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Internet based HIV Prevention for rural MSM: Issues & Preliminary Efficacy Anne Bowen, PhD U. Wyoming.

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Presentation on theme: "Internet based HIV Prevention for rural MSM: Issues & Preliminary Efficacy Anne Bowen, PhD U. Wyoming."— Presentation transcript:


2 Internet based HIV Prevention for rural MSM: Issues & Preliminary Efficacy Anne Bowen, PhD U. Wyoming


4  Rural Culture  Few HIV Prevention Programs  MSM (including IDU)

5  Affordable  Anonymous  Accessible

6  5 year NIH/NIMH Funded Grant  GOAL: Develop and Implement an INTERNET based HIV prevention for Rural MSM  Years 1 & 2: Assessment Study Qualitative and Quantitative Assessment of rural MSM risk  Years 3-5: PROJECT HOPE Develop and Pilot an Internet delivered HIV Prevention

7  Recruiting  Screening  “Frauds” or multiple submitters  Participant Retention  Interventions  Intervention Outcomes


9 Individual Face to Face Internet Chat Rooms  Public and Private Mass Recruiting (Ads) Magazines, Newspapers Internet Ads (big boxes, banners)

10  Types of sites Monthly Fees “Pay for Play” – free profiles, messages cost  Specialty sites, “When Monogamy becomes Monotony”  Streams within sites Dating Relationship X-rated intimate encounters

11  Expensive ($10,000/month)  Many exposures and “clicks”, lower follow-through  Banner Messages Generic or Message framing Ethnicity Money

12  GOAL: Increase minority recruitment  Variables Ethnic specific – pictures and messages Message Framing  Gain & “Safe”  Sun screen, bicycle helmets  Loss Message & “Risk”  Mammograms, HIV Interventions

13 Wyoming Rural AIDS Prevention Projects © , All rights reserved


15 WRAPP HOPE N % Caucasian Hispanic013 African Am.21.0 Native Am.06 Asian or API1.48

16 Finding Qualified Participants

17  Passive Consent  Distraction questions  Non-Qualified Age Sexual identity or behavior  Qualified Rural vs. Urban Pay/no pay

18  Multiple bulleted pages  “Tell me more”  Terms of Participation Page  Accept Username Password  Valid  Other contact information (voluntary)





23 “Frauds”

24  Automatic: IP, machine information  User supplied Required:  Valid  Username, password Optional:  Name, phone, second  Friend’s name, friend phone, friend’s


26  Check Computer generated matches  If yes – Explore Route to Urban (No pay) lock if seems to be a duplicate  If no or not duplicate Activate

27 YesYes YesYes YesYes YesYes YesYes YesYes YesYes


29 N=431% Identical IP Address66 Password54 Phone Username11 Last Name5


31 Label # Tries N%IDInfrequent IP, PW, UN, , Phone Persistent Repeater IP, PW, Phone Hackers IP, reverse phone

32 Reimbursement History Q1 % Yes Q2 Q3 Q4 Infrequent Persistent Repeater Hackers


34  Previous studies say “it’s a must”  WRAPP: Urban vs. Rural  How do we do it? Cash  Mail cash/check  PayPal Gift certificates  Companies  Permissions  Large or small quantities

35  Amounts Money vs. other? Money “required” More money, more “fraud”  Different ways to pay Same amount Increasing amounts

36  Method Phone, letters  Messages Simple Enhanced Bonuses

37 reminder None 1 st 2 nd 3 rd Complete Number Completed 334/57778/24399/16530/66 % Complete 58%32%60%46%94% First Intervention & Q2, only


39 Information Motivation Behavioral Skills HIV Prevention BEHAVIOR Fisher & Fisher

40  Knowledge (Information) Living with HIV HIV Prevention  Life Goals and Sexual Partners (Motivation) New Partners Casual Partners  Contexts of Risk (Behavior) Bar Internet

41 Wyoming Rural AIDS Prevention Projects © , All rights reserved




45  Completers vs. Drop-outs No Differences:  Age, Sexual Orientation, Ethnicity, Religion  Education, Student or Work status, Income  Completers: # Sex partners last 30d (Zero, One, > 2) One significant difference  More of the non-students were monogamous

46  HIV Knowledge  Self-efficacy Mechanical Emotional Refusal  Outcome Expectancies Negative Fell Safer  Willingness to engage in safer sex practices  Behavior (Q1 & Q4 only) # sex partners Frequency of anal sex Frequency of condom use

47  One Intervention Knowledge Intervention:  Knowledge, SE- mech All Interventions:  OE-safe, SE-emot., & SE-refusal  Three Interventions INTERVENTION ORDER didn’t matter ALL outcome variables changed significantly


49 Number of sex partners at Q1 Main Effect of time Paired Comparisons Zero p< p<.001 >=2 p<.001Eta 2 Knowledge Outcome Expectancy Safe Negative Self-efficacy Mech Emot Refusal

50 # Sex partners at Q1 ME Time Paired ComparisonsZero1>=2Eta 2 Limit sex partners to one per month Condoms with new partners, always Oral sex until monog. and text neg Condom until monog. and test neg

51 Number of sex partners at Q1 Zero1>=2 Number Sex Partners Frequency of anal sex Na Condom use for anal sex Na


53 Subset of Interv. completers, Sent requesting F-U Pre-Intervention Questionnaire (N=211) Q5 -1 mo N=55 Post-Intervention Questionnaire (N=211) Q5 -9 mo N=14 Complete interventions

54  Non-Random Sample  ed Q4 completers, asked of do a follow-up  Q5 Follow-up - voluntary 55 at 1 month 14 at 9 months

55 Q4 Only (n = 211) % Q5 (n = 69) % Age Sexual Identity Gay Bisexual **97 3 Ethnicity (Caucasian)7375 Single7371 Residency (<20,000)5648 Employment5159 Full Time Student29*36

56 Pre-test, Post-test, Follow-up

57 Outcome Variables  HIV Knowledge  Willingness to engage in safer sex practices  Self-efficacy ( Mechanical, Emotional, Refusal )  Outcome Expectancies ( Negative, Safer)  Risk Behavior # sex partners Frequency of anal sex Frequency of condom use

58 Q1 M Q4 M Q5 M Knowledge 1 mo. 9 mo <<< > Willingness 1 mo. 9 mo < NS

59 Q1 M Q4 M Q5 M Mechanical 1 mo 9 mo <<< NS Emotional 1 mo. 9 mo <<< NS Refusal 1 mo. 9 mo <<< NS

60 Q1 M Q4 M Q5 M Safety 1 mo. 9 mo << NS Negative 1 mo. 9 mo > <

61 BehaviorN Q1 M Q5 M 30d/# sex partners Anal Sex Index Condom use Index a b.52 c NS >> b.72 c a Excludes participants reporting no sex partners at baseline. b Frequency of anal sex divided by number of sex partners. If no anal sex, index = 0. c Frequency of condom use divided by frequency of anal sex. If no anal sex, index = 1.0.

62 The Good, The Bad, The Future

63  Banner Ads Effectively recruit Tailored Messages increase minority recruitment  “Fraud” accounts Numerous resubmissions Programming and verification

64  3 Interventions > 1  Sign. Improvement  Behavior Change # sexual partners decreased for those with > 2 Freq. anal sex reduced for MSM with 1 SP Condom use for anal sex increased

65 Recruiting “Fraud” Reimbursement Retention: Long-term Maintenance

66  Upgrade Audio Animation Cultural Relevance Translation  Long term follow-up  Translational Studies Clinic use Popular Opinion Leader

67 QUESTIONS? Interventions available at:

68 Project Publications Bowen, A. M., Williams, M. L., Daniel, C. M., & Clayton, S. (2008). Feasibility, acceptability, and preliminary efficacy of Internet HIV prevention research: Targeting rural MSM. J. Behavioral Medicine., Online First Bowen, A. M., Daniel, C. M., Williams, M. L., & Baird, G. L. (2008). Identifying multiple submission in Internet research: Preserving data integrity. AIDS and Behavior, Online First. Clayton, S., *Daniel, C. & Bowen, A. (2008). The Internet: The New Frontier in HIV Prevention. In (Edgar, T., Noar, S. M., & Freimuth, V. S. Eds.) Communication perspectives on HIV/AIDS for the 21 st century. New York: Lawrence Erlbaum Associates Bowen, A. M., Horvath, K., & Williams, M. L. (2007). A randomized control trial of Internet- delivered HIV prevention targeting rural MSM. Health Education Research, 22(1), pp Horvath, K. J., Bowen, A. M., & Williams, M. L. (2006). Virtual and physical venues as contexts for HIV risk among rural MSM. Health Psychology, 25(2), pp Bowen, A. M. (2005). Internet sexuality research with rural MSM: Can we recruit and retain them? Journal of Sex Research, vol. 42(4), pp Williams, M., A. Bowen, and K. Horvath (2005). The social/sexual environment of gay men residing in a rural frontier state: Implications for the development of HIV prevention programs. Journal of Rural Health, 21(1), Bowen, A. M., Williams, M. L., & Horvath, K. (2004). Using the Internet to recruit rural MSM for HIV risk assessment: Sampling issues. AIDS and Behavior, 8(3), pp

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