Project HOPE: Online Social Network Changes in an HIV Prevention Randomized Controlled Trial for African American and Latino Men Who Have Sex With Men

摘要

Objectives. We examined whether and how an HIV prevention diffusion-based intervention spread throughout participants’ online social networks and whether changes in social network ties were associated with increased HIV prevention and testing behaviors. Methods. We randomly assigned 112 primarily racial/ethnic minority men who have sex with men (MSM) to receive peer-delivered HIV (intervention) or general health (control) information over 12 weeks through closed Facebook groups. We recorded participants’ public Facebook friend networks at baseline (September 2010) and follow-up (February 2011), and assessed whether changes in network growth were associated with changes in health engagement and HIV testing. Results. Within-group ties increased in both conditions from baseline to follow-up. Among the intervention group, we found a significant positive relation between increased network ties and using social media to discuss sexual behaviors. We found a positive trending relationship between increased network ties and likelihood of HIV testing, follow-up for test results, and participation in online community discussions. No significant differences were seen within control groups. Conclusions. Among high-risk MSM, peer-led social media HIV prevention interventions can increase community cohesion. These changes appear to be associated with increased HIV prevention and testing behaviors. African American and Latino individuals are at high risk for contracting HIV. 1 In Los Angeles County, California, most of these cases are attributable to men who have sex with men (MSM), who currently account for more than 75% of all HIV cases. 2,3 Researchers, and MSM themselves, have suggested use of novel approaches to increase HIV prevention and testing among at-risk populations. 4,5 Peer leader interventions, based on diffusion theories, are community-based interventions that train community peers to spread HIV prevention information and change HIV prevention-related social norms. 6–9 Successful peer-led interventions have resulted in decreasing anal intercourse up to 25% and increasing condom use up to 16%, with sustained behavior change up to 3 years later. 10–12 Peer-delivered interventions have been found to be acceptable among MSM populations. 13 Social network interventions have shown that information can rapidly diffuse throughout social networks to change health behaviors, 14,15 suggesting that peer-delivered HIV interventions also might diffuse throughout social networks. Growth in social media allows these technologies to be used for peer-led HIV testing interventions, 4 and research supports that peer-led interventions delivered via social media can increase HIV testing. 16 Social networking technologies, such as Facebook, allow users to connect and communicate with other network users by sharing pictures, messages, Web site links, and other multimedia information. 17 High rates of online social networking, especially among groups disproportionately affected by HIV (e.g., MSM), 18 make it important to evaluate whether and how interventions might diffuse throughout online social networks. Although social media can be used to increase HIV prevention, 16,19,20a and health behaviors of (offline) social ties influence our own health behaviors 20b , no known research has studied changes in social network ties during the course of an online social media community HIV intervention or whether and how HIV prevention information and behaviors might spread among group participants in a social media–based HIV testing intervention that is designed for network diffusion. The Harnessing Online Peer Education (HOPE) intervention was a 12-week randomized controlled HIV prevention intervention designed to use peer-led Facebook groups to diffuse HIV information to increase testing among African American and Latino MSM. The study found that participants in the HIV intervention groups were more likely to request an HIV test than were those in the control groups, 16 but whether changes in social network ties (i.e., participants within each group becoming Facebook friends with one another) played a role in these effects among intervention group participants is unknown. The current study used data from the HOPE study and was designed to evaluate the association between changes in online social network structure and HIV prevention and testing among HOPE network participants. Specifically, we have (1) described the change from baseline to follow-up in network ties among HOPE participants as a result of the intervention, (2) presented network visualizations to illustrate changes in network connections among intervention and control group participants, and (3) determined whether changes in social network ties from baseline to follow-up were associated with online community engagement, discussions about HIV prevention, and rates of HIV testing.