Web-Based Behavioral Intervention Utilizing Narrative Persuasion for HIV Prevention Among Chinese Men Who Have Sex With Men (HeHe Talks Project): Intervention Development

Background In the era of potent antiretroviral therapy, a high level of condomless anal intercourse continues to drive increases in HIV incidence in recent years among men who have sex with men. Effective behavior change strategies for promoting HIV-preventive behaviors are warranted. Narrative persuasion is a novel health communication approach that has demonstrated its persuasive advantages in overcoming resistance to counterattitudinal messages. The efficacy of narrative persuasion in promoting health behavior changes has been well documented, but critical research gaps exist for its application to HIV prevention. Objective In this study, we aimed to (1) capitalize on narrative persuasion to design a web-based multisession intervention for reducing condomless anal intercourse among men who have sex with men in Hong Kong (the HeHe Talks Project) by following a systematic development process; and (2) describe the main components of the narrative intervention that potentially determine its persuasiveness. Methods Persuasive themes and subtopics related to reducing condomless anal intercourse were initially proposed based on epidemiological evidence. The biographic narrative interview method was used to elicit firsthand experiential stories from a maximum variation sample of local men who have sex with men with diverse backgrounds and experiences related to HIV prevention; different types of role models were established accordingly. Framework analysis was used to aggregate the original quotations from narrators into collective narratives under 6 intervention themes. A dedicated website was finally developed for intervention delivery. Results A series of video-based intervention messages in biographic narrative format (firsthand experiential stories shared by men who have sex with men) combined with topic-equivalent argumentative messages were produced and programmed into 6 intervention sessions. The 6-week intervention program can be automatically delivered and monitored online. Conclusions We systematically created a web-based HIV prevention intervention derived from peer-generated stories. Strategies used to enhance the efficacy of the narrative intervention have been discussed within basic communication components. This paper describes the methods and experiences of the rigorous development of a narrative communication intervention for HIV prevention, which enables replication of the intervention in the future.

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Web-Based Behavioral Intervention Utilizing Narrative Persuasion for HIV Prevention Among Chinese Men Who Have Sex With Men (HeHe Talks Project): Intervention Development (Preprint)

10.2196/preprints.22312 ◽

2020 ◽

Author(s):

Meiqi Xin ◽

Neil S Coulson ◽

Crystal Li Jiang ◽

Elizabeth Sillence ◽

Andrew Chidgey ◽

...

Keyword(s):

Hiv Prevention ◽

Role Models ◽

Intervention Program ◽

Anal Intercourse ◽

Framework Analysis ◽

Narrative Persuasion ◽

Web Based ◽

Narrative Intervention ◽

Condomless Anal Intercourse ◽

Sex With Men

BACKGROUND In the era of potent antiretroviral therapy, a high level of condomless anal intercourse continues to drive increases in HIV incidence in recent years among men who have sex with men. Effective behavior change strategies for promoting HIV-preventive behaviors are warranted. Narrative persuasion is a novel health communication approach that has demonstrated its persuasive advantages in overcoming resistance to counterattitudinal messages. The efficacy of narrative persuasion in promoting health behavior changes has been well documented, but critical research gaps exist for its application to HIV prevention. OBJECTIVE In this study, we aimed to (1) capitalize on narrative persuasion to design a web-based multisession intervention for reducing condomless anal intercourse among men who have sex with men in Hong Kong (the HeHe Talks Project) by following a systematic development process; and (2) describe the main components of the narrative intervention that potentially determine its persuasiveness. METHODS Persuasive themes and subtopics related to reducing condomless anal intercourse were initially proposed based on epidemiological evidence. The biographic narrative interview method was used to elicit firsthand experiential stories from a maximum variation sample of local men who have sex with men with diverse backgrounds and experiences related to HIV prevention; different types of role models were established accordingly. Framework analysis was used to aggregate the original quotations from narrators into collective narratives under 6 intervention themes. A dedicated website was finally developed for intervention delivery. RESULTS A series of video-based intervention messages in biographic narrative format (firsthand experiential stories shared by men who have sex with men) combined with topic-equivalent argumentative messages were produced and programmed into 6 intervention sessions. The 6-week intervention program can be automatically delivered and monitored online. CONCLUSIONS We systematically created a web-based HIV prevention intervention derived from peer-generated stories. Strategies used to enhance the efficacy of the narrative intervention have been discussed within basic communication components. This paper describes the methods and experiences of the rigorous development of a narrative communication intervention for HIV prevention, which enables replication of the intervention in the future.

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What are the motivations and barriers to pre-exposure prophylaxis (PrEP) use among black men who have sex with men aged 18–45 in London? Results from a qualitative study

Sexually Transmitted Infections ◽

10.1136/sextrans-2018-053773 ◽

2019 ◽

Vol 95 (4) ◽

pp. 262-266 ◽

Cited By ~ 7

Author(s):

T Charles Witzel ◽

Will Nutland ◽

Adam Bourne

Keyword(s):

Black Men ◽

Role Models ◽

Anal Intercourse ◽

Framework Analysis ◽

Intersectionality Theory ◽

Gay Male ◽

Condomless Anal Intercourse ◽

Marginalised Groups ◽

Sex With Men ◽

Exposure Prophylaxis

BackgroundBlack men who have sex with men (BMSM) have higher HIV incidence and prevalence when compared with other men who have sex with men, despite similar risk profiles. New prevention technologies, including pre-exposure prophylaxis (PrEP), may be effective in responding to these inequalities, provided they are appropriately targeted and acceptable to their intended beneficiaries. This study aims to understand the motivations and barriers of BMSM aged 18–45 to PrEP uptake.MethodsTwenty-five BMSM recruited through geolocation social networking apps took part in in-depth interviews between April and August 2016. Intersectionality theory was used as an organising principle. Interviews were transcribed verbatim and analysed using a thematic framework analysis.ResultsFor BMSM with heterogeneous social groups, discussions about sexual health were challenging because of the intersection of ethnic background, family history and religion. This limited conversations about PrEP to gay male friends who often held stigmatising views of condomless anal intercourse. BMSM reported exclusion from gay male spaces (online and offline) which could serve to restrict exposure to PrEP messages. Stereotypes of BMSM intersected with negative conceptions of PrEP users, limiting acknowledgement of PrEP candidacy. For those who had attempted to or successfully accessed it, PrEP was framed as a strategy to mitigate risk and to guard against further stigma associated with HIV infection.DiscussionBMSM operate within a complex set of circumstances related to the intersection of their sexual, ethnic, cultural and religious identities, which shape PrEP acceptability. Interventions which seek to facilitate uptake in this group must be attentive to these. Health promotion and clinical services could seek to facilitate nuanced discussions about the merits of PrEP for those at frequent risk, perhaps while also providing publicly visible PrEP role models for BMSM and other marginalised groups.

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Comparison between daily and on‐demand PrEP (pre‐exposure prophylaxis) regimen in covering condomless anal intercourse for men who have sex with men in Hong Kong: A randomized, controlled, open‐label, crossover trial

Journal of the International AIDS Society ◽

10.1002/jia2.25795 ◽

2021 ◽

Vol 24 (9) ◽

Author(s):

Tsz Ho Kwan ◽

Grace Chung Yan Lui ◽

Teddy Tai Ning Lam ◽

Krystal Chi Kei Lee ◽

Ngai Sze Wong ◽

...

Keyword(s):

Hong Kong ◽

Crossover Trial ◽

Anal Intercourse ◽

Open Label ◽

On Demand ◽

Randomized Controlled ◽

Condomless Anal Intercourse ◽

Sex With Men ◽

Exposure Prophylaxis

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Sex Tourism, Condomless Anal Intercourse, and HIV Risk Among Men Who Have Sex With Men

Journal of the Association of Nurses in AIDS Care ◽

10.1097/jnc.0000000000000018 ◽

2019 ◽

Vol 30 (4) ◽

pp. 405-414 ◽

Cited By ~ 1

Author(s):

Salem Harry-Hernández ◽

Su Hyun Park ◽

Kenneth H. Mayer ◽

Noah Kreski ◽

William C. Goedel ◽

...

Keyword(s):

Hiv Risk ◽

Anal Intercourse ◽

Sex Tourism ◽

Condomless Anal Intercourse ◽

Sex With Men

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Use of poppers and HIV risk behaviours among men who have sex with men in Paris, France: an observational study

Sexual Health ◽

10.1071/sh17217 ◽

2018 ◽

Vol 15 (4) ◽

pp. 370 ◽

Cited By ~ 5

Author(s):

H. Rhodes Hambrick ◽

Su Hyun Park ◽

Joseph J. Palamar ◽

Anthony Estreet ◽

John A. Schneider ◽

...

Keyword(s):

Relative Risk ◽

Smartphone Application ◽

Anal Intercourse ◽

Relative Risk Ratio ◽

Adjusted Relative Risk ◽

Condomless Anal Intercourse ◽

Hiv Seroconversion ◽

Sex With Men ◽

Group Sex ◽

Sexually Transmissible Infection

The use of inhaled nitrites, or poppers, among men who have sex with men (MSM) is prevalent, yet has been associated with HIV seroconversion. We surveyed 580 MSM from a geosocial networking smartphone application in Paris, France, in 2016. Of the respondents, 46.7% reported popper use within the previous 3 months. Regression models adjusted for sociodemographic characteristics found that the use of poppers was significantly (P < 0.05) associated with the following during the prior 3 months: condomless anal intercourse (adjusted relative risk (aRR) 1.27, 95% confidence interval (CI) 1.07–1.50), use of alcohol and/or drugs during sex once or twice (adjusted relative risk ratio (aRRR) 2.33, 95% CI 1.44–2.03), three to five times (aRRR 5.41, 95% CI 2.98–9.84) or six or more times (aRRR 4.09, 95% CI 2.22–7.56), participation in group sex (aRRR 3.70, 95% CI 2.33–5.90) and self-reported diagnosis with any sexually transmissible infection over the previous year (aRR 1.63, 95% CI 1.18–2.27), specifically chlamydia (aRR 2.75, 95% CI 1.29–4.29) and syphilis (aRR 2.27, 95% CI 1.29–4.29).

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Pre-exposure Prophylaxis Uptake and Discontinuation Among Young Black Men Who Have Sex With Men in Atlanta, Georgia: A Prospective Cohort Study

Clinical Infectious Diseases ◽

10.1093/cid/ciz894 ◽

2019 ◽

Vol 71 (3) ◽

pp. 574-582 ◽

Cited By ~ 7

Author(s):

David P Serota ◽

Eli S Rosenberg ◽

Patrick S Sullivan ◽

Annie L Thorne ◽

Charlotte-Paige M Rolle ◽

...

Keyword(s):

Black Men ◽

Prospective Cohort ◽

Anal Intercourse ◽

Hiv Incidence ◽

Transmitted Infection ◽

Factors Associated ◽

Preexposure Prophylaxis ◽

Condomless Anal Intercourse ◽

Sex With Men ◽

Additional Support

Abstract Background Human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) has great potential to reduce HIV incidence among young black men who have sex with men (YBMSM); however, initiation and persistence for this group remain low. We sought to understand the patterns and predictors of PrEP uptake and discontinuation among YBMSM in Atlanta, Georgia. Methods PrEP was offered to all participants in a prospective cohort of YBMSM aged 18–29 years not living with HIV. Time to PrEP uptake, first discontinuation, and final discontinuation were assessed using the Kaplan-Meier method. Cox proportional hazard models were used to identify predictors of uptake and discontinuation. Results After 440 person-years of follow-up, 44% of YBMSM initiated PrEP through the study after a median of 122 days. Of PrEP initiators, 69% had a first discontinuation and 40% had a final discontinuation during the study period. The median time to first PrEP discontinuation was 159 days. Factors associated with PrEP uptake included higher self-efficacy, sexually transmitted infection (STI), and condomless anal intercourse. Factors associated with discontinuation included younger age, cannabis use, STI, and fewer sex partners. HIV incidence was 5.23/100 person-years (95% confidence interval [CI], 3.40–7.23), with a lower rate among those who started PrEP (incidence rate ratio, 0.39; 95% CI, .16–.92). Conclusions Persistent PrEP coverage in this cohort of YBMSM was suboptimal, and discontinuations were common despite additional support services available through the study. Interventions to support PrEP uptake and persistence, especially for younger and substance-using YBMSM, are necessary to achieve full PrEP effectiveness. Clinical Trials Registration NCT02503618.

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App use frequency and condomless anal intercourse among men who have sex with men in Beijing, China: a cross-sectional study

International Journal of STD & AIDS ◽

10.1177/0956462419860293 ◽

2019 ◽

Vol 30 (12) ◽

pp. 1146-1155 ◽

Cited By ~ 3

Author(s):

Qianqian Luo ◽

Zunyou Wu ◽

Zihuang Chen ◽

Yue Ma ◽

Guodong Mi ◽

...

Keyword(s):

Logistic Regression ◽

Sexual Behaviors ◽

Anal Intercourse ◽

Cross Sectional Study ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Condomless Anal Intercourse ◽

Adjusted Logistic Regression ◽

Sex With Men ◽

Beijing China

Gay dating applications (apps) are popular among men who have sex with men (MSM) in China. This study examined the relationship between gay dating app use frequency and condomless anal intercourse (CAI) in a sample of MSM in Beijing. In October 2017, a web-based, cross-sectional survey was conducted among MSM from Beijing, China. Demographics, frequency of app use, and sexual behaviors were collected and analyzed. Multivariable logistic regression and restricted cubic splines were used to evaluate the association between app use frequency and CAI. Of the 9280 participants, the proportion of CAI within one month prior to the survey was 43.3%, and 43.7% logged onto the app ≥11 times per week. In adjusted logistic regression analysis, logging onto the app 6–10 times per week and ≥11 times per week were inversely associated with CAI (adjusted odds ratio [AOR] =0.88 [95%CI, 0.78–0.99]; AOR = 0.88 [95%CI, 0.82–0.97], respectively). Among those 40 years of age or older, logging onto the app ≥11 times per week was associated with lower rates of CAI (AOR = 0.57 [95%CI, 0.40–0.81]). Results indicate that frequent app use was associated with lower odds of CAI among MSM in Beijing, China. Innovative interventions, which take advantage of this popular media platform, should be developed as such apps have been found to reduce the odds of CAI in Beijing.

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Factors related to condomless anal intercourse between men who have sex with men: results from a European bio-behavioural survey

Journal of Public Health ◽

10.1093/pubmed/fdz052 ◽

2019 ◽

Vol 42 (2) ◽

pp. e174-e186 ◽

Cited By ~ 1

Author(s):

N S Sherriff ◽

A M Jones ◽

M Mirandola ◽

L Gios ◽

U Marcus ◽

...

Keyword(s):

Anal Intercourse ◽

Relationship Status ◽

Culturally Appropriate ◽

Regression Analyses ◽

Hiv Status ◽

Sti Prevention ◽

Factors Associated ◽

Hiv Test ◽

Condomless Anal Intercourse ◽

Sex With Men

Abstract Background Relationship status is an important factor associated with condomless anal intercourse (CAI) amongst men who have sex with men (MSM). Methods A multi-centre bio-behavioural survey with MSM was conducted in 13 European cities (n = 4901) exploring factors associated with CAI via bivariate and multivariate multilevel logistic regression analyses. Results Likelihood of CAI with casual partners was associated with being ‘out’ to a majority (AOR = 1.19;95% CI 1,1.42); knowing their HIV status (AOR = 1.86; 95% CI 1.25,2.76); using substances (1–2 AOR = 1.39; 95% CI 1.16,1.63, 2+ AOR = 1.81; 95% CI 1.35,2.42); being older (AOR = 0.98; 95% CI 0.97,0.99); successful sero-communication (AOR = 0.79; 95% CI 0.67,0.94); and, not having a recent HIV test (AOR = 0.78; 95% CI 0.66,0.92). CAI with steady partners was associated with successful sero-communication (AOR = 2.72; 95% CI 2.72,3.66); not having a recent HIV test (AOR = 1.26; 95% CI 1.09,1.46), and; being older (AOR = 0.99; 95% CI 0.98,0.99). Conclusions Understandings of partner type and/or relationship status in relation to CAI amongst MSM can potentially play an important role in the development of culturally appropriate HIV/STI prevention and risk-reduction efforts targeting at-risk MSM. Our results speak to the need to consider segmented and tailored public health and health promotion initiatives for MSM with differing CAI behaviours and relationship profiles.

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