Socio-Technical Environments and HIV Risk Reduction Behaviors among Black Gay Men

1. The Influence of Socio-Technical Environments on the Information Behaviors and HIV Risk Reduction Behaviors of Black Gay Men Megan Threats, MSLIS, Ph.D. Candidate University of North Carolina at Chapel Hill May 29, 2019 329 Health Sciences Library

2. Abstract Young Black men who have sex with men (YBMSM) are disproportionately affected by the HIV epidemic. Recent studies suggest that telehealth modalities are opportune for delivering tailored, culturally-sensitive HIV/STI prevention and treatment interventions. Telehealth modalities, including smartphone applications, offer the opportunity to reach YBMSM who may be difficult to access by traditional means such as in-person, venue-based interventions. To improve our understanding of the potential efficacy of technology-based HIV/STI interventions among YBMSM, this study investigates how and where YBMSM access and interact with HIV/STI-related information. An online survey and semi-structured, in-depth interviews were used to explore and explain the associations between information behavior, technology usage, and HIV risk reduction behaviors among YBMSM.

3. Background • Gaps • Research Questions • Review of Literature • Theoretical Framework • Methods • Anticipated Outcomes and Implications OUTLINE

4. Background Disproportionate burden of HIV infection • 1 in 2 Black MSM will be diagnosed in their lifetime • HIV diagnoses increased 30% among YBMSM aged 25-34 Undiagnosed HIV infection • Infected, yet unaware • Late diagnosis of HIV infection • Delayed and infrequent screening for HIV infection

5. Background Sexual and drug-related risk behaviors • Do not adequately explain HIV/STD disparities • YBMSM report similar (and at times, lower) rates of engagement as other MSM HIV protective and risk reduction behaviors • Never or infrequent STD testing • Failing to treat STDs • Low PrEP initiation and adherence

6. HIV/STD information behaviors • Information seeking • Information encountering • Information use Application of information science-based models and conceptual frameworks to HIV behavioral research Gaps

7. Sexual health decision-making • Use of HIV/STD information acquired to make decisions about the adoption of HIV protective and risk reduction behaviors Motivators of HIV/STI screening Gaps Photo: Shutterstock

8. Phenomenon of Interest The relationship between socio-technical environments, HIV/STI information behaviors and the adoption of HIV protective and risk reduction behaviors among YBMSM

9. Research Questions Where do YBMSM seek HIV/STD information? Where do YBMSM encounter HIV/STD information? Where are they exposed to HIV/STD information? What are motivators of HIV and STI screening among YBMSM?

10. Research Questions What are deterrents of HIV and STI screening among YBMSM? What are motivators of pre-exposure prophylaxis use among YBMSM? What are deterrents of pre-exposure prophylaxis use among YBMSM?

11. Research Questions How do YBMSM use HIV/STD information? • Have they used HIV/STD information to make a decision about obtaining HIV testing or testing for other STDs? How? • Have they used HIV/STD information to make a decision about asking sexual partners or friends to obtain HIV testing or STD testing? • Have they used HIV/STD information to obtain HIV testing and/or STD testing?

12. Research Questions How do YBMSM use HIV/STD information? • Have they used HIV/STD information to begin taking PrEP? • Have they used HIV/STD information to adopt other HIV protective and risk reduction behaviors? (e.g. - treatment of STDs; discussing or disclosing status to partners) How?

13. Empirical studies of information behaviors HIV/STD information seeking • YBMSM - Kingdon et al., 2013; Muessig et al. 2013; Mustanski et al., 2011; Voisin et al., 2013 • Black youth - Dolcini et al., 2015; Veinot et al., 2013 HIV/STD information encountering/use • Dolcini et al. 2015; Jones & Biddlecom, 2011; Stevens et al., 2017; Veinot et al., 2013 • Y(B)MSM - Hussen et al., 2013; Meadowbrooke et al., 2014; Young et al. 2014

14. Information Behaviors • Information seeking • Information encountering • Information use • Applying information • Effects of information Theoretical framework

15. METHODS

16. Data Collection • Survey (online, self-administered) • Semi-structured, in-depth interviews Mixed Methods Sequential explanatory design

17. Qualtrics • Mobile-friendly • Branching logic • Skip logic • Multiple choice • Text entry Online Survey

18. Remote • Zoom platform • Google voice • Explains the how and why Interviews Semi-structured, in-depth

19. Confidentiality • NIH Certificate of Confidentiality • Surveys labeled by identification number (password encrypted) Data Privacy Consent and Confidentiality

20. Sample Inclusion criteria • Black or African American • A man who has had sex with other men • Aged 18-34 • Reside in the state of North Carolina • Legally able to provide informed consent Exclusion criteria • No legal autonomy to provide informed consent • Another adult holds guardianship

21. Sample Survey Sample • N = 164 • Participants who consent to be recontacted for interviews will be sent to separate survey Interview Sample • N = 25 • Sample derived from survey respondents • 18-24 • 25-34 • HIV negative • Living with HIV

22. UNC Chapel Hill Research Studies • HealthMpowerment.org study • UNC Center for AIDS Research • Getn2Matrix Recruitment

23. Recruitment Community-Based Organizations • Triad Health Project • RAIN, Inc. • Alliance of AIDS Services North Carolina • Western North Carolina AIDS Project • PowerHouse Project • Carolinas CARE Partnership • Triangle Empowerment Center • Charlotte Pride Public Health Health Clinics • Durham County Department of Public Health • Eastowne Family Physicians • Rural Health Group North Carolina • Lincoln Community Health Center • Duke PrEP Clinic for HIV Prevention • Wake County Public Health Clinic

24. Recruitment LGBTQ Centers • Duke Center for Sexual and Gender Diversity • Wake Forest LGBTQ Center • LGBTQ Center of Durham University Organizations • UNC Black Graduate and Professional Student Association

25. Social Media Recruitment TWITTER INSTAGRAM TINDER https://www.instagram.com/STINFO_behavior/

26. Incentives Amazon eGift Cards

27. Recruitment Online recruitment; Flyers; Face-to-face; Snowball and quota sampling Survey Consent; online, self-administered; target sample: n= 164 Data analysis Descriptive and inferential statistical analysis of survey data Interviews Remote; survey respondents; target sample: n=25 Data analysis Thematic analysis; drawing conclusions; conceptual model building

28. Conceptual Model Building

29. Memoing Memoing immediately after each interview. Send interview notes to participants Line-by-Line In vivo; codes emerge from data; ask questions, prelim categories Focused Codes that explain large chunks of data. Codes compared across data sources Axial Defining categories and their relationships; assign emergent codes to concepts for model Conceptual model Constant comparative method; theoretical saturation; conceptual integration

30. Validity, Reliability, and Rigor Study Design • Best fit for exploring the phenomenon • Data collection procedures complementary • Sampling strategies for recruiting YBMSM • Sequential explanatory - explain and elaborate on process of seeking, encountering, and using HIV/STD information to make HIV protective and risk reduction behavior decisions

31. Validity, Reliability, and Rigor Interpretive Rigor • Mixed methods design to strengthen weakness of using either solely survey or interview data • Constant comparative method

32. Validity, Reliability, and Rigor Content Validity • Panel of experts (dissertation committee members and information behavior researchers) to review survey items Face Validity • Data collection instruments pilot tested with small sample of YBMSM

33. Validity, Reliability, and Rigor Construct Validity • Survey measures adapted from three survey instruments • Health Information National Trends Survey • National HIV Behavioral Surveillance Questionnaire • Meadowbrooke et al. 2014

34. Validity, Reliability, and Rigor Credibility Strategies • Member checking • Peer debriefing

35. HIV/STI information behaviors HIV/STI testing behavior PrEP usage The relationship between HIV/STI information behaviors and the adoption of HIV protective and risk reduction behaviors Conceptual model Recommendations for the design of HIV prevention interventions, sexual health promotion campaigns, and HIV/STD information materials and resources Anticipated outcomes and implications

36. Questions?

37. Empirical studies of information behaviors HIV/STD information seeking • YBMSM seek information from family, friends, the Internet, school, mass media, community organizations, gay bars, the LGBT community HIV/STD information sought • HIV testing locations • General HIV/AIDS information • HIV/STI treatment information

38. Empirical studies of information behaviors Online HIV/STD information seeking • Mobile phones and computers • Search engines (e.g., Google) • Consumer health information websites (e.g., WebMD)

39. Empirical studies of information behaviors HIV/STI information encountering • Online advertisements (including social networking sites) • Online, while conducting searches for other information • Information shared by friends on social media sites HIV/STI information use • Intention to use HIV/STD information to make HIV testing decisions • Using information encountered to obtain HIV testing

40. Empirical studies of information behaviors HIV/STD information encountering • Internet • Bar/Club • Print media (magazine; brochures) • Clinic or doctor’s office • Community center or agency