lemley,Shea M %A Young,Sean D %A Xie,Haiyi %A Matthews,Abigail G %A Oden,Neal %A Revoredo,Leslie %A Shmueli-Blumberg,Dikla %A Hichborn,Emily G %A McKelle,Erin %A Moran,Landhing M %A Jacobs,Petra %A Marsch,Lisa A %A Klausner,Jeffrey D %+ Department of Population and Public Health Sciences, University of Southern California, 2001 N. Soto St., Los Angeles, CA, 90033, United States, 1 626 757 8602, chrstafylis@outlook.com %K HIV prevention %K PrEP %K home HIV test %K social media %K dating apps %K search engines %K HIV %K human immunodeficiency virus %K self-testing %K infection %K digital health %K health promotion %K MSM %K pre-exposure prophylaxis %K medical information %D 2022 %7 23.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media sites, dating apps, and information search sites have been used to reach individuals at high risk for HIV infection. However, it is not clear which platform is the most efficient in promoting home HIV self-testing, given that the users of various platforms may have different characteristics that impact their readiness for HIV testing. Objective: This study aimed to compare the relative effectiveness of social media sites, dating apps, and information search sites in promoting HIV self-testing among minority men who have sex with men (MSM) at an increased risk of HIV infection. Test kit order rates were used as a proxy to evaluate promotion effectiveness. In addition, we assessed differences in characteristics between participants who ordered and did not order an HIV test kit. Methods: Culturally appropriate advertisements were placed on popular sites of three different platforms: social media sites (Facebook, Instagram), dating apps (Grindr, Jack’D), and information search sites (Google, Bing). Advertisements targeted young (18-30 years old) and minority (Black or Latinx) MSM at risk of HIV exposure. Recruitment occurred in 2 waves, with each wave running advertisements on 1 platform of each type over the same period. Participants completed a baseline survey assessing sexual or injection use behavior, substance use including alcohol, psychological readiness to test, attitudes toward HIV testing and treatment, and HIV-related stigma. Participants received an electronic code to order a free home-based HIV self-test kit. Follow-up assessments were conducted to assess HIV self-test kit use and uptake of pre-exposure prophylaxis (PrEP) at 14 and 60 days post enrollment. Results: In total, 271 participants were enrolled, and 254 were included in the final analysis. Among these 254 participants, 177 (69.7%) ordered a home HIV self-test kit. Most of the self-test kits were ordered by participants enrolled from dating apps. Due to waves with low enrollment, between wave statistical comparisons were not feasible. Within wave comparison revealed that Jack’D showed higher order rates (3.29 kits/day) compared to Instagram (0.34 kits/day) and Bing (0 kits/day). There were no associations among self-test kit ordering and HIV-related stigma, perceptions about HIV testing and treatment, and mistrust of medical organizations. Conclusions: Our findings show that using popular dating apps might be an efficient way to promote HIV self-testing. Stigma, perceptions about HIV testing and treatment, or mistrust of medical organizations may not affect order rates of HIV test kits promoted on the internet. Trial Registration: ClinicalTrials.gov NCT04155502; https://clinicaltrials.gov/ct2/show/NCT04155502 International Registered Report Identifier (IRRID): RR2-10.2196/20417 %M 36149729 %R 10.2196/35648 %U https://formative.jmir.org/2022/9/e35648 %U https://doi.org/10.2196/35648 %U http://www.ncbi.nlm.nih.gov/pubmed/36149729 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 9 %P e30372 %T Effectiveness of Cash Transfer Delivered Along With Combination HIV Prevention Interventions in Reducing the Risky Sexual Behavior of Adolescent Girls and Young Women in Tanzania: Cluster Randomized Controlled Trial %A Kuringe,Evodius %A Christensen,Alice %A Materu,Jacqueline %A Drake,Mary %A Majani,Esther %A Casalini,Caterina %A Mjungu,Deusdedit %A Mbita,Gaspar %A Kalage,Esther %A Komba,Albert %A Nyato,Daniel %A Nnko,Soori %A Shao,Amani %A Changalucha,John %A Wambura,Mwita %+ Department of Sexual and Reproductive Health, National Institute for Medical Research, Isamilo Road, Box 1462, Mwanza, 33104, United Republic of Tanzania, 255 0282500399, evokur@gmail.com %K adolescent %K female %K HIV infections/epidemiology %K HIV infections/prevention and control %K herpes simplex virus type 2 %K incidence %K motivation %K Tanzania %D 2022 %7 19.9.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Poverty and social inequality exacerbate HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. Cash transfers can influence the structural determinants of health, thereby reducing HIV risk. Objective: This study assessed the effectiveness of cash transfer delivered along with combination HIV prevention (CHP) interventions in reducing the risky sexual behavior of AGYW in Tanzania. The incidence of herpes simplex virus type 2 (HSV-2) infection was used as a proxy for sexual risk behavior. Methods: A cluster randomized controlled trial was conducted in 15 matched pairs of communities (1:1 intervention to control) across 3 strata (urban, rural high-risk, and rural low-risk populations) of the Shinyanga Region, Tanzania. The target population was out-of-school AGYW aged 15-23 years who had completed 10-hour sessions of social and behavior change communication. Eligible communities were randomly assigned to receive CHP along with cash transfer quarterly (intervention group) or solely CHP interventions (control group) with no masking. Study recruitment and baseline survey were conducted between October 30, 2017 and December 1, 2017. Participants completed an audio computer-assisted self-interview, HIV counselling and testing, and HSV-2 testing at baseline and during follow-up visits at 6, 12, and 18 months after the baseline survey. A Cox proportional hazards model with random effects specified at the level of clusters (shared frailty) adjusted for matching pairs and other baseline imbalances was fitted to assess the effects of cash transfer on the incidence of HSV-2 infection (primary outcome). Secondary outcomes included HIV prevalence at follow-up, self-reported intergenerational sex, and self-reported compensated sex. All secondary outcomes were measured at each study visit. Results: Of the 3026 AGYW enrolled in the trial (1482 in the intervention and 1544 in the control), 2720 AGYW (1373 in the intervention and 1347 in the control) were included in the final analysis. Overall, HSV-2 incidence was not significantly different at all follow-up points between the study arms in the adjusted analysis (hazard ratio 0.96, 95% CI 0.67-1.38; P=.83). However, HSV-2 incidence was significantly lower in the rural low-risk populations who received the cash transfer intervention (hazard ratio 0.45, 95% CI 0.29-0.71; P=.001), adjusted for potential confounders. Conclusions: Although this trial showed no significant impact of the cash transfer intervention on HSV-2 incidence among AGYW overall, the intervention significantly reduced HSV-2 incidence among AGYW in rural low-risk communities. Factors such as lesser poverty and more asset ownership in urban and rural high-risk communities may have undermined the impact of cash transfer. Trial Registration: ClinicalTrials.gov NCT03597243; https://clinicaltrials.gov/show/NCT03597243 %M 36121686 %R 10.2196/30372 %U https://publichealth.jmir.org/2022/9/e30372 %U https://doi.org/10.2196/30372 %U http://www.ncbi.nlm.nih.gov/pubmed/36121686 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 8 %P e34150 %T Estimating Changes in Population Size and Behavioral Characteristics in Men Who Have Sex With Men Between 2014 and 2019: Longitudinal Study %A Yang,Zijie %A Wei,Lan %A Xie,Wei %A Chen,Lin %A Yang,Zhengrong %A Zhang,Yan %A Liu,Shaochu %A Tan,Wei %A Zheng,Chenli %A Gan,Yongxia %A Li,Dongmin %A Zou,Huachun %A Chen,Wanying %A Ma,Ling %A Ju,Niu %A Sun,Yinghui %A Lv,Fan %A Zhao,Jin %+ Shenzhen Center for Disease Control and Prevention, No. 8 Longyuan, Nanshan, Shenzhen, 518000, China, 86 75525632404, szhaojin@gmail.com %K men who have sex with men %K population size %K HIV/AIDS %K behavioral characteristics %D 2022 %7 16.8.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Men who have sex with men (MSM) are at high risk for HIV infection. Accurate estimation of the population size and monitoring the risk sexual behavioral change of MSM is of great importance to develop targeted HIV prevention and interventions. Objective: The goal of the research was accurate estimation of the population size and monitoring the risk sexual behavioral change of MSM. Methods: Street interception investigation methods were conducted among males aged 16 years and older in selected sites in Shenzhen in 2014 and 2019. A population survey was used to estimate the population size of MSM. Logistic regression analysis was applied to evaluate the difference in behavioral characteristics in MSM from 2014 to 2019. Results: In this study, we surveyed 10,170 participants in 2014, of whom 448 (4.41%, 95% CI 4.01%-4.80%) participants were men who have ever had sex with another man (MSMe) and 229 (2.25%, 95% CI 1.96%-2.54%) were men who had sex with another man in the previous 6 months (MSMa). A total of 10,226 participants were surveyed in 2019, of which 500 (4.90%, 95% CI 4.47%-5.31%) and 208 (2.03%, 95% CI 1.76%-2.31%) participants were MSMe and MSMa, respectively. The results showed that the population size of MSM who are active (MSMa) in Shenzhen was 155,469 (2.29%, 95% CI 2.28%-2.30%) in 2014 and 167,337 (2.05%, 95% CI 2.04%-2.06%) in 2019. It was estimated that there were about 12,005,445 (2.04%, 95% CI 2.04%-2.04%) MSMa in China in 2019. Compared with 2014, the MSMa in 2019 were more likely to seek sex partners through mobile phone apps and less likely to have male and female sex partners in addition to having inconsistent condom use and more than 6 sex partners in the previous 6 months. Conclusions: In Shenzhen, the proportion of MSMa among the general male population was lower in 2019 than in 2014, and the prevalence of HIV risk behavior was reduced in 2019. Although the preferred platform to find male sex partners among MSM has changed, intervention with high–HIV risk MSM could still help to reduce HIV risk behaviors among the whole MSM group. Because MSM prefer to seek sex partners through mobile phone apps, further study is needed to strengthen internet interventions with high–HIV risk MSM to curb the spread of HIV. %M 35972779 %R 10.2196/34150 %U https://publichealth.jmir.org/2022/8/e34150 %U https://doi.org/10.2196/34150 %U http://www.ncbi.nlm.nih.gov/pubmed/35972779 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e35729 %T Reducing New Chlamydia Infection Among Young Men by Promoting Correct and Consistent Condom Use: Protocol for a Randomized Controlled Trial %A Stone,Nicole %A Bedford,Rowena %A Newby,Katie %A Brown,Katherine %A Jackson,Louise %A Bremner,Stephen %A Morrison,Leanne %A McGrath,Nuala %A Nadarzynski,Tom %A Bayley,Jake %A Perry,Nicky %A Graham,Cynthia %+ Department of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Highfield, Southampton, SO17 1BJ, United Kingdom, 44 07871310526, C.A.Graham@soton.ac.uk %K condom fit and feel %K condom use %K pleasure %K digital intervention %K sexual behavior %K health psychology %K behavior intervention %K chlamydia %K sexual health %K randomized controlled trial %D 2022 %7 10.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The health, social, and economic costs of sexually transmitted infections (STIs) represent a major public health concern. Young people are considered one of the groups most at risk for acquiring and transmitting STIs. Correct and consistent condom use has been shown to be the most effective method for reducing STIs; however, condoms are often not used properly. Evidence shows that brief behavior change interventions that focus on skills, communication, and motivation to acquire safe sex practices should be adopted into routine care to reduce STIs. Funding for sexual health services in England has declined dramatically, so novel ways of reducing clinic attendance are being sought. The home-based intervention strategy (HIS-UK) to promote condom use among young men has shown promise in feasibility and pilot studies by demonstrating high acceptability of the intervention in participant and health professional feedback, including aiding men to find condoms they like and feel more confident when using condoms. Objective: The aim of this study is to determine the effectiveness and cost-effectiveness of HIS-UK when compared to usual condom distribution care among young men. Methods: The 3 trial arms consisting of “e-HIS” (HIS-UK delivered digitally), “ProHIS” (HIS-UK delivered face-to-face), and control condition (usual National Health Service [NHS] care) will be compared against the following 3 primary outcomes: the extent to which correct and consistent condom use is increased; improvement of condom use experiences (pleasure as well as fit and feel); and decrease in chlamydia test positivity. Eligibility criteria include men aged 16-25 years at risk of STIs through reporting of condom use errors (ie, breakage or slippage) or condomless penile-vaginal or penile-anal intercourse with casual or new sexual partners during the previous 3 months. Prospective participants will be recruited through targeted advertisements and an opportunistic direct approach at selected sexual health and genitourinary medicine services and university-associated health centers and general practitioner practices. Community and educational establishments will be used to further advertise the study and signpost men to recruitment sites. Participants will be randomly allocated to 1 of 3 trial arms. A repeated measures design will assess the parallel arms with baseline and 12 monthly follow-up questionnaires after intervention and 3 chlamydia screening points (baseline, 6, and 12 months). Results: Recruitment commenced in March 2020. Due to the COVID-19 pandemic, the study was halted and has since reopened for recruitment in Summer 2021. A 30-month recruitment period is planned. Conclusions: If effective and cost-effective, HIS-UK can be scaled up into routine NHS usual care to reduce both STI transmission in young people and pressure on NHS resources. This intervention may further encourage sexual health services to adopt digital technologies, allowing for them to become more widely available to young people while decreasing health inequalities and fear of stigmatization. Trial Registration: ISRCTN Registry ISRCTN11400820; https://www.isrctn.com/ISRCTN11400820 %M 35947422 %R 10.2196/35729 %U https://www.researchprotocols.org/2022/8/e35729 %U https://doi.org/10.2196/35729 %U http://www.ncbi.nlm.nih.gov/pubmed/35947422 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e37339 %T Evaluation of Medical Information on Male Sexual Dysfunction on Baidu Encyclopedia and Wikipedia: Comparative Study %A Ma,Ming %A Yin,Saifu %A Zhu,Mengli %A Fan,Yu %A Wen,Xi %A Lin,Tao %A Song,Turun %+ Department of Urology and Organ Transplantation Center, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan Province, 610041, China, 86 028 854 229 25, songturun1986@scu.edu.cn %K sexual dysfunction %K digital health %K Baidu Encyclopedia %K Wikipedia %K internet %K health information %K DISCERN instrument %D 2022 %7 9.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexual dysfunction is a private set of disorders that may cause stigma for patients when discussing their private problems with doctors. They might also feel reluctant to initiate a face-to-face consultation. Internet searches are gradually becoming the first choice for people with sexual dysfunction to obtain health information. Globally, Wikipedia is the most popular and consulted validated encyclopedia website in the English-speaking world. Baidu Encyclopedia is becoming the dominant source in Chinese-speaking regions; however, the objectivity and readability of the content are yet to be evaluated. Objective: Hence, we aimed to evaluate the reliability, readability, and objectivity of male sexual dysfunction content on Wikipedia and Baidu Encyclopedia. Methods: The Chinese Baidu Encyclopedia and English Wikipedia were investigated. All possible synonymous and derivative keywords for the most common male sexual dysfunction, erectile dysfunction, premature ejaculation, and their most common complication, chronic prostatitis/chronic pelvic pain syndrome, were screened. Two doctors evaluated the articles on Chinese Baidu Encyclopedia and English Wikipedia. The Journal of the American Medical Association (JAMA) scoring system, DISCERN instrument, and Global Quality Score (GQS) were used to assess the quality of disease-related articles. Results: The total DISCERN scores (P=.002) and JAMA scores (P=.001) for Wikipedia were significantly higher than those of Baidu Encyclopedia; there was no statistical difference between the GQS scores (P=.31) for these websites. Specifically, the DISCERN Section 1 score (P<.001) for Wikipedia was significantly higher than that of Baidu Encyclopedia, while the differences between the DISCERN Section 2 and 3 scores (P=.14 and P=.17, respectively) were minor. Furthermore, Wikipedia had a higher proportion of high total DISCERN scores (P<.001) and DISCERN Section 1 scores (P<.001) than Baidu Encyclopedia. Baidu Encyclopedia and Wikipedia both had low DISCERN Section 2 and 3 scores (P=.49 and P=.99, respectively), and most of these scores were low quality. Conclusions: Wikipedia provides more reliable, higher quality, and more objective information than Baidu Encyclopedia. Yet, there are opportunities for both platforms to vastly improve their content quality. Moreover, both sites had similar poor quality content on treatment options. Joint efforts of physicians, physician associations, medical institutions, and internet platforms are needed to provide reliable, readable, and objective knowledge about diseases. %M 35943768 %R 10.2196/37339 %U https://www.jmir.org/2022/8/e37339 %U https://doi.org/10.2196/37339 %U http://www.ncbi.nlm.nih.gov/pubmed/35943768 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 3 %P e36266 %T Sexual Health Assessment Is Vital to Whole Health Models of Care %A Uzdavines,Alex %A Helmer,Drew A %A Spelman,Juliette F %A Mattocks,Kristin M %A Johnson,Amanda M %A Chardos,John F %A Lynch,Kristine E %A Kauth,Michael R %+ Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, ATTN: VA 152, Houston, TX, 77073, United States, 1 713 440 4452, drew.helmer@va.gov %K sexual health %K sexual health assessment %K veteran %K health equity %K health assessment %K whole health model %K communication %K communication barrier %K technological barrier %K health care %K sexuality %K sexual orientation %K gender identity %K sex %K gender %K model %K care %K barrier %K well-being %K comfort %K assessment %K EHR %K electronic health record %K quality %K equity %D 2022 %7 28.7.2022 %9 Viewpoint %J JMIRx Med %G English %X Sexual health is the state of well-being regarding sexuality. Sexual health is highly valued and associated with overall health. Overall health and well-being are more than the absence of disease or dysfunction. Health care systems adopting whole health models of care need to incorporate a holistic assessment of sexual health. This includes assessing patients’ sexual orientation and gender identity (SOGI). If health systems, including but not limited to the Veterans Health Administration (VHA), incorporate sexual health into whole health they could enhance preventive care, promote healthy sexual functioning, and optimize overall health and well-being. Assessing sexual health can give providers important information about a patient’s health, well-being, and health goals. Sexual concerns or dysfunction may also signal undiagnosed health conditions. Additionally, collecting SOGI information as part of a sexual health assessment would allow providers to address problems that drive disparities for lesbian, gay, bisexual, transgender, queer, and similar minority (LGBTQ+) populations. Health care providers do not routinely assess sexual health in clinical practice. One barrier is a gap in communication between patients and providers. Providers cite beliefs that patients will bring up sexual concerns themselves or might be offended by discussing sexual health. Patients often report an expectation that providers will bring up sexual health and being comfortable discussing sexual health with their providers. Within the VHA, the lack of a sexual health template within the electronic health record (EHR) adds an additional barrier. The VHA’s transition toward whole health and updates to its EHR provide unique opportunities to integrate sexual health assessment into routine care. We highlight system modifications to address this within the VHA. These examples may be helpful for other health care systems interested in moving toward whole health. It will be vital for health care systems integrating a whole health approach to develop both practical and educational interventions to address the communication gap. These interventions will need to target both providers and patients in health care systems that transition to a whole health model of care, not just the VHA. Both the communication gap between providers and patients, and the lack of support within some EHR systems for sexual health assessment are barriers to assessing sexual health in primary care clinics. Routine sexual health assessment would benefit patient well-being and present an opportunity to address health disparities for LGBTQ+ populations. Health care systems (ie, both the VHA and other systems) can overcome these barriers by implementing educational interventions and updating their EHRs and back-end data structures. VHA’s expertise in developing and implementing health education interventions and EHR-based quality improvements may help inform interventions beyond VHA. %M 37725523 %R 10.2196/36266 %U https://med.jmirx.org/2022/3/e36266 %U https://doi.org/10.2196/36266 %U http://www.ncbi.nlm.nih.gov/pubmed/37725523 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e32286 %T Strategies to Identify and Reach Young Women Who Sell Sex With HIV Prevention and Care Services: Lessons Learnt From the Implementation of DREAMS Services in Two Cities in Zimbabwe %A Chabata,Sungai T %A Makandwa,Rumbidzo %A Hensen,Bernadette %A Mushati,Phillis %A Chiyaka,Tarisai %A Musemburi,Sithembile %A Busza,Joanna %A Floyd,Sian %A Birdthistle,Isolde %A Hargreaves,James R %A Cowan,Frances M %+ Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), 4 Bath Road, Belgravia, Harare, Zimbabwe, 263 773577686, sungaichabata@gmail.com %K respondent-driven sampling %K peer outreach %K female sex worker %K young women who sell sex %K HIV prevention %K Zimbabwe %K sub-Saharan Africa %D 2022 %7 27.7.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Young women who sell sex (YWSS), are underserved by available HIV prevention and care services. The Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) Partnership aimed to reduce the risk of HIV acquisition among vulnerable populations of adolescent girls and young women, including YWSS, in 10 sub-Saharan African countries. We describe 2 methods, respondent-driven sampling (RDS) and peer outreach, used to refer YWSS for DREAMS services in Zimbabwe, and compare the characteristics and engagement of YWSS referred to these services by each method. We hypothesized that RDS would identify YWSS at higher risk of HIV and those who were less engaged with HIV prevention and care services than peer outreach. Objective: We aimed to compare respondent-driven sampling and peer outreach in recruiting and referring high-risk populations for HIV prevention and care services. Methods: We used RDS, a sampling method designed to reach a representative sample of the network of key populations, and peer outreach, a programmatic approach to identify, reach, and refer YWSS for DREAMS between April and July 2017, and January 2017 and July 2018, respectively, in 2 cities in Zimbabwe. For RDS, we conducted detailed mapping to understand sex work typology and geography, and then purposively selected 10 “seed” participants in each city to initiate RDS. For peer outreach, we initiated recruitment through 18 trained and age-matched peer educators using youth-tailored community mobilization. We described the characteristics and service engagement of YWSS who accessed DREAMS services by each referral approach and assessed the association of these characteristics with referral approach using the chi-square test. Analysis was performed with and without restricting the period when RDS took place. We estimated the relative incremental costs of recruiting YWSS using each strategy for referral to DREAMS services. Results: Overall, 5386 and 1204 YWSS were referred for DREAMS services through peer outreach and RDS, respectively. YWSS referred through RDS were more likely to access DREAMS services compared to YWSS referred through peer outreach (501/1204, 41.6% vs 930/5386, 17.3%; P<.001). Regardless of referral approach, YWSS who accessed DREAMS had similar education levels, and a similar proportion tested HIV negative and reported not using a condom at the last sex act. A higher proportion of YWSS accessing DREAMS through RDS were aged 18-19 years (167/501, 33.3% vs 243/930, 26.1%; P=.004) and more likely to be aware of their HIV status (395/501, 78.8% vs 396/930, 42.6%; P<.001) compared to those accessing DREAMS services through peer outreach. The incremental cost per young woman who sells sex recruited was US $7.46 for peer outreach and US $52.81 for RDS. Conclusions: Peer outreach and RDS approaches can reach and refer high-risk but different groups of YWSS for HIV services, and using both approaches will likely improve reach. International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5085-6 %M 35896024 %R 10.2196/32286 %U https://publichealth.jmir.org/2022/7/e32286 %U https://doi.org/10.2196/32286 %U http://www.ncbi.nlm.nih.gov/pubmed/35896024 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e23823 %T Web-Based Alcohol and Sexual Assault Prevention Program With Tailored Content Based on Gender and Sexual Orientation: Preliminary Outcomes and Usability Study of Positive Change (+Change) %A Gilmore,Amanda K %A Leone,Ruschelle M %A Oesterle,Daniel W %A Davis,Kelly Cue %A Orchowski,Lindsay M %A Ramakrishnan,Viswanathan %A Kaysen,Debra %+ Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, PO Box 3995, Atlanta, GA, 30302, United States, 1 404 413 1416, agilmore12@gsu.edu %K sexual assault prevention %K alcohol %K college students %K sexual and gender minorities %D 2022 %7 22.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use and sexual assault are common on college campuses in the United States, and the rates of occurrence differ based on gender identity and sexual orientation. Objective: We aimed to provide an assessment of the usability and preliminary outcomes of Positive Change (+Change), a program that provides integrated personalized feedback to target alcohol use, sexual assault victimization, sexual assault perpetration, and bystander intervention among cisgender heterosexual men, cisgender heterosexual women, and sexual minority men and women. Methods: Participants included 24 undergraduate students from a large university in the Southwestern United States aged between 18 and 25 years who engaged in heavy episodic drinking in the past month. All procedures were conducted on the web, and participants completed a baseline survey, +Change, and a follow-up survey immediately after completing +Change. Results: Our findings indicated that +Change was acceptable and usable among all participants, despite gender identity or sexual orientation. Furthermore, there were preliminary outcomes indicating the benefit for efficacy testing of +Change. Conclusions: Importantly, +Change is the first program to target alcohol use, sexual assault victimization, sexual assault perpetration, and bystander intervention within the same program and to provide personalized content based on gender identity and sexual orientation. Trial Registration: ClinicalTrials.gov NCT04089137; https://clinicaltrials.gov/ct2/show/NCT04089137 %M 35867393 %R 10.2196/23823 %U https://formative.jmir.org/2022/7/e23823 %U https://doi.org/10.2196/23823 %U http://www.ncbi.nlm.nih.gov/pubmed/35867393 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e30944 %T HIV and Sexually Transmitted Infection Testing Among Substance-Using Sexual and Gender Minority Adolescents and Young Adults: Baseline Survey of a Randomized Controlled Trial %A Parker,Jayelin N %A Choi,Seul Ki %A Bauermeister,Jose A %A Bonar,Erin E %A Carrico,Adam W %A Stephenson,Rob %+ Center for Sexuality and Health Disparities, University of Michigan, 400 N Ingalls, Room 3340, Ann Arbor, MI, 48109, United States, 1 7347644646, jayelinp@umich.edu %K testing %K substance use %K sexual minority %K social determinants %D 2022 %7 1.7.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Gay, bisexual, and other men who have sex with men and transgender individuals are more heavily affected by HIV and other sexually transmitted infections (STIs) than their cisgender, heterosexual peers. In addition, sexual and gender minorities who use substances are often at a further increased risk of HIV and other STIs. Increasing testing for HIV and other STIs allows this hardly reached population to receive early intervention, prevention, and education. Objective: We explored HIV and STI testing patterns among 414 sexual and gender minority adolescents and young adults aged 15 to 29 years who self-reported substance use and lived in southeastern Michigan. Methods: We analyzed data from the baseline survey of a 4-arm randomized controlled trial that aimed to examine the efficacy of a brief substance use intervention for creating gains in engagement in HIV prevention. We fit multinomial logistic regression models to 2 categorical HIV and STI testing variables (lifetime and previous 12 months) based on self-reports of testing (never, STIs only, HIV only, or both). In addition, we compared HIV and STI testing behaviors across demographic characteristics, structural factors, psychosocial barriers, substance use, and sexual behaviors. Results: Our findings showed that 35.5% (147/414) of adolescents and young adults reported not being tested for either HIV or STIs in the previous year, and less than half (168/414, 40.6%) of the sample achieved the Centers for Disease Control and Prevention recommendation of HIV and STI testing once per year. We observed HIV and STI testing disparities across sociodemographic (eg, sexual identity, education, and income) and health (eg, substance use) correlates. Specifically, cisgender gay men who have sex with men were more likely to report being tested for HIV compared with bisexual men and transgender individuals, who were more likely to be tested for STIs. Conclusions: This study illustrates the results of an HIV prevention intervention in southeastern Michigan showing the need for HIV prevention interventions that leverage structural factors, psychosocial barriers, and substance use as key drivers to achieve HIV and STI testing rates to meet the Centers for Disease Control and Prevention guidelines. Trial Registration: ClinicalTrials.gov NCT02945436; http://clinicaltrials.gov/ct2/show/NCT02945436 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.9414 %M 35776441 %R 10.2196/30944 %U https://publichealth.jmir.org/2022/7/e30944 %U https://doi.org/10.2196/30944 %U http://www.ncbi.nlm.nih.gov/pubmed/35776441 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e33867 %T Correlates of Engagement Within an Online HIV Prevention Intervention for Single Young Men Who Have Sex With Men: Randomized Controlled Trial %A Choi,Seul Ki %A Golinkoff,Jesse %A Michna,Mark %A Connochie,Daniel %A Bauermeister,José %+ Department of Family and Community Health, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, United States, 1 2155734734, skchoi@nursing.upenn.edu %K paradata %K mobile health %K mHealth %K digital health intervention %K risk reduction %K HIV prevention %K public health %K digital health %K sexual health %K sexual risks %D 2022 %7 27.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Digital HIV interventions (DHI) have been efficacious in reducing sexual risk behaviors among sexual minority populations, yet challenges in promoting and sustaining users’ engagement in DHI persist. Understanding the correlates of DHI engagement and their impact on HIV-related outcomes remains a priority. This study used data from a DHI (myDEx) designed to promote HIV prevention behaviors among single young men who have sex with men (YMSM; ages 18-24 years) seeking partners online. Objective: The goal of this study is to conduct a secondary analysis of the myDex project data to examine whether YMSM’s online behaviors (eg, online partner-seeking behaviors and motivations) are linked to participants’ engagement (ie, the number of log-ins and the number of sessions viewed). Methods: We recruited 180 YMSM who were randomized into either myDEx arm or attention-control arm using a stratified 2:1 block randomization. In the myDEx arm, we had 120 YMSM who had access to the 6-session intervention content over a 3-month period. We used Poisson regressions to assess the association between YMSM’s baseline characteristics on their DHI engagement. We then examined the association between the participants’ engagement and their self-reported changes in HIV-related outcomes at the 3-month follow-up. Results: The mean number of log-ins was 5.44 (range 2-14), and the number of sessions viewed was 6.93 (range 0-22) across the 3-month trial period. In multivariable models, the number of log-ins was positively associated with high education attainment (estimated Poisson regression coefficient [β]=.22; P=.045). The number of sessions viewed was associated with several baseline characteristics, including the greater number of sessions viewed among non-Hispanic YMSM (β=.27; P=.002), higher education attainment (β=.22; P=.003), higher perceived usefulness of online dating for hookups (β=.13; P=.002) and perceived loneliness (β=.06; P=.004), as well as lower experienced online discrimination (β=–.01; P=.007) and limerence (β=–.02; P=.004). The number of sessions viewed was negatively associated with changes in internalized homophobia (β=–.06; P<.001) and with changes in perceived usefulness of online dating for hookups (β=–.20; P<.001). There were no significant associations between the number of log-ins and changes in the participants’ behaviors at the 90-day follow-up. Conclusions: DHI engagement is linked to participants’ sociodemographic and online behaviors. Given the importance of intervention engagement in the intervention’s effectiveness, DHIs with personalized intervention components that consider the individuals’ differences could increase the overall engagement and efficacy of DHIs. Trial Registration: ClinicalTrials.gov NCT02842060; https://clinicaltrials.gov/ct2/show/NCT02842060. %M 35759333 %R 10.2196/33867 %U https://publichealth.jmir.org/2022/6/e33867 %U https://doi.org/10.2196/33867 %U http://www.ncbi.nlm.nih.gov/pubmed/35759333 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e33538 %T Enablers and Barriers to HIV Services for Gay and Bisexual Men in the COVID-19 Era: Fusing Data Sets from Two Global Online Surveys Via File Concatenation With Adjusted Weights %A Ayala,George %A Arreola,Sonya %A Howell,Sean %A Hoffmann,Thomas J %A Santos,Glenn-Milo %+ Department of Epidemiology and Biostatistics, University of California San Francisco, UCSF Medical Center at Mission Bay, 550 16th St 2nd floor, San Francisco, CA, 94158, United States, 1 4155020955, glenn-milo.santos@ucsf.edu %K COVID-19 %K HIV services %K gay and bisexual men %K sexual health %D 2022 %7 27.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Gay and bisexual men are 26 times more likely to acquire HIV than other adult men and represent nearly 1 in 4 new HIV infections worldwide. There is concern that the COVID-19 pandemic may be complicating efforts to prevent new HIV infections, reduce AIDS-related deaths, and expand access to HIV services. The impact of the COVID-19 pandemic on gay and bisexual men’s ability to access services is not fully understood. Objective: The aim of this study was to understand access to HIV services at the start of the COVID-19 pandemic. Methods: Our study used data collected from two independent global online surveys conducted with convenience samples of gay and bisexual men. Both data sets had common demographic measurements; however, only the COVID-19 Disparities Survey (n=13,562) collected the outcomes of interest (HIV services access at the height of the first COVID-19 wave) and only the Global Men’s Health and Rights Survey 4 (GMHR-4; n=6188) gathered pre-COVID-19 pandemic exposures/covariates of interest (social/structural enablers of and barriers to HIV services access). We used data fusion methods to combine these data sets utilizing overlapping demographic variables and assessed relationships between exposures and outcomes. We hypothesized that engagement with the gay community and comfort with one’s health care provider would be positively associated with HIV services access and negatively associated with poorer mental health and economic instability as the COVID-19 outbreaks took hold. Conversely, we hypothesized that sexual stigma and experiences of discrimination by a health care provider would be negatively associated with HIV services access and positively associated with poorer mental health and economic instability. Results: With 19,643 observations after combining data sets, our study confirmed hypothesized associations between enablers of and barriers to HIV prevention, care, and treatment. For example, community engagement was positively associated with access to an HIV provider (regression coefficient=0.81, 95% CI 0.75 to 0.86; P<.001), while sexual stigma was negatively associated with access to HIV treatment (coefficient=–1.39, 95% CI –1.42 to –1.36; P<.001). Conclusions: HIV services access for gay and bisexual men remained obstructed and perhaps became worse during the first wave of the COVID-19 pandemic. Community-led research that utilizes novel methodological approaches can be helpful in times of crisis to inform urgently needed tailored responses that can be delivered in real time. More research is needed to understand the full impact COVID-19 is having on gay and bisexual men worldwide. %M 35377321 %R 10.2196/33538 %U https://publichealth.jmir.org/2022/6/e33538 %U https://doi.org/10.2196/33538 %U http://www.ncbi.nlm.nih.gov/pubmed/35377321 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e32718 %T User- and Message-Level Correlates of Endorsement and Engagement for HIV-Related Messages on Twitter: Cross-sectional Study %A Oh,Jimin %A Bonett,Stephen %A Kranzler,Elissa C %A Saconi,Bruno %A Stevens,Robin %+ School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, United States, 1 515 231 9890, stepdo@nursing.upenn.edu %K HIV prevention %K social media %K public health %K young adults %K LASSO %K HIV %K Twitter %K digital health %D 2022 %7 17.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Youth and young adults continue to experience high rates of HIV and are also frequent users of social media. Social media platforms such as Twitter can bolster efforts to promote HIV prevention for these individuals, and while HIV-related messages exist on Twitter, little is known about the impact or reach of these messages for this population. Objective: This study aims to address this gap in the literature by identifying user and message characteristics that are associated with tweet endorsement (favorited) and engagement (retweeted) among youth and young men (aged 13-24 years). Methods: In a secondary analysis of data from a study of HIV-related messages posted by young men on Twitter, we used model selection techniques to examine user and tweet-level factors associated with tweet endorsement and engagement. Results: Tweets from personal user accounts garnered greater endorsement and engagement than tweets from institutional users (aOR 3.27, 95% CI 2.75-3.89; P<.001). High follower count was associated with increased endorsement and engagement (aOR 1.05, 95% CI 1.04-1.06; P<.001); tweets that discussed STIs garnered lower endorsement and engagement (aOR 0.59, 95% CI 0.47-1.74; P<.001). Conclusions: Findings suggest practitioners should partner with youth to design and disseminate HIV prevention messages on social media, incorporate content that resonates with youth audiences, and work to challenge stigma and foster social norms conducive to open conversation about sex, sexuality, and health. %M 35713945 %R 10.2196/32718 %U https://publichealth.jmir.org/2022/6/e32718 %U https://doi.org/10.2196/32718 %U http://www.ncbi.nlm.nih.gov/pubmed/35713945 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e38075 %T Interest in HIV Prevention Mobile Phone Apps: Focus Group Study With Sexual and Gender Minority Persons Living in the Rural Southern United States %A Jones,Jeb %A Edwards,O Winslow %A Merrill,Leland %A Sullivan,Patrick S %A Stephenson,Rob %+ Department of Epidemiology, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, United States, 1 4047122275, jeb.jones@emory.edu %K men who have sex with men %K transgender persons %K nonbinary persons %K mHealth %K mobile app %K HIV %K pre-exposure prophylaxis %K PrEP %K sexually transmitted infection testing %K STI testing %K HIV testing %K mobile phone %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) interventions, including smartphone apps, have been found to be an effective means of increasing the uptake of HIV prevention tools, including HIV and sexually transmitted infection (STI) tests and pre-exposure prophylaxis. However, most HIV prevention mHealth apps tested in the United States have been tested among populations living in areas surrounding urban centers. Owing to reduced access to broadband internet and reliable cellular data services, it remains unclear how accessible and effective these interventions will be in rural areas. In addition, gay and bisexual men who have sex with men and gender minority populations in rural areas experience enhanced stigma when compared with their more urban counterparts, and these experiences might affect their willingness and interest in mHealth apps. Objective: This study aimed to conduct online focus groups with men who have sex with men and transgender and gender diverse populations in the rural southern United States to assess their interest in mHealth HIV prevention apps and the features that they would be the most interested in using. Methods: Focus group participants were recruited from a larger pool of sexual and gender minority respondents to a web-based research survey. The participants indicated that they would be willing to participate in an online focus group discussion. Focus groups were conducted via secure Zoom (Zoom Video Communications Inc) videoconferencing. During the focus group discussions, participants were asked to discuss their experiences with HIV and STI prevention and how these experiences were affected by living in a rural area. They were then shown screenshots of a new app to promote HIV and STI prevention among rural populations and asked to provide their opinions on the app’s features. The transcripts of the discussions were reviewed and coded using a constant comparative approach. Results: A total of 6 focus groups were conducted with 26 participants. Most participants were cisgender gay and bisexual men who have sex with men (19/26, 73%); the remaining participants were transgender men (2/26, 8%), were nonbinary people (2/26, 8%), or had multiple gender identities (3/26, 12%). Participants reported numerous barriers to accessing HIV and STI prevention services and accurate information about HIV and STI prevention options. Overall, the participants reported a high degree of interest in mHealth interventions for HIV and STI prevention and suggested several recommendations for the features of an app-based intervention that would be the most useful for rural residents. Conclusions: These focus group discussions indicate that rural residence is not a major barrier to mHealth HIV and STI prevention intervention implementation and that there is a high degree of interest in these approaches to HIV and STI prevention. %M 35699980 %R 10.2196/38075 %U https://formative.jmir.org/2022/6/e38075 %U https://doi.org/10.2196/38075 %U http://www.ncbi.nlm.nih.gov/pubmed/35699980 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35548 %T Geosocial Networking App Use Associated With Sexual Risk Behavior and Pre-exposure Prophylaxis Use Among Gay, Bisexual, and Other Men Who Have Sex With Men: Cross-sectional Web-Based Survey %A Gibson,Laurel P %A Kramer,Emily B %A Bryan,Angela D %+ Department of Psychology and Neuroscience, University of Colorado Boulder, Muenzinger D244, 345 UCB, Boulder, CO, 80309, United States, 1 303 492 8662, laurel.gibson@colorado.edu %K dating app %K mobile dating %K hookup %K gay %K pre-exposure prophylaxis %K sexual risk %K HIV %K STI %K mobile phone %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, geosocial networking (GSN) apps (ie, mobile dating apps) have become central to dating and sexual interactions in recent years. Among gay, bisexual, and other men who have sex with men (GBM), these apps play an important role in reducing barriers and facilitating partner seeking. However, despite these benefits, there are concerns that these apps may facilitate risky sexual behavior and transmission of sexually transmitted infections (STIs) among GBM. Objective: This study aimed to examine the association between GSN app use and sexual risk in a US sample of GBM. Methods: Using a cross-sectional design, respondents (N=223) completed a web-based survey assessing their use of GSN apps, sexual risk and protective behaviors, HIV serostatus, and previous STI diagnoses. Results: Respondents were aged 21-78 (mean 31.90, SD 10.06) years and 69.5% (155/223) were non-Hispanic White. The sample included respondents from 40 states and the District of Columbia. Nearly half (104/223, 47%) of the participants reported using GSN apps. GSN users were more likely to report past-year condomless anal intercourse (P<.001), 3 or more sexual partners in the previous year (P<.001), and a previous STI diagnosis (P=.001) than nonusers. GSN users also reported more frequent use of recreational drugs before sex (P=.001), alcohol use before sex (P<.001), and cannabis use before sex (P=.01). Interestingly, GSN users were also more likely to report having ever taken an HIV test (P<.001) and using pre-exposure prophylaxis (P=.03). The rates of HIV seropositivity did not differ significantly between GSN users and nonusers (P=.53). Among the subset of GSN users, 38 participants reported using only GBM-specific GSN apps (eg, Grindr), whereas 27 participants reported using only sexuality nonspecific GSN apps (eg, Tinder). Exclusive users of GBM–specific apps reported more frequent recreational drug use before sex (P=.01) and were also more likely to report past-year condomless anal intercourse (P<.001), 3 or more sexual partners in the previous year (P=.004), a previous STI diagnosis (P=.002), and HIV testing (P=.003). Alcohol use before sex, cannabis use before sex, pre-exposure prophylaxis use, and HIV rates were similar between both groups (P>.11). Conclusions: The findings suggest that GSN apps may be a useful pathway for interventions aimed at reducing STI risk in GBM. Future prospective studies should examine how risk levels change after the initiation of GSN app use. %M 35699992 %R 10.2196/35548 %U https://formative.jmir.org/2022/6/e35548 %U https://doi.org/10.2196/35548 %U http://www.ncbi.nlm.nih.gov/pubmed/35699992 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35056 %T Online Partner Seeking and Sexual Behaviors Among Men Who Have Sex With Men From Small and Midsized Towns: Cross-sectional Study %A Pravosud,Vira %A Ballard,April M %A Holloway,Ian W %A Young,April M %+ Center for Tobacco Control Research and Education, Cardiovascular Research Institute, University of California, San Francisco, 530 Parnassus Avenue, Suite 366, San Francisco, CA, 94143, United States, 1 415 514 8627, vira.pravosud@ucsf.edu %K men who have sex with men %K MSM %K sexual risk behaviors %K social networking and dating apps %K online tools %K HIV %K sexually transmitted infection %K STI prevention %K mobile phone %D 2022 %7 10.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Men who have sex with men (MSM) residing outside of large urban areas are underrepresented in research on online partner seeking and sexual behaviors related to transmission of HIV. Objective: We aimed to determine associations between the use of the internet or social networking apps (online tools) to meet partners for sex, dating, or for both purposes (online partner seeking) and sexual behaviors among MSM residing in small and midsized towns in Kentucky, United States. Methods: Using peer-referral sampling and online self-administered questionnaires, data were collected from 252 men, aged 18 to 34 years, who had recently (past 6 months) engaged in anal sex with another man and resided in Central Kentucky. Using multivariable logistic regression models, we assessed associations of online partner seeking and HIV-related sexual behaviors. Results: Most (181/252, 71.8%) of the participants reported using online tools for partner seeking. Of these 181 respondents, 166 (91.7%) had used online tools to meet partners for sex (n=45, 27.1% for sex only; and n=121, 72.9% for sex and dating) and 136 (75.1%) had used online tools to meet partners for dating (n=15, 11% for dating only; and n=121, 89% for sex and dating). Adjusted analyses revealed that MSM who had engaged in condomless insertive and receptive anal intercourse were less likely to report online partner seeking (adjusted odds ratio [aOR] 0.22, 95% CI 0.07-0.68; P=.009 and aOR 0.25, 95% CI 0.10-0.66; P=.005, respectively). Increased number of insertive and receptive anal sex partners and substance use before or during sex were associated with higher odds of online partner seeking (aOR 1.31, 95% CI 1.11-1.55; P=.001; aOR 1.20, 95% CI 1.05-1.39; P=.008; and aOR 2.50, 95% CI 1.41-4.44; P=.002, respectively). Conclusions: Among MSM who reside outside of large urban areas and practice online partner seeking, HIV risk-reduction interventions should address safer sex practices, including the risks for HIV transmission associated with alcohol or drug use before or during sex. MSM who do not practice online partner seeking are in need of continued outreach to reduce condomless anal sex. %M 35687395 %R 10.2196/35056 %U https://formative.jmir.org/2022/6/e35056 %U https://doi.org/10.2196/35056 %U http://www.ncbi.nlm.nih.gov/pubmed/35687395 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e33207 %T Using Video Games to Improve the Sexual Health of Young People Aged 15 to 25 Years: Rapid Review %A Franco Vega,Ignacio %A Eleftheriou,Anastasia %A Graham,Cynthia %+ Department of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Room 44/3073, Southampton, SO17 1BJ, United Kingdom, 44 023 8059 3091, c.a.graham@soton.ac.uk %K sex education %K serious games %K sexually transmitted infections %K rapid review %K mobile phone %D 2022 %7 19.5.2022 %9 Review %J JMIR Serious Games %G English %X Background: Sexually transmitted infections and unintended pregnancies among young people remain public health concerns in many countries. To date, interventions that address these concerns have had limited success. Serious games are increasingly being used as educational tools in health and professional public education. Although acknowledged as having great potential, few studies have evaluated the use of serious games in sexual health education among young people, and to date, there have been no published reviews of these studies. Objective: This study aims to assess the effects of video game–based sexual health interventions for risky sexual behavior in young people aged between 15 and 25 years. Methods: A rapid review of randomized controlled trials and quasi–randomized controlled trials was performed. The search included the following bibliographic databases: Cochrane Central Register of Controlled Trials, Embase, MEDLINE, PsycINFO, and Scopus. A total of 2 reviewers independently screened 50% (35/70) of the retrieved articles during the full-text screening phase. Results: From a total of 459 identified citations, after removing duplicates, 327 (71.2%) articles were deemed eligible for title and abstract screening. Of the 327 articles, 70 (21.4%) full texts were screened, from which 10 (3.1%) articles (evaluating 11 different games) were included in the review. The findings highlighted the considerable diversity in video game–based interventions and assessed sexual health outcomes. Although there were some promising findings in outcome studies using game-based interventions, the results across studies were mixed. Conclusions: Although game interventions for sexual health have been in existence for almost three decades, relatively few studies have evaluated them, and the results of previous outcome studies have been mixed. Moreover, there is little clarity regarding which specific elements of a game facilitate positive outcomes. We provide recommendations for future researchers developing video game–based interventions to improve sexual health in young people. %M 35587873 %R 10.2196/33207 %U https://games.jmir.org/2022/2/e33207 %U https://doi.org/10.2196/33207 %U http://www.ncbi.nlm.nih.gov/pubmed/35587873 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e31847 %T The Effects of Internet Exposure on Sexual Risk Behavior Among Sexually Experienced Male College Students in China: Cross-sectional Study %A Xu,Junfang %A Luo,Yan %A Dong,Hengjin %A Zhao,Gang %+ Hangzhou Center for Disease Control and Prevention, 568 Mingshi Road Jianqiaozhen, Hangzhou, 310021, China, 86 13588706065, 13588706065@163.com %K college males %K internet exposure %K sexual partners %K risk behavior %K HIV %K MSM %K social networks %K students %K sexually transmitted infections %K public health %D 2022 %7 2.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As a young subgroup, college students have become the main users of mobile social networks. Considering that people can indiscriminately access explicit sexual content on the internet, coupled with the increase of HIV infections in male college students, the role of the internet in meeting sexual partners and its correlation to risky sexual behavior has become an important topic. Objective: The aim of this study is to explore the effects of internet exposure on sexual partners and sexual risk behavior among sexually experienced male college students. Methods: An institution-based cross-sectional study design was used to collect data through a paper-based questionnaire administered to male college students recruited from colleges and gay organizations in Hangzhou, Zhejiang Province, China. A total of 1045 sexually experienced male students were incorporated in our analysis, with the following information collected: sociodemographic characteristics, sexual intercourse–related behaviors, and sexually transmitted disease (STD) knowledge. Mann-Whitney U and Kruskal-Wallis tests were used to examine differences regarding basic characteristics and sexual risk behaviors between male college students who meet sexual partners via the internet and those who do not. Sequential logistic regression models were employed to examine the influence of meeting sexual partners via the internet on risky sexual behaviors after controlling for other factors. Results: The mean age of the sexually experienced male students was 21.6 (SD 2.0) years. The likelihood of risky sexual behavior was varied, yet it was the highest for those who aim to meet paid sexual partners (145/192, 75.5% to 19/22, 86.4%), followed by those seeking partners for love or romance (258/435, 59.3%). Compared to non-internet partner seekers, internet partner seekers tended to have more casual intercourse (292/542, 53.9% versus 51/503, 10.1%), paid intercourse (32/542, 5.9% versus 12/503, 2.4%), and intercourse with same-sex partners (349/542, 64.4% versus 41/503, 8.2%); they were also more likely to use psychoactive drugs (125/349, 35.8% versus 5/41, 12.2%) and have more than 2 partners. With the increase of HIV and STD knowledge, the probability of having unprotected intercourse decreased for non-internet partner seekers. However, it increased for internet partner seekers with a rising HIV knowledge score. Sequential logistic regression showed that meeting sexual partners on the internet was statistically associated with sexual risk behaviors with multiple sexual partners (odds ratio 4.434; P<.001). Conclusions: Meeting sexual partners via the internet is a common behavior among sexually experienced male college students, and those who meet partners on the internet exhibited higher levels of risky sexual behaviors although they had sufficient HIV and STD knowledge; this is especially true for students who aimed to find partners for sexual intercourse. Thus, more attention should be paid to young adults to address the risky sexual behaviors that may contribute to STD spread among this population. %M 35499864 %R 10.2196/31847 %U https://publichealth.jmir.org/2022/5/e31847 %U https://doi.org/10.2196/31847 %U http://www.ncbi.nlm.nih.gov/pubmed/35499864 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 4 %P e32405 %T Toward Using Twitter for PrEP-Related Interventions: An Automated Natural Language Processing Pipeline for Identifying Gay or Bisexual Men in the United States %A Klein,Ari Z %A Meanley,Steven %A O'Connor,Karen %A Bauermeister,José A %A Gonzalez-Hernandez,Graciela %+ Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Blockley Hall, 4th Floor, 423 Guardian Drive, Philadelphia, PA, 19104, United States, 1 215 746 1101, ariklein@pennmedicine.upenn.edu %K natural language processing %K social media %K data mining %K PrEP %K pre-exposure prophylaxis %K HIV %K AIDS %D 2022 %7 25.4.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Pre-exposure prophylaxis (PrEP) is highly effective at preventing the acquisition of HIV. There is a substantial gap, however, between the number of people in the United States who have indications for PrEP and the number of them who are prescribed PrEP. Although Twitter content has been analyzed as a source of PrEP-related data (eg, barriers), methods have not been developed to enable the use of Twitter as a platform for implementing PrEP-related interventions. Objective: Men who have sex with men (MSM) are the population most affected by HIV in the United States. Therefore, the objectives of this study were to (1) develop an automated natural language processing (NLP) pipeline for identifying men in the United States who have reported on Twitter that they are gay, bisexual, or MSM and (2) assess the extent to which they demographically represent MSM in the United States with new HIV diagnoses. Methods: Between September 2020 and January 2021, we used the Twitter Streaming Application Programming Interface (API) to collect more than 3 million tweets containing keywords that men may include in posts reporting that they are gay, bisexual, or MSM. We deployed handwritten, high-precision regular expressions—designed to filter out noise and identify actual self-reports—on the tweets and their user profile metadata. We identified 10,043 unique users geolocated in the United States and drew upon a validated NLP tool to automatically identify their ages. Results: By manually distinguishing true- and false-positive self-reports in the tweets or profiles of 1000 (10%) of the 10,043 users identified by our automated pipeline, we established that our pipeline has a precision of 0.85. Among the 8756 users for which a US state–level geolocation was detected, 5096 (58.2%) were in the 10 states with the highest numbers of new HIV diagnoses. Among the 6240 users for which a county-level geolocation was detected, 4252 (68.1%) were in counties or states considered priority jurisdictions by the Ending the HIV Epidemic initiative. Furthermore, the age distribution of the users reflected that of MSM in the United States with new HIV diagnoses. Conclusions: Our automated NLP pipeline can be used to identify MSM in the United States who may be at risk of acquiring HIV, laying the groundwork for using Twitter on a large scale to directly target PrEP-related interventions at this population. %M 35468092 %R 10.2196/32405 %U https://publichealth.jmir.org/2022/4/e32405 %U https://doi.org/10.2196/32405 %U http://www.ncbi.nlm.nih.gov/pubmed/35468092 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e31901 %T Recruiting Black Men Who Have Sex With Men (MSM) Couples via Dating Apps: Pilot Study on Challenges and Successes %A Witkovic,Yong Darin %A Kim,Hyunjin Cindy %A Bright,Darius Jovon %A Tan,Judy Y %+ Division of Prevention Science, Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, United States, 1 415 514 7419, judy.tan@ucsf.edu %K African American %K sexual and gender minorities %K homosexuality, male %K HIV %K mHealth intervention %K mobile applications %K apps %K sexual partners %K investigative techniques %K community engagement %K MSM %K Black men %K mobile app %K LGBT %K research methods %K recruitment %K online dating %K social network %D 2022 %7 8.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV disproportionately impacts Black men who have sex with men (MSM), and targeting the primary relationship (ie, couples) using mobile technology for health holds promise for HIV prevention. Web-based recruitment of MSM is commonly employed in HIV prevention and intervention research. However, little known about recruiting Black MSM couples on the internet in the United States. Objective: This study describes the process of recruiting Black MSM couples over social networking and dating apps frequented by MSM. We describe the activities for recruiting, screening, and enrolling participants as part of a randomized trial employing a multipronged recruitment approach. Methods: Black MSM in couples were recruited via three apps (ie, Jack’d, Adam4Adam, and Growlr) between May 2020 and March 2021 during the COVID-19 pandemic in the United States. Black MSM couples were eligible if one or both partners are Black, MSM, and living with HIV, and if both partners were 18 years or older, and have been together for at least 2 months in what they both consider a primary relationship (ie, one in which both partners reported feeling most committed to over any other partner or relationship). Results: A total of 10 Black MSM couples (n=20) were enrolled via social networking apps. App recruitment activities were a combination of passive (eg, in-app advertisements) and active (eg, direct messaging of users) engagement. Recruitment approaches varied by the social networking app owing to differences in app features. A full-time recruiter experienced challenges such as bugs (ie, technical errors in computer program or system), navigating technical requirements specific to each app, and web-based harassment. Conclusions: Despite challenges, it was possible to recruit Black MSM couples virtually into research as part of a multipronged recruitment strategy. We identify tips for using web-based dating and other social networking apps as part of a recruitment strategy in future research with Black MSM couples. %M 35394432 %R 10.2196/31901 %U https://formative.jmir.org/2022/4/e31901 %U https://doi.org/10.2196/31901 %U http://www.ncbi.nlm.nih.gov/pubmed/35394432 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 4 %P e27061 %T eHealth Interventions to Address HIV and Other Sexually Transmitted Infections, Sexual Risk Behavior, Substance Use, and Mental Ill-health in Men Who Have Sex With Men: Systematic Review and Meta-analysis %A Melendez-Torres,GJ %A Meiksin,Rebecca %A Witzel,T Charles %A Weatherburn,Peter %A Falconer,Jane %A Bonell,Chris %+ University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, United Kingdom, 44 07847360259, g.j.melendez-torres@exeter.ac.uk %K men who have sex with men %K HIV and sexually transmitted infections %K mental health %K substance use %K mobile apps %K HIV %K eHealth %K electronic media %K mobile phone apps %K sexual risk %D 2022 %7 6.4.2022 %9 Review %J JMIR Public Health Surveill %G English %X Background: Men who have sex with men experience disproportionately high levels of HIV and other sexually transmitted infections (STIs), sexual risk behavior, substance use, and mental ill-health. These experiences are interrelated, and these interrelations are potentiated by structural conditions of discrimination, stigma, and unequal access to appropriate health services, and they magnify each other and have intersecting causal pathways, worsening both risk for each condition and risk for the negative sequelae of each condition. eHealth interventions could address these issues simultaneously and thus have wide-ranging and greater effects than would be for any 1 outcome alone. Objective: We systematically reviewed the evidence for the effectiveness of eHealth interventions in addressing these outcomes separately or together. Methods: We searched 19 databases for randomized trials of interactive or noninteractive eHealth interventions delivered via mobile phone apps, internet, or other electronic media to populations consisting entirely or principally of men who have sex with men to prevent HIV, STIs, sexual risk behavior, alcohol and drug use, or common mental illnesses. We extracted data and appraised each study, estimated meta-analyses where possible by using random effects and robust variance estimation, and assessed the certainty of our findings (closeness of the estimated effect to the true effect) by using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). Results: We included 14 trials, of which 13 included active versus control comparisons; none reported mental health outcomes, and all drew from 12 months or less of follow-up postintervention. Findings for STIs drew on low numbers of studies and did not suggest consistent short-term (<3 months postintervention; d=0.17, 95% CI –0.18 to 0.52; I2=0%; 2 studies) or midterm (3-12 months postintervention, no meta-analysis, 1 study) evidence of effectiveness. Eight studies considering sexual risk behavior outcomes suggested a short-term, nonsignificant reduction (d=–0.14, 95% CI –0.30 to 0.03) with very low certainty, but 6 studies reporting midterm follow-ups suggested a significant impact on reducing sexual risk behavior (d=–0.12, 95% CI –0.19 to –0.05) with low certainty. Meta-analyses could not be undertaken for alcohol and drug use (2 heterogeneous studies) or for HIV infections (1 study for each of short-term or midterm follow-up), and alcohol outcomes alone were not captured in the included studies. Certainty was graded as low to very low for most outcomes, including all meta-analyses. Conclusions: To create a comprehensive eHealth intervention that targets multiple outcomes, intervention evaluations should seek to generalize both mechanisms and components that are successfully used to achieve change in 1 outcome over multiple outcomes. However, additional evaluations of interventions seeking to address outcomes other than sexual risk behavior are needed before development and evaluation of a joined-up intervention. %M 35384845 %R 10.2196/27061 %U https://publichealth.jmir.org/2022/4/e27061 %U https://doi.org/10.2196/27061 %U http://www.ncbi.nlm.nih.gov/pubmed/35384845 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 4 %P e32156 %T Sexual Partner Referral for HIV Testing Through Social Networking Platforms: Cross-sectional Study %A Chiou,Piao-Yi %A Hung,Chien-Ching %A Chen,Chien-Yu %+ School of Nursing, National Taiwan University College of Medicine, No. 2-1, Xuzhou Rd., Taipei, 100, Taiwan, 886 2 23123456 ext 88427, purechiou2@gmail.com %K HIV testing %K men who have sex with men %K mobile health %K motivational interviewing %K referral and consultation %K risk behavior %K sexual partners %K social networking %D 2022 %7 5.4.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Men who have sex with men (MSM) who undergo voluntary HIV counseling and testing (VCT) often report condomless anal sexual intercourse, having many sexual partners, and being exposed to risky sexual networks. Limited research has discussed the application of motivational interviewing and convenience referral platforms to facilitate the referral of sexual partners for HIV testing among MSM. Objective: This study aimed to evaluate the effects of VCT referral by sexual partners through social networking platforms and the test results after elicited interviews with MSM; compare the characteristics and risk behaviors among MSM tested without referral, index subjects, and referred sexual partners; and explore unknown sexual affiliations through visualizing and quantifying the social network graph. Methods: This was a cross-sectional study. Purposeful sampling was used to recruit index subjects from a community HIV screening station frequented by MSM in Taipei City on Friday and Saturday nights. Respondent-driven sampling was used to recruit sexual partners. Partner-elicited interviews were conducted by trained staff before VCT to motivate MSM to become index subjects and refer sexual partners via the Line app, or to disclose the accounts and profiles of sexual partners on relevant social networking platforms. Referred sexual partners received rapid HIV testing, and the recruitment process was repeated until leads were exhausted. Results: After the interviews, 28.2% (75/266) of MSM were successfully persuaded to become index subjects in the first wave, referring 127 sexual partners via the Line app for rapid HIV testing and disclosing 40 sexual partners. The index subjects and tested sexual partners had more sexual partners (F2=3.83, P=.02), more frequent anal intercourse (F2=10.10, P<.001), and higher percentages of those who had not previously received HIV testing (χ21=6.1, P=.047) compared with MSM tested without referrals. The new HIV-seropositivity rate among tested sexual partners was 2.4%, which was higher than the rate in the other 2 groups. The social network analysis revealed the following 4 types of sexual affiliation: chain, Y, star, and complicated. Among the HIV-negative sexual partners, 26.9% (43/160) had sexual affiliations with HIV-positive nodes, and 40% (10/25) were untested sexual partners with a direct sexual affiliation with an HIV-positive node. Four transmission bridges were found in the network graph. Conclusions: Partner-elicited interviews can effectively promote referral for HIV testing and case identification via Line, and can clarify unknown sexual affiliations of MSM to facilitate the development of a tailored prevention program. Social network analysis is needed for an insightful understanding of the different network structures. %M 35380540 %R 10.2196/32156 %U https://publichealth.jmir.org/2022/4/e32156 %U https://doi.org/10.2196/32156 %U http://www.ncbi.nlm.nih.gov/pubmed/35380540 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e30676 %T Development and Evaluation of Short-Form Measures of the HIV/AIDS Knowledge Assessment Tool Among Sexual and Gender Minorities in Brazil: Cross-sectional Study %A Ferreira,Rayanne C %A Torres,Thiago S %A Ceccato,Maria Das Graças B %A Bezerra,Daniel RB %A Thombs,Brett D %A Luz,Paula M %A Harel,Daphna %+ Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av Brasil 4365 Manguinhos, Rio de Janeiro, 21040-900, Brazil, 55 21 3865 9623, luzpaulamendes@gmail.com %K HIV %K knowledge %K sexual and gender minorities %K Brazil %K preexposure prophylaxis %D 2022 %7 29.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In theoretical models of health behavior, knowledge about disease transmission and self-protective behaviors are conceptualized as important drivers of behavior change. Several studies conducted in Brazil point to an unfortunate convergence of sexual and gender minority (SGM) populations with low levels of HIV knowledge and younger age, lower education, engagement in higher-risk sexual behavior, and never having tested for HIV. Measures to assess level of HIV knowledge have been previously published, including the 12-item HIV/AIDS Knowledge Assessment (HIV-KA) tool. However, measure length can be a barrier to assessment. Objective: We started from the 12-item HIV-KA tool and developed candidate short forms using statistical procedures, evaluated their psychometric properties, and tested the equivalency of their associations with other measures of HIV knowledge compared to the 12-item version. Methods: A convenience sample of SGM was recruited during September 2020 to complete an online survey through advertisements on two social networking apps (Grindr and Hornet). The survey instrument included items on sociodemographic information, prior HIV testing and HIV test results, preexposure prophylaxis (PrEP) and antiretroviral treatment use, sexual behavior, and 3 HIV knowledge measures: the HIV-KA, World Health Organization Knowledge About HIV Transmission Prevention Indicator, and the Brief HIV Knowledge Questionnaire. We used exploratory factor analysis and confirmatory factor analysis (CFA) to assess the factor structure of the of the HIV-KA. We used optimal test assembly (OTA) methods to develop candidate short forms of the HIV-KA and evaluated them based on prespecified reliability, concurrent validity, and statistically equivalent convergent validity criteria. Results: Among 2552 SGM individuals from Brazil, mean age was 35.1 years, 98.2% (2507/2552) cisgender men and 1.8% (45/2552) transgender/nonbinary, 56.5% (1441/2552) White, and 31.0% (792/2552) self-reported HIV positive. CFA indicated a 1-factor structure for the 12-item HIV-KA. Concurrent validity correlations were high for all short forms with 6 items, but only versions with 9 items were as reliable as the full-length form and demonstrated equivalency for convergent validity correlations. Suggesting post hoc convergent validity, HIV knowledge scores using the 9- and 10-item short forms were higher for participants who perceived the Undetectable Equals Untransmittable (U=U) slogan as completely accurate versus not accurate. Suggesting post hoc concurrent validity, participants of younger age, of Black, Pardo or indigenous race, and reporting lower education and lower income scored lower on HIV knowledge. Participants who never tested for HIV scored lower than those who tested negative or positive, while those currently using PrEP scored higher than those reporting past or never use. Conclusions: OTA methods were used to shorten the 12-item HIV-KA to 9-item and 10-item versions while maintaining comparable reliability and validity among a large sample of Brazilian SGM. However, these short forms did not shorten sufficiently to justify deviation from the full measure. %M 35348470 %R 10.2196/30676 %U https://publichealth.jmir.org/2022/3/e30676 %U https://doi.org/10.2196/30676 %U http://www.ncbi.nlm.nih.gov/pubmed/35348470 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e31033 %T Geosocial Networking Smartphone App Use and High-Risk Sexual Behaviors Among Men Who Have Sex With Men Attending University in China: Cross-sectional Study %A Fan,Song %A Li,Peiyang %A Hu,Yuqing %A Gong,Hui %A Yu,Maohe %A Ding,Yi %A Luo,Zhenzhou %A Wu,Guohui %A Ouyang,Lin %A Zou,Huachun %+ School of Public Health (Shenzhen), Sun Yat-sen University, No. 66 Gongchang Road, Guangming District, Shenzhen, 518107, China, 86 2087335651, zouhuachun@mail.sysu.edu.cn %K gay app %K men who have sex with men %K student %K China %K smartphone %K mobile phone %D 2022 %7 28.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Gay apps are smartphone-based geosocial networking apps where many men who have sex with men (MSM) socialize and seek sex partners. Existing studies showed that gay app use is associated with greater odds of high-risk sexual behaviors and potentially more HIV infections. However, little is known about this behavior among young MSM. Objective: We conducted this study to understand gay app use and its influencing factors among MSM attending university in China. Methods: From January to March 2019, participants were recruited from 4 regions with large populations of college students in China: Chongqing, Guangdong, Shandong, and Tianjin. The eligibility criteria were MSM aged 16 years or older, self-identified as a university student, and being HIV negative. A self-administered online structured questionnaire was used to collect data on sociodemographic information, sexual behaviors, gay app use, substance use, and HIV testing history. We performed multivariable log-binomial regression to assess correlates of seeking sex partners via gay apps. Results: A total of 447 MSM attending university with an average age of 20.4 (SD 1.5) years were recruited. Almost all participants (439/447, 98.2%) reported gay app use at some point in their life, and 240/439 (53.7%) reported ever seeking sex partners via gay apps. Blued (428/439, 97.5%) was the most popular gay app. Higher proportions of sexual risk behaviors (including seeking sex partners via apps [P<.001], engaging in group sex [P<.001], having multiple sex partners [P<.001], unawareness of sex partners’ HIV status [P<.001], and using recreational drugs during sex [P<.02]) were positively associated with the increase in the frequency of gay app use. In multivariable analysis, participants who used gay apps to seek sex partners might be more likely to have multiple sex partners in the past 3 months (adjusted prevalence ratio [APR] 1.53, 95% CI 1.33-1.76; P<.001), engage in group sex in the past 3 months (APR 1.55, 95% CI 1.35-1.78; P<.001), and have sex partners with unknown or positive HIV status (APR 1.72, 95% CI 1.46-2.01; P<.001). Conclusions: Seeking sex partners via gay apps may associate with the increased high-risk sexual behaviors among MSM attending university. The causality between seeking sex partners via gay apps and increased high-risk sexual behaviors should be further investigated so as to inform potential policies for HIV prevention. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900020645; http://www.chictr.org.cn/showprojen.aspx?proj=34741 %M 35343911 %R 10.2196/31033 %U https://publichealth.jmir.org/2022/3/e31033 %U https://doi.org/10.2196/31033 %U http://www.ncbi.nlm.nih.gov/pubmed/35343911 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e36446 %T Culturally Tailored Social Media Content to Reach Latinx Immigrant Sexual Minority Men for HIV Prevention: Web-Based Feasibility Study %A Lee,Jane J %A Aguirre Herrera,Joel %A Cardona,José %A Cruz,Loren Yesenia %A Munguía,Lésster %A Leyva Vera,Christopher A %A Robles,Gabriel %+ School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA, 98105, United States, 1 2066168984, janejlee@uw.edu %K social media %K eHealth %K feasibility %K Latinx %K immigrant %K sexual minorities %K gay %K homosexual %K bisexual %K pre-exposure prophylaxis %K HIV prevention %K HIV %K prevention %K web-based %K internet-based %K sexual minority %K sexual health %K digital health %K health technology %K web-based health %K web-based prevention %K health information %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Latinx gay, bisexual, and other sexual minority men are disproportionately affected by HIV in the United States. As Latinx sexual minority men, particularly those who are foreign-born, experience inequitable access to health services, tailored strategies to engage them for HIV prevention are urgently needed. Objective: Our study seeks to address the need for enhanced access to HIV prevention among Latinx immigrant sexual minority men. We developed and piloted a culturally sensitive technology-based campaign focused on HIV testing and pre-exposure prophylaxis (PrEP) uptake. Methods: We used a two-phase approach to assess the feasibility of community-informed social media content in engaging Latinx immigrant sexual minority men for HIV testing and PrEP use. First, we conducted three iterative focus groups with 15 Latinx immigrant sexual minority men to refine the HIV prevention content to be piloted on social media platforms. The finalized content was placed on Instagram and Facebook for 9 days in July and September 2021 to individuals who were in Washington State. Individuals who clicked on the content were directed to a website with additional HIV prevention information. Second, we conducted online surveys (n=60) with website visitors that assessed sociodemographic characteristics, barriers to HIV prevention, and HIV-related transmission risk and prevention behaviors. We conducted descriptive analyses to examine the overall profile of survey respondents and determine the feasibility of culturally informed social media content in reaching Latinx immigrant sexual minority men. Results: Overall, 739 unique users visited the website during the 9-day period when the social media content was posted on Instagram and Facebook. Our sample included 60 Latinx immigrant sexual minority men who completed the online survey. Participants’ mean age was 30.8 years and more than half (n=34, 57%) completed the survey in Spanish. A quarter of participants indicated that they were unauthorized immigrants and 57% (n=34) reported not having medical insurance. Participants reported, on average, having 6 different sexual partners in the last 6 months. Nearly a third of respondents had not tested for HIV in the last 6 months. Only about half (n=32, 53%) of respondents had used PrEP in the last 12 months. Conclusions: Community-driven social media and web-based strategies are feasible ways to engage Latinx immigrant sexual minority men who may traditionally lack access to HIV prevention information and services due to structural and social barriers. The results highlight that culturally relevant social media and web-based outreach strategies that are informed and developed by the community can reach Latinx immigrant sexual minority men for HIV prevention. Findings underscore the need to examine the effectiveness of social media content in promoting HIV testing and PrEP uptake in marginalized Latinx populations. %M 35182416 %R 10.2196/36446 %U https://formative.jmir.org/2022/3/e36446 %U https://doi.org/10.2196/36446 %U http://www.ncbi.nlm.nih.gov/pubmed/35182416 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e28959 %T Mobile Phone Apps for Intimate Partner and Sexual Violence Prevention and Response: Systematic Search on App Stores %A Draughon Moret,Jessica %A Todd,Angela %A Rose,Lauren %A Pollitt,Erin %A Anderson,Jocelyn %+ Betty Irene Moore School of Nursing, University of California, Davis, 2570 48th Street, Suite 2600, Sacramento, CA, 95817, United States, 1 916 734 0511, jdmoret@ucdavis.edu %K rape %K intimate partner violence %K gender-based violence %K smartphone %K mobile phone app %D 2022 %7 8.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Since the 2008 advent of the smartphone, more than 180 billion copies of apps have been downloaded from Apple App Store, with more than 2.6 million apps available for Android and 2.2 million apps available for iOS. Many violence prevention and response apps have been developed as part of this app proliferation. Objective: This study aims to evaluate the prevalence and quality of freely available mobile phone apps targeting intimate partner violence (IPV) and sexual violence (SV) prevention and response. Methods: We conducted a systematic search of violence prevention and response mobile phone apps freely available in Apple App Store (iOS; March 2016) and Google Play Store (Android; July 2016). Search terms included violence prevention, sexual assault, domestic violence, intimate partner violence, sexual violence, forensic nursing, wife abuse, and rape. Apps were included for review if they were freely available, were available in English, and had a primary purpose of prevention of or response to SV or IPV regardless of app target end users. Results: Using the Mobile Application Rating Scale (MARS), we evaluated a total of 132 unique apps. The majority of included apps had a primary purpose of sharing information or resources. Included apps were of low-to-moderate quality, with the overall subjective quality mean for the reviewed apps being 2.65 (95% CI 2.58-2.72). Quality scores for each of the 5 MARS categories ranged from 2.80 (engagement) to 4.75 (functionality). An incidental but important finding of our review was the difficulty in searching for apps and the plethora of nonrelated apps that appear when searching for keywords such as “rape” and “domestic violence” that may be harmful to people seeking help. Conclusions: Although there are a variety of mobile apps available designed to provide information or other services related to SV and IPV, they range greatly in quality. They are also challenging to find, given the current infrastructure of app store searches, keyword prioritization, and highlighting based on user rating. It is important for providers to be aware of these resources and be knowledgeable about how to review and recommend mobile phone apps to patients, when appropriate. %M 35133285 %R 10.2196/28959 %U https://formative.jmir.org/2022/2/e28959 %U https://doi.org/10.2196/28959 %U http://www.ncbi.nlm.nih.gov/pubmed/35133285 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e28137 %T Approaches to Determine and Manage Sexual Consent Abilities for People With Cognitive Disabilities: Systematic Review %A Esmail,Shaniff %A Concannon,Brendan %+ Department of Occupational Therapy, University of Alberta, Corbett Hall, 8205 - 114St 2-64, Edmonton, AB, T6G 2G4, Canada, 1 (780) 492 0397, shaniff.esmail@ualberta.ca %K sexual consent %K capacity %K disability %K sexual expression %K dementia %K ethics %K long-term care %D 2022 %7 4.2.2022 %9 Review %J Interact J Med Res %G English %X Background: This review focused on how sexual consent ability was determined, managed, and enhanced in people with cognitive disabilities, with the aim of better understanding the recurring themes influencing the design and implementation of these approaches. If a person’s consensual ability becomes compromised, owing to either an early or late-onset cognitive disability, the formal systems involved must establish plans to balance the individual’s rights and restrictions on sexual expression. This review identified these plans, focusing on how they promoted the intimacy rights of the individual. Objective: This study aims to identify approaches that determine sexual consent ability in people with cognitive disabilities, identify the means of managing and enhancing sexual consent ability in people with cognitive disabilities, and note the recurring themes that influence how these approaches and management systems are designed and implemented. Methods: A systematic literature review was performed using EBSCOhost (Social Gerontology, CINAHL Plus, MEDLINE, and SocINDEX), Embase, PsyInfo, and Scopus to locate reports on terms expanded on sexual consent and cognitive disability. Results: In all, 47 articles were identified, featuring assessment practices, legal case studies, and clinical standards for managing sexual consent capacity in people with cognitive disabilities. A total of 8 studies (5/8, 63% qualitative and 3/8, 38% quantitative) were included out of the 47 articles identified. Approaches for determining sexual consent included functional capacity and person-centered, integrated, and contextual approaches. Management of sexual consent ability included education, attitude, and advanced directives and support networks. The recurring themes that influenced these approaches included the 3 legal criteria of consent, American Bar Association and American Psychological Association Model, Lichtenberg and Strzepek Instrument, Ames and Samowitz Instrument, Lyden approach, Mental Capacity Act of 2005, and Vancouver Coastal Health Authority of 2009. Conclusions: Determining sexual consent takes a holistic approach, with individuals judged in terms of their adaptive abilities, capacities, and human rights. The attitudes of those using this holistic approach need to be balanced; otherwise, the sexual rights of assessed people could be moved either in favor or against them. The ideal outcome, after person-centered considerations of those living with cognitive disabilities includes the people themselves being involved in the process of personalizing these approaches used to facilitate healthy intimate relationships. %M 35119371 %R 10.2196/28137 %U https://www.i-jmr.org/2022/1/e28137 %U https://doi.org/10.2196/28137 %U http://www.ncbi.nlm.nih.gov/pubmed/35119371 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e30811 %T Interactive Mobile Phone HIV Adherence Support for Men Who Have Sex With Men in the Philippines Connect for Life Study: Mixed Methods Approach to Intervention Development and Pilot Testing %A O'Connor,Cara %A Leyritana,Katerina %A Doyle,Aoife M %A Lewis,James J %A Gill,Randeep %A Salvaña,Edsel Maurice %+ Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 791336248, caraoc@gmail.com %K mHealth %K adherence %K HIV %K antiretroviral therapy %K intervention development %K mobile phone %D 2022 %7 3.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The HIV epidemic in the Philippines is one of the fastest growing epidemics globally, and infections among men who have sex with men are rising at an alarming rate. The World Health Organization recommends the use of mobile health (mHealth) technologies to engage patients in care and ensure high levels of adherence to antiretroviral therapy (ART). Existing mHealth interventions can be adapted and tailored to the context and population served. Objective: This study aims to create a locally tailored intervention using a mobile phone platform to support treatment adherence for HIV patients on ART in the Philippines. Methods: A mixed methods approach guided by the Behavior Change Wheel framework was used to adapt an existing mHealth adherence support platform for the local setting and target population. A literature review, retrospective clinical record review, and focus group discussions with patients were conducted to understand the drivers of ART adherence and tailor the intervention accordingly. The resulting intervention was pilot-tested for 8 weeks, followed by focus group discussions with patients who received the intervention to assess the acceptability of the design. Results: Key issues contributing to nonadherence included side effects, lack of behavioral skills for pill taking, social support, mental health, and substance use. Patients identified mHealth as an acceptable mode of intervention delivery and wanted mHealth services to be highly personalizable. The study team, clinicians, and software developers integrated these findings into the intervention, which included a menu of services as follows: pill reminders, health tips, adherence feedback, appointment reminders, and symptom reporting. During the pilot phase, technical issues in the interactive voice response system (IVRS) were identified and addressed. Patients who participated in the pilot phase expressed a preference for SMS text messaging over the IVRS. Patients responded positively to the appointment reminders and health tips, whereas patient feedback on daily and weekly pill reminders and adherence feedback was mixed. Conclusions: The mobile phone–based SMS text messaging and IVRS intervention was acceptable to men who have sex with men in Manila, the Philippines, and qualitative analysis suggested that the intervention helped promote ART adherence and appointment attendance. %M 35113030 %R 10.2196/30811 %U https://formative.jmir.org/2022/2/e30811 %U https://doi.org/10.2196/30811 %U http://www.ncbi.nlm.nih.gov/pubmed/35113030 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30360 %T Feasibility, Acceptability, and Design of a Mobile Ecological Momentary Assessment for High-Risk Men Who Have Sex With Men in Hanoi, Vietnam: Qualitative Study %A Trang,Kathy %A Le,Lam X %A Brown,Carolyn A %A To,Margaret Q %A Sullivan,Patrick S %A Jovanovic,Tanja %A Worthman,Carol M %A Giang,Le Minh %+ Global TIES for Children, New York University, 627 Broadway, New York City, NY, 10012, United States, 1 212 998 1212, kathytrang.kt@gmail.com %K men who have sex with men %K HIV %K mental disorder %K ecological momentary assessment %K mobile phone %K mHealth %K sexual minorities %K pilot projects %D 2022 %7 27.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Men who have sex with men (MSM) are at a disproportionate risk for HIV infection and common mental disorders worldwide. In the context of HIV, common mental disorders are important and are frequent drivers of suboptimal prevention and treatment outcomes. Mobile ecological momentary assessments (EMAs), or the repeated sampling of people’s behaviors and psychological states in their daily lives using mobile phones, can clarify the triggers and HIV-related sequelae of depressive-anxious symptoms and contribute toward the design of ecological momentary interventions (EMIs) that cater to the contextually varying needs of individuals to optimize prevention and treatment outcomes. Objective: This study aims to characterize the feasibility and acceptability of mobile EMA among high-risk MSM in Hanoi, Vietnam. It aims to evaluate the perceived relevance, usability, and concerns of this group with regard to the content and delivery of mobile EMA and the potential of leveraging such platforms in the future to deliver EMIs. Methods: Between January and April 2018, a total of 46 participants were recruited. The participants completed 6 to 8 mobile EMA surveys daily for 7 days. Surveys occurred once upon waking, 4 to 6 times throughout the day, and once before sleeping. All surveys queried participants’ perceived safety, social interactions, psychological state, and mental health symptoms. The morning survey further queried on sleep and medication use within the past 24 hours, whereas the night survey queried on sexual activity and substance use and allowed participants to share an audio recording of a stressful experience they had that day. At the end of the week, participants were interviewed about their experiences with using the app. Results: Participants completed an average of 21.7 (SD 12.7) prompts over the 7-day period. Excluding nonresponders, the average compliance rate was 61.8% (SD 26.6%). A thematic analysis of qualitative interviews suggested an overall positive reception of the app and 5 recurring themes, which were centered on the relevance of psychological and behavioral items to daily experiences (eg, mental health symptoms and audio recording), benefits of using the app (eg, increased self-understanding), worries and concerns (eg, privacy), usability (eg, confusion about the interface), and recommendations for future design (eg, integrating more open-ended questions). Conclusions: Mobile EMA is feasible and acceptable among young MSM in Vietnam; however, more research is needed to adapt EMA protocols to this context and enhance compliance. Most participants eagerly provided information about their mental health status and daily activities. As several participants looked toward the app for further mental health and psychosocial support, EMIs have the potential to reduce HIV and mental health comorbidity among MSM. %M 35084340 %R 10.2196/30360 %U https://formative.jmir.org/2022/1/e30360 %U https://doi.org/10.2196/30360 %U http://www.ncbi.nlm.nih.gov/pubmed/35084340 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e31381 %T Educators' Perspectives on Integrating Technology Into Sexual Health Education: Implementation Study %A Decker,Martha J %A Harrison,Salish %A Price,Melisa %A Gutmann-Gonzalez,Abigail %A Yarger,Jennifer %A Tenney,Rachel %+ Department of Epidemiology and Biostatistics, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 550 16th Street, Second Floor, San Francisco, CA, 94158, United States, 1 (415) 476 3095, Mara.Decker@ucsf.edu %K adolescent %K sex education %K technology %K mobile app %K implementation %K California %K health educator %D 2022 %7 12.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In the last decade, the use of technology-based sexual health education has increased. Multiple studies have shown the feasibility of technology-based interventions, while a subset has also shown efficacy in improving youths’ sexual health outcomes such as increased condom use and knowledge. However, little is known about health educators’ experiences in integrating technology to augment sexual health curricula. Objective: The purpose of this study was to assess the perceptions and experiences of health educators regarding the incorporation of technology into a sexual health education program designed for underserved youth in Fresno County, California, and to identify facilitators and challenges to incorporating technology into the in-person curriculum. Methods: This implementation study used data collected as part of a cluster randomized controlled trial to evaluate In the Know (ITK), an in-person sexual health education curriculum that includes technology-based content, such as a resource locator, videos, and games, which can be accessed through a mobile app or website. Data from implementation logs from each cohort (n=51) and annual interviews (n=8) with health educators were analyzed to assess the health educators’ experiences using the technology and adaptations made during the implementation. Results: The health educators reported that technological issues affected implementation to some degree: 87% of the time in the first year, which decreased to 47% in the third year as health educators’ familiarity with the app increased and functionality improved. Technology issues were also more common in non–school settings. Successes and challenges in 3 domains emerged: managing technology, usability of the ITK app, and youth engagement. The health educators generally had positive comments about the app and youth engagement with the technology-based content and activities; however, they also noted certain barriers to adolescents’ use of the mobile app including limited data storage and battery life on mobile phones. Conclusions: Health educators require training and support to optimize technology as a resource for engaging with youth and providing sensitive information. Although technology is often presented as a solution to reach underserved populations, educational programs should consider the technological needs and limitations of the participants, educators, and settings. International Registered Report Identifier (IRRID): RR2-10.2196/18060 %M 35019842 %R 10.2196/31381 %U https://humanfactors.jmir.org/2022/1/e31381 %U https://doi.org/10.2196/31381 %U http://www.ncbi.nlm.nih.gov/pubmed/35019842 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e24126 %T Characterizing Awareness of Pre-Exposure Prophylaxis for HIV Prevention in Manila and Cebu, Philippines: Web-Based Survey of Filipino Cisgender Men Who Have Sex With Men %A Restar,Arjee %A Surace,Anthony %A Adia,Alexander %A Goedel,William %A Ogunbajo,Adedotun %A Jin,Harry %A Edeza,Alberto %A Hernandez,Laufred %A Cu-Uvin,Susan %A Operario,Don %+ Department of Epidemiology, School of Public Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, United States, 1 7046409953, arjee_restar@alumni.brown.edu %K HIV prevention %K PrEP %K men who have sex with men %K the Philippines %D 2022 %7 7.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The Philippines is experiencing an HIV crisis and is considering implementing pre-exposure prophylaxis (PrEP) as a national public health strategy for HIV prevention for cisgender men who have sex with men (cis-MSM). However, critical information on the awareness of PrEP among cis-MSM is needed to roll out this public health initiative. Objective: This study aims to assess PrEP awareness and related correlates (ie, sociodemographic variables, social factors, and health care access and use) among Filipino cis-MSM. Methods: We conducted a web-based survey with Filipino cis-MSM (n=179) residing in the cities of Manila and Cebu, Philippines. Multivariable analysis procedures were performed to examine the factors associated with PrEP awareness. Results: Our sample demonstrated high awareness (134/179, 74.9%) and interest (159/179, 88.8%) in taking PrEP. The adjusted model showed that greater odds of PrEP awareness were associated with having a college education or higher versus a high school education or lower (adjusted odds ratio [aOR] 7.30, 95% CI 1.01-52.47), earning between PHP 10,000 (US $198.6) and PHP 20,000 (US $397.2) versus 3 on a sexual health influencer scale were considered to be sexual health influencers (Cronbach α=.87). The primary outcome was the mean number of alters encouraged to test per index for sexual health influencers compared with the number encouraged by noninfluencers. Results: Participants included 371 indexes and 278 alters. Among indexes, 77 (20.8%) were sexual health influencers and 294 (79.2%) were noninfluencers. On average, each sexual health influencer successfully encouraged 1.66 alters to self-test compared to 0.51 alters encouraged by each noninfluencer (adjusted rate ratio 2.07, 95% CI 1.59-2.69). More sexual health influencers disclosed their sexual orientation (80.5% vs 67.3%, P=.02) and were community-based organization volunteers (18.2% vs 2.7%, P<.001) than noninfluencers. More alters of sexual health influencers came from a rural area (45.5% vs 23.8%, P<.001), had below-college education (57.7% vs 37.1%, P<.001), and had multiple casual male sexual partners in the past 6 months (25.2% vs 11.9%, P<.001). Conclusions: Being a sexual health influencer was associated with encouraging more alters with less testing access to self-test for HIV/syphilis. Sexual health influencers can be engaged as seeds to expand HIV/syphilis testing coverage. %M 34061035 %R 10.2196/24303 %U https://www.jmir.org/2021/6/e24303 %U https://doi.org/10.2196/24303 %U http://www.ncbi.nlm.nih.gov/pubmed/34061035 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e21082 %T Geosocial Networking Dating App Usage and Risky Sexual Behavior in Young Adults Attending a Music Festival: Cross-sectional Questionnaire Study %A Garga,Shirali %A Thomas,Meryl %A Bhatia,Ashneet %A Sullivan,Aidan %A John-Leader,Franklin %A Pit,Sabrina %+ University Centre for Rural Health, Western Sydney University, 62 Uralba Street, Lismore, 2480, Australia, 61 429455720, S.Pit@westernsydney.edu.au %K sexual health %K mobile apps %K young adults %K music festival %D 2021 %7 15.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the prevalent use of geosocial networking dating apps (GNDAs), there is limited research on their impact on sexual health outcomes among young music festivals attendees. Objective: This study aims to explore the use of GNDAs and risky sexual behaviors of young adults attending a music festival. Methods: The music festival attendees (N=862) completed a cross-sectional questionnaire study encompassing demographics, dating app use, and risky sexual behaviors in the past year. Associations between these variables were estimated using bivariate and multivariate logistic regression analyses. Results: Of the respondents, 51.9% (448/862) had used GNDAs in the previous year. Compared with people who had 1 partner, people who had 2-5 sexual partners in the previous year had almost 7 times the odds of using dating apps (odds ratio [OR] 6.581, 95% CI 4.643-9.328) and those who had more than 5 partners had 14 times the odds of using dating apps (OR 14.294, 95% CI 8.92-22.906). Condom users were more likely to be app users (P<.001), as were those who relied on emergency Plan B (P=.002), but people using hormonal contraception were less likely to use dating apps (P=.004). After adjusting for sexual orientation and relationship status, those having casual sex had 3.096 (95% CI 2.225-4.307; P<.001) times the odds of using dating apps and those having multiple sexual partners had 3.943 (95% CI 2.782-5.588; P<.001) times the odds of using dating apps. Similarly, after adjusting for sexual orientation, relationship status, and number of sexual partners, people who had no discussions before having sex about sexually transmitted infections (STIs) or boundaries were more likely to use dating apps (OR 1.755, 95% CI 1.232-2.500; P=.002). Those who perceived the risk of having sex without contraception to be very high had 2.486 (95% CI 2.213-5.096; P=.01) times the odds of using dating apps than those who perceived no risk. Compared with those who perceived no risk, people who thought that the risk of having multiple sexual partners was low to high had 1.871 (95% CI 1.024-3.418; P=.04) times the odds of using dating apps. A significant number of app users (389/440, 88.4%) indicated that GNDAs should promote safe sex. Conclusions: This study identified that festival goers engaging in certain high-risk sexual behaviors, including casual sex, having multiple sexual partners, and having sex without discussion about STI status and boundaries, are more likely to use dating apps. Festival goers who perceived sex without any form of contraception, having sex while drunk, and having multiple sexual partners as risky were more likely to be app users. Policy makers and GNDA developers should acknowledge the vulnerability of their users to adverse sexual health outcomes and use GNDAs as a platform to promote risk-reduction practices. %M 33856354 %R 10.2196/21082 %U https://www.jmir.org/2021/4/e21082 %U https://doi.org/10.2196/21082 %U http://www.ncbi.nlm.nih.gov/pubmed/33856354 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25107 %T Development and Evaluation of a Mobile App Designed to Increase HIV Testing and Pre-exposure Prophylaxis Use Among Young Men Who Have Sex With Men in the United States: Open Pilot Trial %A Biello,Katie B %A Hill-Rorie,Jonathan %A Valente,Pablo K %A Futterman,Donna %A Sullivan,Patrick S %A Hightow-Weidman,Lisa %A Muessig,Kathryn %A Dormitzer,Julian %A Mimiaga,Matthew J %A Mayer,Kenneth H %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main Street, 8th Floor, Providence, RI, 02912, United States, 1 (401)8633082, katie_biello@brown.edu %K HIV %K men who have sex with men %K pre-exposure prophylaxis %K pilot study %K mobile apps %K mobile phone %K mHealth %D 2021 %7 24.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: HIV disproportionately affects young men who have sex with men (YMSM) in the United States. Uptake of evidence-based prevention strategies, including routine HIV testing and use of pre-exposure prophylaxis (PrEP), is suboptimal in this population. Novel methods for reaching YMSM are required. Objective: The aim of this study is to describe the development and evaluate the feasibility and acceptability of the MyChoices app, a mobile app designed to increase HIV testing and PrEP use among YMSM in the United States. Methods: Informed by the social cognitive theory, the MyChoices app was developed using an iterative process to increase HIV testing and PrEP uptake among YMSM. In 2017, beta theater testing was conducted in two US cities to garner feedback (n=4 groups; n=28 YMSM). These findings were used to refine MyChoices, which was then tested for initial acceptability and usability in a technical pilot (N=11 YMSM). Baseline and 2-month postbaseline assessments and exit interviews were completed. Transcripts were coded using a deductive approach, and thematic analysis was used to synthesize data; app acceptability and use data were also reported. Results: The MyChoices app includes personalized recommendations for HIV testing frequency and PrEP use; information on types of HIV tests and PrEP; ability to search for nearby HIV testing and PrEP care sites; and ability to order free home HIV and sexually transmitted infection test kits, condoms, and lube. In theater testing, YMSM described that MyChoices appears useful and that they would recommend it to peers. Participants liked the look and feel of the app and believed that the ability to search for and be pinged when near an HIV testing site would be beneficial. Some suggested that portions of the app felt repetitive and preferred using casual language rather than formal or medicalized terms. Following theater testing, the MyChoices app was refined, and participants in the technical pilot used the app, on average, 8 (SD 5.0; range 2-18) times over 2 months, with an average duration of 28 (SD 38.9) minutes per session. At the 2-month follow-up, the mean System Usability Scale (0-100) score was 71 (ie, above average; SD 11.8). Over 80% (9/11) of the participants reported that MyChoices was useful and 91% (10/11) said that they would recommend it to a friend. In exit interviews, there was a high level of acceptability for the content, interface, and features. Conclusions: These data show the initial acceptability and user engagement of the MyChoices app. If future studies demonstrate efficacy in increasing HIV testing and PrEP uptake, the app is scalable to reach YMSM across the United States. Trial Registration: Clinicaltrials.gov NCT03179319; https://clinicaltrials.gov/ct2/show/NCT03179319 International Registered Report Identifier (IRRID): RR2-10.2196/10694 %M 33759792 %R 10.2196/25107 %U https://www.jmir.org/2021/3/e25107 %U https://doi.org/10.2196/25107 %U http://www.ncbi.nlm.nih.gov/pubmed/33759792 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e22564 %T An Interactive Web-Based Sexual Health Literacy Program for Safe Sex Practice for Female Chinese University Students: Multicenter Randomized Controlled Trial %A Wong,Janet Yuen-Ha %A Zhang,Wen %A Wu,Yongda %A Choi,Edmond Pui Hang %A Lo,Herman Hay Ming %A Wong,Wendy %A Chio,Jasmine Hin Man %A Tam,Hau Lin Cherry %A Ngai,Fei Wan %A Tarrant,Marie %A Wang,Man Ping %A Ngan,Hextan Yuen-Sheung %A Fong,Daniel Yee-Tak %+ School of Nursing, University of Hong Kong, Pokfulam, Hong Kong SAR, Hong Kong, 852 39176645, dytfong@hku.hk %K sexual health %K eHealth %K women's health %K sex education %K health literacy %D 2021 %7 12.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexual health concerns among young adults worldwide help to motivate preventative practices against sexually transmitted infections. To foster better sexual health, sexual health literacy must be enhanced. Little research has been conducted on the impact of gender power dynamics on sexual health, such as sexual coercion, even though the prevalence of sexual coercion remains high in China. Objective: This study describes the development and systematic evaluation of a web-based sexual health literacy intervention called “Smart Girlfriend” for female Chinese university students. Methods: A multicenter randomized controlled trial was conducted with 781 female university students at 5 universities with dormitories in Hong Kong. Inclusion criteria were used to select unmarried, female, Chinese university students who were ≥18 years old and had not received a sexual health intervention in the past 12 months. Participants were randomly assigned to 2 groups: one group received an interactive web-based sexual health literacy intervention and the other group received a single webpage of online information about condom use. The intervention content was based on the Health Belief Model and the Continuum of Conflict and Control theory. The primary outcome was self-reported consistency of condom use with every partner at 3-month and 6-month follow-up assessments, analyzed using zero/one inflated beta (ZOIB) regression. The secondary outcome was an appraisal of the knowledge, attitudes, norms, and self-efficacy of condom use using the 25-item Multidimensional Condom Attitudes Scale (MCAS). The intention to treat was applied in analyses. Results: Of 1503 individuals that were screened, 781 (52%) were randomized into 2 groups. The retention rates at the 3-month and 6-month follow-ups were 92% and 91%, respectively. Most participants were born locally (536/746, 72%), and 18% (134/746) self-reported as a sexual minority. ZOIB results regarding the consistency of condom use were not significant [model 1: odds ratio (OR) 2.25 with a 95% credible interval (CrI) of 0.84-6.36; model 2: OR 8.03 (95% CrI 0.22-330.31); model 3: OR 1.21 (95% CrI 0.78-1.86)]. Consistency in the intervention group was 5% higher (95% CI −1.90 to 11.63) than the control group at the 3-month follow-up, and 1% higher (95% CI −5.81 to 8·02) at the 6-month follow-up. MCAS scores at the 3-month follow-up were significantly higher in the intervention group (mean 122.51, SD 15.97) than the control group (mean 119.86, SD 15.85; P=.02). Conclusions: An interactive web-based sexual health literacy program did not significantly increase the consistency of condom use compared to a single webpage of condom use information; however, it did temporarily improve knowledge, attitudes, norms, and self-efficacy regarding condom use. Future revisions of this intervention should be personalized and delivered with a proactive approach. Trial Registration: ClinicalTrials.gov NCT03695679; https://clinicaltrials.gov/ct2/show/NCT03695679 %M 33709941 %R 10.2196/22564 %U https://www.jmir.org/2021/3/e22564 %U https://doi.org/10.2196/22564 %U http://www.ncbi.nlm.nih.gov/pubmed/33709941 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 3 %P e21812 %T The Annual American Men’s Internet Survey of Behaviors of Men Who Have Sex With Men in the United States: Key Indicators Report 2018 %A Wiatrek,Sarah %A Zlotorzynska,Maria %A Rai,Ramona %A Sullivan,Patrick %A Sanchez,Travis %+ Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, United States, 1 470 603 5783, swiatre@emory.edu %K HIV %K internet %K men who have sex with men %K sexually transmitted infections %K surveillance %K survey %D 2021 %7 4.3.2021 %9 Rapid Surveillance Report %J JMIR Public Health Surveill %G English %X The American Men’s Internet Survey (AMIS) is an annual web-based behavioral survey conducted in the United States of men who have sex with men (MSM). This rapid surveillance report describes the sixth cycle of data collection (September-December 2018; AMIS 2018). The key indicators were the same as those previously reported for past AMIS cycles. The AMIS methodology has not substantively changed since AMIS 2017. MSM were recruited from a variety of websites using banner advertisements and email blasts. In addition, participants from AMIS 2017 who agreed to be recontacted for future research were emailed a link to AMIS 2018. Men were eligible to participate if they were aged ≥15 years, resided in the United States, provided a valid US ZIP code, and reported ever having sex with a man or identified as gay or bisexual. The analysis was limited to those who reported having oral or anal sex with a male partner in the past 12 months. We examined demographic and recruitment characteristics using multivariable regression modeling (P<.05) stratified by the participants’ self-reported HIV status. The AMIS 2018 round of data collection resulted in 10,129 completed surveys from MSM representing every US state, Puerto Rico, and Guam. Most participants were non-Hispanic White, aged between 15 and 24 years, living in urban areas in the southern United States, and recruited from general social networking websites. The plurality (4230/10,129, 41.76%) of participants was in the youngest age group, 15-24 years, followed by the 40 years and older age group (3088/10,129, 30.49%). The self-reported HIV prevalence was 6.08% (616/10,129). Compared with HIV-negative or unknown status participants, HIV-positive participants were more likely to have had anal sex without a condom with a male partner in the past 12 months (adjusted odds ratio [aOR] 2.02, 95% CI 1.63-2.50) and more likely to have had anal sex without a condom with a serodiscordant or an unknown status partner (aOR 3.90, 95% CI 3.27-4.66). The reported use of marijuana in the past 12 months was higher among HIV-positive participants than among HIV-negative or unknown status participants (aOR 1.39, 95% CI 1.15-1.68). The reported use of methamphetamines and other illicit substances in the past 12 months was higher among HIV-positive participants than among HIV-negative or unknown status participants (aOR 3.42, 95% CI 2.41-4.87 and aOR 1.90, 95% CI 1.56-2.32, respectively). Most HIV-negative or unknown status participants (6838/9513, 71.88%) reported ever taking an HIV test previously, and 52.51% (4995/9513) of the participants reported undergoing HIV testing in the past 12 months. HIV-positive participants were more likely to report testing and diagnosis of sexually transmitted infections than HIV-negative or unknown status participants (aOR 3.50, 95% CI 2.89-4.24 and aOR 2.61, 95% CI 2.10-3.25, respectively). %M 33496669 %R 10.2196/21812 %U https://publichealth.jmir.org/2021/3/e21812 %U https://doi.org/10.2196/21812 %U http://www.ncbi.nlm.nih.gov/pubmed/33496669 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e22572 %T A Theory-Based mHealth Intervention (Getting Off) for Methamphetamine-Using Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial %A Reback,Cathy J %A Fletcher,Jesse B %A Mata,Raymond P %+ Friends Research Institution, Inc, 6910 Santa Monica Blvd, Los Angeles, CA, 90038, United States, 1 323 463 1601, rmata@friendsresearch.org %K HIV %K AIDS %K methamphetamine %K mHealth %K mobile app %K ART %K mobile phone %D 2021 %7 22.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Methamphetamine (meth) use among men who have sex with men (MSM) is associated with increased HIV prevalence and transmission and substandard advancement along the HIV prevention and care continuum. Given the growth of mobile health (mHealth) technologies, it is no longer necessary to limit meth treatment options to physical, brick-and-mortar sites, and administration using generic, nontailored content. Objective: In a 2-arm randomized controlled trial (RCT; N=300), we aim to evaluate the use of an mHealth intervention (Getting Off) to assess the impact and noninferiority of a cross-platform app (developed from a manualized meth treatment intervention) to help MSM reduce meth use and HIV sexual risk behaviors and improve their advancement along the HIV prevention and care continuum (HIV testing, pre-exposure prophylaxis uptake and persistence, and antiretroviral therapy uptake and adherence). Methods: Participants will be randomized into 2 arms: arm A, with immediate access to the app (immediate delivery: n=150), or arm B, with delayed access to the app after a 30-day period (delayed delivery: n=150). Participants in both arms will use the same Getting Off app and will have 30 days to complete the 24 sessions. Participants will be assessed at the 1-, 2- (delayed delivery arm only), 3-, 6-, and 9-month timepoints to determine observed treatment effects and will be compared with a historical matched sample of participants (n=~600) who received the brick-and-mortar group-based Getting Off intervention. Results: Recruitment began in January 2019 for phase 1, the formative phase. In January and February 2019, 4 focus groups (N=36) were formed to provide input on the adaptation of the group-based manual intervention to a mobile app. Data collection for phase 2, the RCT, is expected to be completed in January 2023. The final results are anticipated in April 2023. Conclusions: By creating a culturally responsive mobile app, Getting Off aims to reduce meth use and improve sexual health outcomes among meth-using MSM. The Getting Off app could have significant public health impact by greatly expanding access to effective, affordable, private, culturally competent, and highly scalable meth treatment for MSM. Trial Registration: Clinicaltrials.gov NCT03884946; https://clinicaltrials.gov/ct2/show/NCT03884946 International Registered Report Identifier (IRRID): DERR1-10.2196/22572 %M 33616547 %R 10.2196/22572 %U https://www.researchprotocols.org/2021/2/e22572 %U https://doi.org/10.2196/22572 %U http://www.ncbi.nlm.nih.gov/pubmed/33616547 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e22277 %T Characteristics of the Users of Troubled Desire, a Web-Based Self-management App for Individuals With Sexual Interest in Children: Descriptive Analysis of Self-assessment Data %A Schuler,Miriam %A Gieseler,Hannes %A Schweder,Katharina W %A von Heyden,Maximilian %A Beier,Klaus M %+ Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin, Charitépl 1, Berlin, 10117, Germany, 49 30 450 520 339, miriam.schuler@charite.de %K pedophilia %K hebephilia %K child sexual offenses %K child sexual abuse material %K web-based assessment %K web-based treatment %D 2021 %7 19.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite the high prevalence of child sexual offenses and the increasing amounts of available child sexual abuse material, there is a global shortage of preventive interventions focusing on individuals at risk of sexual offending. The web-based app Troubled Desire aims to address this shortage by offering self-assessments and self-management training modules in different languages to individuals with sexual interests in prepubescent and early pubescent children (ie, those with pedophilic and hebephiliac sexual interest, respectively). Objective: The aim of this study was to describe the characteristics of the users of the Troubled Desire app. Methods: The fully completed self-assessment data gathered within the first 30 months of this study from October 25, 2017 to April 25, 2020 were investigated. The main outcome measures were (1) sociodemographic information and (2) sexual interests and sexual behaviors of the users of Troubled Desire. Results: The self-assessment was completed by 4161 users. User accesses were mainly from Germany (2277/4161, 54.7%) and the United States (474/4161, 11.4%). Approximately 78.9% (3281/4161) of the users reported sexual interest in children; these users were significantly more likely to report distress and trouble owing to their sexual interest. Further, child sexual offenses and consumption of child sexual abuse material were significantly more common among users with sexual interest in children than among users with no sexual interest in children. Additionally, the majority of the offenses were not known to legal authorities. Conclusions: The Troubled Desire app is useful in reaching out to individuals with sexual interest in prepubescent and early pubescent children. However, future research is warranted to understand the prospective relevance of the Troubled Desire app in the prevention of child sexual offending. %M 33605895 %R 10.2196/22277 %U http://mental.jmir.org/2021/2/e22277/ %U https://doi.org/10.2196/22277 %U http://www.ncbi.nlm.nih.gov/pubmed/33605895 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e20898 %T Peer-to-Peer Sharing of Social Media Messages on Sexual Health in a School-Based Intervention: Opportunities and Challenges Identified in the STASH Feasibility Trial %A Hirvonen,Maija %A Purcell,Carrie %A Elliott,Lawrie %A Bailey,Julia V %A Simpson,Sharon Anne %A McDaid,Lisa %A Moore,Laurence %A Mitchell,Kirstin Rebecca %A , %+ MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley St, Glasgow, G3 7HR, United Kingdom, 44 1413537500, kirstin.mitchell@glasgow.ac.uk %K social media %K sexual health %K sex education %K peer education %K process evaluation %K school %K feasibility studies %K adolescent %K social networking %D 2021 %7 16.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: There is a strong interest in the use of social media to spread positive sexual health messages through social networks of young people. However, research suggests that this potential may be limited by a reluctance to be visibly associated with sexual health content on the web or social media and by the lack of trust in the veracity of peer sources. Objective: The aim of this study was to investigate opportunities and challenges of using social media to facilitate peer-to-peer sharing of sexual health messages within the context of STASH (Sexually Transmitted Infections and Sexual Health), a secondary school-based and peer-led sexual health intervention. Methods: Following training, and as a part of their role, student-nominated peer supporters (aged 14-16 years) invited school friends to trainer-monitored, private Facebook groups. Peer supporters posted curated educational sex and relationship content within these groups. Data came from a feasibility study of the STASH intervention in 6 UK schools. To understand student experiences of the social media component, we used data from 11 semistructured paired and group interviews with peer supporters and their friends (collectively termed students; n=42, aged 14-16 years), a web-based postintervention questionnaire administered to peer supporters (n=88), and baseline and follow-up questionnaires administered to students in the intervention year group (n=680 and n=603, respectively). We carried out a thematic analysis of qualitative data and a descriptive analysis of quantitative data. Results: Message sharing by peer supporters was hindered by variable engagement with Facebook. The trainer-monitored and private Facebook groups were acceptable to student members (peer supporters and their friends) and reassuring to peer supporters but led to engagement that ran parallel to—rather than embedded in—their routine social media use. The offline context of a school-based intervention helped legitimate and augment Facebook posts; however, even where friends were receptive to STASH messages, they did not necessarily engage visibly on social media. Preferences for content design varied; however, humor, color, and text brevity were important. Preferences for social media versus offline message sharing varied. Conclusions: Invitation-only social media groups formed around peer supporters’ existing friendship networks hold potential for diffusing messages in peer-based sexual health interventions. Ideally, interactive opportunities should not be limited to single social media platforms and should run alongside offline conversations. There are tensions between offering young people autonomy to engage flexibly and authentically and the need for adult oversight of activities for information accuracy and safeguarding. %M 33591287 %R 10.2196/20898 %U http://www.jmir.org/2021/2/e20898/ %U https://doi.org/10.2196/20898 %U http://www.ncbi.nlm.nih.gov/pubmed/33591287 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e22980 %T Conducting Virtual, Synchronous Focus Groups Among Black Sexual Minority Men: Qualitative Study %A Dangerfield II,Derek T %A Wylie,Charleen %A Anderson,Janeane N %+ Johns Hopkins School of Nursing, 855 N Wolfe St, Baltimore, MD, 21205, United States, 1 4109553757, ddanger2@jhu.edu %K engagement %K recruitment %K sexual health %K telehealth %D 2021 %7 8.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Focus groups are useful to support HIV prevention research among US subpopulations, such as Black gay, Black bisexual, and other Black sexual minority men (BSMM). Virtual synchronous focus groups provide an electronic means to obtain qualitative data and are convenient to implement; however, the protocols and acceptability for conducting virtual synchronous focus groups in HIV prevention research among BSMM are lacking. Objective: This paper describes the protocols and acceptability of conducting virtual synchronous focus groups in HIV prevention research among BSMM Methods: Data for this study came from 8 virtual synchronous focus groups examined in 2 studies of HIV-negative BSMM in US cities, stratified by age (N=39): 2 groups of BSMM ages 18-24 years, 5 groups of BSMM ages 25-34 years, and 1 group of BSMM 35 years and older. Virtual synchronous focus groups were conducted via Zoom, and participants were asked to complete an electronic satisfaction survey distributed to their email via Qualtrics. Results: The age of participants ranged from 18 to 44 years (mean 28.3, SD 6.0). All participants “strongly agreed” or “agreed” that they were satisfied participating in an online focus group. Only 17% (5/30) preferred providing written informed consent versus oral consent. Regarding privacy, most (30/30,100%) reported “strongly agree” or “agree” that their information was safe to share with other participants in the group. Additionally, 97% (29/30) reported being satisfied with the incentive. Conclusions: Conducting virtual synchronous focus groups in HIV prevention research among BSMM is feasible. However, thorough oral informed consent with multiple opportunities for questions, culturally relevant facilitation procedures, and appropriate incentives are needed for optimal focus group participation. %M 33427671 %R 10.2196/22980 %U http://publichealth.jmir.org/2021/2/e22980/ %U https://doi.org/10.2196/22980 %U http://www.ncbi.nlm.nih.gov/pubmed/33427671 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e17837 %T The Promise and Peril of Mobile Phones for Youth in Rural Uganda: Multimethod Study of Implications for Health and HIV %A Kreniske,Philip %A Basmajian,Alyssa %A Nakyanjo,Neema %A Ddaaki,William %A Isabirye,Dauda %A Ssekyewa,Charles %A Nakubulwa,Rosette %A Hirsch,Jennifer S %A Deisher,Andrea %A Nalugoda,Fred %A Chang,Larry W %A Santelli,John S %+ HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 722 West 168th Street, New York, NY, New York, United States, 1 646 774 6947, pk2361@columbia.edu %K adolescence %K youth %K mobile phones %K cell phones %K mobility %K HIV %K East Africa %D 2021 %7 2.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In East Africa, where landlines are used by 1% of the population and access to the internet is limited, owning a cell phone is rapidly becoming essential for acquiring information and resources. Our analysis illuminates the perils and potential promise of mobile phones with implications for future interventions to promote the health of adolescents and young adults (AYAs) and to prevent HIV infection. Objective: The aim of this study is to describe the current state of AYAs’ phone use in the region and trace out the implications for mobile health interventions. Methods: We identified 2 trading centers that were representative of southern Uganda in terms of key demographics, proportion of cell phone ownership, and community HIV prevalence. We stratified the sample of potential informants by age group (15-19 years and 20-24 years), gender, and phone ownership and randomly sampled 31 key informant interview participants within these categories. In addition, we conducted 24 ethnographic participant observations among AYAs in the communities of study. Results: AYA frequently reported barriers to using their phones, such as difficulty accessing electricity. Nearly all AYAs used mobile phones to participate in the local economy and communicate with sexual partners. Phone use was frequently a point of contention between sexual partners, with many AYAs reporting that their sexual partners associated phone use with infidelity. Few AYAs reported using their phones for health-related purposes, with most getting health information in person from health workers. However, most AYAs reported an instance when they used their phone in an emergency, with childbirth-related emergencies being the most common. Finally, most AYAs reported that they would like to use their phones for health purposes and specifically stated that they would like to use their mobile phones to access current HIV prevention information. Conclusions: This study demonstrates how mobile phones are related to income-generating practices in the region and communication with sexual partners but not access to health and HIV information. Our analysis offers some explanation for our previous study, which suggested an association between mobile phone ownership, having multiple sexual partners, and HIV risk. Mobile phones have untapped potential to serve as tools for health promotion and HIV prevention. %M 33528375 %R 10.2196/17837 %U https://www.jmir.org/2021/2/e17837 %U https://doi.org/10.2196/17837 %U http://www.ncbi.nlm.nih.gov/pubmed/33528375 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e24269 %T A Moderated Mediation Analysis of Condom Negotiation and Sexual Orientation on the Relationship Between Sexual Coercion and Condom Use in Chinese Young Women: Cross-Sectional Study %A Zhang,Wen %A Choi,Edmond Pui Hang %A Fong,Daniel Yee-Tak %A Wong,Janet Yuen-Ha %+ School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, Hong Kong, 852 3917 6641, janetyh@hku.hk %K sex offenses %K sex orientation %K unprotected sex %K online research %K women’s health %D 2021 %7 19.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The high prevalence of sexual coercion against young women has become a significant public health issue in China and other regions around the world. Young women are also especially vulnerable to engage in inconsistent condom use because of low sexual control. Although the relationship between sexual coercion and condom use has been widely demonstrated, the mechanism of this relationship is still unclear. Objective: The objective of this study was to test condom negotiation as a mediator of the relationship between sexual coercion and condom use in young Chinese women and to investigate whether sexual orientation is a moderator. Methods: Data were collected using web-based questionnaires and a total of 402 young Chinese women were included in the analysis. Sexual coercion was measured using a subscale of the Revised Conflict Tactics Scales and condom negotiation was measured using a subscale of the UCLA Multidimensional Condom Attitudes Scale. Sexual orientation was assessed using an item adopted from a previous study and condom use was calculated by the total number of times condoms were used divided by the total number of times sexual intercourse was engaged in during the past 3 months. Moderated mediation analyses were conducted with sexual coercion as the independent variable, condom use consistency as the dependent variable, condom negotiation as the mediator variable, and sexual orientation as a moderator. Results: The moderated mediation analysis indicated that the relationship between sexual coercion and condom use was significantly mediated by condom negotiation and moderated by sexual orientation. The indirect effect of condom negotiation was significant in heterosexual women (indirect effect: –0.80, 95% boot CI –1.67 to –0.36) but not in sexual minority women (indirect effect: –0.33, 95% boot CI –0.86 to 0.31). Conclusions: The results showed that sexual orientation meaningfully affects the relationship between sexual coercion and condom negotiation. The difference in the mechanism of the relation between sexual coercion and sexual behaviors in heterosexual and sexual minority women should be considered for future research and interventions aimed at mitigating the adverse effects of sexual coercion. %M 33464220 %R 10.2196/24269 %U http://publichealth.jmir.org/2021/1/e24269/ %U https://doi.org/10.2196/24269 %U http://www.ncbi.nlm.nih.gov/pubmed/33464220 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e17173 %T Use of Geosocial Networking Apps and HIV Risk Behavior Among Men Who Have Sex With Men: Case-Crossover Study %A Knox,Justin %A Chen,Yi-No %A He,Qinying %A Liu,Guowu %A Jones,Jeb %A Wang,Xiaodong %A Sullivan,Patrick %A Siegler,Aaron %+ Emory University, 1518 Clifton Road NE, Suite 406, Atlanta, GA, 30322, United States, 1 404 712 9733, asiegle@emory.edu %K HIV %K case-crossover study %K dating apps %K geosocial networking apps %K men who have sex with men %K sexual risk behavior %D 2021 %7 15.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: HIV disproportionately affects men who have sex with men (MSM) in China. The HIV epidemic is largely driven by unprotected anal sex (ie, sex not protected by condoms or HIV pre-exposure prophylaxis [PrEP]). The possible association between unprotected anal sex and the use of geospatial networking apps has been the subject of scientific debate. Objective: This study assessed whether users of a gay geospatial networking app in China were more likely to use condoms when they met their partners online versus offline. A case-crossover analysis, with each person serving as his own control, was employed to address the potential bias that men looking for sex partners through an online dating medium might have inherently different (and riskier) patterns of sexual behavior than men who do not use online dating media. Methods: A cross-sectional survey was administered in 2018 to adult male users of Blued—a gay geospatial networking app—in Beijing, Tianjin, Sichuan, and Yunnan, China. A case-crossover analysis was conducted among 1311 MSM not taking PrEP who reported engaging in both unprotected and protected anal sex in the previous 6 months. Multivariable conditional logistic regression was used to quantify the association between where the partnership was initiated (offline or online) and the act of unprotected anal sex, controlling for other interval-level covariates. Four sensitivity analyses were conducted to assess other potential sources of bias. Results: We identified 1311 matched instances where a person reported having both an unprotected anal sex act and a protected anal sex act in the previous 6 months. Of the most recent unprotected anal sex acts, 22.3% (292/1311), were initiated offline. Of the most recent protected anal sex acts, 16.3% (214/1311), were initiated offline. In multivariable analyses, initiating a partnership offline was positively associated with unprotected anal sex (odds ratio 2.66, 95% CI 1.84 to 3.85, P<.001) compared with initiating a partnership online. These results were robust to each of the different sensitivity analyses we conducted. Conclusions: Among Blued users in 4 Chinese cities, men were less likely to have unprotected anal sex in partnerships that they initiated online compared with those that they initiated offline. The relationship was strong, with over 2.5 times the likelihood of engaging in unprotected anal sex in partnerships initiated offline compared with those initiated online. These findings suggest that geospatial networking apps are a proxy for, and not a cause of, high-risk behaviors for HIV infection; these platforms should be viewed as a useful venue to identify individuals at risk for HIV transmission to allow for targeted service provision. %M 33448934 %R 10.2196/17173 %U http://publichealth.jmir.org/2021/1/e17173/ %U https://doi.org/10.2196/17173 %U http://www.ncbi.nlm.nih.gov/pubmed/33448934 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e19109 %T Young People’s Experiences Using an On-Demand Mobile Health Sexual and Reproductive Health Text Message Intervention in Kenya: Qualitative Study %A Mwaisaka,Jefferson %A Gonsalves,Lianne %A Thiongo,Mary %A Waithaka,Michael %A Sidha,Hellen %A Alfred,Otieno %A Mukiira,Carol %A Gichangi,Peter %+ International Centre for Reproductive Health, Kenya, Tom Mboya Street, Mombasa, Kenya, 254 723 206 132, jeffmwaisaka@gmail.com %K mHealth %K mobile phones %K sexual and reproductive health %K Kenya %D 2021 %7 15.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital health usability assessments can help explain how well mobile health (mHealth) apps targeting young people with sexual and reproductive health (SRH) information performed and whether the intended purpose was achieved. However, few digital health assessments have been conducted to evaluate young people’s perceptions regarding mHealth system interactions and content relevance on a wide range of SRH topics. In addition, the majority of randomized controlled trials (RCTs) have focused on push messaging platforms; therefore, the mHealth field lacks sufficient RCTs investigating on-demand mHealth SRH platforms. Objective: The objective of this study was to explore young people’s experiences using an on-demand SRH mHealth platform in Kenya. Methods: We used qualitative data related to the usability of an mHealth platform, Adolescent/Youth Reproductive Mobile Access and Delivery Initiatives for Love and Life Outcome (ARMADILLO), collected at the end of the intervention period. A total of 30 in-depth interviews (IDIs) were held with the intervention participants (15 women and 15 men) to elicit their experiences, opinions, and perspectives on the design and content of the ARMADILLO platform. The study participants were randomly selected from a list of intervention arm participants to participate in the IDIs. The interviews were later transcribed verbatim, translated into English, and coded and analyzed thematically using NVivo version 12 software (QSR International). Results: Respondents reported varied user experiences and levels of satisfaction, ranging from ease of use by the majority of the respondents to systematic frustrations that prevented some participants from progressing to other stages. Interesting features of the mHealth platform included the immediate response participants received when requesting messages, weekly remunerated quizzes, and perceived ability of educative and informative content and messages to change behaviors. Proposed enhancements to the platform included revising some concepts and words for easy understanding and increasing the interactivity of the platform, whereby young people could seek clarity when they came across difficult terms or had additional questions about the information they received. Conclusions: The importance of understanding the range of health literacy and technological variations when dealing with young people cannot be overemphasized. Young people, as mHealth end users, must be considered throughout intervention development to achieve optimum functionality. In addition, young people targeted with mHealth SRH interventions must be sensitized to the interactions on mHealth platforms or any other digital health apps if implemented in a nonresearch setting for optimal use by the targeted audience. %M 33448930 %R 10.2196/19109 %U http://mhealth.jmir.org/2021/1/e19109/ %U https://doi.org/10.2196/19109 %U http://www.ncbi.nlm.nih.gov/pubmed/33448930 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e18650 %T Expert Opinions on Web-Based Peer Education Interventions for Youth Sexual Health Promotion: Qualitative Study %A Martin,Philippe %A Alberti,Corinne %A Gottot,Serge %A Bourmaud,Aurelie %A de La Rochebrochard,Elise %+ Institut National de la Santé Et de la Recherche Médicale (INSERM), Epidémiologie clinique et évaluation économique appliquées aux populations vulnérables (ECEVE), Université de Paris, 10 Avenue de Verdun, Paris, 75010, France, 33 676606491, philippe.martin@inserm.fr %K youth %K health promotion %K internet %K sexual health %K peer education %D 2020 %7 24.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Participatory education, in the form of peer education, may be an effective way to promote youth sexual health. With the advent of the internet, web-based interventions have potential as an attractive new tool for sexual health promotion by peers. Objective: The aim of this study was to evaluate professional experts’ opinions on the perspectives for web-based participatory interventions to promote sexual health by peers and among young people. Methods: Semistructured interviews were carried out with 20 experts (stakeholders in direct contact with young people, researchers, and institutional actors) specializing in sexual health, health promotion, peer education, youth, internet, and social media. After coding with N’Vivo, data were subjected to qualitative thematic analysis. Results: The majority of experts (18/20, 90%) found this kind of intervention to be attractive, but highlighted the necessary conditions, risks, and limitations attached to developing an acceptable peer intervention on the internet for sexual health promotion among young people. Five main themes were identified: (1) an internet intervention; (2) sexual health; (3) internet skills, and uses and the need for moderation; (4) multifaceted peers; and (5) minority peers. In the absence of youth interest for institutional messages, the experts highlighted the attractive participatory features of web-based interventions and the need for geolocalized resources. However, they also warned of the limitations associated with the possibility of integrating peers into education: peers should not be mere messengers, and should remain peers so as not to be outsiders to the target group. Experts highlighted concrete proposals to design an online participatory peer intervention, including the process of peer implication, online features in the intervention, and key points for conception and evaluation. Conclusions: The experts agreed that web-based participatory interventions for youth sexual health promotion must be tailored to needs, uses, and preferences. This type of action requires youth involvement framed in an inclusive and holistic sexual health approach. Peer education can be implemented via the internet, but the design of the intervention also requires not being overly institutional in nature. Involving young people in their own education in an interactive, safe online space has the potential to develop their empowerment and to foster long-term positive behaviors, especially in the area of sexual health. %M 33231552 %R 10.2196/18650 %U http://www.jmir.org/2020/11/e18650/ %U https://doi.org/10.2196/18650 %U http://www.ncbi.nlm.nih.gov/pubmed/33231552 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22878 %T Mobile App Strategy to Facilitate Human Papillomavirus Vaccination Among Young Men Who Have Sex With Men: Pilot Intervention Study %A Fontenot,Holly B %A White,Bradley Patrick %A Rosenberger,Joshua G %A Lacasse,Hailee %A Rutirasiri,Chokdee %A Mayer,Kenneth H %A Zimet,Gregory %+ School of Nursing and Dental Hygiene, University of Hawaii at Manoa, 2528 McCarthy Mall, Webster Hall 412, Honolulu, HI, 96822, United States, 1 808 956 4917, hbfont@hawaii.edu %K human papillomavirus %K men who have sex with men %K vaccination %K mobile health tool %K mHealth %D 2020 %7 4.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile app-based interventions have been identified as potential facilitators for vaccination among young men who have sex with men (MSM). Objective: This pilot study aimed to test the feasibility of a theoretically informed mobile health (mHealth) tool designed to reduce health disparities and facilitate human papillomavirus (HPV) vaccination among a sample of young MSM. Methods: The development of the mHealth tool was guided by previous research, implementation intention theory, and design thinking. We recruited MSM aged 18-26 years through a popular online dating app and linked participants to our mHealth tool, which provided HPV vaccine information and fostered access to care. Results: A total of 42 young MSM participated in this pilot study in Boston, Massachusetts. Participants reported variable HPV knowledge (ie, high knowledge of HPV risk factors and low knowledge of HPV-related cancer risks for men) and positive vaccine beliefs and attitudes. Of those who were either unvaccinated, not up to date, or did not report vaccine status, 23% (8/35) utilized the mHealth tool to obtain HPV vaccination. Participants primarily utilized the tool’s (1) educational components and (2) capabilities facilitating concrete vaccine action plans. Conclusions: We recruited an underserved at-risk population of youth via an online dating app for our mHealth intervention that resulted in in-person health care delivery. This study was limited by enrollment challenges, including low willingness to download the mHealth tool to mobile devices. %M 33146621 %R 10.2196/22878 %U https://www.jmir.org/2020/11/e22878 %U https://doi.org/10.2196/22878 %U http://www.ncbi.nlm.nih.gov/pubmed/33146621 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e16378 %T Effectiveness of a Peer-Led Web-Based Intervention to Improve General Self-Efficacy in Using Dating Apps Among Young Adults: Randomized Clustered Trial %A Wong,William CW %A Sun,Wai Han %A Chia,Shu Ming Cheryl %A Tucker,Joseph D %A Mak,William PH %A Song,Lin %A Choi,Kitty Wai Ying %A Lau,Stephanie Tsz Hei %A Wan,Eric Yuk Fai %+ Department of Family Medicine and Primary Care, University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau,, Hong Kong, China, 852 64883866, wongwcw@hku.hk %K internet %K sexual health %K self-efficacy %K young adult %K risk assessment %D 2020 %7 30.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Online dating apps are popular platforms for seeking romance and sexual relationships among young adults. As mobile apps can easily gain access to a pool of strangers (“new friends”) at any time and place, it leads to heightened sexual health risks and privacy concerns. Objective: This study aimed to evaluate the effectiveness of a peer-led web-based intervention for online dating apps to prepare Chinese college students so that they have better self-efficacy when using dating apps. Methods: An open clustered randomized controlled trial was conducted among students from three colleges (The University of Hong Kong, Hang Seng University of Hong Kong, and Yijin Programme of Vocational Training College) in Hong Kong. Students aged 17 to 27 years who attended common core curriculum or general education were randomized into intervention and control groups. The intervention material, developed with high peer engagement, included four short videos, an interactive scenario game, and a risk assessment tool. An existing website promoting physical activities and healthy living was used as a control. Using the information, motivation, and behavioral skills (IMB) approach to design the evaluation, questionnaires covering participants’ sociodemographics and dating app characteristics, as well as the general self-efficacy scale (GSE) as the primary outcome and the risk propensity scale (RPS) as the secondary outcome were administered before, immediately after, and at 1 month after the intervention. Intention-to-treat analysis was adopted, and between-group differences were assessed using the Mann-Whitney U test. A post-hoc multiple linear regression model was used to examine the correlates of the GSE and RPS. Results: A total of 578 eligible participants (290 in the intervention group and 288 in the control group) participated in the study with 36 lost to follow-up. There were more female participants (318/542, 58.7%) than male participants in the sample, reflecting the distribution of college students. Over half of the participants (286/542, 52.8%) reported the following reasons for using dating apps: being curious (170/498, 34.1%), trying to make new friends (158/498, 31.7%), and finding friends with similar interests (121/498, 24.3%). Overall, the participants in the intervention group reported favorable experiences when compared with the finding in the control group. There was significant improvement in the GSE score and reduction in the RPS score (P<.001) in the intervention group. University of Hong Kong students were more susceptible to risk reduction after the intervention when compared with students from the other two institutions. Conclusions: The online intervention was effective in improving general self-efficacy and reducing risk tendency among young students. Future work is needed to determine if this approach is cost-effective and such behavioral change is sustainable. Trial Registration: ClinicalTrials.gov NCT03685643; https://clinicaltrials.gov/ct2/show/NCT03685643. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-3167-5 %M 33124987 %R 10.2196/16378 %U http://www.jmir.org/2020/10/e16378/ %U https://doi.org/10.2196/16378 %U http://www.ncbi.nlm.nih.gov/pubmed/33124987 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 10 %P e20417 %T Comparing Web-Based Platforms for Promoting HIV Self-Testing and Pre-Exposure Prophylaxis Uptake in High-Risk Men Who Have Sex With Men: Protocol for a Longitudinal Cohort Study %A Lemley,Shea M %A Klausner,Jeffrey D %A Young,Sean D %A Stafylis,Chrysovalantis %A Mulatya,Caroline %A Oden,Neal %A Xie,Haiyi %A Revoredo,Leslie %A Shmueli-Blumberg,Dikla %A Hichborn,Emily %A McKelle,Erin %A Moran,Landhing %A Jacobs,Petra %A Marsch,Lisa A %+ Geisel School of Medicine, Dartmouth College, 46 Centerra Parkway, Suite 301, Lebanon, NH, 03755, United States, 1 603 646 7041, shea.m.lemley@dartmouth.edu %K HIV %K HIV self-testing %K men who have sex with men %K web-based platforms %K online advertising %K social media %K dating apps %K informational search websites %D 2020 %7 19.10.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The majority of those living with HIV in the United States are men who have sex with men (MSM), and young, minority MSM account for more new HIV infections than any other group. HIV transmission can be reduced through detection and early treatment initiation or by starting pre-exposure prophylaxis (PrEP), but rates of testing are lower than recommended among MSM, and PrEP uptake has been slow. Although promoting HIV testing and PrEP uptake by placing advertisements on web-based platforms — such as social media websites and dating apps — is a promising approach for promoting HIV testing and PrEP, the relative effectiveness of HIV prevention advertising on common web-based platforms is underexamined. Objective: This study aims to evaluate the relative effectiveness of advertisements placed on 3 types of web-based platforms (social media websites, dating apps, and informational websites) for promoting HIV self-testing and PrEP uptake. Methods: Advertisements will be placed on social media websites (Facebook, Instagram, and Twitter), dating apps (Grindr, Jack’d, and Hornet), and informational search websites (Google, Yahoo, and Bing) to recruit approximately 400 young (18-30 years old), minority (Black or Latino) MSM at elevated risk of HIV exposure. Recruitment will occur in 3 waves, with each wave running advertisements on 1 website from each type of platform. The number of participants per platform is not prespecified, and recruitment in each wave will occur until approximately 133 HIV self-tests are ordered. Participants will complete a baseline survey assessing risk behavior, substance use, psychological readiness to test, and attitudes and then receive an electronic code to order a free home-based HIV self-test kit. Two follow-ups are planned to assess HIV self-test results and PrEP uptake. Results: Recruitment was completed in July 2020. Conclusions: Findings may improve our understanding of how the platform users’ receptivity to test for HIV differs across web-based platforms and thus may assist in facilitating web-based HIV prevention campaigns. Trial Registration: ClinicalTrials.gov NCT04155502; https://clinicaltrials.gov/ct2/show/NCT04155502 International Registered Report Identifier (IRRID): DERR1-10.2196/20417 %M 33074164 %R 10.2196/20417 %U https://www.researchprotocols.org/2020/10/e20417 %U https://doi.org/10.2196/20417 %U http://www.ncbi.nlm.nih.gov/pubmed/33074164 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22388 %T Risk-Taking Behaviors and Adherence to HIV Pre-Exposure Prophylaxis in Users of Geosocial Networking Apps: Real-World, Multicenter Study %A Wang,Hongyi %A Zhang,Jing %A Chu,Zhenxing %A Hu,Qinghai %A Dong,Willa %A Huang,Xiaojie %A Chen,Yaokai %A Wang,Hui %A He,Xiaoqing %A Zhang,Lukun %A Hu,Zhili %A Bao,Rantong %A Li,Shangcao %A Li,Hang %A Cui,Sitong %A Jin,Xia %A Ding,Haibo %A Geng,Wenqing %A Jiang,Yongjun %A Xu,Junjie %A Shang,Hong %+ NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, 110001, China, 86 8328 2634, hongshang100@hotmail.com %K men who have sex with men (MSM) %K MSM %K HIV/AIDS prevention %K Pre-exposure prophylaxis (PrEP) %K geosocial networking app %K dating app %K adherence %K regimen switch %D 2020 %7 14.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Over half of men who have sex with men (MSM) use geosocial networking (GSN) apps to encounter sex partners. GSN apps’ users have become a unique large subpopulation among MSM for interventions concerning HIV prevention and control. Pre-exposure prophylaxis (PrEP) is a promising measure for HIV prevention, especially for MSM, but its effectiveness largely depends on medication adherence. However, little is known about PrEP adherence among GSN apps’ users, which is critical to addressing the overall optimization of PrEP compliance outside of clinical trials in the context of large-scale implementation. Objective: The objective of this study is to understand the correlation between GSN apps’ use and medication adherence among MSM receiving PrEP, with the aim to increase their awareness about PrEP use in order to increase adherence. Methods: This study based on the China Real-world Oral intake of PrEP (CROPrEP) project, a multicenter, real-world study of Chinese MSM on daily and event-driven PrEP. Eligible participants completed a detailed computer-assisted self-interview on sociodemographic, GSN apps’ use, and sexual behavior. Then participants were followed up for 12 months and assessed for various characteristics (eg, PrEP delivery, adherence assessment, PrEP coverage of sexual activities, and regimens switch). A generalized estimation equation was used to analyze the predictors of medication adherence and regimen conversion among GSN apps’ users and nonusers. Results: At baseline, 756 of the 1023 eligible participants (73.90%) reported primarily using GSN apps to seek sexual partners, and GSN apps’ users are more likely to have high-risk behaviors such as multiple sex partners and condomless anal intercourse than other nonusers (all P<.05). During follow-up, GSN apps’ users had a significantly low level of pill-counting adherence than nonusers (adjusted odds ratio [aOR] 0.8, 95% CI 0.6-1.0, P=.038). In the event-driven group, GSN apps’ users had marginally lower levels of self-reported adherence (aOR 0.7, 95% CI 0.4-1.0, P=.060) and lower PrEP coverage of sexual practices (aOR 0.6, 95% CI 0.4-1.0, P=.038). Additionally, GSN apps’ users seemed more likely to switch from event-driven to daily regimen (aOR 1.8, 95% CI 0.9-3.3, P=.084). Conclusions: GSN apps’ users are highly prevalent among MSM, despite their higher sexual risk and lower adherence levels, suggesting that eHealth needs to be introduced to the GSN platform to promote PrEP adherence. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IIN-17013762; https://tinyurl.com/yy2mhrv4. International Registered Report Identifier (IRRID): RR2-10.1186/s12879-019-4355-y %M 33052132 %R 10.2196/22388 %U http://www.jmir.org/2020/10/e22388/ %U https://doi.org/10.2196/22388 %U http://www.ncbi.nlm.nih.gov/pubmed/33052132 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e19459 %T African American Adolescents and Young Adults, New Media, and Sexual Health: Scoping Review %A Teadt,Sierra %A Burns,Jade C %A Montgomery,Tiffany M %A Darbes,Lynae %+ School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, United States, 1 2692547062, steadt@umich.edu %K African American %K adolescent %K young adult %K technology %K safe sex %K sexually transmitted infections %K sexual behavior %K new media %K social media %K internet %D 2020 %7 5.10.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Rates of sexually transmitted infections and unintended pregnancies are disproportionately high among African American adolescents and young adults (AYA). New media platforms such as social networking sites, microblogs, online video sites, and mobile phone applications may be a promising approach in promoting safe sex and preventing sexually transmitted infections. Objective: The purpose of this scoping review was to address promising approaches in new media that may serve as valuable tools in health promotion, prevention, education, and intervention development aimed at African American AYA. Methods: An electronic search was conducted using Google Scholar, Scopus, Cumulative Index to Nursing and Allied Health (CINHAL), and PubMed online databases. Concept blocks and MeSH terminology were used to identify articles around African American youth and new media. Results: The search yielded 1169 articles, and 16 publications met the criteria. Studies from the review found themes in new media that included feasibility, changing attitudes, and improving knowledge related to sexual health behavior among youth of color. Conclusions: New media is a promising and feasible platform for improving the sexual health of African American AYA. Further research is suggested to better understand the benefits of new media as a sexual health promotion tool among this specific population. %M 33016890 %R 10.2196/19459 %U https://mhealth.jmir.org/2020/10/e19459 %U https://doi.org/10.2196/19459 %U http://www.ncbi.nlm.nih.gov/pubmed/33016890 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e20326 %T Psychological Treatment of Low Sexual Desire in Women: Protocol for a Randomized, Waitlist-Controlled Trial of Internet-Based Cognitive Behavioral and Mindfulness-Based Treatments %A Meyers,Milena %A Margraf,Jürgen %A Velten,Julia %+ Clinical Psychology and Psychotherapy, Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr University Bochum, Massenbergstr. 9-13, Bochum, 44787, Germany, 49 234 32 22159, julia.velten@rub.de %K sexual desire %K sexual dysfunction %K women’s sexual health %K cognitive behavioral therapy %D 2020 %7 29.9.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Psychological therapies are effective treatments for hypoactive sexual desire dysfunction (HSDD; formerly hypoactive sexual desire disorder), a common sexual dysfunction among women. Access to evidence-based treatments, however, remains difficult. Internet-based interventions are effective for a variety of psychological disorders and may be a promising means to close the treatment gap for HSDD. Objective: This article describes the treatment protocol and study design of a randomized controlled trial, aiming to study the efficacy of cognitive behavioral and mindfulness-based interventions delivered via the internet for women with HSDD to a waitlist control group. Outcomes are sexual desire (primary) and sexual distress (secondary). Additional variables (eg, depression, mindfulness, rumination) will be assessed as potential moderators or mediators of treatment success. Methods: A cognitive behavioral and a mindfulness-based self-help intervention for HSDD will be provided online. Overall, 266 women with HSDD will be recruited and assigned either to one of the intervention groups, or to a waitlist control group (2:2:1). Outcome data will be assessed at baseline, at 12 weeks, and at 6 and 12 months after randomization. Intention-to-treat and completer analyses will be conducted. Results: We expect improvements in sexual desire and sexuality-related distress in both intervention groups compared to the waitlist control. Recruitment has begun in January 2019 and is expected to be completed in August 2021. Results will be published in 2022. Conclusions: This study aims to contribute to the improvement and dissemination of psychological treatments for women with HSDD and to clarify whether cognitive behavioral and/or mindfulness-based treatments for HSDD are feasible and effective when delivered via the internet. Trial Registration: ClinicalTrials.gov NCT03780751; https://clinicaltrials.gov/ct2/show/NCT03780751 International Registered Report Identifier (IRRID): DERR1-10.2196/20326 %M 32990248 %R 10.2196/20326 %U http://www.researchprotocols.org/2020/9/e20326/ %U https://doi.org/10.2196/20326 %U http://www.ncbi.nlm.nih.gov/pubmed/32990248 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e19219 %T Evaluation of the Sexual Health Behaviors of Black Male Adolescents and Young Adults Through Social Media Platforms: Web-Based Survey Study %A Burns,Jade %A Johnstone,Keith %A Chavanduka,Tanaka %A Jamison,Cornelius %A Pena,Valery %A Stephenson,Rob %A Darbes,Lynae %+ Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 N. Ingalls, Room 3175, Ann Arbor, MI, 48109, United States, 1 734 936 5311, curryj@umich.edu %K social media %K survey %K adolescent %K young adult %K Black %K males %K sexual health %K service delivery %D 2020 %7 22.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media platforms such as Facebook, Instagram, and Twitter, which have millions of users who interact and communicate every day, have been effective in promoting sexual health interventions and in disseminating reproductive health education. They have also been shown to be useful in health promotion and have been used to track several key metrics (eg, comments, posts) among users of all demographics. However, there is a lack of research on the impact and reach of these social media platforms as a community-based tool for disseminating sexual health information and for increasing engagement among Black adolescents and young adults, which is a targeted high-risk population. Objective: The purpose of this study was to determine the social media platforms and banner advertisements that affected engagement among Black male adolescents and young adults in participating in web-based health surveys. Methods: A web-based survey was conducted from March 2019 to July 2019 to assess sexual health and health behaviors in a convenience sample of Black male adolescents and young adults in the age range of 18-24 years (N=170). Social media metrics from Facebook, Instagram, and Twitter were monitored. This cross-sectional survey comprised several categories, including basic personal information, drug-related risk behaviors, health care, sexual reproductive health questions, attitudes, norms, and perceived control, mental health, violence-related risk behaviors, and social media preferences. Results: Social media advertisements on the Black Male Opinion survey reached approximately 146,412 individuals. Our primary finding of the web-based survey engagement was that referral (eg, group chat, indirect social media sharing) led to as the greatest proportion of recruitment, with Twitter and YouTube as the preferred sites to receive sexual health information. Conclusions: Recognizing the variety of technologies being used among Black male young adults and adolescents can help the community, researchers, and health care providers understand the web-based engagement of this high-risk population. This information may also promote culturally sensitive, customized marketing on sexual health information for this population. %M 32693387 %R 10.2196/19219 %U http://publichealth.jmir.org/2020/3/e19219/ %U https://doi.org/10.2196/19219 %U http://www.ncbi.nlm.nih.gov/pubmed/32693387 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20961 %T Impact of the COVID-19 Pandemic on Partner Relationships and Sexual and Reproductive Health: Cross-Sectional, Online Survey Study %A Li,Guanjian %A Tang,Dongdong %A Song,Bing %A Wang,Chao %A Qunshan,Shen %A Xu,Chuan %A Geng,Hao %A Wu,Huan %A He,Xiaojin %A Cao,Yunxia %+ Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, National Health Commission Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, 81 Meishan Road, Hefei, 230000, China, 86 15395104659, caoyunxia6@126.com %K COVID-19 %K survey %K novel coronavirus %K sexual behavior %K sexual health %K reproductive health %K young adults %K youth %K China %D 2020 %7 6.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In the past few months, the coronavirus disease (COVID-19) pandemic has caused extensive economic and social damage. Objective: The purpose of this study was to assess the impact of COVID-19–related measures on partner relationships and sexual and reproductive health in China. Methods: From May 1 to 5, 2020, 3500 young Chinese individuals were recruited through WeChat or Weibo to participate in a survey to obtain information on sexual and reproductive health (eg, sexual desire, frequency of sexual intercourse, sexual satisfaction, etc). The questionnaire also collected demographic data (eg, age, race, education, current financial status, sexual orientation, relationship status, etc). Results: In total, 967 participants were included in the sexual health analysis. Due to the COVID-19 pandemic and related containment measures, 22% of participants (n=212) reported a decrease in sexual desire; 41% (n=396) experienced a decrease in the sexual intercourse frequency; 30% (n=291) reported an increase in the frequency of masturbation; 20% (n=192) reported a decrease in alcohol consumption before or during sexual activities, and 31% (n=298) reported a deterioration in partner relationships during the pandemic. The logistic regression analysis indicated that the following influenced partner relationships: accommodations during the pandemic (P=.046; odds ratio [OR] 0.59; 95% CI 0.30-0.86); exclusive relationship status (yes or no) (P<.001; OR 0.44; 95 % CI 0.27-0.73); sexual desire (P=.02; OR 2.01; 95% CI 1.38-2.97); and sexual satisfaction (P<.001; OR 1.92; 95% CI 1.54-2.50). COVID-19 also caused disruptions in reproductive health services such as prenatal and postnatal care, childbirth and abortion services, contraception availability, and the management of sexually transmitted infections. Conclusions: Our results show that many young people have wide-ranging issues affecting their sexual and reproductive health due to the COVID-19 pandemic and related containment measures. Strategies and guidelines are needed to safeguard the sexual and reproductive health of young people during this pandemic. %M 32716895 %R 10.2196/20961 %U https://www.jmir.org/2020/8/e20961 %U https://doi.org/10.2196/20961 %U http://www.ncbi.nlm.nih.gov/pubmed/32716895 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e15378 %T Participatory Interventions for Sexual Health Promotion for Adolescents and Young Adults on the Internet: Systematic Review %A Martin,Philippe %A Cousin,Lorraine %A Gottot,Serge %A Bourmaud,Aurelie %A de La Rochebrochard,Elise %A Alberti,Corinne %+ Université de Paris, ECEVE, INSERM, 10 Avenue de Verdun, Paris, 75010, France, 33 676606491, philippe.martin@inserm.fr %K sexual health %K health promotion %K internet %K participatory interventions %K adolescents and young adults %K methods %D 2020 %7 31.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The World Health Organization recommends the development of participatory sexuality education. In health promotion, web-based participatory interventions have great potential in view of the internet’s popularity among young people. Objective: The aim of this review is to describe existing published studies on online participatory intervention methods used to promote the sexual health of adolescents and young adults. Methods: We conducted a systematic review based on international scientific and grey literature. We used the PubMed search engine and Aurore database for the search. Articles were included if they reported studies on participatory intervention, included the theme of sexual health, were conducted on the internet (website, social media, online gaming system), targeted populations aged between 10 and 24 years, and had design, implementation, and evaluation methods available. We analyzed the intervention content, study implementation, and evaluation methods for all selected articles. Results: A total of 60 articles were included, which described 37 interventions; several articles were published about the same intervention. Process results were published in many articles (n=40), in contrast to effectiveness results (n=23). Many of the 37 interventions were developed on websites (n=20). The second most used medium is online social networks (n=13), with Facebook dominating this group (n=8). Online peer interaction is the most common participatory component promoted by interventions (n=23), followed by interaction with a professional (n=16). Another participatory component is game-type activity (n=10). Videos were broadcast for more than half of the interventions (n=20). In total, 43% (n=16) of the interventions were based on a theoretical model, with many using the Information-Motivation-Behavioral Skills model (n=7). Less than half of the interventions have been evaluated for effectiveness (n=17), while one-third (n=12) reported plans to do so and one-fifth (n=8) did not indicate any plan for effectiveness evaluation. The randomized controlled trial is the most widely used study design (n=16). Among the outcomes (evaluated or planned for evaluation), sexual behaviors are the most evaluated (n=14), followed by condom use (n=11), and sexual health knowledge (n=8). Conclusions: Participatory online interventions for young people’s sexual health have shown their feasibility, practical interest, and attractiveness, but their effectiveness has not yet been sufficiently evaluated. Online peer interaction, the major participatory component, is not sufficiently conceptualized and defined as a determinant of change or theoretical model component. One potential development would be to build a conceptual model integrating online peer interaction and support as a component. %M 32735217 %R 10.2196/15378 %U http://www.jmir.org/2020/7/e15378/ %U https://doi.org/10.2196/15378 %U http://www.ncbi.nlm.nih.gov/pubmed/32735217 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e14242 %T Inferring Sexually Transmitted Infection Risk From Attractiveness in Online Dating Among Adolescents and Young Adults: Exploratory Study %A Krishnamurti,Tamar %A Davis,Alexander L %A Fischhoff,Baruch %+ Division of General Internal Medicine, University of Pittsburgh, 200 Meyran Avenue, Parkvale Building Suite 200, Pittsburgh, PA, 15213, United States, 1 412 692 4855, tamark@pitt.edu %K risk perception %K heuristics %K sexually transmitted infections %K online dating %K dating apps %K adolescents %K sexual health %K attractiveness %K halo effect %D 2020 %7 9.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexually transmitted infection (STI) rates are on the rise among adolescents and young adults in the United States. With the popularity of online dating, adolescents and young adults must increasingly rely on limited cues to make initial judgments about potential sexual partners, including judgments about STI risk. Objective: This study aimed to assess whether in the context of online dating, an attractiveness heuristic would be used for STI risk assessment. We hypothesized that consistent with research on halo effects, decision makers would judge more attractive people to be less likely to have STIs. Methods: In a survey experiment, we asked participants to determine which individual in each of 20 sets of paired photographs was enrolled in a personals website for people with publicly disclosed STIs. Results: Despite financial incentives for accuracy and high levels of self-confidence in their judgments, participants performed no better than chance at identifying individuals with self-reported STIs. Contrary to our hypothesis, however, more attractive people were judged as being more likely to have an STI. This relationship appears to be mediated by inferences regarding the target individual’s sexual behavior, with more attractive individuals considered to have more partners. Conclusions: On showing adolescents and young adults photographs offering no diagnostic information about STIs, they appeared to use attractiveness as a cue for sexual risk, which was mediated by the belief that attractive individuals have more sexual opportunities. Health care providers may wish to address this heuristic process among their adolescent patients in discussions about sexual health. %M 32442128 %R 10.2196/14242 %U https://www.jmir.org/2020/6/e14242 %U https://doi.org/10.2196/14242 %U http://www.ncbi.nlm.nih.gov/pubmed/32442128 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e15964 %T A Digital Pornography Literacy Resource Co-Designed With Vulnerable Young People: Development of "The Gist" %A Davis,Angela C %A Wright,Cassandra JC %A Murphy,Stacey %A Dietze,Paul %A Temple-Smith,Meredith J %A Hellard,Margaret E %A Lim,Megan SC %+ Burnet Institute, GPO Box 2284, Melbourne, 3181, Australia, 61 3 9282 2111, angela.davis@burnet.edu.au %K co-design %K pornography literacy %K sexual health %K sex education %D 2020 %7 1.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The impact of viewing pornography at a young age on the sexual health of subgroups of young people is an important public health issue. However, the topic is complex and extremely sensitive, and best practices for research and harm reduction are yet to be defined. Drawing on cross-disciplinary approaches, such as co-design, is one way to achieve a better understanding of the issue among vulnerable young people and to create needs-based and evidence-informed digital resources to promote pornography literacy. Objective: The objective of this study was to co-design a relevant, usable, and acceptable digital prototype to address the pornography literacy needs of vulnerable young people. Methods: In total, 17 young people aged between 14 and 23 years who were engaged in youth services programs or alternative education programs were recruited to participate in 4 co-design workshops with a multidisciplinary design team. Results: Although the participants could identify problems with pornography and critique its messages, they lacked the information to understand alternative healthy attitudes and behaviors. A digital resource that provides detailed and practical information about sex, sexual ethics, and relationships may help vulnerable young people to identify and contrast with any problematic messages they receive from both pornography and society. Embedding this information with pornography literacy messages may be a more effective way of addressing underlying attitudes. Acknowledging information-seeking patterns and leveraging user interaction patterns from commonly used digital platforms among users may enhance engagement with resources. Importantly, digital platforms are perceived among this group as a source of anonymous secondary information but would not be organically accessed among this group without face-to-face conversations as an access point. Conclusions: This paper highlights the potential for pornography literacy to be embedded within real and practical information about having sex, navigating sexuality, and healthy relationships. The study findings include important recommendations for the conceptualization of digital pornography literacy programs and opportunities for cross-disciplinary co-design research to address complex and emerging health issues. %M 32348268 %R 10.2196/15964 %U https://www.jmir.org/2020/6/e15964 %U https://doi.org/10.2196/15964 %U http://www.ncbi.nlm.nih.gov/pubmed/32348268 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 1 %P e18043 %T Association of Social Media Use and High-Risk Behaviors in Adolescents: Cross-Sectional Study %A Vente,Teresa %A Daley,Mary %A Killmeyer,Elizabeth %A Grubb,Laura K %+ Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 16, Chicago, IL, United States, 1 518 339 5440, tvente@luriechildrens.org %K self-harm %K social media %K nonsuicidal self-injury %K sexting %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Previous studies have demonstrated the prevalence of social media use and identified the presence of high-risk behaviors among adolescents, including self-harm and sharing of sexually explicit messages. Objective: This study aimed to identify patterns in the amount of time spent on social media by adolescents who engage in high-risk behavior and the extent to which they use social media as a platform for sharing such behaviors. Methods: This was a descriptive cross-sectional study of 179 adolescents seen in a pediatric clinic at an urban medical center. We used an anonymous self-report survey to obtain demographic characteristics, rates of self-harm thoughts and behaviors, sharing of sexually explicit messages, and social media use as determined by total hours spent on social media per day and the number of applications used. Results: Most adolescents reported spending 3 to 5 hours on social media each day and using 3 or more social media applications. Almost 1 in 8 (22/179, 12.3%) adolescents self-reported having ever engaged in self-injury with a mean age of onset of 11.8 years. Over a quarter (49/179, 27.4%) of adolescents reported sharing sexually explicit messages. Relative risk of engaging in self-injury and or sharing sexually explicit messages increased with the use of 4 or more social media applications (1.66; CI 1.11-2.48). Conclusions: Results show a relationship between the number of social media applications used and increased rates of high-risk behaviors. We identified relevant risk factors that clinicians can use to screen for high-risk behavior and parents can monitor to encourage education about healthy online practices. %M 32452820 %R 10.2196/18043 %U http://pediatrics.jmir.org/2020/1/e18043/ %U https://doi.org/10.2196/18043 %U http://www.ncbi.nlm.nih.gov/pubmed/32452820 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15888 %T A Sexual Health Promotion App for Transgender Women (Trans Women Connected): Development and Usability Study %A Sun,Christina J %A Anderson,Kirsten M %A Kuhn,Tamara %A Mayer,Liat %A Klein,Charles H %+ School of Public Health, Oregon Health & Science University-Portland State University, 506 SW Mill St., Suite 450, SCH, Portland, OR, 97201, United States, 1 503 725 8858, chrsun@pdx.edu %K transgender persons %K HIV %K sexual health %K minority health %K health care disparities %K health status disparities %D 2020 %7 12.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: HIV severely impacts the transgender communities in the United States, and transgender women have the highest HIV incidence rates among any identified risk group. Guided by formative research with transgender women and by an expert advisory panel of transgender women, we designed a prototype mobile app to promote HIV prevention among transgender women. Objective: This study aimed to develop and test the usability and acceptability of the prototype Trans Women Connected mobile app. Methods: We engaged in a 3-phase prototype development process. After conducting formative research about the health needs of this population, we outlined a theory-based app framework and developed three prototype activities (ie, a vision board, a pre-exposure prophylaxis [PrEP] education activity, and an interactive map). We then tested the usability and acceptability of the mobile app and activities with 16 transgender women using pre- and posttests, think-aloud protocols, and open-ended questions. Results: Participants reported high acceptability for the mobile app; the mean rating across all usability and likability questions was 5.9 out of 7. Service utilization intention, goal setting, and social support increased at posttest compared with pretest. Increases in self-efficacy in finding lesbian, gay, bisexual, transgender, and queer–friendly services; intention to seek online social support; and PrEP knowledge were statistically significant. Participants described the app as attractive and useful and perceived all three activities positively. Conclusions: This study describes the development and usability and acceptability evaluation of a prototype mobile app designed for and with transgender women for HIV prevention. The usability testing findings provided important insights toward refining and the further development of the Trans Women Connected mobile app. The results suggest that a mobile health intervention can support positive changes. The remaining development and efficacy randomized trial of the Trans Women Connected mobile app is currently underway. %M 32396131 %R 10.2196/15888 %U https://mhealth.jmir.org/2020/5/e15888 %U https://doi.org/10.2196/15888 %U http://www.ncbi.nlm.nih.gov/pubmed/32396131 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 2 %P e17295 %T Development and Feasibility Testing of a Video Game to Reduce High-Risk Heterosexual Behavior in Spanish-Speaking Latinx Adolescents: Mixed Methods Study %A Pensak,Meredith J %A Lundsberg,Lisbet S %A Stanwood,Nancy L %A Cutler,Abigail S %A Gariepy,Aileen M %+ Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML0526, Cincinnati, OH, 45219, United States, 1 5135097246, pensakmj@ucmail.uc.edu %K adolescent %K Latino %K Latina %K sexual activity %K video game %D 2020 %7 4.5.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Similar to broader health disparities, Latinx adolescents have higher rates of high-risk sexual behavior resulting in pregnancy rates that are 2 times higher and sexually transmitted infection rates that are 5 to 8 times higher than non-Hispanic, white adolescents. Novel approaches are needed to reduce high-risk sexual behavior among Spanish-speaking Latinx adolescents who represent the fastest-growing group of US immigrants. Objective: This study aimed to partner with Spanish-speaking Latinx adolescents in a participatory design process to develop and test a Spanish-language video game intervention to decrease high-risk heterosexual behavior. Methods: This is an iterative, two-phase, mixed methods study. In phase 1, we conducted focus groups with Spanish-speaking Latinx adolescents to elicit feedback on the content and format of an existing English-language video game. Feedback was then incorporated into an expanded and culturally adapted Spanish-language video game. In phase 2, we pilot tested the feasibility, acceptability, and preliminary efficacy of the new Spanish-language video game intervention by measuring known antecedents to sexual behavior (intentions, self-efficacy, risk perception, and knowledge) assessed at enrollment and 12-week follow-up. We applied a thematic analysis to examine focus group feedback and a bivariate analysis to analyze pre- and postquantitative data. Results: In phase 1, 15 Spanish-speaking Latinx adolescents provided feedback for further video game development. A Spanish-language video game was then produced and tested in phase 2. We recruited and enrolled 24 Spanish-speaking Latinx adolescents aged 15 to 17 years. Participants played the video game for an average of 4.2 hours during monitored sessions. Pilot testing demonstrated feasibility and acceptability; 65% (3/20) of participants stated that they would play it again, and 65% (3/20) said they would recommend it to friends. Condom-specific knowledge did significantly increase between baseline and follow-up (P=.007). Other variables of sexual behavior antecedents did not differ significantly between baseline and 12-week follow-up. Conclusions: An iterative participatory design process in partnership with Spanish-speaking adolescents produced an innovative and acceptable Spanish-language video game intervention aimed at decreasing high-risk sexual behavior in adolescents. Pilot testing demonstrated preliminary feasibility and yielded essential information for further video game development. %M 32364507 %R 10.2196/17295 %U http://games.jmir.org/2020/2/e17295/ %U https://doi.org/10.2196/17295 %U http://www.ncbi.nlm.nih.gov/pubmed/32364507 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 4 %P e12098 %T Using Crowdsourcing to Develop a Peer-Led Intervention for Safer Dating App Use: Pilot Study %A Wong,William Chi Wai %A Song,Lin %A See,Christopher %A Lau,Stephanie Tze Hei %A Sun,Wai Han %A Choi,Kitty Wai Ying %A Tucker,Joseph %+ Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, 2/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong, 852 67456763, songlinhk@gmail.com %K dating apps %K intervention mapping %K crowdsourcing %K peer-led approach %K sexual health %D 2020 %7 21.4.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphone-based dating apps are rapidly transforming how people seek potential sexual and romantic partners. However, they can also increase the risk of unsafe sexual behaviors, harassment, and infringement of personal privacy. Current research on interventions for safer dating app use remains insufficient. Objective: The goal of this study was to describe the development of an intervention for safer dating app usage using crowdsourcing and peer-led approaches. Methods: This paper describes the development of an intervention program designed to promote safer dating app use among college students. Crowdsourcing and peer-led approaches were adopted during key stages of the development process. Focus group discussions were held to assess the experience and needs of dating app users. A crowdsourcing contest then solicited ideas for performance objectives for the intervention. These objectives were grouped to further identify practical strategies. A one-day intensive workshop was subsequently held with peer mentors to brainstorm ideas for the production of creative interventional materials. The intervention programs were produced and tested in a pilot study. The app’s effectiveness will be evaluated in a cluster randomized controlled trial. Results: The intervention program consists of a risk assessment tool, a first-person scenario game, and four short videos. The risk assessment tool, comprised of 14 questions, will give the participant a score to determine their level of risk of adverse events when using dating apps. The scenario game is a first-person simulation game where the players are presented with choices when faced with different scenarios. The short videos each last 2-4 minutes, with points of discussion aimed at addressing the risks of using dating apps. The programs were piloted and were found to be relatable and helpful when further modifications were made. Conclusions: Potential challenges identified during the development process included data management and analysis, sustaining peer mentors’ interests and participation, and balancing between providing more information and perpetuating social stigma around dating app use. By integrating new approaches, such as crowdsourcing and the peer-led approach, in developing an intervention for safer dating app use, our development process provides a viable model for developing future interventions to address the risks associated with dating app use. %M 32314975 %R 10.2196/12098 %U http://formative.jmir.org/2020/4/e12098/ %U https://doi.org/10.2196/12098 %U http://www.ncbi.nlm.nih.gov/pubmed/32314975 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e12677 %T Cyberphysical Human Sexual Behavior Acquisition System (SeBA): Development and Implementation Study in China %A Zhou,Xiaoping %A Zhao,Jichao %A Liang,Xun %+ School of Information Science, Qufu Normal University, #57 Jingxuan West Road, Qufu, 273165, China, 86 10 68322509, xunliangruc@163.com %K cyberphysical system %K sexual behavior %K smart sex toys %K mobile social network %D 2020 %7 3.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Sexual health is one of the principal components of human well-being. Traditional methods for observing human sexual behavior typically adopt manual intervention approaches (eg, interviews). However, the data obtained by such traditional approaches suffer from intrinsic bias and limited sample sizes. Sexual behavioral data that are more reflective of the actual situation can be collected by equipping sex toys with sensors. Objective: To address the limitations of traditional human sexual behavior data observation methods, a novel cyberphysical system is proposed to capture natural human sexual behavior data in China at the nationwide level. Methods: A cyberphysical human sexual behavior acquisition system (SeBA) was designed and implemented. SeBA jointly utilizes state of the art information and communication technologies such as smart sex toys, smartphones, and mobile social networks. Smart sex toys enable objective collection of data on human sexual behavior, while the mobile social network provides the possibility of partnered sex in a cyberphysical manner. The objectives and function settings are discussed, and the overall framework of the system architecture is presented. Results: Operation and privacy policies are proposed and the technical solution of SeBA is described. The effectiveness of SeBA was verified based on analysis of users’ human sexual behavior data collected from January 2016 to June 2017. A total of 103,424 solo sexual behaviors were recorded involving 13,047 users, and 61,007 partnered sexual behaviors from 7,140 users were observed. The proportions of males and females in the solo and partnered sex groups were fairly consistent with recent statistics on unmarried individuals in China. We also found that only a small portion of individuals provided information on at least one other attribute besides the required input of gender, such as age, height, location, job, sex preferences, purposes, and interests. Conclusions: To the best of our knowledge, this is the first study to analyze objective human sexual behavior data at the nationwide level. Although the data are restricted to China, this study can provide insight for further research on human sexual behavior based on the huge amount of data available from wireless smart sex toys worldwide. It is anticipated that findings from such objective big data analyses can help deepen our understanding of sexual behavior, as well as improve sexual health and sexual wellness. %M 32271153 %R 10.2196/12677 %U https://mhealth.jmir.org/2020/4/e12677 %U https://doi.org/10.2196/12677 %U http://www.ncbi.nlm.nih.gov/pubmed/32271153 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 4 %P e17901 %T A Mobile Sexual Health App on Empowerment, Education, and Prevention for Young Adult Men (MyPEEPS Mobile): Acceptability and Usability Evaluation %A Gannon,Brittany %A Davis,Rindcy %A Kuhns,Lisa M %A Rodriguez,Rafael Garibay %A Garofalo,Robert %A Schnall,Rebecca %+ School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, United States, 1 2123426886, rb897@columbia.edu %K young adults %K usability %K HIV %K mHealth %K young men %K mobile phone %D 2020 %7 7.4.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV incidence among young adult men who have sex with men (MSM), particularly among black and Latino men, continues to rise. As such, continued HIV prevention interventions for young MSM of color are of utmost importance. Male Youth Pursuing Empowerment, Education and Prevention around Sexuality (MyPEEPS) Mobile is a comprehensive HIV prevention and sexual health education smartphone app initially created to promote sexual health and HIV prevention among adolescent sexual minority young men aged 13 to 18 years. Objective: The objective of this study was to critically appraise the acceptability and usability of MyPEEPS Mobile for young adult MSM aged 19 to 25 years. Methods: Study participants used the mobile app, completed usability questionnaires and in-depth interviews, and reported their experience using the app. Analysis of interview data was guided by the Unified Theory of Acceptance and Use of Technology (UTAUT) to better understand the usability and acceptability of this intervention for young adults. Interview data were coded using the following constructs from the UTAUT model: performance expectancy, effort expectancy, and social influence. Results: A total of 20 young adult MSM (n=10 in Chicago, Illinois, and n=10 in New York, New York) were enrolled in the study. Participants reported that MyPEEPS Mobile was free of functional problems (Health Information Technology Usability Evaluation Scale scores and Post-Study System Usability Questionnaire scores consistent with high usability), easy to use, and useful, with an engaging approach that increased acceptability, including the use of avatars and animation, and inclusive representation of the diverse identities by race and ethnicity, gender identity, and sexual orientation. Recommended areas for improving MyPEEPS Mobile for the target demographic included more adult-oriented graphics, advanced educational content, scenarios for youth with more sexual experience, and search function to increase accessibility of key content. Conclusions: Overall, young adult MSM aged 19 to 25 years described the MyPEEPS Mobile as educational, informative, and usable for their sexual health education and HIV prevention needs, and they provided actionable recommendations to optimize its use and applicability for this age group. %M 32254043 %R 10.2196/17901 %U https://formative.jmir.org/2020/4/e17901 %U https://doi.org/10.2196/17901 %U http://www.ncbi.nlm.nih.gov/pubmed/32254043 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e16336 %T Love My Body: Pilot Study to Understand Reproductive Health Vulnerabilities in Adolescent Girls %A Tzilos Wernette,Golfo %A Countryman,Kristina %A Khatibi,Kristie %A Riley,Erin %A Stephenson,Rob %+ Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, United States, 1 (734) 998 7120, gtzilos@med.umich.edu %K adolescent %K alcohol %K sexually transmitted infections %K risky sex %K pregnancy %D 2020 %7 30.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexually transmitted infections (STIs) are on the rise in the United States, and adolescent girls (15-19 years old) are more susceptible to acquiring STIs than their male peers. The co-occurrence of alcohol use and sexual risk taking contribute significantly to STI acquisition. Mobile health (mHealth) interventions are ideally suited for our target population and have demonstrated increases in STI testing in young people, as well as reductions in alcohol use. Objective: This pilot study used both qualitative and quantitative methods to explore the views of adolescent girls (age range 15-19 years old; 74.6%, 279/374 white) on the desired qualities and content of an mHealth app for sexual health. Methods: We conducted nine 60-min in-depth interviews (IDIs) to gather information and identify themes of sexual health and alcohol use, and we tested the feasibility of using a two-week social media campaign to collect survey information regarding sexual health risk in adolescent girls. Results: We iteratively coded IDIs and identified major themes around pressure of alcohol use, lack of STI knowledge, male pressure to not use condoms, and pregnancy as a worse outcome than STIs. Results from the web-based survey on risky health behaviors, which was completed by 367 participants, support the use of a sexual health app designed for girls. Conclusions: Future work will integrate these themes to inform the development of a culturally sensitive mHealth app to prevent STIs among adolescent girls. %M 32224484 %R 10.2196/16336 %U http://www.jmir.org/2020/3/e16336/ %U https://doi.org/10.2196/16336 %U http://www.ncbi.nlm.nih.gov/pubmed/32224484 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e15330 %T Examination of Gender Stereotypes and Norms in Health-Related Content Posted to Snapchat Discover Channels: Qualitative Content Analysis %A LeBeau,Kelsea %A Carr,Cary %A Hart,Mark %+ College of Public Health and Health Professions, University of Florida, 1225 Center Drive, Health Professions, Nursing, and Pharmacy Room 4176, Gainesville, FL, 32610, United States, 1 8504991952, klebeau@ufl.edu %K social media %K online social networking %K health behavior %K sexual health %K social norms %K gender %K gender role %K mobile applications %D 2020 %7 20.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Snapchat has seen one of the most rapid, and unprecedented, growths in the history of social networking sites and social media with 3 billion Snapchats sent daily. In 2015, Snapchat introduced a new feature, Snapchat Discover, providing a unique way for publishers, such as magazines, to connect their content to Snapchat users. Objective: This study aimed to evaluate qualitatively the health-related content distributed among male-focused and female-focused Discover channels and to determine whether differences exist between the content posted to these channels. Methods: Magazine Discover channels with male and female target audiences were identified based on the magazine’s claimed audience and a search of Snapchat Discover’s magazine publishers, resulting in the selection of two male-focused and two female-focused channels. Stories were collected daily from each of the selected channels during a 4-week period. Using the constant comparative method, 406 Discover stories were collected and analyzed. Results: Differences in health content coverage existed between male- and female-focused channels. General health stories from male channels comprised 7.5% (10/134) of total stories compared with 22.8% (62/272) for female channels. Sexual health stories from male channels comprised 3.0% (4/134) of total stories compared with 18.8% (51/272) for female channels. Moreover, female-focused channels’ content was more comprehensive. Female audiences were portrayed as being health information seekers, concerned with sexual health and male satisfaction, primarily responsible for contraception and pregnancy prevention, and less informed about sex. Male audiences were portrayed as being less likely to seek health information, obsessed with and driven by sex, and less concerned with sexual health. Conclusions: Understanding the content shared to social media is important, especially when considering the implications content may have for behavior. In terms of content, these findings suggest Discover channels appear to promote gender stereotypes and norms for health and sexual health through the information posted. %M 32196461 %R 10.2196/15330 %U http://www.jmir.org/2020/3/e15330/ %U https://doi.org/10.2196/15330 %U http://www.ncbi.nlm.nih.gov/pubmed/32196461 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e13201 %T Associations Between Affective States and Sexual and Health Status Among Men Who Have Sex With Men in China: Exploratory Study Using Social Media Data %A Zheng,Zhi-Wei %A Yang,Qing-Ling %A Liu,Zhong-Qi %A Qiu,Jia-Ling %A Gu,Jing %A Hao,Yuan-Tao %A Song,Chao %A Jia,Zhong-Wei %A Hao,Chun %+ Department of Medical Statistics, School of Public Health, Sun Yat-sen University, No 74, Zhongshan 2nd Road, Guangzhou, 510080, China, 86 13922750299, haochun@mail.sysu.edu.cn %K affect %K men who have sex with men %K sexual behaviors %K health status %K social media %D 2020 %7 31.1.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Affective states, including sentiment and emotion, are critical determinants of health. However, few studies among men who have sex with men (MSM) have examined sentiment and emotion specifically using real-time social media technologies. Moreover, the explorations on their associations with sexual and health status among MSM are limited. Objective: This study aimed to understand and examine the associations of affective states with sexual behaviors and health status among MSM using public data from the Blued (Blued International Inc) app. Methods: A total of 843,745 public postings of 377,610 MSM users located in Guangdong were saved from the Blued app by automatic screen capture. Positive affect, negative affect, sexual behaviors, and health status were measured using the Simplified Chinese Linguistic Inquiry and Word Count. Emotions, including joy, sadness, anger, fear, and disgust, were measured using the Weibo Basic Mood Lexicon. A positive sentiment score and a positive emotion score were also calculated. Univariate and multivariate linear regression models on the basis of a permutation test were used to assess the associations of affective states with sexual behaviors and health status. Results: A total of 5871 active MSM users and their 477,374 postings were finally selected. Both positive affect and positive emotions (eg, joy) peaked between 7 AM and 9 AM. Negative affect and negative emotions (eg, sadness and disgust) peaked between 2 AM and 4 AM. During that time, 25.1% (97/387) of negative postings were related to health and 13.4% (52/387) of negative postings were related to seeking social support. A multivariate analysis showed that the MSM who were more likely to post sexual behaviors were more likely to express positive affect (beta=0.3107; P<.001) and positive emotions (joy: beta=0.027; P<.001), as well as negative emotions (sadness: beta=0.0443; P<.001 and disgust: beta=0.0256; P<.001). They also had a higher positive sentiment score (beta=0.2947; P<.001) and a higher positive emotion score (beta=0.1612; P<.001). The MSM who were more likely to post their health status were more likely to express negative affect (beta=0.8088; P<.001) and negative emotions, including sadness (beta=0.0705; P<.001), anger (beta=0.0058; P<.001), fear (beta=0.0052; P<.001), and disgust (beta=0.3065; P<.001), and less likely to express positive affect (beta=−0.0224; P=.02). In addition, they had a lower positive sentiment score (beta=−0.8306; P<.001) and a lower positive emotion score (beta=−0.3743; P<.001). Conclusions: The MSM social media community mainly expressed their positive affect in the early morning and negative affect after midnight. Positive affective states were associated with being sexually active, whereas negative affective states were associated with health problems, mostly about mental health. Our finding suggests the potential to deliver different health-related intervention strategies (eg, psychological counseling and safe sex promotion) on a social media app according to the affective states of MSM in real time. %M 32012054 %R 10.2196/13201 %U http://www.jmir.org/2020/1/e13201/ %U https://doi.org/10.2196/13201 %U http://www.ncbi.nlm.nih.gov/pubmed/32012054 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 1 %P e16254 %T Engaging African American Youth in the Development of a Serious Mobile Game for Sexual Health Education: Mixed Methods Study %A Patchen,Loral %A Ellis,Lindsey %A Ma,Tony Xuyen %A Ott,Corilyn %A Chang,Katie H K %A Araya,Brook %A Atreyapurapu,Sravanthi %A Alyusuf,Amal %A Gaines Lanzi,Robin %+ MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, United States, 1 2028777128, loral.patchen@medstar.net %K sexual health %K sex education %K African Americans %K youth %K adolescents %K video games %K games, experimental %K community-based participatory research %K user-centered design %D 2020 %7 31.1.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Although teen pregnancy rates decreased dramatically in the United States over the past decade, the rates of sexually transmitted infections (STIs) among adolescents and young adults increased. STI rates disproportionately affect African American youth and young adults. Innovative, accessible, and culturally relevant sexual health interventions are urgently needed. Objective: This study aimed to identify the optimal modality for a game-based sexual health intervention; develop the educational, entertainment, and technological aspects of the serious game; and demonstrate its usability and acceptance by the target population. Methods: This project was grounded in formative data collection with community-based participatory research principles and practices combined with a user-centered design and development approach. Sexually Active Adolescent–Focused Education (SAAFE) was developed using input and feedback from African American youths aged 15 to 21 years who participated in a youth advisory board and focus group discussions to inform the co-design and cocreation of the serious game. The process was highly iterative with multiple sessions for user input following design changes. It proceeded in 3 stages. Social cognitive theory and problem-solving theory were leveraged to provide evidence-based, trauma-informed education through a serious game. Usability testing assessed the quality of user experience with the prototype. Results: Across all 3 stages, a total of 86 self-identified African American males and females aged 15 to 21 years from the District of Columbia and Birmingham, Alabama, participated. Participants requested a dating simulation game. They wanted SAAFE to be customizable, realistic, entertaining, educational, modern, and experiential, linking consequences to their gameplay decisions. Usability testing resulted in an initial System Usability Survey score of 77.7, placing the game in the 82nd percentile and above average for usability. Conclusions: Initial results suggest that the SAAFE prototype is a promising intervention to engage African American youth in sexual health education using a role-playing game. If proven efficacious, the game has the potential to meet the need for sex education, counterbalance unhealthy portrayals of sex in popular media, and respond to the disparities in the STI epidemic. %M 32012041 %R 10.2196/16254 %U http://games.jmir.org/2020/1/e16254/ %U https://doi.org/10.2196/16254 %U http://www.ncbi.nlm.nih.gov/pubmed/32012041 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 1 %P e14803 %T Stigma and Web-Based Sex Seeking Among Men Who Have Sex With Men and Transgender Women in Tijuana, Mexico: Cross-Sectional Study %A Espinosa da Silva,Cristina %A Smith,Laramie R %A Patterson,Thomas L %A Semple,Shirley J %A Harvey-Vera,Alicia %A Nunes,Stephanie %A Rangel,Gudelia %A Pines,Heather A %+ Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC-0507, La Jolla, CA, 92093-0507, United States, 1 8588224831, hpines@health.ucsd.edu %K social stigma %K discrimination %K internet %K mobile apps %K men who have sex with men %K transgender persons %K sexual and gender minorities %K Mexico %D 2020 %7 30.1.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Stigma toward sexual and gender minorities is an important structural driver of HIV epidemics among men who have sex with men (MSM) and transgender women (TW) globally. Sex-seeking websites and apps are popular among MSM and TW. Interventions delivered via Web-based sex-seeking platforms may be particularly effective for engaging MSM and TW in HIV prevention and treatment services in settings with widespread stigma toward these vulnerable populations. Objective: To assess the potential utility of this approach, the objectives of our study were to determine the prevalence of Web-based sex seeking and examine the effect of factors that shape or are influenced by stigma toward sexual and gender minorities on Web-based sex seeking among MSM and TW in Tijuana, Mexico. Methods: From 2015 to 2018, 529 MSM and 32 TW were recruited through venue-based and respondent-driven sampling. Interviewer-administered surveys collected information on Web-based sex seeking (past 4 months) and factors that shape or are influenced by stigma toward sexual and gender minorities (among MSM and TW: traditional machismo, internalized stigma related to same-sex sexual behavior or gender identity, and outness related to same-sex sexual behavior or gender identity; among MSM only: sexual orientation and history of discrimination related to same-sex sexual behavior). A total of 5 separate multivariable logistic regression models were used to examine the effect of each stigma measure on Web-based sex seeking. Results: A total of 29.4% (165/561) of our sample reported seeking sex partners on the Web. Web-based sex seeking was negatively associated with greater endorsement of traditional machismo values (adjusted odds ratio [AOR] 0.36, 95% CI 0.19 to 0.69) and greater levels of internalized stigma (AOR 0.96, 95% CI 0.94 to 0.99). Web-based sex seeking was positively associated with identifying as gay (AOR 2.13, 95% CI 1.36 to 3.33), greater outness (AOR 1.17, 95% CI 1.06 to 1.28), and a history of discrimination (AOR 1.83, 95% CI 1.08 to 3.08). Conclusions: Web-based sex-seeking is relatively common among MSM and TW in Tijuana, suggesting that it may be feasible to leverage Web-based sex-seeking platforms to engage these vulnerable populations in HIV prevention and treatment services. However, HIV interventions delivered through Web-based sex-seeking platforms may have limited reach among those most affected by stigma toward sexual and gender minorities (ie, those who express greater endorsement of traditional machismo values, greater levels of internalized stigma, lesser outness, and nongay identification), given that within our sample they were least likely to seek sex on the Web. %M 32031963 %R 10.2196/14803 %U https://publichealth.jmir.org/2020/1/e14803 %U https://doi.org/10.2196/14803 %U http://www.ncbi.nlm.nih.gov/pubmed/32031963 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e14800 %T Spatiotemporal Analysis of Men Who Have Sex With Men in Mainland China: Social App Capture-Recapture Method %A Hu,Maogui %A Xu,Chengdong %A Wang,Jinfeng %+ State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, A11, Datun road, Beijing, China, 86 10 64888965, wangjf@lreis.ac.cn %K HIV risk %K men who have sex with men %K MSM distribution %K migration %D 2020 %7 24.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In China, the cases of newly diagnosed HIV/AIDS in men who have sex with men (MSM) have increased more than tenfold since 2006. However, the MSM population size, geographical distribution, and migration patterns are largely unknown. Objective: Our aim is to estimate the number, spatial distribution, and migration of MSM populations in mainland China using big data from social networking. Methods: We collected 85 days of data on online users of a social networking MSM app in mainland China. Daily online MSM users and their migration across the country were investigated during a holiday period and a nonholiday period. Using the capture-mark-recapture model, we designed an experiment consisting of two independent samples to estimate the total provincial MSM population. Results: The estimate of MSM in mainland China was 8,288,536 (95% CI 8,274,931-8,302,141), accounting for 1.732% (95% CI 1.729%-1.734%) of adult men aged 18 to 64 years. The average daily number of MSM social networking online across mainland China was 1,198,682 during the nonholiday period. The five provinces (including municipalities) with the highest average number of daily online MSM numbers were Guangdong (n=141,712), Jiangsu (n=90,710), Zhejiang (n=72,212), Shandong (n=68,065), and Beijing (n=66,057). The proportion of daily online MSM among adult men in different cities varied from 0.04% to 0.96%, with a mean of 0.20% (SD 0.14%). Three migrating centers—Guangdong, Beijing, and the Yangtze River Delta (Shanghai-Zhejiang-Jiangsu)—accounted for 57.23% of MSM migrants in the county. Conclusions: The percentage of MSM among adult men in mainland China is at the middle level compared with other Asia and Pacific countries. However, the number of MSM is very large, and the distribution is uneven. Both MSM distribution and migration are highly affected by socioeconomic status. %M 32012086 %R 10.2196/14800 %U https://mhealth.jmir.org/2020/1/e14800 %U https://doi.org/10.2196/14800 %U http://www.ncbi.nlm.nih.gov/pubmed/32012086 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 11 %P e15426 %T Group Sex Events Among Cisgender Men Who Have Sex With Men: Cross-Sectional and Longitudinal Survey Study to Explore Participation and Risk-Taking Behaviors %A Violette,Lauren R %A Niemann,Lisa A %A McMahan,Vanessa M %A Katz,David A %A Chavez,Pollyanna R %A Clark,Hollie A %A Cornelius-Hudson,Andy %A Ethridge,Steven F %A McDougal,Sarah J %A Ure II,George %A Stekler,Joanne D %A Delaney,Kevin P %+ Department of Medicine, University of Washington, 325 Ninth Avenue, Box 359931, Seattle, WA, 98104, United States, 1 206 616 1054, lvio@uw.edu %K men who have sex with men %K group sex %K HIV infection %K sexual networks %K risk %K threesomes %K four-or-more-somes %D 2019 %7 27.11.2019 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Group sex events (GSEs) are common among cisgender men who have sex with men (MSM), pose a unique risk profile for HIV and sexually transmitted disease (STD) transmission, and may be on the rise, in part because of Web-based networking platforms. However, collecting data on GSEs can be challenging, and many gaps exist in our knowledge about GSE participation among MSM. Objective: The objective of this study was to develop survey questions addressing aggregate and partner-specific group sex behaviors to measure prevalence of GSEs and associated risks in persons participating in Project Diagnostic Evaluation To Expand Critical Testing Technologies (DETECT), including MSM seeking HIV and STD testing at a public clinic in Seattle, Washington. Methods: We developed a computer self-assisted survey that included questions about participant demographics, sexual history, and risk behaviors, including group sex, as a part of Project DETECT, a Centers for Disease Control and Prevention–funded study evaluating point-of-care HIV tests. Aggregate and partner-specific questions asked about participation in all GSEs, threesomes, and four-or-more-somes including questions about number and HIV status of sex partners and condom use during the events. To evaluate question performance, we assessed the discrepancies in reporting between the aggregate and partner-specific questions, quantified question refusal rates, and calculated the additional time required to answer the GSE questions. Information about network density (number of partnerships of overlapping duration) was estimated and compared for MSM who did and did not report GSEs. Results: Among 841 visits by 690 MSM who were asked any group sex survey question, participation in a GSE of any type in the past 3 months was reported at 293 visits (293/841, 34.8%). We found that 9.0% (76/841) of MSM in the sample reported ≥1 four-or-more-some in the partner-specific questions but did not report in the aggregate. The proportion of refusals on any given aggregate GSE-related question ranged from 0% (0/273) to 10.6% (15/141) (median 2.6%) and partner-specific questions ranged from 0% (0/143) to 22% (5/23) (median 3.0%), with questions about four-or-more-somes having the highest proportions of refusals. Completing the aggregate group sex questions added 1 to 2 minutes and the partner-specific questions added an additional 2 to 4 minutes per partner to the total survey length. As expected, the partner-specific GSE questions documented higher density of sexual networks that was not captured by asking about total partner counts and overlap of specific partnerships. Conclusions: We found that the Project DETECT survey was able to obtain nuanced information about GSEs. The question skip patterns and consistency checks were effective, and survey fatigue was minimal. More research is needed on GSEs, and our survey represents a promising data collection tool to help fill gaps in knowledge about the subject. %M 31774403 %R 10.2196/15426 %U https://www.researchprotocols.org/2019/11/e15426 %U https://doi.org/10.2196/15426 %U http://www.ncbi.nlm.nih.gov/pubmed/31774403 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 9 %P e13766 %T Interaction Patterns of Men Who Have Sex With Men on a Geosocial Networking Mobile App in Seven United States Metropolitan Areas: Observational Study %A Abuelezam,Nadia N %A Reshef,Yakir A %A Novak,David %A Grad,Yonatan Hagai %A Seage III,George R %A Mayer,Kenneth %A Lipsitch,Marc %+ William F Connell School of Nursing, Boston College, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, United States, 1 617 552 2312, nadia.abuelezam@bc.edu %K men who have sex with men %K sexual behavior %K race factors %K population dynamics %D 2019 %7 12.09.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The structure of the sexual networks and partnership characteristics of young black men who have sex with men (MSM) may be contributing to their high risk of contracting HIV in the United States. Assortative mixing, which refers to the tendency of individuals to have partners from one’s own group, has been proposed as a potential explanation for disparities. Objective: The objective of this study was to identify the age- and race-related search patterns of users of a diverse geosocial networking mobile app in seven metropolitan areas in the United States to understand the disparities in sexually transmitted infection and HIV risk in MSM communities. Methods: Data were collected on user behavior between November 2015 and May 2016. Data pertaining to behavior on the app were collected for men who had searched for partners with at least one search parameter narrowed from defaults or used the app to send at least one private chat message and used the app at least once during the study period. Newman assortativity coefficient (R) was calculated from the study data to understand assortativity patterns of men by race. Pearson correlation coefficient was used to assess assortativity patterns by age. Heat maps were used to visualize the relationship between searcher’s and candidate’s characteristics by age band, race, or age band and race. Results: From November 2015 through May 2016, there were 2,989,737 searches in all seven metropolitan areas among 122,417 searchers. Assortativity by age was important for looking at the profiles of candidates with correlation coefficients ranging from 0.284 (Birmingham) to 0.523 (San Francisco). Men tended to look at the profiles of candidates that matched their race in a highly assortative manner with R ranging from 0.310 (Birmingham) to 0.566 (Los Angeles). For the initiation of chats, race appeared to be slightly assortative for some groups with R ranging from 0.023 (Birmingham) to 0.305 (Los Angeles). Asian searchers were most assortative in initiating chats with Asian candidates in Boston, Los Angeles, New York, and San Francisco. In Birmingham and Tampa, searchers from all races tended to initiate chats with black candidates. Conclusions: Our results indicate that the age preferences of MSM are relatively consistent across cities, that is, younger MSM are more likely to be chatted with and have their profiles viewed compared with older MSM, but the patterns of racial mixing are more variable. Although some generalizations can be made regarding Web-based behaviors across all cities, city-specific usage patterns and trends should be analyzed to create targeted and localized interventions that may make the most difference in the lives of MSM in these areas. %M 31516124 %R 10.2196/13766 %U https://www.jmir.org/2019/9/e13766/ %U https://doi.org/10.2196/13766 %U http://www.ncbi.nlm.nih.gov/pubmed/31516124 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 9 %P e13837 %T The #MeToo Movement in the United States: Text Analysis of Early Twitter Conversations %A Modrek,Sepideh %A Chakalov,Bozhidar %+ Health Equity Institute, San Francisco State University, 1600 Hollaway Avenue HSS 386, San Francisco, CA, 94132, United States, 1 415 405 7556, smodrek@sfsu.edu %K social media %K sexual abuse %K sexual assault %K machine learning %K infodemiology %K infoveillance %D 2019 %7 03.09.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The #MeToo movement sparked an international debate on the sexual harassment, abuse, and assault and has taken many directions since its inception in October of 2017. Much of the early conversation took place on public social media sites such as Twitter, where the hashtag movement began. Objective: The aim of this study is to document, characterize, and quantify early public discourse and conversation of the #MeToo movement from Twitter data in the United States. We focus on posts with public first-person revelations of sexual assault/abuse and early life experiences of such events. Methods: We purchased full tweets and associated metadata from the Twitter Premium application programming interface between October 14 and 21, 2017 (ie, the first week of the movement). We examined the content of novel English language tweets with the phrase “MeToo” from within the United States (N=11,935). We used machine learning methods, least absolute shrinkage and selection operator regression, and support vector machine models to summarize and classify the content of individual tweets with revelations of sexual assault and abuse and early life experiences of sexual assault and abuse. Results: We found that the most predictive words created a vivid archetype of the revelations of sexual assault and abuse. We then estimated that in the first week of the movement, 11% of novel English language tweets with the words “MeToo” revealed details about the poster’s experience of sexual assault or abuse and 5.8% revealed early life experiences of such events. We examined the demographic composition of posters of sexual assault and abuse and found that white women aged 25-50 years were overrepresented in terms of their representation on Twitter. Furthermore, we found that the mass sharing of personal experiences of sexual assault and abuse had a large reach, where 6 to 34 million Twitter users may have seen such first-person revelations from someone they followed in the first week of the movement. Conclusions: These data illustrate that revelations shared went beyond acknowledgement of having experienced sexual harassment and often included vivid and traumatic descriptions of early life experiences of assault and abuse. These findings and methods underscore the value of content analysis, supported by novel machine learning methods, to improve our understanding of how widespread the revelations were, which likely amplified the spread and saliency of the #MeToo movement. %M 31482849 %R 10.2196/13837 %U https://www.jmir.org/2019/9/e13837/ %U https://doi.org/10.2196/13837 %U http://www.ncbi.nlm.nih.gov/pubmed/31482849 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e13853 %T The Attitudes of Therapists and Physicians on the Use of Sex Robots in Sexual Therapy: Online Survey and Interview Study %A Eichenberg,Christiane %A Khamis,Marwa %A Hübner,Lisa %+ Faculty of Medicine, Sigmund Freud PrivatUniversität, Freudplatz 3A, Vienna, 1020, Austria, 43 1 90 500 70, christiane@rz-online.de %K robotics %K sexual health %K therapy %D 2019 %7 20.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Various types of robots have already been successfully used in medical care, and the use of new technologies is also playing an increasing role in the area of sexuality. Sex robots are marketed as advanced sex toys and sex dolls with artificial intelligence. Only a few considerations about the therapeutic use of sex robots in sexual therapy are debated in expert discussions. Objective: The aim of this study was to conduct a first exploratory survey on the attitudes of sex therapists and physicians toward the therapeutic benefits of sex robots. Methods: This study comprised a quantitative online survey and a qualitative interview study. A self-constructed questionnaire was used to survey the general attitudes of sex therapists and physicians regarding the benefits of sex robots in therapy. The qualitative study was designed to gain in-depth insight into the participants’ beliefs and attitudes. Therefore, semistructured interviews were conducted. The quantitative data were evaluated by statistical analysis, and the interviews were transcribed and analyzed by using a grounded theory approach. Results: A total of 72 sex therapists and physicians completed our self-constructed questionnaire (response rate 15%, 72/480). Only a few respondents (11%, 8/72) said that the use of sex robots was not conceivable for them, and almost half of all therapists and physicians could imagine recommending sex robots in therapy (45%, 33/72). The attitude toward sex robots as a therapeutic tool was very heterogeneous, with gender (P=.006), age (P=.03), and occupational differences (P=.05); female therapists, older therapists, and psychologists (in contrast to physicians) were more critical toward the therapeutic use of sex robots. The analysis of the 5 interviews identified 3 high-level core themes that were representative of the participants’ responses: (1) the importance of the personal definition of sex robots for the assessment of their therapeutic benefits, (2) therapeutic benefits and dangers of sex robots, and (3) considerations on the quality of human-robot sexuality. Initial insights into the possible therapeutic use of sex robots in different disorders (eg, sexual dysfunction or pedophilia) and situations were gained from the perspective of sex therapists. Conclusions: The results of this study provide a first overview of the potential therapeutic use of sex robots. Moral, ethical, and treatment-related issues in this context are still unresolved and need to be further researched. We suggest integrating the topic into the training of sex therapists to form opinions beyond media images and to show therapy possibilities. Scientists engaged in sexual research should be involved in the development of sex robots to design robots with positive effects on sexual education, sexual therapy, sexual counseling, and sexual well-being for interested groups. %M 31432784 %R 10.2196/13853 %U https://www.jmir.org/2019/8/e13853/ %U https://doi.org/10.2196/13853 %U http://www.ncbi.nlm.nih.gov/pubmed/31432784 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e13220 %T Brief Motivational Interviewing Delivered by Clinician or Computer to Reduce Sexual Risk Behaviors in Adolescents: Acceptability Study %A Shafii,Taraneh %A Benson,Samantha K %A Morrison,Diane M %+ Division of Adolescent Medicine, Department of Pediatrics, University of Washington School of Medicine, CSB-200 PO Box 5371, Seattle, WA, 98145, United States, 1 206 987 2028, taraneh.shafii@seattlechildrens.org %K sexual health %K risk behaviors %K adolescent %K healthcare providers %K computer-assisted diagnosis %K teen health %K preventive care %D 2019 %7 10.7.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Clinicians are expected to screen their adolescent patients for an increasing number of health behaviors and intervene when they uncover risky behaviors, yet, the clinic time allotted to screen, intervene, and provide resources is insufficient. Brief motivational interviewing (MI) offers succinct behavior change counseling; however, for implementation, clinicians need training, skill, and time. Computerized screening and counseling adjuvants may help clinicians increase their scope of behavioral screening, especially with sensitive topics such as sexual health, and provide risk-reduction interventions without consuming provider time during visits. Objective: The objectives of this study were to (1) understand the extent to which health care providers use brief MI for sexual health discussions with adolescent patients and (2) assess the acceptability of incorporating a brief MI-based intervention to reduce sexual risk behaviors into their clinical practice delivered by either themselves or a computer. Methods: At a national medical conference, surveys were administered to clinicians who provide sexual health care to adolescents. They were asked about their current use of MI for sexual risk behavior discussions and their willingness to implement computerized sexual health screening and computerized sexual risk behavior interventions into their clinical practice. Results: The large majority (87.6%, 170/194) of clinicians already used MI with their patients with less than half (72/148, 48.6%) reporting they had been formally trained in MI. Despite all (195/195, 100.0%) clinicians feeling very or completely comfortable discussing sexual risk behaviors with their patients, the large majority (160/195, 82.1%) reported it would be useful, very useful, or extremely useful for a computerized program to do it all: screen their patients, generate risk profiles, and provide the risk-reduction counseling rather than doing it themselves. Conclusions: In this study, most clinicians used some form of brief MI or client-centered counseling when discussing sexual risk behaviors with adolescents and are very comfortable doing so. However, the large majority would prefer to implement computerized sexual health screening, risk assessment, and sexual risk behavior interventions into their clinical care of adolescents. %R 10.2196/13220 %U http://www.jmir.org/2019/7/e13220/ %U https://doi.org/10.2196/13220 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12657 %T Feasibility of Using Short Message Service and In-Depth Interviews to Collect Data on Contraceptive Use Among Young, Unmarried, Sexually Active Men in Moshi, Tanzania, and Addis Ababa, Ethiopia: Mixed Methods Study With a Longitudinal Follow-Up %A Pima,Francis Maganga %A Oshosen,Martha %A Ngowi,Kennedy Michael %A Habte,Bruck Messele %A Maro,Eusebious %A Teffera,Belete Eshete %A Kisigo,Godfrey %A Swai,Iraseni Ufoo %A Msangi,Salim Semvua %A Ermias,Amha %A Mmbaga,Blandina T %A Both,Rosalijn %A Sumari-de Boer,Marion %+ Department of Clinical Trials, Kilimanjaro Clinical Research Institute, PO Box 2236, Moshi,, United Republic of Tanzania, 255 754331948, m.sumari@kcri.ac.tz %K SMS %K contraceptives %K sexual behavior %K feasibility %K young unmarried men %D 2019 %7 26.06.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Data on contraceptive needs and use among young unmarried men are limited. Conventional ways of data collection may lead to limited and unreliable information on contraceptive use due to sensitivity of the topic, as many young men feel ashamed to discuss their behavior of using contraceptives. As short message service (SMS) is anonymous and a commonly used means of communication, we believe that if deployed, it will create a promising user-friendly method of data collection. Objective: The objective was to investigate the feasibility of using SMS to collect data on sexually active, young, unmarried men’s sexual behavior and contraceptive preferences, practices, and needs in Addis Ababa, Ethiopia, and Moshi, Tanzania. Methods: We enrolled men aged 18-30 years who were students (in Ethiopia and Tanzania), taxi or local bus drivers/assistants (Ethiopia and Tanzania), Kilimanjaro porters (Tanzania), or construction workers (Ethiopia). Young men were interviewed using a topic list on contraceptive use. They were followed up for 6 months by sending fortnightly SMS texts with questions about contraceptive use. If the young men indicated that they needed contraceptives during the reporting period or were not satisfied with the method they used, they were invited for a follow-up interview. At the end of the study, we conducted exit interviews telephonically using a semistructured questionnaire to explore the feasibility, acceptability, and accuracy of using SMS to validate the study findings in both countries. Results: We enrolled 71 young unmarried men—35 in Tanzania and 36 in Ethiopia. In Moshi, 1908 messages were delivered to participants and 1119 SMS responses were obtained. In Ethiopia, however, only 525 messages were sent to participants and 248 replies were received. The question on dating a girl in the past weeks was asked 438 times in Tanzania and received 252 (58%) replies, of which 148 (59%) were “YES.” In Ethiopia, this question was asked 314 times and received 64 (20%) replies, of which 52 (81%) were “YES” (P=.02 for difference in replies between Tanzania and Ethiopia). In Tanzania, the question on contraceptive use was sent successfully 112 times and received 108 (96%) replies, of which 105 (94%) were “YES.” In Ethiopia, the question on contraceptive use was asked 17 times and received only 2 (11%) replies. Exit interviews in Tanzania showed that SMS was accepted as a means of data collection by 22 (88%) of the 25 interviewed participants. Conclusions: Despite network and individual challenges, the SMS system was found to be feasible in Moshi, but not in Addis Ababa. We recommend more research to scale up the method in different groups and regions. %M 31244476 %R 10.2196/12657 %U http://formative.jmir.org/2019/2/e12657/ %U https://doi.org/10.2196/12657 %U http://www.ncbi.nlm.nih.gov/pubmed/31244476 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 2 %P e14815 %T Correction: Google for Sexual Relationships: Mixed-Methods Study on Digital Flirting and Online Dating Among Adolescent Youth and Young Adults %A Lykens,James %A Pilloton,Molly %A Silva,Cara %A Schlamm,Emma %A Wilburn,Kate %A Pence,Emma %+ Center for Research and Education on Gender and Sexuality, San Francisco State University, 835 Market Street, 5th Floor, Suite 525, San Francisco, CA,, United States, 1 415 817 4520, james.lykens@etr.org %D 2019 %7 21.06.2019 %9 Corrigenda and Addenda %J JMIR Public Health Surveill %G English %X %M 31228178 %R 10.2196/14815 %U http://publichealth.jmir.org/2019/2/e14815/ %U https://doi.org/10.2196/14815 %U http://www.ncbi.nlm.nih.gov/pubmed/31228178 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 6 %P e13338 %T Sexting, Web-Based Risks, and Safety in Two Representative National Samples of Young Australians: Prevalence, Perspectives, and Predictors %A Milton,Alyssa C %A Gill,Benjamin A %A Davenport,Tracey A %A Dowling,Mitchell %A Burns,Jane M %A Hickie,Ian B %+ Brain and Mind Centre, University of Sydney, 88 Mallet Street, Camperdown, 2050, Australia, 61 2 86276947, alyssa.milton@sydney.edu.au %K youth %K sexual behavior %K cyberbullying %K mental health %K internet %K safety %K risk %D 2019 %7 17.06.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: The rapid uptake of information and communication technology (ICT) over the past decade—particularly the smartphone—has coincided with large increases in sexting. All previous Australian studies examining the prevalence of sexting activities in young people have relied on convenience or self-selected samples. Concurrently, there have been recent calls to undertake more in-depth research on the relationship between mental health problems, suicidal thoughts and behaviors, and sexting. How sexters (including those who receive, send, and two-way sext) and nonsexters apply ICT safety skills warrants further research. Objective: This study aimed to extend the Australian sexting literature by measuring (1) changes in the frequency of young people’s sexting activities from 2012 to 2014; (2) young people’s beliefs about sexting; (3) association of demographics, mental health and well-being items, and internet use with sexting; and (4) the relationship between sexting and ICT safety skills. Methods: Computer-assisted telephone interviewing using random digit dialing was used in two Young and Well National Surveys conducted in 2012 and 2014. The participants included representative and random samples of 1400 young people aged 16 to 25 years. Results: From 2012 to 2014, two-way sexting (2012: 521/1369, 38.06%; 2014: 591/1400, 42.21%; P=.03) and receiving sexts (2012: 375/1369, 27.39%; 2014: 433/1400, 30.93%; P<.001) increased significantly, not sexting (2012: 438/1369, 31.99%; 2014: 356/1400, 25.43%; P<.001) reduced significantly, whereas sending sexts (2012: n=35/1369, 2.56%; 2014: n=20/1400, 1.43%; P>.05) did not significantly change. In addition, two-way sexting and sending sexts were found to be associated with demographics (male, second language, and being in a relationship), mental health and well-being items (suicidal thoughts and behaviors and body image concerns), and ICT risks (cyberbullying others and late-night internet use). Receiving sexts was significantly associated with demographics (being male and not living with parents or guardians) and ICT risks (being cyberbullied and late-night internet use). Contrary to nonsexters, Pearson correlations demonstrated that all sexting groups (two-way, sending, and receiving) had a negative relationship with endorsing the ICT safety items relating to being careful when using the Web and not giving out personal details. Conclusions: Our research demonstrates that most young Australians are sexting or exposed to sexting in some capacity. Sexting is associated with some negative health and well-being outcomes—specifically, sending sexts is linked to suicidal thoughts and behaviors, body image issues, and ICT safety risks, including cyberbullying and late-night internet use. Those who do sext are less likely to engage in many preventative ICT safety behaviors. How the community works in partnership with young people to address this needs to be a multifaceted approach, where sexting is positioned within a wider proactive conversation about gender, culture, psychosocial health, and respecting and caring for each other when on the Web. %M 31210139 %R 10.2196/13338 %U https://mental.jmir.org/2019/6/e13338/ %U https://doi.org/10.2196/13338 %U http://www.ncbi.nlm.nih.gov/pubmed/31210139 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 6 %P e13462 %T An Affirmative Coping Skills Intervention to Improve the Mental and Sexual Health of Sexual and Gender Minority Youth (Project Youth AFFIRM): Protocol for an Implementation Study %A Craig,Shelley L %A McInroy,Lauren B %A Eaton,Andrew David %A Iacono,Gio %A Leung,Vivian WY %A Austin,Ashley %A Dobinson,Cheryl %+ Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON, M5S 1V4, Canada, 1 4169788847, shelley.craig@utoronto.ca %K sexual and gender minorities %K youth %K coping behavior %K pragmatic clinical trial %K cognitive behavioral therapy %K implementation science %D 2019 %7 06.06.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sexual and gender minority youth (SGMY, aged 14-29 years) face increased risks to their well-being, including rejection by family, exclusion from society, depression, substance use, elevated suicidality, and harassment, when compared with their cisgender, heterosexual peers. These perils and a lack of targeted programs for SGMY exacerbate their risk for HIV and other sexually transmitted infections. Cognitive behavioral therapy (CBT) interventions support clients by generating alternative ways of interpreting their problems and beliefs about themselves. CBT, tailored to the experiences of SGMY, may help SGMY improve their mood and coping skills by teaching them how to identify, challenge, and change maladaptive thoughts, beliefs, and behaviors. Based on the promising results of a pilot study, a CBT-informed group intervention, AFFIRM, is being tested in a pragmatic trial to assess its implementation potential. Objective: The aim of this study is to scale-up implementation and delivery of AFFIRM, an 8-session manualized group coping skills intervention focused on reducing sexual risk behaviors and psychosocial distress among SGMY. Our secondary aim is to decrease sexual risk taking, poor mental health, and internalized homophobia and to increase levels of sexual self-efficacy and proactive coping among SGMY. Methods: SGMY are recruited via flyers at community agencies and organizations, as well as through Web-based advertising. Potential participants are assessed for suitability for the group intervention via Web-based screening and are allocated in a 2:1 fashion to the AFFIRM intervention or a wait-listed control in a stepped wedge wait-list crossover design. The intervention groups are hosted by collaborating community agency sites (CCASs; eg, community health centers and family health teams) across Ontario, Canada. Participants are assessed at prewait (if applicable), preintervention, postintervention, 6-month follow-up, and 12-month follow-up for sexual health self-efficacy and capacity, mental health indicators, internalized homophobia, stress appraisal, proactive and active coping, and hope. Web-based data collection occurs either independently or at CCASs using tablets. Participants in crisis are assessed using an established distress protocol. Results: Data collection is ongoing; the target sample is 300 participants. It is anticipated that data analyses will use effect size estimates, paired sample t tests, and repeated measures linear mixed modeling in SPSS to test for differences pre- and postintervention. Descriptive analyses will summarize data and profile all variables, including internal consistency estimates. Distributional assumptions and univariate and multivariate normality of variables will be assessed. Conclusions: AFFIRM is a potentially scalable intervention. Many existing community programs provide safe spaces for SGMY but do not provide skills-based training to deal with the increasingly complex lives of youth. This pragmatic trial could make a significant contribution to the field of intervention research by simultaneously moving AFFIRM into practice and evaluating its impact. International Registered Report Identifier (IRRID): DERR1-10.2196/13462 %M 31172957 %R 10.2196/13462 %U https://www.researchprotocols.org/2019/6/e13462/ %U https://doi.org/10.2196/13462 %U http://www.ncbi.nlm.nih.gov/pubmed/31172957 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 2 %P e10695 %T Google for Sexual Relationships: Mixed-Methods Study on Digital Flirting and Online Dating Among Adolescent Youth and Young Adults %A Lykens,James %A Pilloton,Molly %A Silva,Cara %A Schlamm,Emma %A Wilburn,Kate %A Pence,Emma %+ Center for Research and Education on Gender and Sexuality, San Francisco State University, 835 Market Street, 5th Floor, Suite 525, San Francisco, CA,, United States, 1 415 817 4520, james.lykens@etr.org %K youth %K sexual health %K online dating %K adolescent health %D 2019 %7 16.05.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: According to a 2015 report from the Pew Research Center, nearly 24% of teens go online almost constantly and 92% of teens are accessing the internet daily; consequently, a large part of adolescent romantic exploration has moved online, where young people are turning to the Web for romantic relationship-building and sexual experience. This digital change in romantic behaviors among youth has implications for public health and sexual health programs, but little is known about the ways in which young people use online spaces for sexual exploration. An examination of youth sexual health and relationships online and the implications for adolescent health programs has yet to be fully explored. Objective: Although studies have documented increasing rates of sexually transmitted infections and HIV among young people, many programs continue to neglect online spaces as avenues for understanding sexual exploration. Little is known about the online sexual health practices of young people, including digital flirting and online dating. This study explores the current behaviors and opinions of youth throughout online sexual exploration, relationship-building, and online dating, further providing insights into youth behavior for intervention opportunities. Methods: From January through December 2016, an exploratory study titled TECHsex used a mixed-methods approach to document information-seeking behaviors and sexual health building behaviors of youth online in the United States. Data from a national quantitative survey of 1500 youth and 12 qualitative focus groups (66 youth) were triangulated to understand the experiences and desires of young people as they navigate their sexual relationships through social media, online chatting, and online dating. Results: Young people are using the internet to begin sexual relationships with others, including dating, online flirting, and hooking up. Despite the fact that dating sites have explicit rules against minor use, under 18 youth are using these products regardless in order to make friends and begin romantic relationships, albeit at a lower rate than their older peers (19.0% [64/336] vs 37.8% [440/1163], respectively). Nearly 70% of youth who have used online dating sites met up with someone in person (44.78% [30/67] under 18 vs 74.0% [324/438] over 18). Focus group respondents provided further context into online sexual exploration; many learned of sex through pornography, online dating profiles, or through flirting on social media. Social media played an important role in vetting potential partners and beginning romantic relationships. Youth also reported using online dating and flirting despite fears of violence or catfishing, in which online profiles are used to deceive others. Conclusions: Youth are turning to online spaces to build sexual relationships, particularly in areas where access to peers is limited. Although online dating site use is somewhat high, more youth turn to social media for online dating. Sexual relationship-building included online flirting and online dating websites and/or apps. These findings have implications for future sexual health programs interested in improving the sexual health outcomes of young people. Researchers may be neglecting to include social media as potential sources of youth hookup culture and dating. We implore researchers and organizations to consider the relationships young people have with technology in order to more strategically use these platforms to create successful and youth-centered programs to improve sexual health outcomes. %M 31099335 %R 10.2196/10695 %U http://publichealth.jmir.org/2019/2/e10695/ %U https://doi.org/10.2196/10695 %U http://www.ncbi.nlm.nih.gov/pubmed/31099335 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 2 %P e12451 %T Estimation of the Population Size of Men Who Have Sex With Men in Vietnam: Social App Multiplier Method %A Son,Vo Hai %A Safarnejad,Ali %A Nga,Nguyen Thien %A Linh,Vu Manh %A Tu,Le Thi Cam %A Manh,Pham Duc %A Long,Nguyen Hoang %A Abdul-Quader,Abu %+ The Joint United Nations Programme on HIV/AIDS, Green One United Nations House, , Hanoi, Vietnam, 84 +84243 850 1887, ali.safarnejad@gmail.com %K HIV %K AIDS %K population size estimation %K men who have sex with men %K respondent-driven sampling %K Vietnam %D 2019 %7 17.04.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although the prevalence of HIV among men who have sex with men (MSM) in Vietnam has been increasing in recent years, there are no estimates of the population size of MSM based on tested empirical methods. Objective: This study aimed to estimate the size of the MSM population in 12 provinces in Vietnam and extrapolate from those areas to generate a national population estimate of MSM. A secondary aim of this study was to compare the feasibility of obtaining the number of users of a mobile social (chat and dating) app for MSM using 3 different approaches. Methods: This study used the social app multiplier method to estimate the size of MSM populations in 12 provinces using the count of users on a social app popular with MSM in Vietnam as the first data source and a questionnaire propagated through the MSM community using respondent-driven sampling as the second data source. A national estimation of the MSM population is extrapolated from the results in the study provinces, and the percentage of MSM reachable through online social networks is clarified. Results: The highest MSM population size among the 12 provinces is estimated in Hanoi and the lowest is estimated in Binh Dinh. On average, 37% of MSM in the provinces surveyed had used the social app Jack’d in the last 30 days (95% CI 27-48). Extrapolation of the results from the study provinces with reliable estimations results in an estimated national population of 178,000 MSM (95% CI 122,000-512,000) aged 15 to 49 years in Vietnam. The percentage of MSM among adult males aged 15 to 49 years in Vietnam is 0.68% (95% CI 0.46-1.95). Conclusions: This study is the first attempt to empirically estimate the population of MSM in Vietnam and highlights the feasibility of reaching a large proportion of MSM through a social app. The estimation reported in this study is within the bounds suggested by the Joint United Nations Programme on HIV/AIDS. This study provides valuable information on MSM population sizes in provinces where reliable estimates were obtained, which they can begin to work with in program planning and resource allocation. %M 30994469 %R 10.2196/12451 %U http://publichealth.jmir.org/2019/2/e12451/ %U https://doi.org/10.2196/12451 %U http://www.ncbi.nlm.nih.gov/pubmed/30994469 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e12573 %T The Characteristics and Quality of Mobile Phone Apps Targeted at Men Who Have Sex With Men in China: A Window of Opportunity for Health Information Dissemination? %A Yang,Guoli %A Long,Jian %A Luo,Dan %A Xiao,Shuiyuan %A Kaminga,Atipatsa Chiwanda %+ Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, 238 Shangmayuanling Road, Changsha, 410078, China, 86 0731 84805414, xiaosy@live.com %K mobile application %K homosexuality, male %K quality %K character %D 2019 %7 27.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A number of mobile phone apps has been developed specifically for men who have sex with men (MSM). We will call these mobile phone apps MSM apps for simplicity. At present, the characteristics and quality and purpose of these MSM apps are unclear. Objective: The aim of this study was to objectively and comprehensively evaluate the characteristics and quality of the MSM apps to assess whether they disseminated health information among the MSM in China. Methods: We searched 2 dominant mobile phone app stores (Apple Store and Android Market) to obtain MSM apps using the keywords MSM, gay, lesbian, gay, bisexual, and transgender (LGBT), 男同，同志，男男性接触者，同性恋，基友, and 双性恋. Apps were excluded if they did not have a Chinese language interface or if their target population was not MSM. Basic information about the eligible apps for this study, such as app name, app store category, and date of last update was gathered from the specified app stores. The quality of apps was rated by 2 independent raters using Mobile App Rating Scale (MARS). The intraclass correlation coefficient (ICC) between raters was computed as a measure for interrater reliability of the MARS. All analyses were conducted using SPSS version 20.0 (SPSS Inc). Results: A total of 575 apps were reviewed between September 15, 2018 and September 30, 2018, out of which, 532 apps were excluded. Finally, 43 apps were included. Of the 43 apps, 16 were from the Apple Store, 10 were from Android Market, and 17 were available in both app stores. In addition, 39 out of 43 apps were for social and sexual networking, whereas 10 contained sexual health information, for example, HIV/sexually transmitted diseases knowledge, HIV test, and condom use. The average rating was 4 stars. The number of downloads for 21 apps exceeded 10,000. A total of 31 apps had acceptable quality (as defined by a MARS score of >3), with functionality as the highest scoring domain, followed by information quality, esthetics, and engagement. Interrater reliability was excellent for the overall mean app quality scores (ICC=.946; 95% CI 0.904-0.970) and the subjective quality scores (ICC=.910; 95% CI 0.841-0.950). Conclusions: By reviewing the available apps, we found that MSM apps are popular. The majority of MSM apps are for dating, whereas few of them contain HIV prevention and health information. The overall quality of the apps is acceptable. The utilization of mobile phone technologies is a promising way for delivering HIV prevention messages to MSM. We recommend that researchers and app developers should work together to disseminate health information for MSM via mobile technologies. %M 30916658 %R 10.2196/12573 %U http://mhealth.jmir.org/2019/3/e12573/ %U https://doi.org/10.2196/12573 %U http://www.ncbi.nlm.nih.gov/pubmed/30916658 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 12 %P e11303 %T The Effect of Using Geosocial Networking Apps on the HIV Incidence Rate Among Men Who Have Sex With Men: Eighteen-Month Prospective Cohort Study in Shenyang, China %A Xu,Junjie %A Yu,Huan %A Tang,Weiming %A Leuba,Sequoia I %A Zhang,Jing %A Mao,Xiang %A Wang,Hongyi %A Geng,Wenqing %A Jiang,Yongjun %A Shang,Hong %+ Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, 155 Nanjing North Street, Heping District, Shenyang,, China, 86 8328 2634, hongshang100@hotmail.com %K geosocial networking apps %K dating apps %K HIV %K incidence %K homosexuality %K male %K cohort study %D 2018 %7 21.12.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Men who have sex with men (MSM) frequently seek partners through mobile apps (geosocial networking [GSN] apps). However, it is unclear whether GSN apps’ use is associated with the increase in HIV incidence among MSM. Objective: The aim of this study was to clarify the characteristics of GSN apps’ users and to determine the association and putative mechanisms between GSN apps’ use behavior and HIV incidence. Methods: We conducted an 18-month prospective cohort study of MSM in Shenyang, China, and the participants were surveyed every 3 months from March 2015 to December 2016. An in-person interview collected information on sociodemographics, GSN apps’ use, recreational drug use, and sexual behaviors. In addition, blood was drawn to test for HIV and syphilis. We used a multivariable Cox regression model to determine possible predictors for increased HIV incidence. Results: Of the enrolled 686 HIV-negative MSM, 431 (431/686, 62.8%) were GSN apps’ users. Compared with GSN apps’ nonusers, GSN apps’ users were younger; had an earlier age of sexual debut; and in the past 3 months, were more likely to have used recreational drugs, more likely to have had 5 or more casual partners (CPs), more likely to have had group sex with males, and more likely to have had condomless anal intercourse (CAI) with male steady partners (SPs). In addition, 59.4% (256/431) of the GSN apps’ users were willing to accept HIV and AIDS prevention information push services through GSN apps. In total, 19 MSM seroconverted to HIV during the follow-up period; the HIV incidence density rate was 8.5 (95% CI 5.0-13.5) per 100 person-years (PY) among GSN apps’ users and 2.0 (95% CI 0.4-5.8) per 100 PY among nonusers. New HIV infections were independently associated with ever using GSN apps to seek male sexual partners (P=.04) and in the past 3 months, using recreational drugs (P=.048), having group sex with males (P=.01), and having CAI with male CPs (P=.02). Conclusions: GSN apps’ use is associated with higher HIV incidence and may be mediated through recreational drug use and having multiple CPs. Researchers must develop an intervention propagated through GSN apps to reach this high-risk population to mitigate the HIV epidemic in the MSM community. %M 30578225 %R 10.2196/11303 %U http://www.jmir.org/2018/12/e11303/ %U https://doi.org/10.2196/11303 %U http://www.ncbi.nlm.nih.gov/pubmed/30578225 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 12 %P e10683 %T Meeting Sexual Partners Through Internet Sites and Smartphone Apps in Australia: National Representative Study %A Watchirs Smith,Lucy %A Guy,Rebecca %A Degenhardt,Louisa %A Yeung,Anna %A Rissel,Chris %A Richters,Juliet %A Liu,Bette %+ Kirby Institute, University of New South Wales, Sydney, Level 6, Wallace Wurth Building, Sydney, 2052, Australia, 61 293859254 ext 9254, lwatchirs-smith@kirby.unsw.edu.au %K dating websites %K internet %K mobile phone %K sexually transmitted diseases %K health risk behaviors %D 2018 %7 18.12.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Studies have reported on the proportion of the population looking for potential sexual partners using internet sites and smartphone apps, but few have investigated those who have sex with these partners, arguably a more important target group for health promotion. Objective: This study aimed to determine the proportion of people who have had sex with someone they met on an internet site or a smartphone app in the previous year. Methods: We analyzed data from the 2012-2013 Second Australian Study of Health and Relationships, a nationally representative telephone survey of Australian residents aged 16-69 years (N=20,091). The participation rate for the telephone survey was 66.22%. The prevalence of looking for a potential partner, physically meeting, and having sex with someone first met through an internet site or a smartphone app was estimated. Multivariate logistic regression was used for men and women separately to determine demographic and behavioral factors associated with having had sex with someone met on an internet site or a smartphone app in the last year. Results: Overall, 12.09% of respondents had looked for potential partners using these technologies and 5.40% had done so in the last year. In the last year, 2.98% had met someone in person and 1.95% reported having had sex with someone first met on an internet site or a smartphone app. The prevalence of all behaviors was greater in men than in women and in younger respondents than in older respondents. Among sexually active men, factors associated with having had sex with someone met using internet sites or smartphone apps included identifying as gay or bisexual (adjusted odds ratio, AOR: 15.37, 95% CI 8.34-28.35), having either 2-3 or >3 sexual partners in the last year (AOR: 9.20, 95% CI 9.20-34.68 and AOR: 35.77, 95% CI 18.04-70.94, respectively), having had a sexually transmissible infection (STI) test in the past year (AOR: 2.02, 95% CI 1.21-3.38), or an STI in the last year (AOR: 3.15, 95% CI 1.25-7.97). Among sexually active women, factors associated with having had sex with someone met on an internet site or a smartphone app were as follows: having either 2-3 or >3 sexual partners in the last year (AOR: 32.01, 95% CI 13.17-77.78 and AOR: 71:03, 95 % CI 27.48-183.57, respectively), very low and low income (vs very high AOR: 3.40, 95% CI 1.12-10.35), and identifying as lesbian or bisexual (AOR: 2.27, 95% CI 1.04-4.49). Conclusions: More than a third of adults who had looked for potential partners using websites and apps each year had sex with such partners, and those who had done so were more sexually active, suggesting that dating and hookup websites and applications are suitable settings for targeted sexual health interventions. %M 30563809 %R 10.2196/10683 %U https://www.jmir.org/2018/12/e10683/ %U https://doi.org/10.2196/10683 %U http://www.ncbi.nlm.nih.gov/pubmed/30563809 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 3 %P e61 %T Using Geosocial Networking Apps to Understand the Spatial Distribution of Gay and Bisexual Men: Pilot Study %A Card,Kiffer George %A Gibbs,Jeremy %A Lachowsky,Nathan John %A Hawkins,Blake W %A Compton,Miranda %A Edward,Joshua %A Salway,Travis %A Gislason,Maya K %A Hogg,Robert S %+ School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada, 1 250 213 1743, kcard@sfu.ca %K service access %K geosocial networking apps %K gay and bisexual men %K spatial distribution %K gay neighborhoods %D 2018 %7 08.08.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: While services tailored for gay, bisexual, and other men who have sex with men (gbMSM) may provide support for this vulnerable population, planning access to these services can be difficult due to the unknown spatial distribution of gbMSM outside of gay-centered neighborhoods. This is particularly true since the emergence of geosocial networking apps, which have become a widely used venue for meeting sexual partners. Objective: The goal of our research was to estimate the spatial density of app users across Metro Vancouver and identify the independent and adjusted neighborhood-level factors that predict app user density. Methods: This pilot study used a popular geosocial networking app to estimate the spatial density of app users across rural and urban Metro Vancouver. Multiple Poisson regression models were then constructed to model the relationship between app user density and areal population-weighted neighbourhood-level factors from the 2016 Canadian Census and National Household Survey. Results: A total of 2021 app user profiles were counted within 1 mile of 263 sampling locations. In a multivariate model controlling for time of day, app user density was associated with several dissemination area–level characteristics, including population density (per 100; incidence rate ratio [IRR] 1.03, 95% CI 1.02-1.04), average household size (IRR 0.26, 95% CI 0.11-0.62), average age of males (IRR 0.93, 95% CI 0.88-0.98), median income of males (IRR 0.96, 95% CI 0.92-0.99), proportion of males who were not married (IRR 1.08, 95% CI 1.02-1.13), proportion of males with a postsecondary education (IRR 1.06, 95% CI 1.03-1.10), proportion of males who are immigrants (IRR 1.04, 95% CI 1.004-1.07), and proportion of males living below the low-income cutoff level (IRR 0.93, 95% CI 0.89-0.98). Conclusions: This pilot study demonstrates how the combination of geosocial networking apps and administrative datasets might help care providers, planners, and community leaders target online and offline interventions for gbMSM who use apps. %M 30089609 %R 10.2196/publichealth.8931 %U http://publichealth.jmir.org/2018/3/e61/ %U https://doi.org/10.2196/publichealth.8931 %U http://www.ncbi.nlm.nih.gov/pubmed/30089609 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 2 %P e38 %T Predictors of Facebook User Engagement With Health-Related Content for Gay, Bisexual, and Other Men Who Have Sex With Men: Content Analysis %A Card,Kiffer George %A Lachowsky,Nathan %A Hawkins,Blake W %A Jollimore,Jody %A Baharuddin,Fahmy %A Hogg,Robert S %+ Faculty of Health Science, Simon Fraser University, c/o Faculty of Health Sciences, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada, 1 7789884269, kiffercard@gmail.com %K social media %K health promotion %K gay and bisexual men %K user engagement %D 2018 %7 06.04.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media is used by community-based organizations (CBOs) to promote the well-being of gay and bisexual men (GBM). However, few studies have quantified which factors facilitate the diffusion of health content tailored for sexual minorities. Objective: The aim of this study was to identify post characteristics that can be leveraged to optimize the health promotion efforts of CBOs on Facebook. Methods: The Facebook application programming interface was used to collect 5 years’ of posts shared across 10 Facebook pages administered by Vancouver-based CBOs promoting GBM health. Network analysis assessed basic indicators of network structure. Content analyses were conducted using informatics-based approaches. Hierarchical negative binomial regression of post engagement data was used to identify meaningful covariates of engagement. Results: In total, 14,071 posts were shared and 21,537 users engaged with these posts. Most users (n=13,315) engaged only once. There was moderate correlation between the number of posts and the number of CBOs users engaged with (r=.53, P<.001). Higher user engagement was positively associated with positive sentiment, sharing multimedia, and posting about pre-exposure prophylaxis, stigma, and mental health. Engagement was negatively associated with asking questions, posting about dating, and sharing posts during or after work (versus before). Conclusions: Results highlight the existence of a core group of Facebook users who facilitate diffusion. Factors associated with greater user engagement present CBOs with a number of strategies for improving the diffusion of health content. %M 29625953 %R 10.2196/publichealth.8145 %U http://publichealth.jmir.org/2018/2/e38/ %U https://doi.org/10.2196/publichealth.8145 %U http://www.ncbi.nlm.nih.gov/pubmed/29625953 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 7 %P e141 %T Development of a Tailored HIV Prevention Intervention for Single Young Men Who Have Sex With Men Who Meet Partners Online: Protocol for the myDEx Project %A Bauermeister,Jose Arturo %A Tingler,Ryan C %A Demers,Michele %A Harper,Gary W %+ University of Pennsylvania, 418 Curie Blvd, Suite 222L, Philadelphia, PA, 19104, United States, 1 215 898 9993, bjose@upenn.edu %K eHealth %K HIV prevention %K Internet %K risk reduction %K sexually transmitted infections %D 2017 %7 19.07.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: New cases of human immunodeficiency virus (HIV) among young men who have sex with men (YMSM), aged 18 to 24, underscore the importance of developmentally-informed HIV programs for YMSM. We developed an online intervention focused on risk reduction strategies across different sexual partner types. Intervention activities focus on assisting YMSM reflect on their partner-seeking behaviors, develop sexual decision-making rules to reduce their HIV risks, and consider the adoption of HIV prevention behaviors. Objective: This pilot, randomized controlled trial (RCT) aims to examine the feasibility, acceptability, and preliminary efficacy of a tailored, Web-based HIV prevention intervention for single YMSM. Methods: We designed a prospective RCT of online-recruited cis-gender men (N=180) who reported recent unprotected anal intercourse, self-report as HIV negative or are unaware of their HIV status, and meet sexual partners through online dating apps. Individuals in the control arm receive an attention-control condition that includes HIV/sexually transmitted infection (STI) information currently available on sex education websites. Individuals in the intervention arm receive a 6-session Web-based program tailored on their demographic information, partner-seeking behaviors and relationship desires, and prior sexual attitudes and behaviors. This tailored content will match HIV prevention messages and safer sex skills with YMSM’s outcome expectancies when meeting new partners and thereby help them consider how to integrate safer sex practices into different partner types. Study assessments are taken at baseline, 30-, 60-, and 90-day follow-ups. Intervention acceptability and preliminary efficacy will be explored in sexual risk behaviors and HIV/STI testing. Results: The RCT launched in November 2016 and is ongoing. To date, 180 eligible individuals have been enrolled, consented, and randomized. Of the 120 individuals in the intervention arm, 51.7% (62/120) identify as non-Hispanic white and half of the control arm identifies as non-Hispanic white. There were no differences observed by arm for race and/or ethnicity, age, or sexual orientation. Conclusions: Although there are in-person evidence-based interventions with proven efficacy for YMSM, few HIV/STI prevention interventions delivered online exist. Online interventions may ease access to comprehensive HIV/STI education among YMSM and allow personalized content to be delivered. The online intervention that we developed, myDEx, aims to alleviate the gaps within HIV prevention for YMSM by utilizing tailored, Web-based content with the goal of developing skills for same-sex dating and relationship building, while reducing their risks for HIV/STI. Trial Registration: ClinicalTrials.gov NCT02842060; https://clinicaltrials.gov/ct2/show/NCT02842060 (Archived by WebCite at http://www.webcitation.org/6rcJdxF9v) %M 28724513 %R 10.2196/resprot.7965 %U http://www.researchprotocols.org/2017/7/e141/ %U https://doi.org/10.2196/resprot.7965 %U http://www.ncbi.nlm.nih.gov/pubmed/28724513 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e124 %T Safe Sex Messages Within Dating and Entertainment Smartphone Apps: A Review %A Huang,Evelyn Tzu-Yen %A Williams,Henrietta %A Hocking,Jane S %A Lim,Megan SC %+ Austin Hospital, Austin Health, 145 Studley Road, Heidelberg, 3084, Australia, 61 3 9496 5000, drevelynhuang@gmail.com %K mobile apps %K sexual health %K STDs %K sexually transmitted diseases %K mobile health %K mHealth %D 2016 %7 08.11.2016 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Smartphone apps provide a new platform for entertainment, information distribution, and health promotion activities, as well as for dating and casual sexual encounters. Previous research has shown high acceptability of sexual health interventions via smartphone apps; however, sexual health promotion apps were infrequently downloaded and underused. Integrating sexual health promotion into established apps might be a more effective method. Objective: The objective of our study was to critically review popular sex-related apps and dating apps, in order to ascertain whether they contain any sexual health content. Methods: Part 1: In January 2015, we used the term “sexual” to search for free apps in the Apple iTunes store and Android Google Play store, and categorized the sexual health content of the 137 apps identified. Part 2: We used the term “dating” to search for free geosocial-networking apps in the Apple iTunes and Android Google Play stores. The apps were downloaded to test functionality and to determine whether they included sexual health content. Results: Part 1: Of the 137 apps identified, 15 (11.0%) had sexual health content and 15 (11.0%) contained messages about sexual assault or violence. The majority of the apps did not contain any sexual health content. Part 2: We reviewed 60 dating apps: 44 (73%) targeting heterosexual users, 9 (15%) targeting men who have sex with men (MSM), 3 (5%) targeting lesbian women, and 4 (7%) for group dating. Only 9 dating apps contained sexual health content, of which 7 targeted MSM. Conclusions: The majority of sex-related apps and dating apps contained no sexual health content that could educate users about and remind them of their sexual risks. Sexual health practitioners and public health departments will need to work with app developers to promote sexual health within existing popular apps. For those apps that already contain sexual health messages, further study to investigate the effectiveness of the content is needed. %M 27826133 %R 10.2196/mhealth.5760 %U http://mhealth.jmir.org/2016/4/e124/ %U https://doi.org/10.2196/mhealth.5760 %U http://www.ncbi.nlm.nih.gov/pubmed/27826133 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 1 %N 1 %P e4 %T Geosocial-Networking App Usage Patterns of Gay, Bisexual, and Other Men Who Have Sex With Men: Survey Among Users of Grindr, A Mobile Dating App %A Goedel,William C %A Duncan,Dustin T %+ School of Medicine, Department of Population Health, New York University, 227 East 30th Street, Room 628A, New York, NY, 10016, United States, 1 646 501 2715, wcg219@nyu.edu %K homosexuality %K MSM %K men who have sex with men %K male %K mobile apps %K dating apps %K mobile phones %K HIV %K AIDS prevention %D 2015 %7 08.05.2015 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Geosocial-networking apps like Grindr have been used increasingly among men who have sex with men (MSM) to meet anonymous partners. These mobile dating apps employ global positioning system technology to facilitate connections with other users based on their current location. These new technologies have generated quicker and easier modes for men who have sex with men to meet potential partners based on attraction and physical proximity. Objective: The aim of this study is to describe geosocial-networking app use and recent sexual behaviors of MSM in the Atlanta metropolitan statistical area. Methods: Our sample was recruited from Grindr, the most commonly used of these mobile apps among MSM, using broadcast advertising. Advertisements were displayed over the course of a 72-hour period and participants were directed to a Web-based survey. Results: In total, 604 men clicked through the advertisement, and 92 users completed the survey. One-third (38.0%) of the men reported using these mobile apps to meet new sexual partners, and one-fifth (18.5%) used them to “kill time” when bored. Men reporting currently being in a relationship were less likely to report using these mobile apps to meet other MSM to date or to find a boyfriend or romantic partner, but more likely to report using these mobile apps to meet other MSM to have sex, X224=12.1, P=.016. Respondents had current accounts on 3.11 mobile apps (SD 1.84) on average, with Grindr being the most common (100%), followed by Scruff (52.5%), and Jack’d (45.7%). Most men were most active in the late night (40.2%), and on weekdays (64.1%). Each day, on average, men reported opening these mobile apps 8.38 times (SD 8.10) and spent 1.31 hours (SD 1.15) on these mobile apps. The age respondents began using these mobile apps was associated with the age at their first instance of insertive anal sex (r80=.527, P<.001) and receptive anal sex (r76=.527, P<.001). Conclusions: These findings suggest that MSM use multiple mobile apps and spend significant time on them. For these reasons, HIV prevention interventions could be delivered on these mobile apps. %M 27227127 %R 10.2196/publichealth.4353 %U http://publichealth.jmir.org/2015/1/e4/ %U https://doi.org/10.2196/publichealth.4353 %U http://www.ncbi.nlm.nih.gov/pubmed/27227127 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 3 %N 4 %P e64 %T A Formative Evaluation of a Social Media Campaign to Reduce Adolescent Dating Violence %A Lambert,Danielle N %A Bishop,Lauren E %A Guetig,Stephanie %A Frew,Paula M %+ Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, 500 Irvin Court, Suite 200, Decatur, GA, 30030, United States, 1 404 712 8546, pfrew@emory.edu %K adolescents %K dating violence %K social media %K formative evaluation %D 2014 %7 12.11.2014 %9 Protocol %J JMIR Res Protoc %G English %X Background: The Emory Jane Fonda Center implemented the Start Strong Atlanta social marketing campaign, “Keep It Strong ATL”, in 2007 to promote the development of healthy adolescent relationships and to foster the prevention of adolescent dating abuse among 11-14 year olds. Objective: A formative evaluation was conducted to understand whether messages directed at the target audience were relevant to the program’s relationship promotion and violence prevention goals, and whether the “Web 2.0” social media channels of communication (Facebook, Twitter, YouTube, Flickr, Tumblr, and Pinterest) were reaching the intended audience. Methods: Mixed methodologies included qualitative interviews and a key informant focus group, a cross-sectional survey, and web analytics. Qualitative data were analyzed using constant comparative methodology informed by grounded theory. Descriptive statistics were generated from survey data, and web analytics provided user information and traffic patterns. Results: Results indicated that the Keep It Strong ATL social marketing campaign was a valuable community resource that had potential for broader scope and greater reach. The evaluation team learned the importance of reaching adolescents through Web 2.0 platforms, and the need for message dissemination via peers. Survey results indicated that Facebook (ranked 6.5 out of 8) was the highest rated social media outlet overall, and exhibited greatest appeal and most frequent visits, yet analytics revealed that only 3.5% of “likes” were from the target audience. These results indicate that the social media campaign is reaching predominantly women (76.5% of viewership) who are outside of the target age range of 11-14 years. Conclusions: While the social media campaign was successfully launched, the findings indicate the need for a more focused selection of communication channels, timing of media updates to maximize visibility, balancing message tone and delivery, and incorporating differentiated messaging for the target audiences. Collaboration with parents and community partners is also emphasized in order to expand the campaign’s reach and create more channels to disseminate relationship promotion and dating violence prevention messaging to the intended audience. %M 25405494 %R 10.2196/resprot.3546 %U http://www.researchprotocols.org/2014/4/e64/ %U https://doi.org/10.2196/resprot.3546 %U http://www.ncbi.nlm.nih.gov/pubmed/25405494