February 27, 2010 Jen Hecht, STOP AIDS Project

1. Preferences for interventions to reduce HIV and STD transmission online among San Francisco MSM: results from one study February 27, 2010 Jen Hecht, STOP AIDS Project Dan Wohlfeiler, CA STD Control Branch/CA STD/HIV Prevention Training Center Coco Auerswald,UCSF H. Fisher Raymond, SFDPH Funded by California HIV/AIDS Research Program

2. What we’ll cover here • Focus groups and surveys of MSM in San Francisco – implications for practice • Introduce you to a national survey • Show you ads from our upcoming survey

3. Our goal To come up with interventions that customers want to participate in (or may benefit from even if they don’t participate in them), that website/venue owners want to implement, that public health believes will work, and that don’t depend on ongoing funding.

4. Background for WHERE study • We’re not successful enough at reducing transmission among MSM • Many of us don’t want formal prevention efforts • We asked MSM: • which interventions they currently use, • what they would like to see, and • whether they would use new strategies

5. Percentage of MSM using HIV-prevention services or programs during past 12 months, by venue – US NHBS, 2003-2005 Sanchez T, Finlayson T, Drake A, Behel S, Cribbin M, Dinenno E, Hall T, Kramer S, Lansky A; Centers for Disease Control and Prevention (CDC). Human immunodeficiency virus (HIV) risk, prevention, and testing behaviors--United States, National HIV Behavioral Surveillance System: men who have sex with men, November 2003-April 2005. MMWR Surveill Summ. 2006 Jul 7;55(6):1-16.

6. Networks and risk • Sexual networks are connections between people based on sexual relationships • HIV risk is both about individual factors – such as condom use – and location in a network • Prevention needs to address both • The internet – and other venues where men go to find partners– have qualities we can leverage to reduce risk

7. What networks can look like online (and what they can do)

8. What SF focus groups said about this: • “Everybody’s just a little bit away from everybody else…if you’re not being careful, it can lead to a serious infection.” • “Six degrees of separation” • “You’re not only sleeping with him, but with everybody he has ever slept with”

9. Six focus groups from WHERE study Held in Summer 2008: • STOP AIDS staff • HIV-positive MSM • MSM under 30 • MSM who only reported safe sex • MSM who reported high risk sex • MSM of color

10. Do you agree or disagree? • It’s easy to find a hook-up in San Francisco. • It’s easy to find a boyfriend in San Francisco. • I find out more about an apartment I’m renting, or a car I’m buying, than I do about a new sex partner.

11. Key themes • Conversations about HIV status with potential partners often aren’t happening • Many men prefer talking about level of risk to HIV status • High degree of agreement that people lied when looking for new partners. (“Isn’t the whole point of going on Craigslist being able to lie?”)

12. The lies we tell • I’m “clean.” • I got tested yesterday. • This is my first time. • I’m single.

13. Conversations about risk are easier than HIV status “…in earlier years, it was positive vs. negative, and now it’s more – barebacking vs. non-barebacking.” (High risk MSM)

14. Automatic reminders to get tested with a link to sites “It’s not invasive…and also the ability to find somewhere near you, if you decide to take action on that message..I think that having that piece built into it is very important.”

15. Implications Guys will disclose information if it doesn’t limit their chances of getting laid Guys want control, not big-brother Guys liked the idea of “looking for safe sex only” Guys like anonymity on hookup sites (vs. links to Facebook, etc)

16. SF Consumers’ Preferences for Search Options on One Websiten = 67

18. Differences between groups • High levels of indifference about many interventions • Guys were more likely to say they liked an idea than to say they would use it • Negative guys liked “looking for protected only” more than positive guys • Few people said they’d use outreach – highest risk guys were least likely

19. Preference for online outreach

20. Preference for “no pnp” option High risk men – more likely to use meth – less likely to check “no pnp.” May suggest that guys are being honest.

21. Next steps Getting in touch with website owners…can you help? • Find out which interventions webmasters want to support and are willing to implement, • Which interventions STD and HIV directors want to invest in • Which interventions guys around the country say they’ll actually use. • Conversations with webmasters are ongoing

22. How we’ll do it • Online national survey funded by amfAR • Webmasters – 12 completed to date; launched November 2009 • STD and HIV directors -- 60 completed to date; launched November 2009 • 3500 website users -- launching shortly

24. THANKS • All the men that participated • Tom Kennedy and STOP AIDS staff and volunteers • Willi McFarland • Alberto Currotto • Bill Woods

25. Thank you! Contact info: Dan Wohlfeiler, dwohlfei@cdph.ca.gov Jen Hecht, jhecht@stopaids.org