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Online HIV prevention tool reduces STI occurrence

Krystal Madkins

The online interactive intervention for HIV prevention known as Keep It Up! led to significantly lower STI occurrence and a small but significant decrease in condomless anal sex, according to findings recently published in the American Journal of Preventive Medicine.

“Previous studies have relied on self-report of risk behaviors such as condomless anal sex or number of sex partners. Self-report of risk behaviors is susceptible to bias as some participants may not remember exactly how many times they had condomless sex or the number of partners they’ve had. Some participants may also not disclose certain behaviors to researchers because of stigma or wanting to make, in their opinion, a positive impression on the researchers,” Krystal Madkins, MPH, of the Institute for Sexual and Gender Minority Health and Wellbeing at Northwestern University told Healio Family Medicine.

Researchers conducted surveys and performed STI testing through a rectal or urine exam of 901 men aged between 18 and 29 years who have sex with other men, then randomly assigned them in an approximately 1:1 ratio to visit the Keep It Up! website — an intervention that uses videos, interactive animation, games and modules to enhance HIV knowledge, encourage and educate about safer behaviors, and instill self-efficacy for HIV prevention strategies — or receive the same information through static text and images. Participants were followed up with after 1 year.

Madkins and colleagues found that at month 12, incident chlamydia or gonorrhea was 40% lower for those who used Keep It Up! (RR = 0.6; 95% CI, 0.38-0.95). In addition, 37% of those using Keep It Up! and 44% of those using the static text and images reported engaged in condomless anal sex (Prevalence Ratio = 0.83; 95% CI, 0.7-0.99).

“To the best of our knowledge, our research study is the first randomized controlled trial of an online intervention for men who have sex with men to include a biological outcome along with behavioral outcomes. By including a biological outcome that is linked to HIV risk behaviors, we have a less biased understanding of the behaviors in which our participants may be engaged,” Madkins said in the interview. “This study highlights the importance of contextualizing HIV and STI prevention messages.”

She said the research also provides other important take-home messages for primary care physicians.

“Rather than just giving out basic HIV prevention information (eg, fluids that can transmit HIV), physicians should take steps to make sure their patients feel comfortable enough to disclose the behaviors they’re engaging in and use that as a springboard to shape their prevention messages. If a patient discloses that they sleep with men and women, talk about how precautions are the same or differ. If a patient discloses that they meet sex partners while drinking in bars and it leads to problems with using condoms, walk through steps they can take to make sure they still use condoms properly regardless of alcohol or substance use,” Madkins said.

“I’d also recommend that physicians encourage their patients to get tested for rectal STIs. Most of the STIs in our study were at the rectal site and would have been missed if we relied solely on urethral testing. Given that rectal STIs can increase a person’s risk of becoming infected with HIV, it would be very beneficial to their patients’ health to get tested and treated for these STIs,” she added. – by Janel Miller

Disclosure: Madkins reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.