Approximately 80% of American adults used the Internet in 2010 [1]. 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 [2]. A Pew Internet & American Life Project survey showed that 83% of Internet users searched for health information in 2010 [1]. 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 [3-17]. 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 [18-28].

A large number of studies [25,29-32], including a recent World Health Organization report [33], 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.

Demographics, health conditions, and Internet access of the participants in this study are shown in Table 1. 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 Table 2), 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 [1]. 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) [9,13]. 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 [13].

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 [25,32]. Because the health care goal is to control symptoms and prevent disability rather than cure them [25], both HIV infection and chronic diseases require considerable patient self-care or self-monitoring of symptoms [32]. 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 [6] 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 [36].

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 [37].

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.