This project proposes to reconfigure traditional HIV prevention intervention mechanisms to better serve young men who have sex with men (YMSM), whose social and sexual patterns are increasingly shaped by social networking. Drawing on the Information Motivation Behavior model and the principles of Motivational Interviewing (MI), this project will engage HIV-negative YMSM (ages 18-29) in an intervention intended to impact their readiness to change behaviors that put them at risk for HIV infection, namely drug use and sexual risk. The proposed project is a modification of an existing intervention (the Young Men's Health Project or YMHP), in which 24% of those who consented to participate in longitudinal assessments declined participation in the intervention component. This group reported significantly more sexual risk behaviors than intervention participants, however, did not find our current mode of intervention delivery - four weekly office visits with a trained counselor - to fit their lifestyle or preferences. In response to pilot data collected from these participants, the proposed project adapts the existing intervention to support changes in (1) the intervention tailoring process (incorporating key informant feedback instead of delivering solely researcher-designed sessions) and (2) the space in which the intervention takes place (online rather than face-to-face). The study will iteratively adapt and pilot-test the existing face-to-face intervention for delivery through social networking sites, such as Facebook, to increase engagement of high-risk YMSM, who have been difficult to enroll in traditional intervention efforts. This pilot study entails a two-phase process. During Phase I, 15 former YMHP participants (intervention decliners and those who only completed one session) will participate in focus groups to advise us on the feasibility and pragmatic specifications of an HIV prevention intervention received via the instant messaging (IM) function of Facebook. Transcripts of these focus groups will be examined to isolate key recommendations for modifying the delivery modality, structure, and procedures. Once the intervention is modified, the focus groups will be reconvened for additional feedback, from which we will further adjust the intervention. During Phase II, 30 high-risk YMSM (ages 18-29) who are Facebook users will be enrolled in a pilot of the modified intervention. The intervention will span 4 weeks and contain 8 bi-weekly 30 minute MI chat-window sessions consisting of a sequential progression of intervention approaches tailored to each participant's readiness to change their drug use and high risk sexual behavior. Data from Phase II will include pre-post intervention behavioral risk assessments, as well as individual interviews with all 30 intervention participants for a qualitative evaluation regarding the feasibility and acceptability of the intervention's process, structure, and content. The proposed design provides an ideal forum to develop, implement, and iteratively fine-tune a pioneering, interactive intervention delivered via social networking, which will in turn set the stage for a larger efficacy trial.
Findings from the proposed study will inform existing HIV prevention interventions for high-risk drug-using young men who have sex with men (YMSM), in order to make them more acceptable, culturally appropriate, and accessible to this population. This iterative modification of a face-to-face intervention to be delivered via social networking will facilitate more successful recruitment of hard-to-engage HIV-negative behaviorally risky YMSM. This model has tangible benefits to sexual risk and drug use reduction efforts nationally as it (1) provides a pragmatic alternative to the traditional face-to-face intervention model, (2) facilitates engagement with a wider, more diverse pool of high-risk YMSM, including underserved rural populations, and (3) provides a feasible and culturally acceptable protocol for online intervention trials among high-risk YMSM to public health/service agencies, allowing them to circumvent budget, time and staffing constraints.
