Peer group education through social media: turning the tide of the MSM HIV epidemic?

The link between social networking technology and risk-taking sexual behaviour appears to be a complex one.  On the one hand, there is a strong likelihood that social networking increases MSM at risk by involving them in sexual networks.  For example, according to the European MSM Internet Survey, 58% of MSM reporting a non-steady partner over the last twelve months also report having met that partner on the Internet.  On the other hand, there is also evidence of risk-reducing behaviours like increased communication before sexual encounters may become more pronounced (sti.bmj/STI&AidsConferenceVienna/2013/marcus&schmidt).  So how about using the technologies, that spread MSM HIV transmission, to prevent that transmission? (sti.bmj/STI&AIDSConferenceVienna2013/Young)

This intriguing possibility has recently been explored in a small randomized control trial (Young & Coates) that uses facebook to deliver the peer education (Young&Coates).  The use of peer education is one of a number of interventions that has been considered as a means to influence MSM sexual behaviour, and has been trialled in a handful of studies with varied results (sti.bmj/Lorenc&Lindsay). Other studies have evaluated the effectiveness of educational tools made available to the MSM community on the internet – such as the ISEAN Hivos program in SE Asia (sti.bmj/Nasution) and a recent program in Peru (sti.bmj/Blas&Kurth). The novelty of Y&C’s study is to bring the two kinds of intervention together, using the social networking to deliver the peer education.  The rationale for this is the apparent popularity of social networking among the ethnic populations, and LGBT populations, that are precisely those most at risk from HIV.

The participants were 112 MSM, 85% Afro-American or Latino, recruited from the Internet and social websites: the peer educators, 16 Afro-American or Latino MSM, recruited from community organizations, screened online, then given three 3-hour training sessions at UCLA.  28 participants and four peer educators were randomly assigned to each one of four closed groups on facebook – two intervention and two control.  The intervention group peer educators were encouraged to initiate and maintain engagement of their participants on HIV prevention: those in the control groups, were to do so on general health issues.

The principal quantifiable outcome of the 12 week trial was the request, return and follow-up of home HIV testing kits which participants were told they could obtain at the end of each four week section of the 12 week trial.  In the intervention arm 25/57 kits (41%) were requested, 9/25 kits (36%) returned, and 8 followed up for test results – as against 11/55 (20%) requested, 2/11 returned (18%) and 0 followed up for test results in the control arm. The peer educators were paid a total of $120 US each for participation over the whole twelve-week period.

While these are promising findings, and warrant further research,  this kind of intervention, like other peer education interventions reviewed by Lorenc & Lindsay are certainly “resource intensive and challenging to implement” (sti.bmj/Lorenc&Lindsay).

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