Policy makers and intervention strategists are increasingly aware that the Internet provides opportunities to meet young people “where they are at.” For example, young gay, bisexual and other men who have sex with men (gbMSM) represent a population that might benefit from online interventions that address sexually transmitted and blood borne infections, including HIV (STBBI). This is especially relevant given that young gbMSM experience disproportionately high rates of STBBI and are often considered a ‘hidden’ or ‘hard-to-reach’ population.
It is not currently known, however, whether or not online interventions to address STBBI represent an effective strategy. To better understand the state of knowledge in this area, we conducted a systematic review to identify studies that have assessed the effectiveness of online interventions addressing STBBI among young gbMSM.
Systematic review outcomes
Our review identified 17 studies; all but one of the studies reported significant effects on sexual risk behaviour change (e.g., fewer reported experiences of condomless sex) and/or knowledge outcomes.
We found that 16 studies focused on ‘proof-of-concept’ or ‘one-off’ interventions. These interventions were piloted for the purpose of studying with no intention of disseminating or scaling up in real-world conditions.
Our review also found that, while online interventions show promise at addressing STBBI among young gbMSM, little emphasis has been placed on assessing how these interventions can have different outcomes for different groups of young gbMSM. This type of outcome data is critical to our understandings of whether or not online interventions drive inequity. For example, while most of the studies included one or more measures to describe the sample composition (e.g. by socioeconomic status, sexual identity, HIV status), few reported on the differential intervention effects by socio-economic status, sexual or gender identity, ethno-racial characteristics or HIV status.
Implications for practice
Our review found that online interventions show promise in addressing STBBI among young gbMSM, including via changes in both sexual risk behaviour and knowledge outcomes. Moving the science forward in this area will benefit from research that is able to identify the distinctive experiences of particular subgroups of young gbMSM (e.g., those who live in rural versus urban communities).
We also suggest that future intervention research should prioritize the assessments of various ‘live’ interventions, including those that are currently being experienced by enormous numbers of young gbMSM in the ‘real world’ (rather than focusing on ‘proof-of-concept’ trials), as well as online sexual health programs that provide a service to the public (e.g., GetCheckedOnline.com). For example, Grindr recently provided users with the option to disclose their serostatus, viral load (e.g. ‘undetectable’) and/or use of PrEP on users’ profile pages. Identifying the effects that these kinds of ‘real-world’ interventions may have on the social and sexual health outcomes of young gbMSM is a critical ‘next-step’ for intervention research in this area.
For further information
The full systematic review is an open access publication and is freely available at: http://onlinelibrary.wiley.com/doi/10.1002/jia2.25017/abstract
This study was funded by the Canadian Institutes of Health Research.