Strategies to reduce STD and HIV transmission among men who meet partners online have typically been created without consultation with website owners or users. The public health field has relied heavily on behavioral interventions, and has not fully leveraged the internet’s assets in disseminating information efficiently, or helping men who have sex with men (MSM) make informed choices about their partners. The lack of coordinated approaches between website owners and public health has had negative consequences for both website owners and public health efforts and strained relationships between them.
To help build consensus about how to prioritize interventions, we wanted to identify potential interventions and strategies that have the support of the owners of dating and hook-up websites used by gay, bisexual and trans men; the users themselves, and HIV/STD directors in the United States. We developed a list of 41 behavioral and structural online prevention strategies by reviewing current websites, literature, and conducting focus groups. We asked website owners (n=18) about their willingness to participate in, or support these strategies; users (n=3050) about their willingness to use them; and HIV/STD directors (n=82) about their perceptions of their potential impact on HIV/STD transmission.
A majority of all three stakeholder groups expressed high levels of support for eight strategies. These included allowing users to filter partners by their profile information; including a specific sub-section or chat room of a website for men with specific sexual interests (“safe sex only,” “barebacking,” “HIVpositive”, etc.); including safe sex preferences as a profile option; access to sexual health experts; access to sex-positive videos, showing men dealing with issues like safe sex, telling someone their HIV status, or related issues; an online STD testing directory searchable by zip code; automatic reminders at intervals of users’ choice to get tested; and e-cards to notify partners of a potential exposure to an STD.
By moving ahead on the eight behavioral and structural strategies on which all stakeholders agreed, STD and HIV prevention efforts will be more consistent across websites, hopefully resulting in greater utilization of prevention strategies by users, and better utilization of resources. Website owners and public health directors will be better able to develop productive partnerships. Data about user willingness may also be helpful in finding areas of agreement regarding strategies that website owners are currently less likely to support, and provide guidance as to how to modify them in ways that will be accepted by all.