Social Media Engagement and HIV Testing Among Men Who Have Sex With Men in China: A Nationwide Cross-Sectional Survey

Background Many interventions find that social media engagement with health promotion materials can translate into behavioral changes. However, only a few studies have examined the ways in which specific actions on various social media platforms are correlated with health behaviors. Objective The objective of this study was to examine the association between social media use and HIV testing behaviors among Chinese men who have sex with men (MSM). Methods In July 2016, a Web-based survey was conducted to recruit MSM in 8 Chinese cities through Blued (Blue City Holdings Ltd.), the world’s largest gay mobile phone app. Data on sociodemographic variables, social media use platforms and behaviors, sexual behaviors, and HIV testing histories were collected. HIV testing–related social media use was defined as having ever engaged with HIV testing content on social media, which was further divided into observing (ie, receiving), endorsing (eg, liking and sharing), and contributing (eg, posting or commenting on HIV testing materials). Confirmatory factor analysis (CFA) was conducted to determine the best division of HIV testing–related social media use. Univariate and multivariable logistic regressions were used to examine the association between HIV testing–related social media use and HIV testing behaviors. Results A total of 2105 individuals participated in the survey. Among them, 46.75% (984) were under the age of 24 years, 35.43% (746) had high school education or less, and 47.74% (587) had condomless sex in the last 3 months. More than half of the respondents (58.14%, 1224/2105) reported HIV testing–related social media use. Additionally, HIV testing–related social media use, especially on multifunctional platforms such as WeChat, was found to be associated with recent HIV testing (adjusted odds ratio [aOR] 2.32, 95% CI 1.66-3.24). Contributing on social media was correlated with recent HIV testing (aOR 2.10, 95% CI 1.40-3.16), but neither observing (aOR 0.66, 95% CI 0.38-1.15) nor endorsing (aOR 1.29, 95% CI 0.88-1.90) were correlated. Conclusions Our data suggest that social media use, particularly on multifunctional platforms such as WeChat and with contributing behaviors, is correlated with HIV testing among MSM in China. Campaigns that promote active participant contribution on social media beyond passive observation and endorsement of promotional materials are needed. This study has implications for the design and implementation of social media interventions to promote HIV testing.

[1]  J. D. de Wit,et al.  Estimating Levels of HIV Testing, HIV Prevention Coverage, HIV Knowledge, and Condom Use Among Men Who Have Sex With Men (MSM) in Low-Income and Middle-Income Countries , 2009, Journal of acquired immune deficiency syndromes.

[2]  Zunyou Wu,et al.  Internet-Facilitated, Voluntary Counseling and Testing (VCT) Clinic-Based HIV Testing among Men Who Have Sex with Men in China , 2013, PloS one.

[3]  James B. Weaver,et al.  Social Media Engagement and Public Health Communication: Implications for Public Health Organizations Being Truly “Social” , 2013, Public Health Reviews.

[4]  Cat Jones.  Slacktivism and the social benefits of social video: Sharing a video to 'help' a cause , 2015, First Monday.

[5]  K. DeWalt,et al.  Participant Observation: A Guide for Fieldworkers , 2001 .

[6]  Weiming Tang,et al.  Creative Contributory Contests to Spur Innovation in Sexual Health: 2 Cases and a Guide for Implementation. , 2015, Sexually transmitted diseases.

[7]  Brandon Van Der Heide,et al.  Social Media as Information Source: Recency of Updates and Credibility of Information , 2014, J. Comput. Mediat. Commun..

[8]  S. Chapman,et al.  Tobacco control advocacy in the age of social media: using Facebook, Twitter and Change , 2012, Tobacco Control.

[9]  J. Tucker,et al.  Providing HIV-related services in China for men who have sex with men , 2016, Bulletin of the World Health Organization.

[10]  Yumi Jung,et al.  Engagement across three social media platforms: An exploratory study of a cause-related PR campaign , 2013 .

[11]  S. Rhodes,et al.  Acceptability and Feasibility of Using Established Geosocial and Sexual Networking Mobile Applications to Promote HIV and STD Testing Among Men Who Have Sex with Men , 2015, AIDS and Behavior.

[12]  C. Vandelanotte,et al.  Are Health Behavior Change Interventions That Use Online Social Networks Effective? A Systematic Review , 2014, Journal of medical Internet research.

[13]  J. Mandel,et al.  Lack of HIV testing and awareness of HIV infection among men who have sex with men, Beijing, China. , 2006, AIDS education and prevention : official publication of the International Society for AIDS Education.

[14]  M. Emch,et al.  HIV Self-Testing Among Online MSM in China: Implications for Expanding HIV Testing Among Key Populations , 2014, Journal of acquired immune deficiency syndromes.

[15]  Sean D. Young,et al.  The Relationship between Online Social Networking and Sexual Risk Behaviors among Men Who Have Sex with Men (MSM) , 2013, PloS one.

[16]  Wenjing Xie,et al.  Social network site use, mobile personal talk and social capital among teenagers , 2014, Comput. Hum. Behav..

[17]  Gunther Eysenbach,et al.  Improving the Quality of Web Surveys: The Checklist for Reporting Results of Internet E-Surveys (CHERRIES) , 2004, Journal of medical Internet research.

[18]  Annie Y. S. Lau,et al.  The influence of social networking sites on health behavior change: a systematic review and meta-analysis , 2015, J. Am. Medical Informatics Assoc..

[19]  Shawn M. Bergman,et al.  Twitter versus Facebook: Exploring the role of narcissism in the motives and usage of different social media platforms , 2014, Comput. Hum. Behav..

[20]  Jane D. Brown,et al.  A social media-based physical activity intervention: a randomized controlled trial. , 2012, American journal of preventive medicine.

[21]  Liang Chen,et al.  Social support exchanges in a social media community for people living with HIV/AIDS in China , 2015, AIDS care.

[22]  T. McCoy,et al.  Using Social Media to Increase HIV Testing Among Gay and Bisexual Men, Other Men Who Have Sex With Men, and Transgender Persons: Outcomes From a Randomized Community Trial. , 2016, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[23]  S. Rhodes,et al.  weCARE: A Social Media-Based Intervention Designed to Increase HIV Care Linkage, Retention, and Health Outcomes for Racially and Ethnically Diverse Young MSM. , 2016, AIDS education and prevention : official publication of the International Society for AIDS Education.

[24]  Joseph D. Tucker,et al.  Gay Apps for Seeking Sex Partners in China: Implications for MSM Sexual Health , 2015, AIDS and Behavior.

[25]  Hye-Jin Paek,et al.  Examination of Media Channels and Types as Health Information Sources for Adolescents: Comparisons for Black/White, Male/Female, Urban/Rural , 2010 .

[26]  Annice E Kim,et al.  The Use of Social Media by State Tobacco Control Programs to Promote Smoking Cessation: A Cross-Sectional Study , 2014, Journal of medical Internet research.

[27]  J. Ananworanich,et al.  Innovative strategies using communications technologies to engage gay men and other men who have sex with men into early HIV testing and treatment in Thailand , 2015, Journal of virus eradication.

[28]  M. Lim,et al.  Predictors of “Liking” Three Types of Health and Fitness-Related Content on Social Media: A Cross-Sectional Study , 2015, Journal of medical Internet research.

[29]  S. McCormack,et al.  Identifying undiagnosed HIV in men who have sex with men (MSM) by offering HIV home sampling via online gay social media: a service evaluation , 2016, Sexually Transmitted Infections.

[30]  Steve Goodman,et al.  Social media engagement behaviour: a uses and gratifications perspective , 2016 .

[31]  H. Korda,et al.  Harnessing Social Media for Health Promotion and Behavior Change , 2013, Health promotion practice.

[32]  C. Hawn.  Take two aspirin and tweet me in the morning: how Twitter, Facebook, and other social media are reshaping health care. , 2009, Health affairs.

[33]  Bolin Cao,et al.  Faster and Riskier? Online Context of Sex Seeking Among Men Who Have Sex With Men in China , 2017, Sexually transmitted diseases.

[34]  A. Nardone,et al.  Low HIV testing uptake following diagnosis of a sexually transmitted infection in Spain: implications for the implementation of efficient strategies to reduce the undiagnosed HIV epidemic , 2016, AIDS care.

[35]  Tamara Taggart,et al.  Social Media and HIV: A Systematic Review of Uses of Social Media in HIV Communication , 2015, Journal of medical Internet research.

[36]  J. Barnett,et al.  Interactive communication with the public: qualitative exploration of the use of social media by food and health organizations. , 2015, Journal of nutrition education and behavior.

[37]  Brandon Miller,et al.  "They're the modern-day gay bar": Exploring the uses and gratifications of social networks for men who have sex with men , 2015, Comput. Hum. Behav..

[38]  Chao-Hsien Hsieh,et al.  Effects of Internet Popular Opinion Leaders (iPOL) Among Internet-Using Men Who Have Sex With Men , 2013, Journal of medical Internet research.

[39]  J. Klausner,et al.  Using Grindr, a Smartphone Social-Networking Application, to Increase HIV Self-Testing Among Black and Latino Men Who Have Sex With Men in Los Angeles, 2014. , 2016, AIDS education and prevention : official publication of the International Society for AIDS Education.

[40]  Weiming Tang,et al.  Social Media Interventions to Promote HIV Testing. , 2016, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[41]  L. Struik,et al.  The Role of Facebook in Crush the Crave, a Mobile- and Social Media-Based Smoking Cessation Intervention: Qualitative Framework Analysis of Posts , 2014, Journal of medical Internet research.

[42]  Gerald C. Kane,et al.  What's Different about Social Media Networks? A Framework and Research Agenda , 2014, MIS Q..

[43]  Jeffrey D Fisher,et al.  Information-motivation-behavioral skills model-based HIV risk behavior change intervention for inner-city high school youth. , 2002, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[44]  W. Chou,et al.  Social Media Use in the United States: Implications for Health Communication , 2009, Journal of medical Internet research.

[45]  Cara Wallis,et al.  New Media Practices in China: Youth Patterns, Processes, and Politics , 2011 .

[46]  Lixuan Zhang,et al.  Motivations and Usage Patterns of Weibo , 2012, Cyberpsychology Behav. Soc. Netw..

[47]  J. Parsons,et al.  Feasibility, Acceptability, and Preliminary Efficacy of a Live-Chat Social Media Intervention to Reduce HIV Risk Among Young Men Who Have Sex With Men , 2015, AIDS and Behavior.

[48]  Rosanna Peeling,et al.  Crowdsourcing HIV Test Promotion Videos: A Noninferiority Randomized Controlled Trial in China. , 2016, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[49]  T. Coates,et al.  Project HOPE: online social network changes in an HIV prevention randomized controlled trial for African American and Latino men who have sex with men. , 2014, American journal of public health.

[50]  Vineet Chopra,et al.  The Role of Social Media in Online Weight Management: Systematic Review , 2013, Journal of medical Internet research.

[51]  Cognitive Load Implications of Social Media in Teaching and Learning , 2015 .

[52]  R. Wolitski,et al.  HIV testing among men who have sex with men--21 cities, United States, 2008. , 2011, MMWR. Morbidity and mortality weekly report.

[53]  J. Tucker,et al.  Social media interventions to prevent HIV: A review of interventions and methodological considerations. , 2016, Current opinion in psychology.

[54]  Tashuna Albritton,et al.  Exploring Social Networking Technologies as Tools for HIV Prevention for Men Who Have Sex With Men. , 2015, AIDS education and prevention : official publication of the International Society for AIDS Education.