Personality Traits and eHealth Study Enrollment Among Racial and Sexual Minoritized Men Living with HIV.

Inequities in eHealth research enrollment persist among Black and Latinx sexual minoritized men (SMM) partly due to socio-ecological barriers. Less is known about how personality traits are associated with their study enrollment. We examined the role of personality traits among 1,285 U.S. Black and Latinx SMM living with HIV recruited from sexual networking websites/apps for an eHealth intervention. Lower neuroticism and higher openness were associated with greater odds of study enrollment among Latinx SMM. Given these exploratory findings, future research should examine this phenomenon, along with well-established socio-ecological factors such as medical mistrust to better understand eHealth study enrollment gaps among Black and Latinx SMM.

Behavioral Efficacy of a Sexual Health Mobile App for Men Who Have Sex With Men: Randomized Controlled Trial of Mobile Messaging for Men.

BACKGROUND: Gay, bisexual, and other men who have sex with men (GBMSM) face the highest burden of HIV in the United States, and there is a paucity of efficacious mobile health (mHealth) HIV prevention and care interventions tailored specifically for GBMSM. We tested a mobile app combining prevention messages and access to core prevention services for GBMSM. OBJECTIVE: This study aims to measure the efficacy of the Mobile Messaging for Men (M-cubed) app and related services to increase HIV prevention and care behaviors in diverse US GBMSM. METHODS: We conducted a randomized open-label study with a waitlist control group among GBMSM in 3 groups (low-risk HIV-negative group, high-risk HIV-negative group, and living-with-HIV [LWH] group) recruited online and in venues in Atlanta, Detroit, and New York City. Participants were randomly assigned to receive access to the app immediately or at 9 months after randomization. The app provided prevention messages in 6 domains of sexual health and offered ordering of at-home HIV and sexually transmitted infection test kits, receiving preexposure prophylaxis (PrEP) evaluations and navigation, and service locators. Serostatus- and risk-specific prevention outcomes were evaluated at baseline, at the end of the intervention period, and at 3, 6, and 9 months after the intervention period. RESULTS: In total, 1226 GBMSM were enrolled and randomized; of these 611 (49.84%) were assigned to the intervention group and 608 (99.51%) were analyzed, while 615 (50.16%) were assigned to the control group and 612 (99.51%) were analyzed. For high-risk GBMSM, allocation to the intervention arm was associated with higher odds of HIV testing during the intervention period (adjusted odds ratio [aOR] 2.02, 95% CI 1.11-3.66) and with higher odds of using PrEP in the 3 months after the intervention period (aOR 2.41, 95% CI 1.00-5.76, P<.05). No changes in HIV prevention or care were associated with allocation to the intervention arm for the low-risk HIV-negative and LWH groups. CONCLUSIONS: Access to the M-cubed app was associated with increased HIV testing and PrEP use among high-risk HIV-negative GBMSM in 3 US cities. The app could be made available through funded HIV prevention providers; additional efforts are needed to understand optimal strategies to implement the app outside of the research setting. TRIAL REGISTRATION: ClinicalTrials.gov NCT03666247; https://clinicaltrials.gov/ct2/show/NCT03666247. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/16439.

A Syndemic Model of Exchange Sex Among HIV-Positive Men Who Have Sex With Men.

Exchange sex is a behavior associated with HIV transmission risk among men who have sex with men (MSM). Few studies have examined exchange sex among HIV-positive MSM. We utilize a syndemic framework to account for co-occurring psychosocial problems that suggest the presence of intertwining epidemics (i.e., syndemics), which have not been examined within the context of exchange sex among HIV-positive MSM. In 2015, MSM were recruited via online sexual networking Web site and app advertisements for Sex Positive![+], a video-based online intervention that aimed to improve health outcomes for men living with HIV. Participants completed surveys every three months for a year. Surveys covered demographics, drug use, exchange sex, intimate partner violence (IPV), and past 2-week depressive symptoms. We conducted three logistic regression models to assess syndemic factors associated with exchange sex in the past 3 months. Of the 722 HIV-positive MSM included in the sample, 59 (8%) reported exchange sex in the past 3 months at 12-month follow-up. HIV-positive MSM who had more syndemic factors had greater odds of exchange sex. Exchange sex was associated with being African-American/Black, age 18-29 years, past and present experiences with IPV, stimulant use, polysubstance use, and depressive symptoms. Exchange sex was associated with multiple psychosocial factors, indicating exchange sex may be part of a syndemic involving substance use, depression, HIV, and IPV. Interventions should address the social and behavioral circumstances that perpetuate environments that can foster multiple negative health outcomes.

Stimulant Use and Study Protocol Completion: Assessing the Ability of Men Who Have Sex with Men to Collect Dried Blood Spots for Laboratory Measurement of HIV Viral Load.

Stimulant use is associated with higher HIV viral load (VL) and sexual HIV transmission risk among men who have sex with men (MSM) living with HIV. There is little research on willingness of drug users living with HIV to fully participate in studies, especially those involving self-collection of biomarker data. This study presents findings from an at-home dried blood spot collection study measuring laboratory-quantified VL among U.S. HIV-positive MSM who reported high-risk sexual behavior and/or suboptimal antiretroviral therapy (ART) adherence to assess the association between drug-use behavior and (1) ability to complete a study protocol and (2) VL outcomes. Among recruited participants (n = 766), 35% reported stimulant drug use (amphetamines, cocaine, crack, crystal meth, ecstasy, or a combination of stimulant drugs), 39% reported using other drugs (heroin, marijuana, prescription opioids, and others), and 27% reported no drug use in the past 3 months. In all, 61% of enrolled participants completed the study protocol. Stimulant drug users were less likely (ARR 0.84; 95% CI 0.72-0.98) to complete the protocol than other drug users. Furthermore, other drug users were significantly less likely than non-drug users (ARR 0.52; 95% CI 0.28-0.97) to have an HIV VL result ≥ 1500 copies/mL. This study provides important estimates regarding the likelihood of participation in biomedical research activities among HIV-positive MSM with varying drug-use behaviors, showing that it is feasible to conduct such biomedical studies with drug-using MSM who report high-risk sexual behavior and struggle with their ART adherence.

Changes in Sleep Quality and Associated Health Outcomes among Gay and Bisexual Men Living with HIV.

Objectives/Background: Although gay, bisexual, and other men who have sex with men (GBMSM) bear a disproportionate burden of HIV in the U.S., they are underrepresented in HIV-related sleep research. This study sought to (a) investigate changes in self-reported sleep quality among a sample of GBMSM living with HIV during participation in an online sexual risk reduction intervention and (b) examine whether changes in sleep quality predicted later health outcomes.Method/Participants: Men (n = 505) completed measures of sleep quality, psychological distress, condom use self-efficacy, and antiretroviral therapy (ART) adherence. Analyses focused on data obtained from participants as part of the eligibility survey, baseline assessment, and the 9- and 12-month follow-up assessments.Results: Most participants did not report changes in their sleep quality (i.e., 50.1% maintained good sleep quality, 22.8% maintained poor sleep quality) between study screening and 9-month follow-up. Nevertheless, 17.0% indicated improved sleep quality and 10.1% indicated a negative change in sleep quality. Compared to those who maintained good sleep quality during the study, men whose sleep quality declined by 9 months reported significantly greater symptoms of depression and anxiety, as well as lower ART adherence and condom use self-efficacy at 12 months. Similarly, men who maintained poor sleep quality reported greater symptoms of depression and anxiety at 12 months. Men whose sleep quality improved reported better mental health than those with poor or worsening sleep quality.Conclusions: Findings suggest that optimizing sleep health should be prioritized in interventions aimed at improving overall well-being of GBMSM living with HIV.

Early Sexual Experiences, Mental Health, and Risk Behavior among Black Non-Hispanic and Hispanic / Latino Men Who Have Sex with Men (MSM).

Black and Latino men who have sex with men (MSM) are disproportionately affected by childhood sexual abuse (CSA). Investigating these histories is often confounded by underreporting and varied definitions of abuse. Unrecognized abuse may manifest in unhealthy ways, specifically psychological distress, substance use, and high-risk sexual behaviors. Black and Hispanic/Latino MSM in New York City discussed formative sexual experiences in in-person interviews. Eligible men reported a sexual experience occurring before age 16 with a man or woman 18 or older at the time. Among interviewees (n = 61), men living with HIV were significantly younger at the time of their first sexual experience with a male partner compared to HIV-negative men. Approximately half of interviewees (47.5%) scored at or above the diagnostic cutoff for post-traumatic stress disorder (PTSD). Hispanic/Latino men had increased odds of scoring at or above the diagnostic cutoff for PTSD compared to Black non-Hispanic men. Further, nearly half of interviewees (46%) scored at or above the diagnostic cutoff for harmful drug use or possible drug dependence. Study findings have implications for future research using an indirect approach to uncovering potential sexual abuse during childhood, and associations with adult health outcomes.

Evaluation of Sex Positive! A Video eHealth Intervention for Men Living with HIV.

Sex Positive![+] is a two-arm, video-based web intervention aimed at reducing condomless anal sex (CAS) with partners of known and unknown serostatus that was delivered online to a racially and ethnically diverse sample of 830 gay, bisexual, and other men who have sex with men living with HIV. Men in each arm received 6 weekly videos after completing a baseline assessment and 4 weekly booster videos following a 6-month assessment. Follow-up assessments were conducted every 3 months for 1 year. At 3-month follow-up, men in the intervention arm reported significantly reduced risk of having unknown serodiscordant CAS partners than men in the control arm (RR 0.60, 95% CI 0.39-0.92), partially supporting study hypotheses. Aside from this finding, similar reductions in sexual risk behaviors were observed in both arms over the study period. There is much to be learned about video-based web interventions in terms of methodological development and intervention delivery, including frequency and duration of intervention components.

If You Film It Will They Watch? Factors Associated with Willingness to View Safer Sex Messaging in Internet-Based Sexually Explicit Media.

Research on the association between viewing condomless sex in sexually explicit media (SEM) and engaging in risk behavior suggests the need for SEM-based safer sex messaging (e.g., PrEP, condom use), though few studies have considered viewer willingness to watch SEM containing HIV/STI prevention messages. Online survey data from a racially diverse sample of 859 men and women were used to investigate factors associated with willingness to watch SEM with safer sex messaging. Analyses were conducted separately for three groups: heterosexual men and other men who only report sex with women, heterosexual women and other women who only report sex with men, and gay, bisexual, and other men who have sex with men. All three groups expressed some willingness to view safer sex messages in SEM and a majority viewed the SEM industry as having some responsibility to provide this type of messaging. Factors associated with greater willingness varied across the three groups. These findings have implications for the design and implementation of safer sex messaging in SEM.

Sexual risk taking and the HIV care continuum in an online sample of men who have sex with men.

Antiretroviral Therapy (ART) suppresses HIV replication, reducing the risk of transmission. However, many people living with HIV in the US are not virally suppressed even after diagnosis and initiating ART, and may become disengaged from care at each stage of the HIV care continuum (HCC). In the current study we assessed the sexual risk behaviors of MSM by HCC stage. US MSM who completed an online survey (N = 12,995) in 2015 were categorized into 6 HCC groups. Mean age was 39.2 and a majority identified as White (49.6%). At every stage of the HCC, we found higher proportions of individuals engaged in care compared to CDC estimates. A majority of the sample was HIV-positive and engaged in care, with 67.2% of HIV-positive participants reporting viral suppression with ART. Across HCC groups, participants reported high rates of past 6-month condomless anal sex (CAS) (79.2%-84.8%) and CAS with serodiscordant or unknown status partners (38.0%-84.1%). Notably, MSM with unknown HIV serostatus reported the highest proportion of CAS and serodiscordant CAS. HIV-positive MSM not on ART were more likely to report an STI diagnosis (p < .002) compared to those unaware of their HIV status or HIV negative. Moreover, young Black MSM were less likely to be on ART (p < .002) or virally suppressed (p < .002) compared to older White MSM. Our findings highlight potentially problematic sexual risk behaviors among MSM by level of HCC engagement, which can impede the preventive impact of ART. Online platforms provide an avenue to assess the progress of MSM along the HCC, as well as other subpopulations in need of appropriate behavioral interventions to decrease HIV incidence.

Reasons for Non-Disclosure of Sexual Orientation Among Behaviorally Bisexual Men: Non-Disclosure as Stigma Management.

Although bisexual men are known to be less likely to disclose their sexual orientation to others than gay men, the reasons why bisexual men choose or feel unable to disclose have received minimal research attention. To examine the reasons behaviorally bisexual men offer for not disclosing to their friends, family, and female partners, in-depth interviews were conducted with an ethnically diverse sample of 203 men who had not disclosed their same-sex behavior to their female sexual partners in New York City. Men were recruited from multiple venues and online sources using a targeted sampling approach. Transcripts were thematically analyzed using Atlas.ti software. Contrary to the theory that non-disclosure is due to uncertainty about one's sexual identity, the reasons offered for non-disclosure revealed that it was largely a method to avoid stigmatizing reactions from others. Men reported a number of specific reasons for non-disclosure, including (1) anticipation of negative emotional reactions; (2) anticipation of negative changes in relationships; (3) belief that others held stigmatizing attitudes toward homosexuality; (4) prior experience with negative reactions to disclosure; (5) wanting to maintain others' perceptions of him; (6) fear that those told would disclose to additional people; and (7) fear of rejection due to culture or religion. These findings provide insights into the reasons why many behaviorally bisexual men choose not to disclose, potential reasons why bisexual and gay men differ in the extent to which they disclose, and potential reasons why some bisexual men report greater emotional distress than gay men. Further, they suggest that greater attention needs to be placed on addressing the stigmatizing contexts that confront bisexual men and providing them with strategies to manage stigma.

Sexually Explicit Media Use by Sexual Identity: A Comparative Analysis of Gay, Bisexual, and Heterosexual Men in the United States.

Advances in production and distribution of sexually explicit media (SEM) online have resulted in widespread use among men. Limited research has compared contexts of use and behaviors viewed in Internet SEM by sexual identity. The current study examined differences in recent SEM use (past 6 months) by sexual identity among an ethnically diverse sample of 821 men who completed an online survey in 2015. Both gay and bisexual men reported significantly more frequent use of Internet SEM compared to heterosexual men. Although most participants reported viewing SEM at home (on a computer, tablet, or smartphone), significantly more gay men reported SEM use at a sex party or commercial sex venue than either heterosexual or bisexual men. Sexual identity predicted viewing of high-risk and protective behaviors in separate logistic regression models. Specifically, compared to heterosexual men, gay and bisexual men had increased odds of viewing condomless anal sex (gay OR 5.20, 95 % CI 3.35-8.09; bisexual OR 3.99, 95 % CI 2.24-7.10) and anal sex with a condom (gay OR 3.93, 95 % CI 2.64-5.83; bisexual OR 4.59, 95 % CI 2.78-7.57). Compared to gay men, heterosexual and bisexual men had increased odds of viewing condomless vaginal sex (heterosexual OR 27.08, 95 % CI 15.25-48.07; bisexual OR 5.59, 95 % CI 3.81-8.21) and vaginal sex with a condom (heterosexual OR 7.90, 95 % CI 5.19-12.03; bisexual OR 4.97, 95 % CI 3.32-7.44). There was also evidence of identity discrepant SEM viewing as 20.7 % of heterosexual-identified men reported viewing male same-sex behavior and 55.0 % of gay-identified men reported viewing heterosexual behavior. Findings suggest the importance of assessing SEM use across media types and contexts and have implications for research to address the potential influence of SEM on sexual behavior (e.g., investigate associations between viewing condomless vaginal sex and engaging in high-risk encounters with female partners).

Drug Use, Sexual Risk, and Syndemic Production Among Men Who Have Sex With Men Who Engage in Group Sexual Encounters.

OBJECTIVES: We surveyed men who have sex with men (MSM) to determine whether sexual risk behaviors, recent drug use, and other psychosocial problems differed between men who engaged in one-on-one and group sexual encounters. METHODS: We conducted an Internet-based cross-sectional survey of 7158 MSM aged 18 years or older in the United States recruited from a gay-oriented sexual networking Web site in 2008. Among MSM who engaged in group sexual encounters, we compared their past-60-day sexual behaviors in one-on-one encounters and group sexual encounters. We also compared risk profiles and syndemic production between men who did and did not participate in group sex. RESULTS: Men reporting a group-sex encounter had significantly higher polydrug use and sexual risk than did the men not reporting group sex in the past 60 days. The odds of engaging in group sex with 4 or more sexual partners significantly increased with the number of psychosocial problems, supporting evidence of syndemic production. CONCLUSIONS: We identified a particularly high-risk subgroup in the MSM population with considerable psychosocial problems that may be reached online. Research is needed on how to engage these high-risk men in combination prevention interventions.

Socially-integrated transdisciplinary HIV prevention.

Current ideas about HIV prevention include a mixture of primarily biomedical interventions, socio-mechanical interventions such as sterile syringe and condom distribution, and behavioral interventions. This article presents a framework for socially-integrated transdisciplinary HIV prevention that may improve current prevention efforts. It first describes one socially-integrated transdisciplinary intervention project, the Transmission Reduction Intervention Project. We focus on how social aspects of the intervention integrate its component parts across disciplines and processes at different levels of analysis. We then present socially-integrated perspectives about how to improve combination antiretroviral treatment (cART) processes at the population level in order to solve the problems of the treatment cascade and make "treatment as prevention" more effective. Finally, we discuss some remaining problems and issues in such a social transdisciplinary intervention in the hope that other researchers and public health agents will develop additional socially-integrated interventions for HIV and other diseases.

Sexually explicit media on the internet: a content analysis of sexual behaviors, risk, and media characteristics in gay male adult videos.

Recent research suggests that viewing sexually explicit media (SEM), i.e., adult videos, may influence sexual risk taking among men who have sex with men. Despite this evidence, very little is known about the content of gay male SEM on the Internet, including the prevalence of sexual risk behaviors and their relation to video- and performer-characteristics, viewing frequency, and favorability. The current study content analyzed 302 sexually explicit videos featuring male same-sex performers that were posted to five highly trafficked adult-oriented websites. Findings revealed that gay male SEM on the Internet features a variety of conventional and nonconventional sexual behaviors. There was a substantial prevalence of unprotected anal intercourse (UAI) (34 %) and was virtually the same as the prevalence of anal sex with a condom (36 %). The presence of UAI was not associated with video length, amateur production, number of video views, favorability, or website source. However, the presence of other potentially high-risk behaviors (e.g., ejaculation in the mouth, and ejaculation on/in/rubbed into the anus) was associated with longer videos, more views, and group sex videos (three or more performers). The findings of high levels of sexual risk behavior and the fact that there was virtually no difference in the prevalence of anal sex with and without a condom in gay male SEM have important implications for HIV prevention efforts, future research on the role of SEM on sexual risk taking, and public health policy.

Conceptions of privacy and the non-disclosure of same-sex behaviour by behaviourally-bisexual men in heterosexual relationships.

Little attention has been paid to why some behaviourally-bisexual men (i.e., men who have sex with both men and women) choose not to disclose their same-sex behaviour. Using Communication Privacy Management (CPM) theory, we report on the ways these men conceptualise their same-sex behaviour as private, and thus feel justified in not disclosing it to family, friends and female partners. In-depth interviews were conducted with an ethnically diverse sample of 203 non-disclosing behaviourally-bisexual men in New York City. The men offered a number of privacy rules to justify their non-disclosure, including: (1) their same-sex behaviours were their own business and nobody else's, (2) others had no reason to know, (3) the topic of sexual behaviour was too personal, (4) they were private people in general and (5) it was inappropriate to discuss same-sex behaviour in many contexts. Some privacy rules were used more often to justify non-disclosure to friends and family than to female partners. These findings provide insights into the reasons for non-disclosure among behaviourally-bisexual men, offer support for and extend CPM theory for the management of sexual information and offer insights into the importance of privacy for the design and delivery of health-promotion services for this population.

Understanding Black and Latino sexual minority men's perspectives on assessment of sexual history in diverse health care settings.

OBJECTIVE: This exploratory analysis aims to understand conditions under which cisgender Black and Latino sexual minority men (SMM) would be willing to share potentially abusive childhood sexual experiences with health care providers. Black and Latino SMM may be overrepresented among childhood sexual abuse (CSA) survivors, but some abusive experiences are appraised as consensual due to cultural pressures, leading to underreporting and a delay in identification and treatment. Prior research highlights the importance of screening for sexual abuse histories in primary care and substance use treatment settings, though studies indicate that such assessments rarely occur. METHOD: In-depth qualitative interviews were conducted with 61 cisgender Black and Latino SMM who reported sexual experiences in childhood that met criteria for CSA. Interviews explored men's experiences with and attitudes toward sexual history taking in diverse health care settings. RESULTS: Most respondents felt that providers should assess sexual history and be aware of prior abuse. Barriers to disclosure included perceived provider bias and insincerity and concerns that provider characteristics (e.g., gender) might limit their ability to understand a client's experiences. CONCLUSIONS: Findings suggest that a trauma-informed approach to the assessment of sexual histories should consider that patients' current physical and mental states may be (in)directly linked to earlier, traumatic events and that intersecting identities (e.g., gender and race) could influence men's willingness to share their histories. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Service provider interpretations of childhood sexual experiences among sexual minority men.

In this study, we report findings from a directed content analysis of service provider (SP) interpretations of early sexual experiences depicted in vignettes created from retrospective interviews with Black sexual minority men. Specifically, we explore whether SP recognize circumstances of abuse in the vignette narrators' sexual histories. Data for this analysis come from in-person qualitative interviews conducted with 35 providers working in substance abuse treatment and allied health service settings (e.g., mental health, HIV prevention and outreach) across the New York City area. The interviewees were asked to evaluate each of five vignettes depicting a range of early sexual experiences as described by the narrators [e.g., unwanted experiences with a male or female consistent with definitions of childhood sexual abuse (CSA), consensual sex with an older male or female]. Based on analysis of provider responses to the vignettes, we found that most recognized differences in age and authority as abuse indicators. Many of the providers struggled with assertions by vignette narrators that they had consented to the encounters-specifically those that could be considered abusive. Findings highlight areas to focus on in developing additional provider training, including the challenges of defining CSA, age and other factors that influence consent, and how cultural background and sexual minority status may shape men's appraisals of their experiences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining Cultural Competency and Sexual Abuse Training Needs Among Service Providers Working with Black and Latino Sexual Minority Men.

Black and Latino sexual minority men (SMM) with a history of childhood sexual abuse (CSA) may be reluctant to disclose such experiences or may appraise them as consensual because of cultural norms. Anticipated stigma, medical mistrust, and concerns that providers lack training in sexuality may complicate their efforts to obtain treatment for long-term health consequences of CSA. It is important to examine the training needs of service providers working with SMM who may disclose sexual abuse. Qualitative interviews were conducted with 35 substance use disorder (SUD) treatment and allied health service providers across the New York City area. Themes included the importance of training in cultural competence, trauma-informed care, and assessment of-and counseling for-CSA. Further education in these areas can enable providers to recognize indicators of abuse in their clients' sexual histories and to more effectively and safely respond to this information. Future studies are encouraged to test a trauma-informed approach to screening for CSA history with Black and Latino SMM who present to SUD treatment and allied health service providers. This research should consider provider perspectives in developing such an approach and will likely involve training and evaluation to ensure adequate preparedness and effective service delivery.

Factors associated with mobile app-based ordering of HIV self-test kits among men who have sex with men in Atlanta, Detroit and New York City: an exploratory secondary analysis of a randomized control trial.

INTRODUCTION: The United States Centers for Disease Control and Prevention currently recommends HIV screening at least annually among sexually active gay, bisexual and other men who have sex with men (MSM), but only half report being tested in the past year in the United States. As HIV self-test kits are becoming more available around the United States via web and app-based interventions, it is important to understand who is willing and able to order them. This analysis sought to better understand predictors of free HIV self-test kit utilization among MSM in M-cubed, an HIV prevention mobile app intervention trial in Atlanta, Detroit and New York City. METHODS: We conducted an exploratory secondary analysis of self-report and in-app data collected from the intervention arm of the M-Cubed study from 24 January 2018 to 31 October 2019. Behavioural, demographic and other potential predictors of HIV self-test ordering were identified from Social Cognitive Theoretical underpinnings of the app, and from the literature. Significant predictor variables in bivariate analyses were considered for inclusion in the empiric multivariable model. Demographic variables chosen a priori were then added to a final model estimating adjusted prevalence ratios (aPR). RESULTS: Over half of the 417 intervention participants ordered an HIV self-test kit during the study. In bivariate analyses, ordering a kit was associated with HIV testing history, plans to get tested and reported likelihood of getting tested. In the final model, participants were more likely to order a kit if they reported plans to get tested in the next 3 months (aPR = 1.58, 95% CI: 1.18-2.11) or had not tested for HIV in the past 3 months (aPR = 1.38, 95% CI: 1.13-1.70). There was no difference in HIV self-test kit ordering by income, race/ethnicity or age. CONCLUSIONS: HIV testing is an important tool in ending the HIV epidemic and must be accessible and frequent for key populations. This study demonstrates the effectiveness of HIV self-test kits in reaching populations with suboptimal testing rates and shows that self-testing may supplement community-based and clinical testing while helping overcome some of the structural barriers that limit access to annual HIV prevention services for MSM.

Video selection and assessment for an app-based HIV prevention messaging intervention: formative research.

Background: Gay, bisexual, and other men who have sex with men (GBMSM) continue to be overrepresented in human immunodeficiency virus (HIV) infection in the United States. HIV prevention and care interventions that are tailored to an individual's serostatus have the potential to lower the rate of new infections among GBMSM. Mobile technology is a critical tool for disseminating targeted messaging and increasing uptake of basic prevention services including HIV testing, sexually transmitted infection (STI) testing, and pre-exposure prophylaxis (PrEP). Mobile Messaging for Men (M-Cubed) is a mobile health HIV prevention intervention designed to deliver video- and text-based prevention messages, provide STI and HIV information, and link GBMSM to prevention and healthcare resources. The current report describes an iterative process of identifying and selecting publicly available videos to be used as part of the M-Cubed intervention. We also conducted interviews with GBMSM to assess the acceptability, comprehension, and potential audience reach of the selected video messages. Methods: The selection of videos included balancing of specific criteria [e.g., accuracy of scientific information, video length, prevention domains: HIV/STI testing, antiretroviral therapy (ART), PrEP, engagement in care, and condom use] to ensure that they were intended for our GBMSM audiences: HIV-negative men who engage in condomless anal sex, HIV-negative men who do not engage in condomless anal sex, and men living with HIV. This formative study included in-person interviews with 26 GBMSM from three U.S. cities heavily impacted by the HIV epidemic-New York City, Detroit, and Atlanta. Results: Following a qualitative content analysis, the study team identified five themes across the interviews: participant reactions to the video messages, message comprehension, PrEP concerns, targeting of video messaging, and prompted action. Conclusions: Study results informed a final selection of 12 video messages for inclusion in a randomized controlled trial of M-Cubed. Findings may serve as a guide for researchers who plan to develop HIV prevention interventions that utilize publicly available videos to promote behavioral change. Further, the findings presented here suggest the importance of developing videos with broad age and gender diversity for use in interventions such as M-Cubed, and in other health promotion settings.