A Mixed-Methods Study on the Acceptability of Using eHealth for HIV Prevention and Sexual Health Care Among Men Who Have Sex With Men in China

Background Human immunodeficiency virus (HIV) infection disproportionately affects men who have sex with men (MSM). Over half of all HIV-positive MSM in China may not know their HIV status. Mobile phones and Web interventions (eHealth) are underutilized resources that show promise for supporting HIV education, testing, and linkage to care. Objective This mixed-methods study among MSM in China assessed technology utilization and eHealth acceptability for sexual health care. Methods We conducted in-depth interviews and an online survey. Qualitative analyses informed the development of the Internet survey, which was administered through two popular MSM websites. Bivariate and multivariate analysis assessed characteristics of MSM interested in eHealth for sexual health care. Results The qualitative sample included MSM across a range of ages, education, marital status, sexuality, and HIV testing experience. Qualitative findings included the importance of the Internet as the primary source of information about sexual health, HIV and other sexually transmitted diseases (STDs), use of the Internet to enable HIV testing opportunities by facilitating connections with both the gay community and health care providers, and mixed perceptions regarding the confidentiality of eHealth tools for sexual health. Among the Internet sample (N=1342), the average age was 30.6 years old, 82.81% (1098/1342) were single, and 53.42% (711/1331) had completed college. In the past 3 months, 38.66% (382/988) had condomless sex and 60.53% (805/1330) self-reported having ever tested for HIV. The majority of men owned computers (94.14%, 1220/1296) and mobile phones (92.32%, 1239/1342), which many had used to search for HIV/STD information and testing sites. In multivariate analysis, interest in using computers or mobile phones to support their sexual health care was associated with being a student, prior use of computers or mobile phones to search for general health information, prior use of computers or mobile phones to search for HIV/STD information, and confidentiality concerns. Conclusions MSM in this sample had high utilization of technology and interest in eHealth despite confidentiality concerns. Future eHealth interventions can thoughtfully and creatively address these concerns as a priority for successful implementation.

[1]  L. Peyrin-Biroulet,et al.  Syphilis and Social Upheaval in China , 2010 .

[2]  J. Haar,et al.  Can text messaging results reduce time to treatment of Chlamydia trachomatis? , 2008, Sexually Transmitted Infections.

[3]  W. Mcfarland,et al.  Untested and undiagnosed: barriers to HIV testing among men who have sex with men, Beijing, China , 2011, Sexually Transmitted Infections.

[4]  Mary Jane Rotheram-Borus,et al.  Innovation in sexually transmitted disease and HIV prevention: internet and mobile phone delivery vehicles for global diffusion. , 2010, Current opinion in psychiatry.

[5]  N. Zhang,et al.  Sexual Infidelity in China: Prevalence and Gender-Specific Correlates , 2012, Archives of sexual behavior.

[6]  G. Rutherford,et al.  Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection. , 2012, The Cochrane database of systematic reviews.

[7]  I. Shah,et al.  Can the Internet be used effectively to provide sex education to young people in China? , 2006, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[8]  Dan Myung,et al.  Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy. , 2011, AIDS patient care and STDs.

[9]  Ray Y. Chen,et al.  Engaging HIV-infected patients in antiretroviral therapy services: CD4 cell count testing after HIV diagnosis from 2005 to 2009 in Yunnan and Guangxi, China. , 2011, Chinese medical journal.

[10]  S. Vermund,et al.  Effectiveness of HIV Risk Reduction Interventions among Men who have Sex with Men in China: A Systematic Review and Meta-Analysis , 2013, PloS one.

[11]  Khatry-Chhetry Mukund Bahadur,et al.  Cell phone short messaging service (SMS) for HIV/AIDS in South Africa: a literature review. , 2010, Studies in health technology and informatics.

[12]  C. Beyrer,et al.  HIV among men who have sex with men in Malawi: elucidating HIV prevalence and correlates of infection to inform HIV prevention , 2013, Journal of the International AIDS Society.

[13]  H. Fisher Raymond,et al.  Possible Increase in HIV and Syphilis Prevalence Among Men Who Have Sex with Men in Guangzhou, China: Results from a Respondent-Driven Sampling Survey , 2011, AIDS and Behavior.

[14]  Huldrych F. Günthard,et al.  Antiretroviral treatment of adult HIV infection: 2012 recommendations of the International Antiviral Society-USA panel. , 2012, JAMA.

[15]  B. Yip,et al.  Discordant Immunologic and Virologic Responses to Highly Active Antiretroviral Therapy Are Associated With Increased Mortality and Poor Adherence to Therapy , 2005, Journal of acquired immune deficiency syndromes.

[16]  W. Jack,et al.  Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial , 2010, The Lancet.

[17]  C. Boyer,et al.  Development and Pretesting Multimedia HIV‐Prevention Text Messages for Mobile Cell Phone Delivery , 2011, The Journal of the Association of Nurses in AIDS Care : JANAC.

[18]  Heimar F. Marin,et al.  Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages , 2012, Int. J. Medical Informatics.

[19]  Cristian Pop-Eleches,et al.  Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders , 2011, AIDS.

[20]  R. Peeling,et al.  The epidemic of sexually transmitted infections in China: implications for control and future perspectives , 2011, BMC medicine.

[21]  H. Rees,et al.  Addressing the Achilles' heel in the HIV care continuum for the success of a test-and-treat strategy to achieve an AIDS-free generation. , 2014, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[22]  H. Xing,et al.  Online Sex-Seeking Behaviors Among Men Who have Sex with Men: Implications for Investigation and Intervention , 2012, AIDS and Behavior.

[23]  T. Quinn,et al.  Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group. , 2000, The New England journal of medicine.

[24]  Michele L. Ybarra,et al.  Current trends in internet-and cell phone-based HIV prevention and intervention programs , 2007, Current HIV/AIDS reports.

[25]  Lavinia Lin,et al.  Feasibility and willingness of using e-technologies for HIV prevention and research targeting Chinese MSM , 2013, AIDS care.

[26]  Yan Song,et al.  A comparison of four sampling methods among men having sex with men in China: implications for HIV/STD surveillance and prevention , 2011, AIDS care.

[27]  M. Lim,et al.  SMS STI: A Review of the Uses of Mobile Phone Text Messaging in Sexual Health , 2008, International journal of STD & AIDS.

[28]  Myron S. Cohen,et al.  Syphilis in China: results of a national surveillance programme , 2007, The Lancet.

[29]  S. Bull,et al.  A pilot programme using mobile phones for HIV prevention , 2011, Journal of telemedicine and telecare.

[30]  Zunyou Wu,et al.  HIV and syphilis prevalence among men who have sex with men: a cross-sectional survey of 61 cities in China. , 2013, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[31]  William L. Parish,et al.  Clients of female sex workers: a population-based survey of China. , 2011, The Journal of infectious diseases.

[32]  N. Dickson,et al.  Actual and undiagnosed HIV prevalence in a community sample of men who have sex with men in Auckland, New Zealand , 2012, BMC Public Health.

[33]  N. He,et al.  Social Network and Other Correlates of HIV Testing: Findings from Male Sex Workers and Other MSM in Shanghai, China , 2012, AIDS and Behavior.

[34]  Sheana Bull,et al.  A Systematic Review of Recent Smartphone, Internet and Web 2.0 Interventions to Address the HIV Continuum of Care , 2015, Current HIV/AIDS Reports.

[35]  Robert Garofalo,et al.  Improving Adherence to Antiretroviral Therapy for Youth Living with HIV/AIDS: A Pilot Study Using Personalized, Interactive, Daily Text Message Reminders , 2012, Journal of medical Internet research.

[36]  K. Wong,et al.  Use of the Internet for sex partnership in men who have sex with men before HIV infection. , 2011, Public health.

[37]  Emily C. Pike,et al.  Mobile Phone Applications for the Care and Prevention of HIV and Other Sexually Transmitted Diseases: A Review , 2013, Journal of medical Internet research.

[38]  S. Mills,et al.  Two internet-based approaches to promoting HIV counselling and testing for MSM in China , 2014 .

[39]  Jie Zhang,et al.  Differences between Internet and community samples of MSM: implications for behavioral surveillance among MSM in China , 2008, AIDS care.

[40]  Emily C. Pike,et al.  HealthMpowerment.org: Feasibility and acceptability of delivering an Internet intervention to young Black men who have sex with men , 2012, AIDS care.

[41]  J. Castilla,et al.  Combined antiretroviral treatment and heterosexual transmission of HIV-1: cross sectional and prospective cohort study , 2010, BMJ : British Medical Journal.

[42]  B. Branson,et al.  Prevalence of undiagnosed HIV infection among persons aged ≥13 years--National HIV Surveillance System, United States, 2005-2008. , 2012, MMWR supplements.

[43]  Sheana S Bull,et al.  Putting prevention in their pockets: developing mobile phone-based HIV interventions for black men who have sex with men. , 2013, AIDS patient care and STDs.

[44]  Roger Detels,et al.  Evaluation of a web-based intervention for improving HIV/AIDS knowledge in rural Yunnan, China , 2007, AIDS.

[45]  J. Hiller,et al.  Internet use and risk behaviours: an online survey of visitors to three gay websites in China , 2007, Sexually Transmitted Infections.

[46]  Zunyou Wu,et al.  Sexual Risk Behaviors and HIV Infection Among Men Who Have Sex With Men Who Use the Internet in Beijing and Urumqi, China , 2010, Journal of acquired immune deficiency syndromes.

[47]  H. Zou,et al.  HIV Testing Among Men Who Have Sex with Men in China: A Systematic Review and Meta-Analysis , 2012, AIDS and Behavior.

[48]  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.

[49]  Deborah Estrin,et al.  Identifying preferences for mobile health applications for self-monitoring and self-management: Focus group findings from HIV-positive persons and young mothers , 2013, Int. J. Medical Informatics.

[50]  Sociodemographic and sexual behavior characteristics of an online MSM sample in Guangdong, China , 2014, AIDS care.

[51]  Michael G Cato,et al.  Following the Trail of an HIV‐Prevention Web Site Enhanced for Mobile Cell Phone Text Messaging Delivery , 2012, The Journal of the Association of Nurses in AIDS Care : JANAC.

[52]  Michael Rayment,et al.  Prevention of HIV-1 infection with early antiretroviral therapy , 2012, Journal of Family Planning and Reproductive Health Care.

[53]  Xiao-rong Wang,et al.  A Comparison of HIV Infection and Related Risk Factors Between Money Boys and Noncommercial Men Who Have Sex With Men in Shenzhen, China , 2012, Sexually transmitted diseases.

[54]  K. Muessig,et al.  Antiviral agents and HIV prevention: controversies, conflicts, and consensus. , 2012, AIDS.

[55]  J. Lau,et al.  Comparison of risk behaviors and socio-cultural profile of men who have sex with men survey respondents recruited via venues and the internet , 2010, BMC public health.

[56]  Matthias Egger,et al.  Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis , 2009, AIDS.

[57]  J. Lau,et al.  A randomized controlled study to evaluate the efficacy of an Internet-based intervention in reducing HIV risk behaviors among men who have sex with men in Hong Kong , 2008, AIDS care.