J. Michael Wilkerson

The Future of Internet-Based HIV Prevention: A Report on Key Findings from the Men’s INTernet (MINTS-I, II) Sex Studies

The Internet and other new media have changed how men who have sex with men (MSM) find and interact with sexual partners. This social phenomenon, paired with growing evidence that use of the Internet increases MSM’s risk for HIV infection, makes it crucial that innovative technology-based HIV prevention interventions are developed for this population. In this commentary we explain why technology-based HIV prevention interventions are urgently needed; we then highlight findings from some of the first Internet-based HIV prevention for MSM studies that show the potential for future interventions; we next discuss ways for interventionists to conceptualize new media as a tool for HIV prevention; and finally we discuss emerging trends for technology-based HIV-prevention research.

Recommendations for Internet-Based Qualitative Health Research With Hard-to-Reach Populations

Researchers new to online qualitative health research frequently have questions about how to transfer knowledge of offline data collection to an online environment. In this article, we present best-practice guidelines derived from the literature and our experience to help researchers determine if an online qualitative study design is appropriate for their research project and, if so, when to begin data collection with a hard-to-reach population. Researchers should reflect on administrative, population, and data collection considerations when deciding between online and offline data collection. Decisions must be made regarding whether to conduct interviews or focus groups, to collect data using asynchronous or synchronous methods, and to use only text or to incorporate visual media. Researchers should also reflect on human subjects, recruitment, research instrumentation, additional data collection, and public relations considerations when writing protocols to guide the research team’s response to various situations. Our recommendations direct researchers’ reflection on these considerations.

A Commentary on the Role of Sexually Explicit Media (SEM) in the Transmission and Prevention of HIV among Men who have Sex with Men (MSM)

Although research has been conducted over the last half century to test the hypothesis that pornography, or sexually explicit media (SEM), influences behavior, information regarding usage and its effect on men who have sex with men (MSM) is limited. It is important for researchers studying online risk factors for HIV to consider the relationship between SEM consumption and risky sexual behavior, particularly given the exponential increase in SEM exposure as a result of the near-compulsory use of the Internet. In this commentary, we review findings regarding this relationship from studies of international and heterosexual populations. We then suggest future directions for research regarding MSM in the United States and practical applications of such research if the results from other populations extend to them. Research suggests there might be ways to use SEM to create innovative approaches to online HIV prevention, particularly among such at-risk populations as youth and MSM of lower socio-economic statuses.

Creating a Culturally Competent Clinical Environment for LGBT Patients

Health administrators and educators working in clinical settings are often charged with cultivating a culturally competent clinical environment for lesbian, gay, bisexual, and transgender (LGBT) patients. To better understand what constitutes such an environment, we conducted seven focus groups with health care providers and LGBT patients living in a Midwestern metropolitan area of the United States. Findings identified a culturally competent clinical environment consisting of structural components such as décor and patient flow, systemic components, such as mission statements, policies, and forms, and interpersonal components, such as a trusting provider-patient relationship. Strategies to create a more culturally competent clinical environment were identified.

Online and offline sexual health-seeking patterns of HIV-negative men who have sex with men.

To inform health information targeting, we used cross-sectional data from 2577 HIV-negative MSM to identify groups of men who access similar sources. Offline, more men reported talking to a physician about HIV than about having sex with men; fewer than half attended a safer sex workshop. Online, men sought information primarily through Internet search engines, GLBT websites, or health websites. A latent class analysis identified four groups of health seekers: minimal health seekers, those who accessed online sources only, those who sought information mostly from health professionals, and those who sought information from diverse sources. Minimal health seekers, 9% of the sample, were the group of greatest concern. They engaged in unprotected anal sex with multiple partners but infrequently testing for HIV or sought sexual health information. By encouraging health seeking from diverse sources, opportunities exist to increase men’s knowledge of HIV/STI prevention and, when necessary, access to medical care.

The SEM Risk Behavior (SRB) Model: A New Conceptual Model of how Pornography Influences the Sexual Intentions and HIV Risk Behavior of MSM

While the effects of sexually explicit media (SEM) on heterosexuals’ sexual intentions and behaviors have been studied, little is known about the consumption and possible influence of SEM among men who have sex with men (MSM). Importantly, conceptual models of how Internet-based SEM influences behavior are lacking. A total of 79 MSM participated in online focus groups about their SEM viewing preferences and sexual behavior. Of these, 23 reported recent exposure to a new behavior via SEM. Whether participants modified their sexual intentions and/or engaged in the new behavior depended on three factors: arousal when imagining the behavior, pleasure when attempting the behavior and trust between sex partners. Based on MSM’s experience, we advance a model of how viewing a new sexual behavior in SEM influences sexual intentions and behaviors. The model includes five paths: three paths result in the maintenance of sexual intentions and behaviors, one path results in a modification of sexual intentions while maintaining previous sexual behaviors and one path results in a modification of both sexual intentions and behaviors. With this model, researchers have a framework to test associations between SEM consumption and sexual intentions and behavior, and public health programs have a framework to conceptualize SEM-based HIV/STI prevention programs.

Recruitment strategies of methamphetamine-using men who have sex with men into an online survey

Abstract Recruiting hidden populations into online research remains challenging. In this manuscript, we report lessons learned from our efforts to recruit methamphetamine-using men who have sex with men. Between July and October 2012, we implemented a four-phase recruitment strategy to enroll a total of 343 methamphetamine-using MSM into an online survey about recent substance use, sexual behavior, and various psychosocial measures. The four phases were implemented sequentially. During phase one, we placed advertisements on mobile applications, and during phase two, we placed advertisements on traditional websites formatted for browsers. During phase three, we used e-mail to initiate snowball recruitment, and during phase four, we used social media for snowball recruitment. Advertisements on mobile devices and websites formatted for browsers proved to be expensive options and resulted in few eligible participants. Our attempts to initiate a snowball through e-mail also proved unsuccessful. The majority (n = 320) of observations in our final dataset came from our use of social media. However, participant fraud was a concern, requiring us to implement a strong participant verification protocol. For maximum recruitment and cost-effectiveness, researchers should use social media for recruitment provided they employ strong participant verification protocols.

Sociosexual Identity Development and Sexual Risk Taking of Acculturating Collegiate Gay and Bisexual Men.

How collegiate gay and bisexual men acquire a sociosexual identity appears to affect their sexual health. Analysis of interview data from 25 self-identified collegiate gay or bisexual men resulted in the development of a collective sexual script for men acquiring a sociosexual identity. Changes in an individual’s acting out of a cultural scenario seemed to occur when resolving intrapsychic conflict arising from new sexual experiences. Persons working with young collegiate gay and bisexual men may find this sexual script helpful when developing sex education programs.

Performance of the Duke Religion Index and the spiritual well-being scale in online samples of men who have sex with men.

Religiosity is associated with behaviors that reduce the risk of HIV/STI infection among general-population and heterosexual-specific samples. Whether this association is similar to homosexual persons is unknown. Measures of religiosity have not been evaluated psychometrically among men who have sex with men (MSM), a population who, because of stigma, experience religiosity differently than heterosexual persons. We assessed the duke religion index and the spiritual well-being in two samples of MSM. Neither instrument produced adequate model fit. To study the association between religiosity and HIV/STI risk behaviors among MSM, scales are needed that measure the religious and spiritual experiences of MSM.

Correlates of Human Immunodeficiency Virus/Sexually Transmitted Infection (HIV/STI) Testing and Disclosure among HIV-Negative Collegiate Men Who Have Sex with Men.

Abstract Objective: To determine the extent to which personal, behavioral, and environmental factors are associated with human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing and disclosure. Participants: Nine hundred thirty HIV-negative collegiate men who have sex with men (MSM) who completed an online survey about alcohol use and sexual behavior. Methods: Correlates of testing and disclosure significant in bivariate analyses (p < .05) were grouped into personal, behavioral, or environmental factors and entered into multivariable logistic regression models. Results: About half of participants tested for HIV (51.9%) and for STIs (45.8%) at least annually. Over half (57.8%) of participants always/almost always discussed HIV status with new sex partners; 61.1% with new unprotected sex partners. Personal and behavioral factors (age and outness) explained differences in testing, and the behavioral factor (routine testing) explained differences in disclosure. Conclusions: Collegiate MSM should be supported in coming out, encouraged to engage in routine testing, and counseled on discussing HIV/STI status with potential sex partners.