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      Effect of an Online Video-Based Intervention to Increase HIV Testing in Men Who Have Sex with Men in Peru

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          Abstract

          Background

          Although many men who have sex with men (MSM) in Peru are unaware of their HIV status, they are frequent users of the Internet, and can be approached by that medium for promotion of HIV testing.

          Methods

          We conducted an online randomized controlled trial to compare the effect of HIV-testing motivational videos versus standard public health text, both offered through a gay website. The videos were customized for two audiences based on self-identification: either gay or non-gay men. The outcomes evaluated were ‘intention to get tested’ and ‘HIV testing at the clinic.’

          Findings

          In the non-gay identified group, 97 men were randomly assigned to the video-based intervention and 90 to the text-based intervention. Non-gay identified participants randomized to the video-based intervention were more likely to report their intention of getting tested for HIV within the next 30 days (62.5% vs. 15.4%, Relative Risk (RR): 2.77, 95% Confidence Interval (CI): 1.42–5.39). After a mean of 125.5 days of observation (range 42–209 days), 11 participants randomized to the video and none of the participants randomized to text attended our clinic requesting HIV testing (p = 0.001). In the gay-identified group, 142 men were randomized to the video-based intervention and 130 to the text-based intervention. Gay-identified participants randomized to the video were more likely to report intentions of getting an HIV test within 30 days, although not significantly (50% vs. 21.6%, RR: 1.54, 95% CI: 0.74–3.20). At the end of follow up, 8 participants who watched the video and 10 who read the text visited our clinic for HIV testing (Hazard Ratio: 1.07, 95% CI: 0.40–2.85).

          Conclusion

          This study provides some evidence of the efficacy of a video-based online intervention in improving HIV testing among non-gay-identified MSM in Peru. This intervention may be adopted by institutions with websites oriented to motivate HIV testing among similar MSM populations.

          Trial registration

          Clinicaltrials.gov NCT00751192

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          Most cited references20

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          The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change.

          Traditionally smoking cessation studies use smoker and nonsmoker categories almost exclusively to represent individuals quitting smoking. This study tested the transtheoretical model of change that posits a series of stages through which smokers move as they successfully change the smoking habit. Subjects in precontemplation (n = 166), contemplation (n = 794), and preparation (n = 506) stages of change were compared on smoking history, 10 processes of change, pretest self-efficacy, and decisional balance, as well as 1-month and 6-month cessation activity. Results strongly support the stages of change model. All groups were similar on smoking history but differed dramatically on current cessation activity. Stage differences predicted attempts to quit smoking and cessation success at 1- and 6-month follow-up. Implications for recruitment, intervention, and research are discussed.
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            Stages of change and decisional balance for 12 problem behaviors.

            This integrative study investigated the generalization of the transtheoretical model across 12 problem behaviors. The cross-sectional comparisons involved relationships between two key constructs of the model, the stages of change and decisional balance. The behaviors studied were smoking cessation, quitting cocaine, weight control, high-fat diets, adolescent delinquent behaviors, safer sex, condom use, sunscreen use, radon gas exposure, exercise acquisition, mammography screening, and physicians' preventive practices with smokers. Clear commonalities were observed across the 12 areas, including both the internal structure of the measures and the pattern of changes in decisional balance across stages.
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              HIV testing within at-risk populations in the United States and the reasons for seeking or avoiding HIV testing.

              We determined proportions of high-risk persons tested for HIV, the reasons for testing and not testing, and attitudes and perceptions regarding HIV testing, information that is critical for planning prevention programs. Cross-sectional interview study of persons at high risk for HIV infection (men who have sex with men [MSM]; injection drug users [IDUs]; and heterosexual persons recruited from gay bars, street outreach, and sexually transmitted disease clinics) among six states participating in the HIV Testing Survey (HITS) in 1995 to 1996 (HITS-I) and 1998 to 1999 (HITS-II). Overall testing rates were lower in the HITS-I (1226/1599 [77%]) than in the HITS-II (1375/1711 [80%]) (p =.01). Persons or=25 years old (HITS-I: 71% vs. 78%, respectively, p=.007; HITS-II: 63% vs. 85%, respectively, p<.001). The main reasons for testing and not testing were the same in both surveys, but the proportions of reasons for not testing differed (e.g., "unlikely exposed to HIV" [HITS-I (17%) vs. HITS-II (30%), p<.0001], "afraid of finding out HIV-positive" [HITS-I (27%) vs. HITS-II (18%), p<.0001]). Attitudes regarding HIV testing differed among tested and untested respondents, especially among MSM. HIV testing rates were higher in the HITS-II, but testing rates decreased among the youngest respondents. Denial of HIV risk factors and fear of being HIV-positive were the principal reasons for not being tested. Availability of new HIV therapies may have contributed to decreased fear of finding out that one is HIV infected as a reason to avoid testing. The increased proportion of persons at risk who did not test because they believed they were unlikely to have been exposed highlights the need for prevention efforts to address risk perceptions.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2010
                3 May 2010
                : 5
                : 5
                : e10448
                Affiliations
                [1 ]Unit of Epidemiology, HIV and STD, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
                [2 ]NGO Via Libre, Lima, Peru
                [3 ]Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, United States of America
                [4 ]Department of Anthropology, University of Washington, Seattle, Washington, United States of America
                [5 ]Departments of Global Health, and of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, United States of America
                [6 ]School of Nursing, University of Washington, Seattle, Washington, United States of America
                Tulane University, United States of America
                Author notes

                Conceived and designed the experiments: MMB IA. Performed the experiments: MMB IA RC. Analyzed the data: MMB IA CPC SMG AMK AK. Contributed reagents/materials/analysis tools: MMB IA CPC RC SMG AMK AK. Wrote the paper: MMB IA CPC RC SMG AMK AK.

                Article
                09-PONE-RA-11198R1
                10.1371/journal.pone.0010448
                2862715
                20454667
                5afb66d0-578f-4281-9124-df07ad36ca52
                Blas et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                : 23 June 2009
                : 27 November 2009
                Page count
                Pages: 10
                Categories
                Research Article
                Infectious Diseases/HIV Infection and AIDS
                Public Health and Epidemiology/Epidemiology
                Public Health and Epidemiology/Global Health
                Public Health and Epidemiology/Infectious Diseases
                Public Health and Epidemiology/Screening

                Uncategorized
                Uncategorized

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