eHealth Strategy to reach men who have sex with men for HIV counselling and testing
April is dedicated to Health Awareness (Health Systems Trust, 2014). Therefore, AfroAIDSinfo presents an article describing an eHealth approach to promote voluntary HIV counselling and testing among men who have sex with men that use the Internet.
In April 2010, the South African President Jacob Zuma launched a nationwide human immunodeficiency virus (HIV) counselling and testing (HCT) campaign which saw the testing of 15.6 million people by mid-2011 (Department of Monitoring & Evaluation, 2012). Although the HCT campaign exceeded its target of testing 15 million people, in a country with 51.8 million people, 70% of the population remained untested (Statistics South Africa, 2012). Therefore, new ways of promoting HCT should be strategised.
In addition to the launch of the National Strategic Plan 2012-2016 (NSP; NSP, 2012), 2012 saw the implementation of the eHealth Strategy South Africa 2012-2016 (DoH, 2012) which aims to create an integrated eHealth platform with information and communication technologies (ICTs). Some of the ways in which the eHealth Strategy 2012-2016 aims to address the concurrent HIV and TB epidemic are by increasing the number of people living with HIV/AIDS (PLWHA) on antiretroviral therapy (ART); integrating HIV/AIDS and TB treatment, care and support with primary health care; and scaling up HCT to cover a larger area. The eHealth Strategy also aims to use existing communications infrastructure to educate communities on public health issues including HIV/AIDS.
Internet-based HCT recruitment strategy
One such community is men who have sex with men (MSM). To reach this community, researchers in China (Zou et al., 2013) and Peru (Blas et al., 2007) as well as a student-run clinic in the United States of America (Faldecker et al., 2011) have posted banners and engaged members of the online MSM community in chat rooms, through e-mails, short message services (SMS) text messaging, or instant messaging to promote the uptake of HCT.
Zou et al. (2013) spent four hours (18:00-22:00) every day over a 60-day period reaching out to MSM on three major Chinese online MSM community websites. The researchers engaged in passive and active outreach. Passive outreach entailed having the MSM websites host a banner for 54 days inviting members for a health check-up at two participating clinics. When a member clicked on the banner, this directed him to a webpage which fully explained the study and provided him with the contact details of the two clinics and the two volunteers who would conduct the HCT. Active outreach entailed posting advertisements in the chat rooms of these websites and sending invitations to the websites’ users via SMS, e-mail and instant messaging using the contact information the volunteers obtained from user profiles. They also conversed with users via the telephone, instant messaging or online chat rooms.
In total, 3,332 MSM responded to the advertisements of which 429 were recruited into the study. Educated, young individuals, who had never been married, mostly comprised the study population. The HCT offered by Zou et al. (2013) included syphilis testing.
Blas et al. (2007) followed a similar approach but did not engage in active outreach. They had two banners on one national MSM website. One banner offered free HIV testing while the other did not. Their target population was the MSM in Lima, Peru. The banner offering free HCT received 6 570 clicks while the other banner was clicked 2 070 times. The delivered impressions for the incentivised and non-incentivised banners were 12 240 and 12 232, respectively. A little less than twice the amount of surveys were received for the incentivised banner (713 participants) than for the one not offering any incentive (411 participants). Of the 713 participants who completed the survey that was linked to the incentivised banner, 80 took up HCT.
In a subsequent study, Blas et al. (2013) interviewed gay-identified closet, out-of-the-closet, and self-identified heterosexual MSM garnered from the online community to establish the most effective advertising principles to reach this community. Some of the themes and principles they found in their qualitative study are listed below.
The qualitative study by Blas et al. (2013) gave the following insights:
- Televised HIV/AIDS awareness messages should have a positive message so as not to increase the fear of a positive HIV diagnosis, thereby dissociating HIV-infection from death. One’s life does not end with a positive diagnosis.
- Dark, gloomy colours and settings all strengthen the association between HIV and death as do the colours red and black.
- Messages should increase risk perception by portraying common risky situations in the media followed by the message: “he or she might be at risk”.
- The participants also suggested that websites inviting online MSM and other at-risk populations should explain who will be conducting the HCT, the venue, and the HCT process followed with information on what would happen after a positive HIV-test result.
- The content of the message should not use images of stereotypical, effeminate MSM and not contain gay-related jargon or the words HIV, AIDS, or health centre.
- MSM were willing to go for HCT even if condoms and lubricants were the only incentives.
Although no formal study was done by Feldacker et al. (2011), they provided some guidelines to the success of their programme. Their clinic saw MSM travelling as far as 145 km (90 miles) to receive HCT. They published profiles in the personals section of a large classifieds website, on an MSM online dating site, and on major social networking sites. They actively advertised their HCT service twice a week while regularly updating the social network profiles with relevant information. They also engaged members of these sites in conversation upon inquiry.
Research on the effectiveness of the use of this health promotion strategy in the South African, and sub-Saharan African, context is lacking. Yet in the context of the eHealth Strategy South Africa 2012-2016, this Internet-based strategy to invite members of online MSM communities for HCT holds promise. Therefore, considering its use and providing funds for research to be conducted in an African context will be a worthwhile investment since it is only by a multi-pronged approach that all populations at high risk of HIV infection will consider undergoing HCT.
- Blas, M. M., Alva, I. E., Cabello, R., Garcia, P. J., Carcamo, C., Redmon, M., et al. (2007) ‘Internet as a tool to access high-risk men who have sex with men from a resource-constrained setting: a study from Peru’ Sexually Transmitted Intections 83, 567-570.
- Blas, M. M., Menacho, L. A., Alva, I. E., Cabello, R. and Orellana, E. R. (2013) ‘Motivating men who have sex with men to get tested for HIV through the internet and mobile phones: A qualitative study’ PLoS ONE 8, e54012.
- Department of Monitoring & Evaluation (2012) ‘Midterm Review of the Priorities of Government: March 2012’ [Online] Accessed on 16 October 2013.
- DoH (Department of Health) (2012) [Online] Accessed on 25 January 2014.
- Feldacker, C., Torrone, E., Triplette, M., Smith, J. C., and Leone, P. A. (2011) 'Reaching and retaining high-risk HIV/AIDS clients through the internet' Health Promotion Practice 12, 522-528.
- Health Systems Trust (2013) 'Health Calendar 2014' [Online] Retrieved 05 March 2014.
- National Strategic Plan 2012-2016 (2012) [Online] Accessed 16 October 2013.
- Statistics South Africa (2012) ‘Census 2011 Statistical Release’ [Online] Accessed on 26 March 2014.
- Zou, H., Wu, Z., Yu, J., Li, M., Ablimit, M., Li, F. and Poundstone, K. (2013) ‘Internet-facilitated, voluntary counseling and testing (VCT) clinic-based HIV testing among men who have sex with men in China’ PLoS ONE 8, e51919.
Author: Waldo Adams (BSc Hons Biochemistry)
Reviewed by: Hendra van Zyl (MPH), Jean Fourie (MPhil) and Michelle Moorhouse (MBBCh, DA)
Date: April 2014
Adams, W. (2014) eHealth Strategy to reach men who have sex with men for HIV counselling and testing, AfroAIDSinfo. Issue 14 no. 4, Policy (Open access).
2 April, 2014