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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).
To estimate the prevalence of Internet use among HIV-seropositive MSM and compare their online behaviors with HIV-seronegative men with chronic disease(s).
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.
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,
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.
Approximately 80% of American adults used the Internet in 2010 [
A large number of studies [
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 [
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
Demographics, health condition, and Internet access of the participants in the study.
Variable | HIV serostatus | All participants |
||
|
HIV– |
HIV+ |
|
|
Age (years), median (IQR) | 60 (53-65) | 54 (49-60) | 57 (51-63) | |
|
|
|
|
|
|
White | 80 (80.0) | 46 (48.4) | 126 (64.6) |
|
Nonwhite | 20 (20.0) | 49 (51.6) | 69 (35.4) |
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|
|
|
|
|
Employeda | 69 (69.0) | 46 (48.4) | 115 (59.0) |
|
Unemployed | 30 (30.0) | 43 (45.3) | 73 (37.4) |
|
No response | 1 (1.0) | 6 (6.3) | 7 (3.6) |
|
|
|
|
|
|
No therapy use | — | 6 (6.3) | — |
|
HAART | — | 85 (89.5) | — |
|
Combination therapy | — | 4 (4.2) | — |
|
|
|
|
|
|
None | 45 (45.0) | — | — |
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Cancer only | 5 (5.0) | — | — |
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Other chronic conditionb | 26 (26.0) | — | — |
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Both cancer and other(s) | 3 (3.0) | — | — |
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No response | 21 (21.0) | — | — |
Self-reported HIV, n (%) | — | 62 (65.3) | — | |
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|
|
|
|
|
No | 4 (4.0) | 16 (16.8) | 20 (10.3) |
|
Only at home | 42 (42.0) | 38 (40.0) | 80 (41.0) |
|
Only at other locationsc | 10 (10.0) | 13 (13.7) | 23 (11.8) |
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Both home and others | 42 (42.0) | 27 (28.4) | 69 (35.4) |
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No response | 2 (2.0) | 1 (1.1) | 3 (1.5) |
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|
|
|
|
|
Internet for general health | 11 (11.0) | 13 (13.7) | 24 (12.3) |
aincluding full-time, part-time, and self-employment
bOther chronic conditions included depression, kidney disease, erectile dysfunction, diabetes, arthritis, high blood pressure, heart disease, etc.
cOther locations included workplace and library.
The online behaviors of the HIV-seropositive participants were compared to the HIV-seronegative men with chronic disease(s) (see
Online behaviors of the HIV-seropositive participants compared to the HIV-seronegative participants with chronic disease.
Online behavior | HIV serostatus, n (%) | ||
|
HIV– with chronic disease |
HIV+ |
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|||
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1-2 | 5 (15.2) | 14 (22.9) |
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3-4 | 11 (33.2) | 12 (19.7) |
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5-9 | 5 (15.2) | 14 (23.0) |
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≥10 | 12 (36.4) | 21 (34.4) |
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No response | 0 |
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|||
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No | 6 (18.2) | 23 (37.7) |
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Yes | 25 (75.7) | 37 (60.7) |
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No response | 2 (6.1) | 1 (1.6) |
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|||
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No | 10 (30.3) | 22 (36.1) |
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Yes | 21 (63.6) | 38 (62.3) |
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No response | 2 (6.1) | 1 (1.6) |
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|||
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No | 18 (54.5) | 33 (54.1) |
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Yes | 12 (36.4) | 25 (41.0) |
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No response | 3 (9.1) | 3 (4.9) |
aHIV-related information for the HIV-seropositive participants and specific disease-related information for the HIV-seronegative men with chronic disease(s).
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,
Analysis results of multiple logistic regressions.
Covariates | Internet use ≥10 hours/week | Online disease-related search | ||||||
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General information | New medications/ |
Support/advice | ||||
|
OR |
|
OR |
|
OR |
|
OR |
|
Age (5-yr increase) | 0.99 |
.95 | 0.71 |
.03 | 0.75 |
.06 | 0.74 |
.03 |
Nonwhite vs white | 0.70 |
.49 | 1.30 |
.64 | 1.07 |
.90 | 2.66 |
.06 |
HIV+ vs HIV with chronic disease | 1.03 |
.96 | 0.20 |
.01 | 0.55 |
.26 | 0.52 |
.24 |
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 [
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 [
Coursaris and Liu [
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.
Questionnaire.
acquired immune deficiency syndrome
highly active antiretroviral therapy
human immunodeficiency virus
Multicenter AIDS Cohort Study
men who have sex with men
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.
None declared.