HOPE peer educators guide private Facebook groups to improve HIV prevention and testing behaviors.
Peer educators are trained over three 3-hour sessions to deliver HIV prevention and testing information through private HOPE Facebook groups. Peer educators are men who have sex with men (MSM). Peer leader training addresses general information about HIV and epidemiology, discussing sensitive topics, and using social media for communication. Four to six peer leaders are assigned to one HOPE Facebook group of 25-35 MSM. Peer leaders use private messages, private chatrooms, and public post and comment threads to engage with conversation about HIV prevention and testing with their group at least once a week.
HIV risk behaviors
Young Adults (18-30)
Summary: This study demonstrated the feasibility of recruiting and training African American and Latino MSM to be HOPE peer educators. Researchers recruited 16 African American and Latino MSM in the Los Angeles (LA) area using referrals from community outreach groups and social media. Participants were assigned to be peer leaders in HIV prevention groups or general health groups. Participants either received HOPE peer leader training or similar training that was tailored to general health. Surveys assessing general knowledge of HIV and general health, experience with social media, and comfort using social media for outreach were administered before and after training to evaluate whether participants were qualified to be HOPE peer leaders. Scores for knowledge of general health and HIV were above a passing level (above 70% correct) before training and there were no significant differences between scores before and after training. Most participants were comfortable using social media for communication before training and after training all participants reported being comfortable with using social media for communication. Finally, most participants reported they were comfortable discussing most sensitive topics; the proportion of participants who reported being comfortable discussing sexual positions increased from before training (43.75%) to after training (93.33%).
Take Away: HOPE peer leader training may improve comfort discussing some sensitive topics over social media, but intensive training is unnecessary because peer leaders were often qualified before training.
Summary: Researchers used online and community outreach to recruit and randomize 112 MSM living in LA into one of two HOPE Facebook groups or two Facebook groups targeting general health for 12 weeks. Recruitment targeted African American and Latino MSM, but after recruiting 70% of the sample, researchers opened recruitment to other MSM. Researchers also recruited 16 African American and Latino MSM referred from community organizations to be peer leaders. Groups included four peer leaders and 28 participants. Peer leaders were asked to communicate with their group at least once a week and record their interactions with participants. Participants could choose their level of involvement after joining their group. Participants could receive one free HIV testing kit during the study and received monthly reminders to request a kit. Researchers tracked participants’ testing kit requests, returns, and result follow-ups. Participants completed assessments of social media use, comfort with discussing sensitive topics online, and HIV risk and health behaviors at baseline and post-intervention. Significantly more participants in the intervention group (44%) requested an HIV testing kit than in the control group (20%). Rates of returning and following-up on the HIV tests were low. Nine of the 25 intervention group participants who requested a test returned it, and eight of those followed-up about results. Two of the 11 control group participants who requested a test returned it, and none of them followed-up about results.
Take Away: Private Facebook groups guided by HOPE peer leaders may improve African American and Latino MSM’s HIV testing behavior.
The HOPE social media intervention for global HIV prevention: A cluster randomized controlled trial in Peru.
Summary: In this 12-week randomized controlled trial of HOPE in Peru, researchers recruited 556 MSM who lived in Lima, Peru and were HIV negative or of unknown HIV status using online advertisements. Additionally, researchers recruited 34 MSM referred by staff at a community organization for gay men based on their rapport with MSM at the organization. Participants in the intervention group (n=278) joined one of four HOPE Facebook groups of 28-32 participants and four to six peer leaders each, but would choose their subsequent levels of engagement with the group. Participants in the control group (n=278) received usual HIV prevention and testing services provided by local organizations and were asked to join unguided Facebook groups. Participants could receive one free HIV test during the intervention period and received monthly reminders of this opportunity. Peer leaders recorded their communication with their HOPE groups and engagement from participants. Participants completed assessments of their internet and social media use, sexual health behaviors, and risk behaviors at baseline and post-intervention (12 weeks). Participants in the intervention group were 2.79 and 2.61 times, respectively, more likely than the control group to request an HIV test and get tested for HIV.
Take Away: HOPE Facebook groups may improve HIV testing behaviors in Peruvian MSM.
Summary: Researchers analyzed publicly posted messages in the HOPE Facebook groups (n=57) during the LA-based HOPE trial. Researchers thematically coded 485 conversations posted to HOPE group pages and compared themes to participant outcomes. Researchers coded posts as relating to HIV and knowledge, HIV and stigma, HIV and culture, HIV advocacy, HIV-STI prevention and testing, MSM culture, or general conversation. Friendly conversation made up more than half (59%) of conversations. Otherwise, the most common topic was HIV-STI prevention and testing (15%). Other conversations were about MSM culture (12%), HIV and knowledge (6%), HIV and stigma (4%), and HIV advocacy (3%). HIV and culture made up less than one percent of conversations (0.2%). Over the course of the 12-week study, participants increased conversations about HIV testing and prevention and decreased general conversation. Participants who requested an HIV testing kit participated in HIV-related conversations more than other participants, but participation in friendly conversation did not differ by HIV testing kit requests.
Take Away: Conversations about HIV in HOPE Facebook groups may promote HIV testing among group members
Ethical issues in using social media to deliver an HIV prevention intervention: Results from the HOPE Peru study.
Summary: Researchers contacted participants from the intervention and control groups of the HOPE Peru study and recruited the first 211 participants who would respond to take a one-year follow-up survey. The survey assessed comfort with and understanding of the recruitment, informed consent, intervention, and post-intervention procedures during the study and their perceived benefits of participating in the study. Participants were also asked about the extent to which they felt participating benefited their health care, friendships, knowledge, daily lives, and HIV testing and prevention behaviors. The intervention group reported being significantly more comfortable with the Facebook group and communicating over Facebook and significantly more likely to have safe sex and get tested for HIV than the control group. Participants in the intervention group also were significantly more likely to report improved HIV care and having learned where to receive sexual health services as a result of participating in the study.
Take Away: Participating in HOPE Facebook groups may result in improved HIV prevention and testing behaviors and service access compared to a control group one year after participating in the group.
Project HOPE: Online social network changes in an HIV prevention randomized controlled trial for African American and Latino men who have sex with men.
Summary: Researchers recorded friendships between HOPE trial participants, based on screenshots of lists of Facebook friends before and after their participation in the Los Angeles-based HOPE trial. Using data about connections between participants through Facebook, researchers examined how participants’ social networks changed between before and after they participated and how these social networks were related to HIV prevention and testing outcomes. At baseline, most social ties connected HOPE peer leaders to members of their group, as peer leaders friended members of their group for the study. At follow-up within-group ties between multiple group members and between group members and peer leaders increased in the intervention and control groups. There was a significant positive relationship between numbers of network ties and using social media to talk about sexual behaviors and partners in the intervention group.
Take Away: The connections gained through HIV prevention and testing-focused Facebook groups may encourage members to discuss sexual behaviors and practices over social media.
Feasibility of recruiting peer educators to promote HIV testing using Facebook among men who have sex with men in Peru.
Summary: Researchers recruited and trained 34 MSM living in Lima, Peru to be peer leaders for Peruvian HOPE Facebook groups. Peer leaders were recruited from a group of MSM who were active members of a gay-serving community organization. Training for the peer leaders included information specific to Peru (e.g. epidemiology, treatment sites). Peer leaders completed evaluations of knowledge of HIV, experience with using Facebook for communication, and comfort with using Facebook for discussing sensitive topics before and after training. Peer leaders had to score above 70% on HIV knowledge questions and report being at least comfortable with using Facebook to discuss sensitive topics to be considered qualified to be a HOPE peer leader. Peer leaders met requirements for knowledge of HIV and comfort with using Facebook prior to training and there were no significant differences between pre- and post-training assessments. Most peer leaders reported being comfortable using Facebook to discuss sensitive topics on the post-training assessment and there were significant increases in percentages of peer leaders who reported feeling comfortable discussing sexual partners and sexually transmitted infections between the pre- and post-training assessments.
Take Away: Training Peruvian MSM to peer leaders in Facebook groups for discussing HIV and prevention may improve their levels of comfort with discussing sensitive topics over Facebook.
Summary: HOPE trial participants were asked to refer their African American and Latino Facebook friends with whom they had been sex partners to researchers to complete a survey. The survey assessed internet and social media use, the HIV risk behaviors, and whether HOPE trial participants had discussed the HOPE intervention and health behaviors with them. Researchers completed descriptive analyses of HOPE trial participants and referred participants and completed statistical analyses to compare HOPE trial participants who provided referrals and those who did not. Researchers were contacted by 67 people referred by 15 HOPE participants, 44 referred participants consented and completed the survey. Most HOPE trial participants who provided referrals had been in the intervention group during the trial (66.7%). HOPE trial participants who provided referrals spent significantly more time online than participants who did not provide referrals. More than half of referred participants spent more than three hours online a day (54.5%). The majority of referred participants reported discussing the HOPE trial (61.4%) and health behaviors (54.5%) with a HOPE trial participant. Referred participants also reported being slightly more likely on average to change their health behaviors after talking to the HOPE trial participant than before talking to the participant.
Take Away: HOPE Facebook groups and health information can be disseminated through members’ social networks, particularly among members and their social connections who spend more time online.