Published on 03.05.13 in Vol 15, No 5 (2013): May
Online Health-Searching Behavior Among HIV-Seropositive and HIV-Seronegative Men Who Have Sex With Men in the Baltimore and Washington, DC Area
Background: Searching online for health information is common among American adults. However, there have been few studies to investigate the online health-searching behaviors among men who have sex with men (MSM) with human immunodeficiency virus (HIV).
Objective: To estimate the prevalence of Internet use among HIV-seropositive MSM and compare their online behaviors with HIV-seronegative men with chronic disease(s).
Methods: This study was performed at the Baltimore/Washington, DC site of the Multicenter AIDS Cohort Study (MACS). A total of 200 MACS participants were asked to answer a self-administered questionnaire on a first-come basis during a semiannual study visit (from July to November 2011); 195 (97.5%) participants completed the survey. Multiple logistic regression models were used to investigate the factors influencing their online health-searching behaviors.
Results: The median age of the 195 MSM participants was 57 years, 64.6% were white, 59.0% were employed, and 88.2% had Internet access at home and/or other locations. Of the 95 HIV-seropositive participants, 89.5% currently used highly active antiretroviral therapy (HAART) and 82.1% had Internet access. After adjusting for age and race/ethnicity, the HIV-seropositive participants were less likely to perform online searches for general disease-related information compared to the HIV-seronegative men with chronic disease(s) (OR 0.20, 95% CI 0.06-0.68, P=.01). There were no statistically significant associations with HIV status and searching for new medications/treatments (OR 0.55, 95% CI 0.19-1.55, P=.26) or support/advice from other patients (OR 0.52, 95% CI 0.18-1.53, P=.24). Increasing age by 5 years led to a decrease by 29% in the odds of online health-related searches for general information (OR 0.71, 95% CI 0.52-0.98, P=.03) and 26% for support/advice from other patients (OR 0.74, 95% CI 0.56-0.98, P=.03). A decrease of 25% for new medications/treatments was also seen, but was not statistically significant (OR 0.75, 95% CI 0.57-1.01, P=.06).
Conclusions: This study shows that HIV-seropositive MSM have similar online health-searching behaviors as HIV-seronegative men with chronic disease(s). Independent of HIV status, older MSM are less likely to perform online health-related searches.
J Med Internet Res 2013;15(5):e78)
Approximately 80% of American adults used the Internet in 2010 . For Internet users, searching online for health information has become highly prevalent. A national survey in 2005 found 59% of Internet users did online searching for health information for themselves [ ]. A Pew Internet & American Life Project survey showed that 83% of Internet users searched for health information in 2010 [ ]. Some studies have shown a high prevalence of health-related Internet use among people with human immunodeficiency virus (HIV) and suggested such Internet use to be beneficial in coping, support, and self-control in health behaviors [ - ]. Studies have also demonstrated that Internet use among people living with chronic diseases (such as diabetes and cancer) provides a sense of support and self-management [ - ].
A large number of studies [, - ], including a recent World Health Organization report [ ], have suggested that HIV has shifted from a rapidly debilitating and fatal illness to a manageable chronic disease. However, few studies have compared the online health-searching behaviors of HIV-seropositive people with those of HIV-seronegative people with chronic disease(s).
We conducted a study of the online health-searching behaviors among the HIV-seropositive and HIV-seronegative men who have sex with men (MSM) currently enrolled in the Baltimore/Washington, DC site of the Multicenter AIDS Cohort Study (MACS). The aims of this study were to estimate the prevalence of Internet use and online heath-searching behaviors among the HIV-seropositive MSM compared to the HIV-seronegative men with chronic disease(s), and to identify the factors influencing these behaviors.
The MACS is an ongoing prospective study of the natural and treated histories of HIV infection among MSM in the United States. A total of 6972 men were recruited (4954 in 1984-1985, 668 in 1987-1991, and 1350 in 2001-2003) at 4 centers located in Baltimore/Washington, DC; Chicago; Los Angeles; and Pittsburgh. The study design of the MACS has been described in detail previously [, ] and only methods relevant to the present study are presented here. All MACS questionnaires are available on the MACS website. MACS study protocols were approved by the institutional review boards of each of the participating centers, their community partners, and community advisory boards, and informed consent was obtained from all participants. MACS participants return every 6 months for detailed interviews, physical examinations, and collection of blood for laboratory testing and storage in a central repository. The interview includes a battery of questions related to medical conditions, medical treatments, sexual behavior, illicit drug use, and alcohol consumption since the previous visit. For this study, 200 participants (150 from Baltimore and 50 from Washington, DC) answered a self-administered questionnaire (see for details) on a first-come basis during their routine semiannual study visits from July to November 2011.
Participants were asked about HIV or chronic disease(s) (including cancer, diabetes, depression, kidney disease, erectile dysfunction, etc); about their Internet access and where they accessed the Internet (no access, only at home, only at other locations including workplace and library, or both at home and other locations); the number of hours per week they used the Internet for personal purposes (1-2, 3-4, 5-9, ≥10 hours/week); and about whether they have used online disease-related searches for general information, new medications/treatments, and support/advice from other patients.
The outcomes of interest were the hours of Internet use and online disease-related searching. Participants’ HIV status, age, and race/ethnicity (obtained from the centralized MACS database) were included as covariates.
Descriptive statistics were generated by HIV status. The prevalence of Internet access was calculated. Univariate associations of Internet access with participant’s employment status, race/ethnicity, age, and HIV status were examined using chi-square tests or Fisher exact tests for categorical variables, or Mann-Whitney tests for continuous variables. The associations between online behaviors and HIV status were investigated by using multiple logistic regression models. Age and race/ethnicity were included in the model. Statistical significance was evaluated at the .05 level. All analyses were performed using SAS version 9.2 (SAS Institute, Inc, Cary, NC, USA).
Demographics, health conditions, and Internet access of the participants in this study are shown in. The median age was 57 years (IQR 51-63). Most were white (64.6%) and employed (59.0%), including full-time, part-time, and self-employment. Of the 195 participants completing the questionnaire, 172 (88.2%) used the Internet, 149 (76.4%) had Internet access at home, and 24 (12.3%) used a smartphone to access the Internet for general health. Of the 95 HIV-seropositive participants, 85 (89.5%) currently used highly active antiretroviral therapy (HAART) and 78 (82.1%) had Internet access. Of the 100 HIV-seronegative participants, 34 (34.0%) had cancer or other chronic disease(s). Having Internet access was statistically significantly associated with participant’s employment status (P=.046), race/ethnicity (P<.001), and HIV status (P=.004), but was not associated with participant’s age (P=.30). Internet access was higher among the employed participants compared to the unemployed (93.8% vs 84.9%), the white participants compared to the nonwhite participants (96.8% vs 76.5%), and the HIV-seronegative compared to the HIV-seropositive (95.9% vs 83.0%) (data not shown).
The online behaviors of the HIV-seropositive participants were compared to the HIV-seronegative men with chronic disease(s) (see), of which 23 participants without Internet access (or no response), 61 HIV-seronegative participants without chronic disease(s) (or no response), and 17 HIV-seropositive participants who did not report their HIV infection in the survey were excluded. Of 61 HIV-seropositive participants and 33 HIV-seronegative participants with chronic disease(s), 21 (34.4%) and 12 (36.4%) spent ≥10 hours per week on the Internet for personal searching, respectively. There were no statistically significant differences between these 2 groups (OR 1.03, 95% CI 0.38-2.74, P=.96).
After adjusting for age and race/ethnicity, the HIV-seropositive participants were less likely to search online for general disease-related information compared to the HIV-seronegative men with chronic disease(s) (OR 0.20, 95% CI 0.06-0.68, P=.01). There were no statistically significant differences in searching for new medications/treatments (OR 0.55, 95% CI 0.19-1.55, P=.26) or for support/advice from other patients (OR 0.52, 95% CI 0.18-1.53, P=.24) between these 2 groups. Increasing age by 5 years led to a decrease by 29% in the odds of online health-related searches for general information (OR 0.71, 95% CI 0.52-0.98, P=.03) and 26% for support/advice from other patients (OR 0.74, 95% CI 0.56-0.98, P=.03). A decrease of 25% for new medications/treatments was also seen, but was not statistically significant (OR 0.75, 95% CI 0.57-1.01, P=.06).
To the best of our knowledge, this study is the first to compare the online behaviors among HIV-seropositive and HIV-seronegative MSM with chronic disease(s). We found that the HIV-seropositive participants showed similar online health-searching behaviors compared to the HIV-seronegative with chronic disease(s) participants. Independent of HIV status, older participants were less likely to do online health-related research.
In this study, 88% of the surveyed participants had Internet access, close to the prevalence (79%) among American adults in a 2010 report from the Pew Research Center . In our study, 82% of the HIV-seropositive participants had access to Internet, more than the reported 56% from earlier studies of people living with HIV and/or acquired immune deficiency syndrome (AIDS) [ , ]. Among our HIV-seropositive participants, 68% had Internet access at home, more than twice than the number (33%) reported by Kalichman et al in 2002 [ ].
It has been known that HIV disease meets several chronic disease criteria, including an uncertain course, a prescribed treatment regimen, requirements of self-care and management, changes in roles and relationships, shifts in identity, and psychological distress [, ]. Because the health care goal is to control symptoms and prevent disability rather than cure them [ ], both HIV infection and chronic diseases require considerable patient self-care or self-monitoring of symptoms [ ]. As such, it was not unexpected that our results showed no statistical differences in the online health-searching behaviors of HIV-seropositive participants and HIV-seronegative participants with chronic disease(s).
Coursaris and Liu  found that support-related information, including advice, referral, situation appraisal, and teaching, was exchanged most frequently in online HIV/AIDS self-help groups, which is in agreement with our observations. Of the HIV-seropositive participants with Internet access, 41% searched online for support/advice from other patients and 61% searched online for HIV-related information, more than the finding of a study of people living with HIV/AIDS that reported 45% for Internet health information-seeking behavior [ ].
This study also showed that the odds of online health-related searching decreased with increasing age, in agreement with a recent report from the Pew Research Center that showed American adults older than 65 years were less likely than other age groups to use the Internet .
Certain limitations of this study deserve attention. We surveyed a convenience sample of MACS participants. Self-administration of the questionnaire did not provide an opportunity for participants to ask questions about the survey, so we could not verify the accuracy of the participants’ interpretation of the survey questions and, thus, their responses. In addition, our sample was limited to participants enrolled in the Baltimore/Washington, DC site; therefore, our results may not be generalizable to all MACS participants or all HIV-infected men. Recall bias may have been present.
Although the sample size in this study is small, our results provide valuable insight into the expanding Internet use of health self-management of HIV-seropositive MSM and HIV-seronegative MSM with chronic disease(s). Further study is needed to substantiate these findings. The high prevalence of online health searching observed among the MSM participants in the Baltimore/Washington, DC site will encourage MACS to expand the online health-searching behavior study to all sites.
Support of the Baltimore-Washington, DC MACS site was provided by the National Institute of Allergy and Infectious Diseases, with additional supplemental funding from the National Cancer Institute (U01-AI-035042, UL1-RR025005 (GCRC). This study was funded by the Notice of Availability of Recovery Act Funds for Administrative Supplements, NOT-DD-99-056.
Conflicts of Interest
Multimedia Appendix 1
Questionnaire.PDF File (Adobe PDF File), 57KB
- Zickuhr K. Generations 2010. Washington, DC: Pew Internet & American Life Project; 2010 Dec 16. URL: http://www.pewinternet.org/~/media//Files/Reports/2010/PIP_Generations_and_Tech10.pdf [accessed 2012-11-13] [WebCite Cache]
- Atkinson NL, Saperstein SL, Pleis J. Using the internet for health-related activities: findings from a national probability sample. J Med Internet Res 2009;11(1):e4 [FREE Full text] [CrossRef] [Medline]
- Brashers DE, Haas SM, Neidig JL, Rintamaki LS. Social Activism, self-advocacy, and coping with HIV illness. Journal of Social and Personal Relationships 2002;19:113-133. [CrossRef]
- Brashers DE, Neidig JL, Goldsmith DJ. Social support and the management of uncertainty for people living with HIV or AIDS. Health Commun 2004;16(3):305-331. [CrossRef] [Medline]
- Chou FY, Holzemer WL, Portillo CJ, Slaughter R. Self-care strategies and sources of information for HIV/AIDS symptom management. Nurs Res 2004;53(5):332-339. [Medline]
- Coursaris CK, Liu M. An analysis of social support exchanges in online HIV/AIDS self-help groups. Computers in Human Behavior 2009;25:911-918. [CrossRef]
- Friedland J, Renwick R, McColl M. Coping and social support as determinants of quality of life in HIV/AIDS. AIDS Care 1996 Feb;8(1):15-31. [CrossRef] [Medline]
- Gómez EJ, Cáceres C, López D, Del Pozo F. A web-based self-monitoring system for people living with HIV/AIDS. Comput Methods Programs Biomed 2002 Jul;69(1):75-86. [Medline]
- Kalichman SC, Benotsch EG, Weinhardt L, Austin J, Luke W, Cherry C. Health-related Internet use, coping, social support, and health indicators in people living with HIV/AIDS: preliminary results from a community survey. Health Psychol 2003 Jan;22(1):111-116. [Medline]
- Kalichman SC, Benotsch EG, Weinhardt LS, Austin J, Luke W. Internet use among people living with HIV/AIDS: association of health information, health behaviors, and health status. AIDS Educ Prev 2002 Feb;14(1):51-61. [Medline]
- Kalichman SC, Cain D, Cherry C, Pope H, Eaton L, Kalichman MO. Internet use among people living with HIV/AIDS: coping and health-related correlates. AIDS Patient Care STDS 2005 Jul;19(7):439-448. [CrossRef] [Medline]
- Kalichman SC, Cherry C, Cain D, Pope H, Kalichman M, Eaton L, et al. Internet-based health information consumer skills intervention for people living with HIV/AIDS. J Consult Clin Psychol 2006 Jun;74(3):545-554. [CrossRef] [Medline]
- Kalichman SC, Weinhardt L, Benotsch E, DiFonzo K, Luke W, Austin J. Internet access and Internet use for health information among people living with HIV-AIDS. Patient Educ Couns 2002 Feb;46(2):109-116. [Medline]
- Lovejoy NC, Morgenroth BN, Paul S, Freeman E, Christianson B. Potential predictors of information-seeking behavior by homosexual/bisexual (gay) men with a human immunodeficiency virus seropositive health status. Cancer Nurs 1992 Apr;15(2):116-124. [Medline]
- Reeves PM. Coping in cyberspace: the impact of Internet use on the ability of HIV-positive individuals to deal with their illness. J Health Commun 2000;5 Suppl:47-59. [CrossRef] [Medline]
- Thomas S, Shuter J. Internet access and usage in a sample of inner-city HIV-infected patients. J Assoc Nurses AIDS Care 2010;21(5):444-448. [CrossRef] [Medline]
- Horvath KJ, Danilenko GP, Williams ML, Simoni J, Amico KR, Oakes JM, et al. Technology use and reasons to participate in social networking health websites among people living with HIV in the US. AIDS Behav 2012 May;16(4):900-910. [CrossRef] [Medline]
- Fox S, Purcell K. Chronic Disease and the Internet. Washington, DC: Pew Internet & American Life Project; 2010 Mar 24. URL: http://pewinternet.org/~/media//Files/Reports/2010/PIP_Chronic_Disease_with_topline.pdf [accessed 2012-11-13] [WebCite Cache]
- Glasgow RE, Kurz D, King D, Dickman JM, Faber AJ, Halterman E, et al. Twelve-month outcomes of an Internet-based diabetes self-management support program. Patient Educ Couns 2012 Apr;87(1):81-92. [CrossRef] [Medline]
- Kaufman N. Internet and information technology use in treatment of diabetes. Int J Clin Pract Suppl 2010 Feb(166):41-46. [CrossRef] [Medline]
- Kroenke CH, Kubzansky LD, Schernhammer ES, Holmes MD, Kawachi I. Social networks, social support, and survival after breast cancer diagnosis. J Clin Oncol 2006 Mar 1;24(7):1105-1111. [CrossRef] [Medline]
- Longo DR, Schubert SL, Wright BA, LeMaster J, Williams CD, Clore JN. Health information seeking, receipt, and use in diabetes self-management. Ann Fam Med 2010;8(4):334-340 [FREE Full text] [CrossRef] [Medline]
- McKay HG, Glasgow RE, Feil EG, Boles SM, Barrera MJ. Internet-based diabetes self-management and support: Initial outcomes from the Diabetes Network project. Rehabilitation Psychology 2002 2002;47(1):31-48. [CrossRef]
- Zrebiec JF, Jacobson AM. What attracts patients with diabetes to an internet support group? A 21-month longitudinal website study. Diabet Med 2001 Feb;18(2):154-158. [Medline]
- Swendeman D, Ingram BL, Rotheram-Borus MJ. Common elements in self-management of HIV and other chronic illnesses: an integrative framework. AIDS Care 2009 Oct;21(10):1321-1334 [FREE Full text] [CrossRef] [Medline]
- Glasgow RE, Christiansen SM, Kurz D, King DK, Woolley T, Faber AJ, et al. Engagement in a diabetes self-management website: usage patterns and generalizability of program use. J Med Internet Res 2011;13(1):e9 [FREE Full text] [CrossRef] [Medline]
- Kuijpers W, Groen WG, Aaronson NK, van Harten WH. A systematic review of web-based interventions for patient empowerment and physical activity in chronic diseases: relevance for cancer survivors. J Med Internet Res 2013;15:e37. [Medline]
- Stellefson M, Chaney B, Barry AE, Chavarria E, Tennant B, Walsh-Childers K, et al. Web 2.0 chronic disease self-management for older adults: a systematic review. J Med Internet Res 2013;15(2):e35 [FREE Full text] [CrossRef] [Medline]
- Aberg JA. The changing face of HIV care: common things really are common. Ann Intern Med 2006 Sep 19;145(6):463-465. [Medline]
- Gifford AL, Groessl EJ. Chronic disease self-management and adherence to HIV medications. J Acquir Immune Defic Syndr 2002 Dec 15;31 Suppl 3:S163-S166. [Medline]
- Palella FJ, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 1998 Mar 26;338(13):853-860. [CrossRef] [Medline]
- Siegel K, Lekas HM. AIDS as a chronic illness: psychosocial implications. AIDS 2002;16 Suppl 4:S69-S76. [Medline]
- World Health Organization (WHO). HIV/AIDS is becoming a manageable chronic disease: WHO. 2011 Nov 30. URL: http://www.searo.who.int/LinkFiles/Press_Releases_PR-1535.pdf [accessed 2012-11-13] [WebCite Cache]
- Kaslow RA, Ostrow DG, Detels R, Phair JP, Polk BF, Rinaldo CR. The Multicenter AIDS Cohort Study: rationale, organization, and selected characteristics of the participants. Am J Epidemiol 1987 Aug;126(2):310-318. [Medline]
- Dudley J, Jin S, Hoover D, Metz S, Thackeray R, Chmiel J. The Multicenter AIDS Cohort Study: retention after 9 1/2 years. Am J Epidemiol 1995 Aug 1;142(3):323-330. [Medline]
- Samal L, Saha S, Chander G, Korthuis PT, Sharma RK, Sharp V, et al. Internet health information seeking behavior and antiretroviral adherence in persons living with HIV/AIDS. AIDS Patient Care STDS 2011 Jul;25(7):445-449 [FREE Full text] [CrossRef] [Medline]
- Zickuhr K, Madden M. Older adults and internet use: for the first time, half of adults ages 65 and older are online. Washington, DC: Pew Internet & American Life Project; 2012 Jun 06. URL: http://pewinternet.org/~/media/Files/Reports/2012/PIP_Older_adults_and_internet_use.pdf [accessed 2012-12-04] [WebCite Cache]
|AIDS: acquired immune deficiency syndrome|
|HAART: highly active antiretroviral therapy|
|HIV: human immunodeficiency virus|
|MACS: Multicenter AIDS Cohort Study|
|MSM: men who have sex with men|
Edited by G Eysenbach; submitted 12.12.12; peer-reviewed by J Gillett, P Reeves, M Ybarra; comments to author 17.02.13; revised version received 20.02.13; accepted 25.02.13; published 03.05.13
©Ying Li, J Polk, Michael Plankey. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 03.05.2013.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.