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HIV Prevention and Care in the Digital Age

Chiasson, Mary Ann DrPH*†; Hirshfield, Sabina PhD*; Rietmeijer, Cornelis MD, PhD

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 15th, 2010 - Volume 55 - Issue - p S94-S97
doi: 10.1097/QAI.0b013e3181fcb878
Supplement Article

Objectives: To describe the technologic advances in the digital media, including computers, mobile phones, and the Internet, that have greatly expanded opportunities to deliver evidence-based HIV education, prevention, and treatment programs.

Methods: This article examines the use of digital media in the United States and its potential role in HIV prevention and care.

Results: Although the “digital divide” is shrinking, access varies by age, race/ethnicity, and education. The Internet is an important medium for delivering universal and targeted HIV education and prevention, especially for men who have sex with men, who report going online to seek health information online and for social and sexual networking. Online and off-line behavioral interventions using digital media range from computerized multimedia interventions that take into account individual behaviors to brief untailored video interventions. Numerous Web sites facilitate access to care by providing a variety of services, including location of and linkage to HIV testing and treatment sites. HIV treatment and adherence programs that use online medical records text messaging, paging, and tablet computer-based counseling tools are also being developed.

Conclusions: HIV prevention and care programs using digital media have great potential to cost-effectively meet the complex needs of diverse and often underserved populations living with or at high risk of HIV.

From the *Research and Evaluation, Public Health Solutions, New York, NY; †Division of Infectious Diseases, Columbia University Medical Center, New York, NY; and ‡Internet and STD Center of Excellence, Denver Public Health Department, Denver, CO.

Supported in part by the Centers for Disease Control and Prevention and the Association for Prevention Teaching and Research Cooperative Agreement No. 5U50CD300860-21, Project TS-1400.

Presented in part at the CDC National STD Prevention Conference (C.R.), March 8-11, 2010, Atlanta, GA; CDC National HIV Prevention Conference (S.H.), August 23-26, 2009, Atlanta, GA; CDC National HIV Prevention Conference (M.A.C.), December 2-5, 2007, Atlanta, GA.

The authors report no conflicts of interest to disclose.

Correspondence to: Mary Ann Chiasson, DrPH, Research and Evaluation, Public Health Solutions, 220 Church Street, 5th floor, New York, NY 10013 (e-mail: machiasson@healthsolutions.org).

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INTRODUCTION

Technologic advances in digital media, including computers, mobile phones, and the Internet, have revolutionized the way we communicate with each other, both personally and professionally. The transformation of the Internet from Web 1.0 as a unidirectional information source to the interactive and participatory Web 2.0 has important implications for HIV transmission, HIV education and prevention, and medical management of HIV. The Internet's borderless geographic and demographic social networks and equally limitless possibilities for interventions have the potential to change both community norms and individual behavior cost-effectively.

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DISCUSSION

Who's Online

In 2010, most adults (77%) and nearly all teenagers (93%) in the United States are online.1,2 Overall, 41% of Americans use social networking sites with the greatest use (75%) reported by those between 18 and 29 years of age.1 This group also leads in the use of mobile phones (94%) and texting: 88% text, and of these, 80% texted a median of 20 times during the past 24 hours.1 Yet even within this group, there are variations by race/ethnicity and education, despite the high usage levels. Whites are more likely to use the Internet (95%) than blacks (91%) or Hispanics (73%), and those with some college (96%) are more likely to be online than those without (83%),1 suggesting that the digital divide is closing. However, disparities are still seen among 18-29 year olds who create profiles on a social networking site: whites (83%), blacks (71%), Hispanics (52%), and those with some college (86%), compared with only 59% of those with no college.1 The limited data available on Internet access among those living with HIV show similar disparities by race/ethnicity and education but far lower overall rates. Only about the half report ever using the Internet (P. Messeri, MD, personal communication, June 21, 2010).3 Not surprisingly, active drug use, poverty, and homelessness are associated with very low rates of Internet access4; text messaging may be an effective way to contact such difficult-to-reach populations.5

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Seeking Sex Online and HIV Risk

Most studies of the relationship between Internet use and sexual behavior have focused on gay, bisexual, and other men who have sex with men (MSM) because they account for the majority of newly reported HIV-infected population in the United States6 and frequently seek sexual partners online.7 Most population-based studies do not compare the prevalence of seeking sex online by gender and sexual orientation.8 Community-based studies have found that MSM are more likely to seek sex partners online than gay women and heterosexual men and women.9-12 High-risk sexual behavior observed in online studies largely reflects the risk-taking profile of individuals who choose to seek sex partners both online and off-line and is not associated with the Internet per se.10,12-17 Manhunt (www.manhunt.net) and Adam4Adam (www.adam4adam.com) are 2 of the largest Web sites for MSM seeking sex partners in the United States and abroad. Manhunt members can send e-mails, text messages, and instant video messages to potential partners. Adam4Adam members can locate potential partners through “Plan-a-Trip” before they reach their destination. MSM who meet sex partners online report more sex partners,18-21 sex with casual partners,18-21 and more unprotected anal intercourse,22 although their behavior is similarly risky with partners met off-line.14-16,23 Thus, those meeting partners online can expand their sexual networks, thereby increasing the potential for transmission of HIV and other sexually transmitted infections (STIs).7,24,25

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Health Education Online

Many Americans search for health information online, with 75% of all adults and 28% of all teens online reporting this activity.2 At best, the Internet may provide access to the most current and most scientifically accurate information available on all aspects of HIV/AIDS, from risk factors for transmission and acquisition to early signs and symptoms to HIV testing and treatment. There are numerous sites targeting both professional and lay audiences. Two recently published studies provide comprehensive assessments of national and international HIV/AIDS resources online for clinicians and researchers that include sources for treatment guidelines, disease management, and continuing medical education.26,27

Web sites such as The Body (www.thebody.com) and POZ (www.poz.com) are dedicated to education and clinical information on HIV/AIDS testing, diagnosis, treatment, and prevention for consumers and include access to experts, forums, blogs, and other digital media. In addition to traditional informational Web sites, a number of interactive safer sex educational Web sites, many targeted to teens,28 and nontraditional sites, such as “Kicesie's Sex Ed-What They Don't Teach You In School” on YouTube,29 have been developed. For young gay men, the Internet fills an important unmet need for sexual health education and support during the coming out process, although it can also expose them to homophobic messages.30 Despite this ready access to information, separating disinformation from scientific fact can be difficult even for the most experienced searcher. Unsurprisingly, therefore, the Internet is also a fertile field for AIDS denialists (those who deny that HIV causes AIDS) and proponents of unproven treatments for HIV.

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Expanding Access to Care

The Internet can facilitate the diagnosis and treatment of HIV and other STIs through Web sites that provide education and information about the location of community-based testing and clinic-based HIV and STI services (eg, www.hivtest.org). Web-based,31-33 text,34 and instant messaging35 programs have also been developed to educate and encourage testing through clinic referrals, preprinted laboratory requisition slips, and provision of online access to STI test results.36 In addition, Internet sex partner notification for STI exposure is proving to be acceptable to MSM,37 and Internet-based partner notification programs have been developed,38 although the effectiveness of the latter has not been demonstrated.39,40

Self-collection kits for mail-in testing for HIV41 and a number of other STIs and home test kits can be purchased online, although the cost of kits from commercial sites can be high.42 Self-collection kits for mail-in STI testing are also available from public health Web sites in some geographic areas.43 HIV and STI self-collection kits for mail-in testing and home testing are appealing to many for reasons of both privacy and convenience.41,44,45 However, a recent study found that consumer services available from commercial Web sites may be poor and testing accuracy may be variable: Although mail-in specimen test results were highly accurate, home tests were often inaccurate.42

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Improving HIV Treatment and Adherence

The Internet and development of Web-based applications have had a major impact on medical record keeping and access to medical records by patients. Web-based electronic records can be shared easily by all who need access, including medical care providers and the patient. Using industry-standard software to protect the confidentiality of information, Web-based electronic medical records offer the timely and active sharing of test results. The sharing of STI test results online is a promising development that not only enhances patients' access to their test results but also may improve treatment outcomes.31,36 Likewise, the provision of HIV viral load and CD4 test results online, including trends over time, could provide the patients with important tools in managing their illness. Because adherence to antiretroviral treatment is critically important in adequately suppressing HIV in infected individuals and preventing the emergence of resistant HIV strains, there has been considerable interest in developing adherence interventions. One such intervention used an Internet-based paging system to improve adherence among patients who had failed more traditional off-line adherence systems46; another piloted the use of a tablet computer-based counseling tool to improve adherence and to reduce secondary transmission of HIV in an HIV-infected population with mixed computer use experience.47

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Behavioral Interventions Off-line and Online Using Digital Media

HIV/STI behavioral interventions using digital media have been developed in many forms, ranging from complex computer-tailored multimedia interventions that take into account individual behaviors and stages of change to brief untailored video interventions.28,48-50 Interventions using digital media are appealing because they can be delivered consistently either alone or in combination with more traditional counseling modalities and in a variety of settings, either in person via computer or video in clinics, social service agencies, and schools51-57 or electronically via text messaging,58 handheld computers,2 or online.59-68 Effective HIV prevention interventions that use digital media are likely to be highly cost-effective because they are easily replicated after development, require minimal staffing, and have unlimited geographic reach.69

The development of online HIV prevention interventions of proven efficacy is an area of intensive research, although it lags far behind online interventions for smoking,70 obesity,71 and mental72 and physical health problems.73 Of the 7 published randomized trials of intensive individual-level online HIV behavioral interventions primarily targeted to MSM, 5 have demonstrated some reduction in 1 or more HIV risk behaviors,60-62 an increase in HIV testing,63 or short-term increases in knowledge, self-efficacy, and outcome expectancies.64 Two trials reported no changes in behavior,65,66 attributable to a variety of factors, including loss to follow-up, participant fatigue, technical problems, Internet connection speed, single-session intervention, and content not tailored to all outcomes or study populations. Preliminary efficacy studies using soap opera video delivery to handheld computers,2 online dramatic video,59,67 chat room,68 and mobile phone texting58 interventions have also been published in addition to findings from a brief physician e-mail intervention to reduce at-risk adolescents' display of risk behavior on a social networking Web site.74

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FUTURE DIRECTIONS

A new generation of HIV prevention interventions is needed to stem the tide of infections in the United States. Digital media are increasingly being used in all aspects of HIV prevention and care to meet the complex needs of diverse and often underserved, vulnerable populations worldwide.75 Effective evidence-based approaches using digital media have the potential to play an important role in achieving the goals of the National HIV/AIDS Strategy for the United States76 in the future; translation of existing evidence-based interventions into digital media formats and development of new effective interventions that capitalize on the technologic advances in digital media are both a priority.

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REFERENCES

1. Taylor P, Keeter S, eds. Millennials: A Portrait of Generation Next: Confident. Connected. Open to Change. Washington, DC: Pew Research Center; 2010:25-38. Available at: http://pewsocialtrends.org/assets/pdf/millennials-confident-connected-open-to-change.pdf. Accessed August 10, 2010.
2. Jones S, Fox S. Generations Online in 2009. Pew Internet Project Data Memo. Washington, DC: Pew Research Center; 2009. Available at: http://www.pewinternet.org/Reports/2009/Generations-Online-in-2009.aspx. Accessed July 8, 2009.
3. Shacham E, Stamm K, Overton ET. Can you hear me now? Limited use of technology among an urban HIV-infected cohort. AIDS Care. 2009;21:1000-1006. doi:10.1007/s10461-009-9652-9.
4. Redpath DP, Reynolds GL, Jaffe A, et al. Internet access and use among homeless and indigent drug users in Long Beach, California. Cyberpsychol Behav. 2006;9:548-551.
5. Maher JE, Pranian K, Drach L, et al. Using text messaging to contact difficult-to-reach study participants. Am J Public Health. 2010;100:969-970. doi:10.2105/AJPH.2009.188391.
6. Hall HI, Song R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA. 2008;300:520-529.
7. Liau A, Millet G, Marks G. Meta-analytic examination of online sex-seeking and sexual risk behavior among men who have sex with men. Sex Transm Dis. 2006;33:576-584.
8. Princeton survey research associates international for the Pew Internet & American Life Project 2010. Available at: http://pewinternet.org/Reports/2010/Mobile-Access-2010.aspx. Accessed August 10, 2010.
9. Lever J, Grov C, Royce T, et al. Searching for love in all the “Write” places: exploring Internet personals use by sexual orientation, gender, and age. Int J Sex Health. 2008;20:233-246.
10. Bolding G, Davis M, Hart G, et al. Heterosexual men and women who seek sex through the Internet. Int J STD AIDS. 2006;17:530-534.
11. Rietmeijer C, Bull S, McFarlane M, et al. Risks and benefits of the Internet for populations at risk for sexually transmitted infections (STIs): results of an STI clinic survey. Sex Transm Dis. 2003;30:15-19.
12. McFarlane M, Kachur R, Bull S, et al. Women, the Internet, and sexually transmitted infections. J Womens Health (Larchmt). 2004;13:689-694.
13. Al-Tayyib AA, McFarlane M, Kachur R, et al. Finding sex partners on the Internet: what is the risk for sexually transmitted infections? Sex Transm Infect. 2009;85:216-220. doi:10.1136/sti.2008.032631.
14. Chiasson MA, Hirshfield S, Remien RH, et al. A comparison of on-line and off-line sexual risk in men who have sex with men: an event-based on-line survey. J Acquir Immune Defic Syndr. 2007;44:235-243.
15. Mustanski BS. Are sexual partners met online associated with HIV/STI risk behaviours? Retrospective and daily diary data in conflict. AIDS Care. 2007;19:822-827.
16. Bolding G, Davis M, Hart G, et al. Gay men who look for sex on the Internet: is there more HIV/STI risk with online partners? AIDS. 2005;19:961-968.
17. Hirshfield S, Remien RH, Humberstone M, et al. Substance use and high-risk sex among men who have sex with men: a national online study in the USA. AIDS Care. 2004;16:1036-1047.
18. Taylor M, Aynalem G, Smith L, et al. Correlates of Internet use to meet sex partners among men who have sex with men diagnosed with early syphilis in Los Angeles County. Sex Transm Dis. 2004;31:552-556.
19. Rosser BR, Miner MH, Bockting WO, et al. HIV risk and the Internet: results of the Men's INTernet Sex (MINTS) Study. AIDS Behav. 2009;13:746-756. doi:10.1007/s10461-008-9399-8.
20. Horvath KJ, Rosser BR, Remafedi G. Sexual risk taking among young Internet-using men who have sex with men. Am J Public Health. 2008;98:1059-1067.
21. Rosser B, Oakes J, Horvath K, et al. HIV sexual risk behavior by men who use the Internet to seek sex with men: results of the Men's INTernet Sex Study-II (MINTS-II) AIDS Behav. 2009;13:488-498. doi:10.1007/s10461-009-9524-3.
22. Hooper S, Rosser BR, Horvath KJ, et al. An online needs assessment of a virtual community: what men who use the Internet to seek sex with men want in Internet-based HIV prevention. AIDS Behav. 2008;12:867-875. doi:10.1007/s10461-008-9373-5.
23. Rhodes S, DiClement R, Cecil H, et al. Risk among men who have sex with men in the United States: a comparison of an Internet sample and a conventional outreach sample. AIDS Educ Prev. 2002;14:41-50.
24. McFarlane M, Bull SS, Rietmeijer CA. The Internet as a newly emerging risk environment for sexually transmitted diseases. JAMA. 2000;284:443-446.
25. Klausner J, Wolf W, Fischer-Ponce L, et al. Tracing a syphilis outbreak through cyberspace. JAMA. 2000;284:447-449.
26. Armstrong WS, del Rio C. HIV-associated resources on the internet. Top HIV Med. 2009;17:151-162.
27. Krakower D, Kwan CK, Yassa DS, et al. iAIDS: HIV-related Internet resources for the practicing clinician. Clin Infect Dis. 2010;51:813-822.
28. Noar SM, Clark A, Cole C, et al. Review of interactive safer sex Web sites: practice and potential. Health Commun. 2006;20:233-241.
29. Rietmeijer CA, McFarlane M. Web 2.0 and beyond: risks for sexually transmitted infections and opportunities for prevention. Curr Opin Infect Dis. 2009;22:67-71. doi:10.1097/QCO.0b013e328320a871.
30. Mustanski B, Lyons T, Garcia SC. Internet use and sexual health of young men who have sex with men: a mixed-methods study. Arch Sex Behav. Epub ahead of print. doi:10.1007/s10508-009-9596-1.
31. Koekenbier RH, Davidovich U, van Leent EJ, et al. Online-mediated syphilis testing: feasibility, efficacy, and usage. Sex Transm Dis. 2008;35:764-769. doi:10.1097/OLQ.0b013e31816fcb0a.
32. Klausner JD, Levine DK, Kent CK. Internet-based site-specific interventions for syphilis prevention among gay and bisexual men. AIDS Care. 2004;16:964-970.
33. Levine DK, Scott KC, Klausner JD. Online syphilis testing-confidential and convenient. Sex Transm Dis. 2005;32:139-141.
34. Levine D, McCright J, Dobkin L, et al. SEXINFO: a sexual health text messaging service for San Francisco youth. Am J Public Health. 2008;98:393-395. doi:10.2105/AJPH.2007.110767.
35. Moskowitz DA, Melton D, Owczarzak J. PowerON: the use of instant message counseling and the Internet to facilitate HIV/STD education and prevention. Patient Educ Couns. 2009;77:20-26. doi:10.1016/j.pec.2009.01.002.
36. Ling SB, Richardson DB, Mettenbrink CJ, et al. Evaluating a Web-based test results system at an urban STI clinic. Sex Transm Dis. 2010;37;259-263. doi:10.1097/OLQ.0b013e3181d3d037.
37. Mimiaga MJ, Tetu AM, Gortmaker S, et al. HIV and STD status among MSM and attitudes about Internet partner notification for STD exposure. Sex Transm Dis. 2008;35:111-116.
38. Levine D, Woodruff AJ, Mocello AR, et al. InSPOT: the first online STD partner notification system using electronic postcards. PLoS Med. 2008;5:e213. doi:10.1371/journal.pmed.0050213.
39. Kerani R, Fleming M, DeYoung B, et al. A randomized controlled trial comparing inSPOT and patient-delivered partner therapy to standard partner notification among MSM: the good, the bad, and the ugly [abstract #91]. Presented at: 2010 National STD Prevention Conference; March 8-11, 2010; Atlanta, GA.
40. Rietmeijer C, Westergaard B, Richardson D. Evaluation of an on-line partner notification program [abstract #A7f]. Presented at: 2010 National STD Prevention Conference; March 8-11, 2010; Atlanta, GA.
41. Frank AP, Wandell MG, Headings MD, et al. Anonymous HIV testing using home collection and telemedicine counseling. A multicenter evaluation. Arch Intern Med. 1997;157:309-314.
42. Owens SL, Arora N, Quinn N, et al. Utilising the internet to test for sexually transmitted infections: results of a survey and accuracy testing. Sex Transm Infect. 2010;86:112-116. doi:10.1136/sti.2009.037226.
43. Gaydos CA, Dwyer K, Barnes M, et al. Internet-based screening for Chlamydia trachomatis to reach non-clinic populations with mailed self-administered vaginal swabs. Sex Transm Dis. 2006;33:451-457.
44. Tebb KP, Paukku MH, Pai-Dhungat MR, et al. Home STI testing: the adolescent female's opinion. J Adolesc Health. 2004;35:462-467.
45. Graseck AS, Secura GM, Allsworth JE, et al. Home screening compared with clinic-based screening for sexually transmitted infections. Obstet Gynecol. 2010;115:745-752. doi:10.1097/AOG.0b013e3181d4450d.
46. Safren SA, Hendriksen ES, Desousa N, et al. Use of an on-line pager system to increase adherence to antiretroviral medications. AIDS Care. 2003;15:787-793.
47. Skeels MM, Kurth A, Clausen M, et al. CARE+ user study: usability and attitudes towards a tablet PC computer counseling tool for HIV+ men and women. AMIA Annu Symp Proc. 2006:729-733.
48. Noar SM, Black HG, Pierce LB. Efficacy of computer technology-based HIV prevention interventions: a meta-analysis. AIDS. 2009;23:107-115. doi:10.1097/QAD.0b013e32831c5500.
49. Lustria ML, Cortese J, Noar SM, et al. Computer-tailored health interventions delivered over the Web: review and analysis of key components. Patient Educ Couns. 2009;74:156-173. doi:10.1016/j.pec.2008.08.023.
50. Marsch LA, Bickel WK, Grabinski MJ. Application of interactive, computer technology to adolescent substance abuse prevention and treatment. Adolesc Med State Art Rev. 2007;18:342-356.
51. O'Donnell C, O'Donnell L, Doval A, et al. Reductions in STD infections subsequent to an STD clinic visit: using video-based patient education to supplement provider interactions. Sex Transm Dis. 1998;25:161-168.
52. Rosser BR, Hatfield LA, Miner MH, et al. Effects of a behavioral intervention to reduce serodiscordant unsafe sex among HIV positive men who have sex with men: the Positive Connections randomized controlled trial study. J Behav Med. 2010;33:147-158. doi:10.1007/s10865-009-9244-1.
53. Warner L, Klausner JD, Rietmeijer CA, et al. Effect of a brief video intervention on incident infection among patients attending sexually transmitted disease clinics. PLoS Med. 2008;5:e135. doi:10.1371/journal.pmed.0050135.
54. Marsch LA, Bickel WK. Efficacy of computer-based HIV/AIDS education for injection drug users. Am J Health Behav. 2004;28:316-327.
55. Chen HT, Grimley DM, Waithaka Y, et al. A process evaluation of the implementation of a computer-based, health provider-delivered HIV-prevention intervention for HIV-positive men who have sex with men in the primary care setting. AIDS Care. 2008;20:51-60.
56. Lightfoot M, Comulada WS, Stover G. Computerized HIV preventive intervention for adolescents: indications of efficacy. Am J Public Health. 2007;97:1027-1030.
57. Roye C, Silverman PP, Krauss B. A brief, low-cost, theory-based intervention to promote dual method use by black and Latina female adolescents: a randomized clinical trial. Health Educ Behav. 2007;34:608-621.
58. Juzang I, Fortune T, Black S, et al. A pilot programme using mobile phones for HIV prevention. J Telemed Telecare. In press.
59. Hirshfield S, Chiasson MA, Scheinmann R, et al. Reduction in HIV transmission risk among HIV+ MSM in an online HIV prevention trial [abstract LB1-3]. Presented at: CDC National HIV Prevention Conference; August 23-26, 2009; Atlanta, GA.
60. Bull S, Pratte K, Whitesell N, et al. Effects of an Internet-based intervention for HIV prevention: The Youthnet Trials. AIDS Behav. 2008;13:474-487. doi:10.1007/s10461-008-9487-9.
61. Carpenter KM, Stoner SA, Mikko AN, et al. Efficacy of a Web-based intervention to reduce sexual risk in men who have sex with men. AIDS Behav. 2010;14;549-557. doi:10.1007/s10461-009-9578-2.
62. Rosser BR, Oakes JM, Konstan J, et al. Reducing HIV risk behavior of MSM through persuasive computing: results of the Men's INTernet Study (MINTS-II). AIDS. 2010;24:2099-2107.
63. Blas MM, Alva IE, Carcamo CP, et al. Effect of an online video-based intervention to increase HIV testing in men who have sex with men in Peru. PLoS One. 2010;5:e10448. doi:10.1371/journal.pone.0010448.
64. Bowen AM, Horvath K, Williams ML. A randomized control trial of Internet-delivered HIV prevention targeting rural MSM. Health Educ Res. 2007;22:120-127. doi:10.1093/her/cyl057.
65. Bull SS, Lloyd L, Rietmeijer C, et al. Recruitment and retention of an online sample for an HIV prevention intervention targeting men who have sex with men: the Smart Sex Quest Project. AIDS Care. 2004;16:931-943.
66. Lau JT, Lau M, Cheung A, et al. A randomized controlled study to evaluate the efficacy of an Internet-based intervention in reducing HIV risk behaviors among men who have sex with men in Hong Kong. AIDS Care. 2008;20:820-828. doi:10.1080/09540120701694048.
67. Chiasson M, Shaw FS, Humberstone M, et al. Increased HIV disclosure three months after an online video intervention for men who have sex with men (MSM). AIDS Care. 2009;21:1081-1089. doi:10.1080/09540120902730013.
68. Rhodes SD, Hergenrather KC, Duncan J, et al. A pilot intervention utilizing Internet chat rooms to prevent HIV risk behaviors among men who have sex with men. Public Health Rep. 2010;125(Suppl 1):29-37.
69. Cohen DA, Wu SY, Farley TA. Comparing the cost-effectiveness of HIV prevention interventions. J Acquir Immune Defic Syndr. 2004;37:1404-1414.
70. Shahab L, McEwen A. Online support for smoking cessation: a systematic review of the literature. Addiction. 2009;104:1792-1804. doi:10.1111/j.1360-0443.2009.02710.x.
71. Enwald HP, Huotari ML. Preventing the obesity epidemic by second generation tailored health communication: an interdisciplinary review. J Med Internet Res. 2010;12:e24. doi:10.2196/jmir.1409.
72. Spek V, Cuijpers P, Nyklicek I, et al. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med. 2007;37:319-328. doi:10.1017/S0033291706008944.
73. Cuijpers P, van Straten A, Andersson G. Internet-administered cognitive behavior therapy for health problems: a systematic review. J Behav Med. 2008;31:169-177. doi:10.1007/s10865-007-9144-1.
74. Moreno MA, Vanderstoep A, Parks MR, et al. Reducing at-risk adolescents' display of risk behavior on a social networking web site: a randomized controlled pilot intervention trial. Arch Pediatr Adolesc Med. 2009;163:35-41. doi:10.1001/archpediatrics.2008.502.
75. Swendeman D, Rotheram-Borus MJ. Innovation in sexually transmitted disease and HIV prevention: Internet and mobile phone delivery vehicles for global diffusion. Curr Opin Psychiatry. 2010;23:139-144. doi:10.1097/YCO.0b013e328336656a.
76. The White House Office of National AIDS Policy. National HIV/AIDS Strategy for the United States. Washington, DC: The White House; 2010. Available at: http://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf. Accessed August 10, 2010.
Keywords:

HIV; Internet; prevention; sexually transmitted infection; computer technology; MSM

© 2010 Lippincott Williams & Wilkins, Inc.