Webbased HIV behavioral surveillance project: Young MSM in San Francisco

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Web-based HIV behavioral surveillance project
Young MSM in San Francisco

• Greg Rebchook, Ph.D.1
• H. Fisher Raymond, MPH2
• Alberto Curotto, Ph.D. 1
• 1Center for AIDS Prevention Studies
• 2San Francisco Department of Public Health

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Presentation Overview

• Background of online research with MSM
• Our experiences with online recruitment
• Local results
• Conclusion discussion

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Research on MSM the Internet

• Internet is a popular tool for MSM to meet
  partners
• High rates of UAI w/non-primary partners
• Internet using men more likely to report UAI
  STDs?
• Great potential to enhance HIV prevention efforts
• Good resource for social support
• Research with YMSM is vital
• Available for MSM lt 21
• YMSM today grew up with the Information
  Superhighway and lead rich online lives

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Online Recruitment

• Pros
• Can access many people
• Younger people often online
• Safe
• Convenient
• 24/7 potential
• Privacy

• Cons
• Unknown identity of participants
• Duplicate participants
• Difficult to reach MSM of color
• Incentives are challenging
• Dynamic nature of venues
• Still only reaches a small percentage of Internet
  users
• Difficult to attract attention in an online
  commercial environment

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WHBS Project

• CDC sponsors behavioral surveillance to monitor
  trends in HIV-risk behaviors among at-risk
  populations
• SF Bay area is one of the National HIV Behavioral
  Surveillance communities
• Given popularity of the Internet, CDC asked
• Can online venues be productive locations to
  supplement NHBS efforts for MSM?
• Are online data comparable to offline data?
• Possible to reach MSM who dont attend physical
  venues?
• CDC funded 6 cities, including SF, to conduct
  web-based surveys of MSM

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WHBS Recruitment Methods

• Two waves of data collection
• Wave 1 March April 2006
• Wave 2 April July 2007
• Three different recruitment strategies in SF
• Live recruiters in online venues (W1)
• Direct marketing on websites popular with MSM (W1
  W2)
• Referrals from previous respondents (W2)

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Live recruiting is a nightmare!

• Very labor intensive
• Invasive
• Trying to reach people who dont want to be
  reached
• Difficult to build trust rapport
• TOS violations

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Live recruiting is a nightmare!

• Approached 2900 people
• 134 (5) Screened
• 134 (100) Eligible
• 66 (50) Enrolled
• 58 (88) Completed survey
• Goal was to recruit 250 participants

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Expense Live recruiting

• 2 staff supervision
• 362 staff hours total
• 18,118
• 312/ completed MSM interview (much higher than
  direct marketing)
• 40 recruitment events
• For comparison NHBS (F2F survey) 248 /
  completed MSM interview

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Referrals from participants

• 825 men completed a survey
• All were asked to invite their friends to the
  survey
• 32 individuals agreed to send a total of 72
  emails
• These emails generated 18 impressions, 14
  screened, 12 eligibles, 12 agreed to participate
  and 6 completed surveys.
• None of the 6 who completed surveys agreed to
  send further invitations

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Direct Marketing

• Ads ran constantly from 4/17/07 to 5/17/07
• Ads ran sporadically later in May and in June
  2007
• Over 1.2 million impressions
• Over 26,000 click throughs

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Direct Marketing
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Venues

• Manhunt (geo-targeted to CA only)
• gay.com
• Dlist (not SF)
• Black Gay Chat
• MySpace
• BigMuscle Media
• Friendster
• 365 gay
• SFGate
• Hi5
• We couldnt advertise on rentboy, facebook,
  adam4adam, men4now
• By accident on adtegity, ecrush, euniverse,
  Idle, Intermix, Maxmen, photobucket, fastclick,
  prosportsdaily, rivals, slingo, soap, tickle,
  webdate

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Diversity of models

• From what we can tell, the specific models did
  not affect click-through rates in SF
• More study is needed on this question

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Need to capture attention

• Flash used when possible, on most sites
• Rich media expanding ads used to float ad
  across screen
• Interstitial ads used so the ad between pages
  it appeared as the only content on the page ()

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Expense DM

• Expense for recruiting in Direct Marketing
• 45/completed MSM survey in Wave 1
• 12/completed MSM survey in Wave 2
• Direct Marketing ended up being much less
  expensive than live recruiting from venues

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Survey

• All participants gave informed consent prior to
  taking the survey
• Survey length
• Approximately 10-15 minutes
• Content
• Demographics
• Internet use
• HIV-related risk in past 12 months
• HIV/STD testing history
• Details about sexual activity with 5 most recent
  partners

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Age of SF WHBS participants
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Race/ethnicity of YMSM
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Sexual Orientation of YMSM
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Education of YMSM
Note not all variables add up to 100 due to
missing data
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County of Residence
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HIV Testing History of YMSM
Note not all variables add up to 100 due to
missing data
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88 of YMSM attended physical venues
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gt30 of YMSM spent gt21 hrs/wk online
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Number of sex partners

• W1 74 of YMSM had 1 or more partners (Mean6.9
  Mdn2.5) 47 met one or more partners online
• W2 76 of YMSM had 1 or more partners (Mean6.7
  Median2.5) 45 met one or more partners online
• About 50 of partners were met online

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Unprotected Anal Intercourse

• W1 40 of YMSM had 1 or more UAI partners
• UAI was associated with having more partners
• W2 48 of YMSM had 1 or more UAI partners
• UAI was associated with having more partners,
  meeting partners online, and being HIV

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Conclusion

• Over 1/3 of local YMSM reported UAI
• Continuing HIV prevention efforts needed,
  especially for
• YMSM with multiple partners
• YMSM who meet partners online
• Success of direct marketing recruitment could
  mean that banner ads could promote websites for
• HIV prevention information
• Referrals to local services
• Online HIV prevention programs

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Contact information
Henry Raymond Fisher 25 Van Ness, Suite 500 San
Francisco, CA 94102 TEL [phone] hfisher.raym
ond_at_sfdph.org