Published on 02.11.15 in Vol 17, No 11 (2015): November
Social Media and HIV: A Systematic Review of Uses of Social Media in HIV Communication
Background: Social media, including mobile technologies and social networking sites, are being used increasingly as part of human immunodeficiency virus (HIV) prevention and treatment efforts. As an important avenue for communication about HIV, social media use may continue to increase and become more widespread.
Objective: The objective of this paper is to present a comprehensive systematic review of the current published literature on the design, users, benefits, and limitations of using social media to communicate about HIV prevention and treatment.
Methods: This review paper used a systematic approach to survey all literature published before February 2014 using 7 electronic databases and a manual search. The inclusion criteria were (1) primary focus on communication/interaction about HIV/acquired immunodeficiency syndrome (AIDS), (2) discusses the use of social media to facilitate communication, (3) communication on the social media platform is between individuals or a group of individuals rather than the use of preset, automated responses from a platform, (4) published before February 19, 2014, and (5) all study designs.
Results: The search identified 35 original research studies. Thirty studies had low or unclear risk of at least one of the bias items in the methodological quality assessment. Among the 8 social media platform types described, short message service text messaging was most commonly used. Platforms served multiple purposes including disseminating health information, conducting health promotion, sharing experiences, providing social support, and promoting medication adherence. Social media users were diverse in geographic location and race/ethnicity; studies commonly reported users aged 18-40 years and users with lower income. Although most studies did not specify whether use was anonymous, studies reported the importance of anonymity in social media use to communicate about HIV largely due to the stigma associated with HIV. The ability to share and receive information about HIV was the most commonly reported benefit of social media use and the most common challenges were related to technology. Measures of frequency of use, satisfaction, and effects of use varied across studies.
Conclusions: Using social media to bridge communication among a diverse range of users, in various geographic and social contexts, may be leveraged through pre-existing platforms and with attention to the roles of anonymity and confidentiality in communication about HIV prevention and treatment. More robust research is needed to determine the effects of social media use on various health and social outcomes related to HIV.
J Med Internet Res 2015;17(11):e248
Social media platforms, including mobile technologies and social networking sites, are being used increasingly as part of human immunodeficiency virus (HIV) prevention and treatment efforts [- ]. Importantly, social media provides users with the opportunity to generate, share, and receive information through bi- and multidirectional exchanges, which may transcend geographic borders and provide an opportunity for anonymity [ - ]. Although stigma and cultural context may prevent people living with HIV/acquired immunodeficiency syndrome (AIDS) and at-risk populations from accessing in-person HIV prevention and treatment initiatives [ , ], social media can offer a neutral platform for engagement [ ]. For example, individuals can seek and share information about specific prevention strategies [ , ], engage in dialog about HIV research [ ], and leverage support for issues such as medication adherence and emotional coping for living with HIV [ - ]. Additionally, the increased social support provided by social media has been shown to improve treatment adherence and access to HIV testing and prevention services [ , ], and assist with coping with HIV-related stigma [ ]. Social media use among key populations affected by the HIV epidemic, including men who have sex with men (MSM) [ - ], racial and ethnic minorities [ ], and adolescents [ , ] is increasing, and studies demonstrate that these groups use social media to form social ties, access health information and emotional support, and build a sense of community with peers [ - ]. The social media activity of these groups can be leveraged to facilitate community engagement [ - ], which has been identified by the Joint United Nations Programme on HIV/AIDS (UNAIDS) as a critical component in HIV control efforts [ ].
The widespread use of social media represents an important avenue for communication about HIV [, ]. Further, as the globalization of HIV and its presence in more geographically distant and underserved communities increases, social media provides an opportunity to extend the reach of HIV prevention and treatment efforts. Currently lacking, however, is a thorough examination of the various users, platforms, and approaches to using social media to communicate about HIV. The objective of this paper is to address this gap by presenting a comprehensive systematic review of the current published literature on the design, users, benefits, and limitations of using social media to communicate about HIV prevention and treatment. This examination can inform critical next steps to ensure appropriate use of social media to reach and engage those most affected by HIV in their local milieu.
This review paper followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines  and used a systematic approach to retrieve relevant research studies. The review included all study designs and study methods, including qualitative, quantitative, and mixed-methods studies. The literature search was conducted on February 19, 2014, using the following 7 electronic databases: Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Dissertations, Embase, PsycINFO, PubMeb Central, and Web of Science. The searches were performed using the following defined search terms: (HIV OR “Human immunodeficiency virus” OR hiv infection* OR hiv infections[mesh] OR acquired immunodeficiency syndrome[mesh] OR “acquired immunodeficiency syndrome”) AND (“online community” OR “online communities” OR “virtual community” OR “virtual communities” OR Social Media[mesh] OR “social media” OR “Web 2.0″ OR “social medium” OR Social Networking[mesh] OR Social network*) AND (technolog* OR mobile* OR Internet OR online OR Blogging[mesh] OR blog* OR weblog* OR microblog* OR micro-blog* OR Twitter OR tweet* OR “mobile apps” OR “mobile app” OR “mobile applications” OR “mobile application” OR “online forum” OR “online forums” OR “bulletin board” OR “bulletin boards” OR “message board” OR “message boards” OR Skype OR instant messag* OR text messag* OR texting OR text messaging[mesh] OR YouTube OR Flickr OR Facebook OR LinkedIn OR MySpace OR SecondLife OR “Second Life” OR Listserv OR listserve OR “mailing list” OR “mailing lists” OR podcast* OR webcast* OR wiki*). Manual reference searches of identified systematic reviews were also completed.
The retrieved articles were screened for relevance, duplication, and the selection criteria. The inclusion criteria were (1) primary focus on communication/interaction about HIV/AIDS; (2) discusses the use of social media to facilitate communication (social media was defined as platforms allowing for bi- or multidirectional exchange, including blogs, discussion boards, Facebook, etc); (3) communication on the social media platform was between individuals or a group of individuals rather than the use of preset, automated responses from a platform; (4) all literature published before February 19, 2014; and (5) all study designs. The exclusion criteria were (1) the focus on communication/interaction about HIV/AIDS was limited to study implications; (2) not in English; (3) commentary, letters to the editor or opinion pieces, protocols, and feature articles (ie, narrative-style journalistic pieces); (4) primary focus on marketing or advertising; (5) studies in which the social media platform was used for recruitment only; and (6) social media platform was used for data collection purposes only.
We completed title, abstract, and full-text review to identify all studies meeting inclusion and exclusion criteria. Three researchers (MRI, TT, CG) independently screened article titles for inclusion in abstract review. Next, working in pairs, the full research team independently reviewed and evaluated all retrieved abstracts and full texts, and reached consensus on the inclusion for the analysis. The interrater reliability between reviewers was 0.90, indicating strong agreement. Discrepancies were discussed within each dyad until consensus was reached; if no consensus was reached, the article underwent review by the full research team until consensus was reached. Studies excluded during the full-text review stage and their reasons for exclusion are listed in.
Data were extracted using a set of 58 defined fields related to the design of the social media platform, social media user characteristics, use of the social media platform, benefits and disadvantages of using the social media platform, and study outcomes. Working in pairs, the research team independently extracted data from each article and then reconciled their responses to ensure consistency.
Two members of the research team (TT, MG) conducted a quality assessment of the 35 included studies using a checklist tool for assessing quality in observational studies . The 6 domains used to assess risk of bias included (1) methods for selecting study participants, (2) methods for measuring exposure and outcome variables, (3) design-specific source of bias, (4) method of control confounding, (5) statistical methods, and (6) other biases (including conflict of interest and disclosure of funding sources). For each study, the quality of each of these 6 items was categorized as low risk (+), high risk (-), or unclear (?) as recommended by the Cochrane Collaboration [ ]. We added an additional category of not applicable (N/A).
In all, 35 selected studies [- , - ] met the inclusion criteria (see PRISMA diagram; ). Nine studies used qualitative research methods [ , , , , , , , , ], 11 studies used quantitative research methods [ , , , , , , , , , , ], and 15 studies used mixed methods [ , , , , , - , , , , - ]. The 35 included studies were summarized by study method, type of social media platform, participants/sample type and sample size, and topic(s) of discussion (see ). The most commonly described social media platforms to facilitate discussion around HIV were short message service (SMS) text messaging [ , , - , , , , ], discussion boards or forums [ , , , , , , , , ], and social networking sites (eg, Facebook) [ , , , , , , ] (the full list of social media platforms is provided in ). The studies included a range of social media users, including the general public, people living with HIV/AIDS (PLWHA), and/or health professionals. Social media platforms discussed in the studies included a variety of communication features, such as discussion facilitators, directed or guided communication, and chat features. Studies reported various purposes for HIV communication on the social media platform, such as disseminating health information and/or promoting health [ , , , , , - , - , , ], sharing thoughts and experiences [ , , , , , , ], providing social support [ , , , , ], and promoting medication adherence [ , , , , ]. Topics of discussion included a range of issues related to HIV prevention (eg, skills and strategies to reduce risk), treatment (eg, medication adverse effects and adherence), coping (eg, disclosure, addressing stigma), and access to resources (eg, HIV services, online resources).
|Social media toola||Studies|
|Blogs (n=4)||Adam et al (2011) , Eastham (2011) [ ], Kvasny & Igwe (2008) [ ], Strand (2011) [ ]|
|Discussion forum/board (n=9)||Baelden et al (2012) , Brennan et al (1991) [ ], Coursaris & Liu (2009) [ ], Desouza & Jyoti Dutta (2008) [ ], Lou et al (2006) [ ], Mo & Coulson (2008) [ ], Rothpletz-Puglia et al (2013) [ ], Yamauchi 2010 [ ], Zhuang & Bresnahan (2012) [ ]|
|SMS text messaging (n=9)||Broaddus & Dickson-Gomez (2013) , Dean et al (2012) [ ], Divecha et al (2012) [ ], Dunbar et al (2003) [ ], Hightow-Weidman et al (2014) [ ], Horvath et al (2013) [ ], Lester et al (2010) [ ], Wicks et al (2010) [ ], Yamauchi (2010) [ ]|
|Social networking site (n=7)||Bull et al (2012) , Divecha et al (2012) [ ], Hildebrand et al (2013) [ ], Ko et al (2013) [ ], Pedrana et al (2013) [ ], Rice et al (2012) [ ], Young & Jaganath (2013) [ ]|
|Social networking site to private correspondence (n=3)||Feldacker et al (2011) , Hightow-Weidman et al (2014) [ ], Young & Jaganath (2013) [ ]|
|Video (n=3)||Desouza & Jyoti Dutta (2008) , Leon et al (2011) [ ], Skrajner et al (2009) [ ]|
|Chat (n=5)||Leon et al (2011) , Moskowitz et al (2009) [ ], Pavlescak (2007) [ ], Rhodes (2004) [ ], Rhodes et al (2010) [ ]|
|Conferencing (n=1)||Reid et al (2012) |
a Some studies used multiple platforms.
Among the 35 included studies, 5 were at low risk for all 6 methodological quality items (see). The remaining 30 studies were at high or unclear risk of at least one of the bias items; none of the studies were at high risk for all bias items.
Characteristics of Social Media Platform Users
The characteristics of social media users in the selected studies were diverse, representing a range of groups and populations. An assessment of the use of each type of social media platform by user characteristics did not produce a consistent trend. As such, the following results are across all types of social media platforms.
A total of 31 studies provided information on the location of social media users and 4 [, , , ] did not provide this information. Seventeen studies described users located in the United States [ , , , - , , , - , ] and/or Canada [ , ]. Eight studies described users located in a region other than the United States or Canada [ , , , , , , , ], most commonly South Africa [ , , ] and China [ , ]. Four studies described a global focus with users located in both the United States or Canada, and other countries [ , , , ]. Two studies [ , ] described an unrestricted geographic focus.
Sexual Orientation and HIV Status
A total of 12 studies reported social media users’ sexual orientation, which included heterosexual, homosexual, bisexual, and unsure or questioning [, , , , , , , - , , ]. All 12 studies included homosexual participants and 2 also included unsure or questioning participants [ , ]. Seventeen studies reported the HIV status of social media users [ , - , , , , , , , , , , - ]. These studies reported a range of study populations, including samples that were HIV-positive only, HIV-positive and HIV-negative, and unknown HIV status. Ten studies were exclusively for HIV-positive users, meaning only users who identified as HIV-positive could access the social media platform [ , , , , , , , - ]. None of the included studies were exclusively for HIV-negative users.
Age and Gender
In all, 24 studies reported social media users’ age, ranging from adolescents to older adults aged 61 years and older [, , , - , , , - , - , - ]; most of these studies included users aged 18 to 40 years [ , , - , , , , - , - , , , ]. Twenty-six studies reported social media users’ gender [ , - , - , , , , , - ]; 7 studies only included males [ , , , , , , ] and 2 only included females [ , ]. Of the 17 studies that included both male and female participants, 11 had a majority of male participants [ , , , , , , , , , , ].
In all, 18 studies reported social media users’ race or ethnicity including, but not limited to, black, non-Hispanic white, Latino, and Asian [, - , - , , , , - ]. Among the 17 studies in the United States and Canada reporting race, 5 reported more black social media users than non-Hispanic whites or other racial or ethnic minorities [ , , , , ]. One of the 15 international studies reported users’ nationality [ ]; the remaining 14 studies did not report users’ race, ethnicity, or nationality.
Reporting of social media users’ socioeconomic status (SES) varied across studies. Twenty-five studies did not report users’ income or employment status; of the remaining 10 studies, 6 studies reported users’ income [, , , , , ] and 4 studies reported employment status [ , , , ]. Studies reporting employment status included users who were unemployed, employed full- or part-time, retired, and/or disabled. Although social media users’ income ranged from less than US $10,000 to US $80,000 a year, 5 of 6 studies reporting users’ income included low-income users reporting less than US $10,000 a year [ , , , , ]; 1 study was not in the United States, whereas the other 4 were in the United States. Thirteen studies reported users’ current education and highest level of education attained, which ranged from high school or less to postcollege [ , , , , , , , , , , , , ].
Design of Social Media Platforms
All studies reported on some aspect of the social media platform, such as whether the platform required disclosure of identity and how users were engaged on the platform.
Process of Engagement
In all, 6 studies created new social media platforms [, , , , , ]; the remaining studies used pre-existing platforms (eg, Facebook, YouTube, or SMS text messaging systems). Twenty-two studies reported that users were already accessing the platform before engagement for study purposes [ , , , , - , - , , , , , - , - ] and 10 studies reported that users started using the platform for the purpose of the study [ , , - , , , , , ]. Social media facilitators included researchers [ , , , , , , , , , , , ]; nonresearchers, such as community members and program staff [ , , , , , , , , , , , , , , , ]; and both researchers and nonresearchers [ , , , , , ].
Communication on Social Media Platform
The most common form of communication on social media platforms was described as communication between users [- , , - , , , , , , , - ] followed by communication between users and staff/professionals (eg, clinicians, counselors, health educators, or health professionals) [ , , , , , , , - , , ]. Communication between individuals (ie, one-to-one messaging) was more common between staff and users, and communication between groups of individuals (ie, posting for a group to read and respond to) was more common among users alone.
Offline or in-person components that served a complementary or related programmatic purpose to the social media platform were reported in 11 studies [, , , , - , , , , ]. Of these, 8 studies described complementary services being provided in-person, with the most common services being clinical care, counseling, or testing [ , , , , ]. Additionally, a study described how social media users attended in-person workshops to help inform the process of online engagement [ ] and 2 studies had options for individuals to be part of a content-equivalent offline program [ , ].
Disclosure of Identity During Platform Use
Most studies [- , , , , , , , , , - , - ] did not clarify whether communication was anonymous or if social media users communicated using their real name or any other identifiable information. Two studies [ , ] indicated that users had the option to communicate using their real names. Five studies [ , , , , ] stated that users communicated using their real names or faces on the platform. Two of these studies described videophone [ ] or webcams [ ] as components of the social media platform, and 3 of the studies [ , , ] involved clinicians or staff contacting individuals for whom they knew the identity.
Benefits of Social Media Use
The most common benefits to using social media to communicate about HIV that studies reported were (1) access to information, (2) enhanced ability to communicate, (3) having an anonymous identity, (4) a sense of social and emotional support, (5) establishing a virtual community, and (6) geographical reach. For most studies, benefits were perceived by the target groups/populations. For other studies, the researchers reported on their perceptions of benefits or challenges related to the social media use.
The ability to receive and share information was reported as a benefit in 12 studies. Studies described users appreciating the ease and convenience of accessing information related to HIV care, treatment, and prevention through social media. For example, users in 4 studies [, , , ] reported being able to receive information online from other PLWHA about disease management. Another study [ ] explored how social media users interested in HIV research in India were able to share information with other local and global users engaged in the same issues. One study [ ] described how teens use their phones to find medical information and share information about HIV and other sexually transmitted infections on social media. Social media users in the remaining 6 studies [ , , , , , ] reported varied benefits, including access to an alternative, nontraditional source of information about HIV prevention and testing.
There were 9 studies reporting enhanced communication as a benefit. Users stated that social media provided them with an alternative, not in-person, way to communicate about sexual health, HIV testing, and condom use with peers, health professionals, and sexual partners. For example, in one study , PLWHA reported a benefit from being able to use social media to communicate with health professionals without leaving their homes. Social media users in 7 studies [ , , , , , , ] including adolescents, noted that social media platforms such as SMS text messaging and Facebook allowed them to communicate about topics that they felt uncomfortable discussing in-person, such as condom use and HIV testing. In another study [ ], a group of black American bloggers reported that the use of social media, specifically blogging, opened channels for communication about HIV, a topic they believed was underdiscussed within the black community.
Another benefit users reported was the anonymous nature of the social media platforms. Users in 6 studies [, , , , , ] mentioned that the anonymity on social media platforms helped to decrease stigma, fear, and discrimination around HIV and allowed participants to tell personal stories about their sexual orientation and HIV status in a manner they would not with friends, family members, or sexual partners offline. The other 2 studies reported that the anonymity of the website allowed adolescent users to seek HIV prevention information [ ] and MSM participants to successfully engage in the intervention [ ].
Another benefit users reported from engaging in an online community was a sense of social and emotional support [, , , , , , , ]. More specifically, adolescents, PLWHA, and MSMs reported experiencing a sense of community from engaging with others through social media [ , , , ]. Lastly, the ability for health care workers to reach patients and community members to engage with one another, regardless of geographical location, was reported as a benefit of using a social media platform to communicate about HIV [ , , , , , ].
Disadvantages of Social Media Use
The most common disadvantages to using social media to communicate about HIV prevention and treatment that studies reported were related to (1) technology barriers, (2) cost, (3) lack of physical interaction, and (4) lack of privacy.
Technological barriers were reported in 12 studies and included users’ problems with poor Internet connection [, , , , ], insufficient access to computers [ , ], lack of technical help [ , ], poor quality of video and audio transmissions [ ], low information technology literacy [ ], and technical “glitches” [ ]. Ten studies reported the cost of social media equipment (ie, personal computers) [ , , , ], Internet access [ , , ], and human resources [ , , ] as barriers.
Lack of physical interaction was a disadvantage reported in 6 studies [, , , , , ] and included limitations in the amount of support health professionals can offer online. Additionally, the absence of verbal or nonverbal cues and the lack of transparency prevented some health professional users from being able to tailor their services and support to specific users. Other recurring disadvantages included lack of privacy and confidentiality [ , , , , ], which prevented participants from sharing personal information out of fear that their information would not be protected. Less frequently cited disadvantages included lack of interest [ - ] and lack of time to communicate with other social media users [ ].
Outcomes of Social Media Use
The most common outcomes of social media use reported were the (1) frequency of social media use, (2) user satisfaction, (3) type of information shared, and (4) effects of social media use.
A total of 19 studies measured frequency of use in a variety of ways. The range of methods used to measure frequency of use included the number of days the social media platform was used ; number of visitors [ , ]; number of videophone calls [ ] or video viewings [ , , ]; number of instant message counseling sessions [ ]; and number of conversations [ , , ], messages [ , , ], posts [ , , ], attendance [ ], and/or hits on the study website [ ].
Eight studies measured users’ satisfaction with the platform by assessing acceptability [, , ], usefulness [ ], quality [ ], and access [ ] on a scale of high, medium, and low satisfaction. Across these studies, users rated their satisfaction with the various social media platforms as high and reported that they found the platforms simple to use [ , ]. Users also reported the platforms provided access to a diverse group of users and that they would recommend the platform to their friends [ ].
Five studies measured the type of information shared on the platforms (eg, access to HIV testing and safer sex strategies) and 4 studies reported that most of the messages contained informational support [, , , ] followed by emotional and social network support [ ]. Six studies measured the effects of social media use and found an increase in HIV knowledge [ ], HIV-related discussions with online friends [ ], number of people seeking HIV testing services [ ], and new HIV-positive patients identified [ ] along with improved medication adherence among HIV-positive participants [ , ].
Our review yielded 35 studies that used social media to communicate about HIV. Social media has been shown to facilitate discussion and information exchange on a range of health issues . To our knowledge, this is the first review of the current landscape and users of social media to communicate about HIV exclusively. Our findings illustrate the following: (1) the value of using pre-existing social media platforms, (2) the diversity among the characteristics of users, and (3) the importance of the role of anonymity on the platform. Consideration of these findings will help extend the field of social media, specifically when related to communication about HIV prevention and treatment.
Most studies use pre-existing social media platforms (eg, a Facebook page) rather than creating new platforms. There may be a number of benefits to using pre-existing social media platforms to communicate about HIV, which might explain their widespread use. First, developing new social media platforms may be costly or resource intensive; some of these costs may be mitigated by using pre-existing platforms. Second, communicating through pre-existing platforms may decrease barriers associated with end-users learning new social media technology. Lastly, users’ familiarity with the platform and connection to other existing users may facilitate more open communication as social media ties increase and users form new virtual communities [, ]. However, despite the potential ease of using pre-existing platforms, health care professionals in some of the selected studies reported limitations in their ability to form relationships with social media users in comparison to face-to-face interaction. This limitation may have an effect on user satisfaction and use of the platform, which is a matter of concern given the recent increase in digital interactions within health care [ ]. Therefore, providing training and support to both users and facilitators (eg, health care professionals) is critical when implementing social media initiatives to mitigate technological or other usage barriers.
Characteristics of social media platform users communicating about HIV within our selected studies span a wide range of geographic locations, sexual orientations, ages, genders, races, and SES. This is encouraging, given the diverse and global nature of the HIV epidemic, and supports other studies that show the high acceptability and use of social media across diverse groups [, , ]. An assessment of the use of varying social media platforms by different types of users did not result in clear patterns; however, several studies in our review describe engagement of traditionally underserved populations, such as low-income individuals, MSM, and PLWHA on a variety of different social media platforms. Given that these populations are often underaccessed with traditional HIV interventions [ - ], these studies show that social media may be a useful engagement strategy [ ]. Our findings also suggest that social media can increase access to both social support and information on HIV prevention and treatment. This increase in access is especially significant for PLWHA who may face barriers to accessing care or prevention resources in-person and for other marginalized groups such as rural populations or young MSM [ , ]. As in other studies [ , ], our review finds that most studies reporting age of platform users engage individuals aged 18 to 40 years, suggesting that health promotion messages using social media may have significant reach within this age group. Given the increasing number of adolescents living with and at risk for HIV [ , ], and the increasing numbers of individuals aged 50 years and older affected by HIV [ ], there is a need to explore the feasibility of using social media to communicate about HIV prevention and treatment within these age groups. Additionally, future research could investigate other technologies that may be more acceptable or effective at reaching these populations
Social media platforms have varying designs and features, such as options for anonymity, which can be tailored to meet the needs of target populations and increase use and acceptability of the platform [, ]. Anonymity allows users to control the information they disclose about themselves, which may allow marginalized populations to feel more comfortable communicating about HIV on social media platforms [ , ]. Most studies in this review do not indicate whether or not individuals communicated using their real names. Interestingly, anonymity is cited as a key benefit and lack of privacy is cited as a key barrier to using social media to communicate about HIV. This dichotomy suggests that social media platforms used to communicate about HIV should allow participants to choose if they would like to remain anonymous in order to facilitate engagement. HIV is a highly stigmatized disease [ , ] in which PLWHA make decisions about disclosure of their HIV status [ , ]. These decisions affect subsequent health behaviors, access to social support, and interactions with sexual partners and social networks [ - ]. Social media platforms may provide PLWHA with an opportunity to anonymously rehearse HIV status disclosure, which may facilitate disclosure in real-world settings [ ]. An important next step to using social media to communicate about HIV is to identify which designs best create and facilitate a sense of privacy, confidentiality, and safety.
This review has several limitations. The outcomes of social media communication about HIV prevention and treatment vary greatly. Given the range of outcomes reported, it is difficult to draw any conclusions on how these outcomes relate to the characteristics of users and platforms across studies. This variation represents a significant challenge in surveying the landscape of social media use to communicate about HIV prevention and treatment. Further, the range of literature available on the effectiveness of social media in communication about HIV prevention and treatment is limited. However, this review is a first step to categorizing gaps and trends in the literature in order to identify areas for future research. Despite concerns in the literature about the accuracy of information shared on social media [- ], this barrier was not reported in our selected studies, and our review was not designed to assess the quality of the information being shared on social media. In addition, the majority of studies selected for this review were at either high or unclear risk of bias for at least one of the bias items. This is a limitation because it is an indicator of the quality of evidence available in the literature and highlights the need for stronger evidence. Lastly, social media use is likely utilized by grassroots and community organizations in HIV communication outside of research contexts; this review did not capture these efforts.
Despite these limitations, our review shows that social media is a promising approach to engage individuals in a dynamic discourse about HIV prevention and treatment, and may allow diverse groups to collaborate on strategies to address the epidemic. Findings from our review are important to design new or leverage pre-existing social media platforms for communication about HIV prevention and treatment, and to illuminate the opportunities for further examination of social media platforms and specific HIV prevention and treatment outcomes.
Support for this work was provided by the Brocher Foundation, the UNC Center for AIDS Research (NIAID P30-AI50410), and the Social and Ethical Aspects of Research on Curing HIV Working Group (searchiv) (NIAID R01A108366-01). Additional support for Tamara Taggart and Donaldson F Conserve provided by a fellowship from the National Institute of Allergy and Infectious Diseases of the National Institutes of Health (Award Number T32AI007001). Additional support for Malika Roman Isler provided by North Carolina Translational and Clinical Sciences Institute, which is supported through the National Institutes of Health (NIH), grant 1UL1TR001111. We acknowledge Lara Handler, UNC School of Medicine librarian, for conducting the initial search for studies; Abigail Weiner Shapiro, MSPH, doctoral student in Health Behavior at the UNC Gillings School of Global Public Health and Alexi McHugh, undergraduate student at the University of South Carolina, Columbia, for their support in data extraction. We thank Joseph Tucker, MD, PhD, MA, Assistant Professor, UNC School of Medicine, for sharing his expertise in systematic review analyses. The content is solely the responsibility of the authors and does not necessarily represent the official views of any funding agencies.
Conflicts of Interest
Multimedia Appendix 1
Studies excluded during full text review.PDF File (Adobe PDF File), 97KB
Multimedia Appendix 2
Summary of selected studies (n=35).PDF File (Adobe PDF File), 36KB
Multimedia Appendix 3
Quality assessment of selected studies.PDF File (Adobe PDF File), 45KB
- Noar SM, Willoughby JF. eHealth interventions for HIV prevention. AIDS Care 2012;24(8):945-952. [CrossRef] [Medline]
- Bastawrous A, Armstrong MJ. Mobile health use in low- and high-income countries: an overview of the peer-reviewed literature. J R Soc Med 2013 Apr;106(4):130-142. [CrossRef] [Medline]
- Guse K, Levine D, Martins S, Lira A, Gaarde J, Westmorland W, et al. Interventions using new digital media to improve adolescent sexual health: a systematic review. J Adolesc Health 2012 Dec;51(6):535-543. [CrossRef] [Medline]
- Muessig KE, Nekkanti M, Bauermeister J, Bull S, Hightow-Weidman LB. A systematic review of recent smartphone, Internet and Web 2.0 interventions to address the HIV continuum of care. Curr HIV/AIDS Rep 2015 Jan 28;12(1):173-190. [CrossRef] [Medline]
- Kaplan AM, Haenlein M. Users of the world, unite! The challenges and opportunities of Social Media. Business Horizons 2010 Jan;53(1):59-68. [CrossRef]
- Boyd D, Ellison N. Social network sites: definition, history, and scholarship. J Comput-Mediat Comm 2007;13(1):210-230.
- Kamel Boulos MN, Wheeler S. The emerging Web 2.0 social software: an enabling suite of sociable technologies in health and health care education. Health Info Libr J 2007 Mar;24(1):2-23. [CrossRef] [Medline]
- Hughes D, Rowe M, Batey M, Lee A. A tale of two sites: Twitter vs Facebook and the personality predictors of social media usage. Computers in Human Behavior 2012 Mar;28(2):561-569. [CrossRef]
- Mahajan AP, Sayles JN, Patel VA, Remien RH, Sawires SR, Ortiz DJ, et al. Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. AIDS 2008 Aug;22 Suppl 2:S67-S79 [FREE Full text] [CrossRef] [Medline]
- Turan B, Stringer KL, Onono M, Bukusi EA, Weiser SD, Cohen CR, et al. Linkage to HIV care, postpartum depression, and HIV-related stigma in newly diagnosed pregnant women living with HIV in Kenya: a longitudinal observational study. BMC Pregnancy Childbirth 2014 Dec 3;14(1):400 [FREE Full text] [CrossRef] [Medline]
- Blackstock OJ, Haughton LJ, Garner RY, Horvath KJ, Norwood C, Cunningham CO. General and health-related Internet use among an urban, community-based sample of HIV-positive women: implications for intervention development. AIDS Care 2015 Apr;27(4):536-544. [CrossRef] [Medline]
- Ko N, Hsieh C, Wang M, Lee C, Chen C, Chung A, et al. Effects of Internet popular opinion leaders (iPOL) among Internet-using men who have sex with men. J Med Internet Res 2013;15(2):e40 [FREE Full text] [CrossRef] [Medline]
- Desouza R, Jyoti DM. Global and local networking for HIV/AIDS prevention: the case of the Saathii E-forum. J Health Commun 2008 Jun;13(4):326-344. [CrossRef] [Medline]
- Coursaris CK, Liu M. An analysis of social support exchanges in online HIV/AIDS self-help groups. Computers in Human Behavior 2009 Jul;25(4):911-918. [CrossRef]
- Horvath KJ, Oakes JM, Rosser BR, Danilenko G, Vezina H, Amico KR, et al. Feasibility, acceptability and preliminary efficacy of an online peer-to-peer social support ART adherence intervention. AIDS Behav 2013 Jul;17(6):2031-2044 [FREE Full text] [CrossRef] [Medline]
- Mo PK, Coulson NS. Exploring the communication of social support within virtual communities: a content analysis of messages posted to an online HIV/AIDS support group. Cyberpsychol Behav 2008 Jun;11(3):371-374. [CrossRef] [Medline]
- Strand C. Blogging: a new tool for coping and accessing psycho-social support for people living with HIV? In: Smedberg A, editor. E-Health Communities and Online Self-Help Groups: Applications and Usage. Hershey, PA: IGI Global; 2011:106-120.
- León A, Cáceres C, Fernández E, Chausa P, Martin M, Codina C, et al. A new multidisciplinary home care telemedicine system to monitor stable chronic human immunodeficiency virus-infected patients: a randomized study. PLoS One 2011;6(1):e14515 [FREE Full text] [CrossRef] [Medline]
- Hailey JH, Arscott J. Using technology to effectively engage adolescents and young adults into care: STAR TRACK Adherence Program. J Assoc Nurses AIDS Care 2013;24(6):582-586. [CrossRef] [Medline]
- Wohlfeiler D, Hecht J, Volk J, Fisher RH, Kennedy T, McFarland W. How can we improve online HIV and STD prevention for men who have sex with men? Perspectives of hook-up website owners, website users, and HIV/STD directors. AIDS Behav 2013 Nov;17(9):3024-3033 [FREE Full text] [CrossRef] [Medline]
- Justumus P, Colby D, Mai Doan Anh T, Balestre E, Becquet R, Orne-Gliemann J. Willingness to use the Internet to seek information on HIV prevention and care among men who have sex with men in Ho Chi Minh City, Vietnam. PLoS One 2013;8(8):e71471 [FREE Full text] [CrossRef] [Medline]
- Jaganath D, Gill HK, Cohen AC, Young SD. Harnessing Online Peer Education (HOPE): integrating C-POL and social media to train peer leaders in HIV prevention. AIDS Care 2012;24(5):593-600 [FREE Full text] [CrossRef] [Medline]
- Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, et al. Putting prevention in their pockets: developing mobile phone-based HIV interventions for black men who have sex with men. AIDS Patient Care STDS 2013 Apr;27(4):211-222 [FREE Full text] [CrossRef] [Medline]
- Young SD, Zhao M, Teiu K, Kwok J, Gill H, Gill N. A social-media based HIV prevention intervention using peer leaders. J Consum Health Internet 2013 Oct 1;17(4):353-361 [FREE Full text] [CrossRef] [Medline]
- Cubbage J. African Americans and social media. In: Langmia K, Tyree TC, O’Brien P, Sturgis I, editors. Social Media: Pedagogy and Practice. Lanham, MD: University Press of America; 2014:103-127.
- Lenhart A, Purcell K, Smith A, Zickuhr K. Social Media & Mobile Internet Use Among Teens and Young Adults. Washington, DC: Pew Internet & American Life Project; 2010 Feb 03. URL: http://www.pewinternet.org/files/old-media//Files/Reports/2010/PIP_Social_Media_and_Young_Adults_Report_Final_with_toplines.pdf [accessed 2015-02-16] [WebCite Cache]
- Madden M, Lenhart A, Cortesi S, Gasser U, Duggan M, Smith A, et al. Teens, Social Media, and Privacy. Washington, DC: Pew Internet & American Life Project; 2013 May 21. URL: http://www.pewinternet.org/files/2013/05/PIP_TeensSocialMediaandPrivacy_PDF.pdf [accessed 2015-02-12] [WebCite Cache]
- Young SD, Holloway I, Jaganath D, Rice E, Westmoreland D, Coates T. Project HOPE: online social network changes in an HIV prevention randomized controlled trial for African American and Latino men who have sex with men. Am J Public Health 2014 Sep;104(9):1707-1712. [CrossRef] [Medline]
- Jones K, Eathington P, Baldwin K, Sipsma H. The impact of health education transmitted via social media or text messaging on adolescent and young adult risky sexual behavior: a systematic review of the literature. Sex Transm Dis 2014 Jul;41(7):413-419. [CrossRef] [Medline]
- Martinez O, Wu E, Shultz AZ, Capote J, López RJ, Sandfort T, et al. Still a hard-to-reach population? Using social media to recruit Latino gay couples for an HIV intervention adaptation study. J Med Internet Res 2014;16(4):e113 [FREE Full text] [CrossRef] [Medline]
- Gibbons MC, Fleisher L, Slamon RE, Bass S, Kandadai V, Beck JR. Exploring the potential of Web 2.0 to address health disparities. J Health Commun 2011;16 Suppl 1:77-89. [CrossRef] [Medline]
- Yonker LM, Zan S, Scirica CV, Jethwani K, Kinane TB. "Friending" teens: systematic review of social media in adolescent and young adult health care. J Med Internet Res 2015;17(1):e4 [FREE Full text] [Medline]
- Dozier A, Hacker K, Silberberg M, Ziegahn L. Clinical and Translational Science Awards Consortium Community Engagement Key Function Committee Task Force on the Principles of Community Engagement, ed. 2011. The value of social networking in community engagement URL: http://www.atsdr.cdc.gov/communityengagement/pce_social_intro.html [WebCite Cache]
- Ei Chew H, LaRose R, Steinfield C, Velasquez A. The use of online social networking by rural youth and its effects on community attachment. Information, Communication & Society 2011 Aug;14(5):726-747. [CrossRef]
- Kim Y, Hsu S, de Zúñiga HG. Influence of social media use on discussion network heterogeneity and civic engagement: the moderating role of personality traits. J Commun 2013 May 11;63(3):498-516. [CrossRef]
- United Nations Development Programme (UNDP), Joint United Nations Programme on HIV/AIDS (UNAIDS). Understanding and Acting on Critical Enablers and Development Synergies for Strategic Investments. New York: United Nations Development Programme; 2012. URL: http://www.unaids.org/sites/default/files/sub_landing/files/201211_UNAIDS_UNDP_Enablers_and_Synergies_en.pdf [WebCite Cache]
- Duggan M, Ellison N, Lampe C, Lenhart A, Madden M. Social Media Update 2014. Washington, DC: Pew Internet & American Life Project; 2015 Jan 09. URL: http://www.pewinternet.org/files/2015/01/PI_SocialMediaUpdate20144.pdf [accessed 2015-02-06] [WebCite Cache]
- Duggan M, Smith A. Social Media Update 2013. Washington, DC: Pew Internet & American Life Project; 2013 Dec 30. URL: http://www.pewinternet.org/files/2013/12/PIP_Social-Networking-2013.pdf [accessed 2015-02-06] [WebCite Cache]
- Moher D. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009 Aug 18;151(4):264. [CrossRef]
- Sanderson S, Tatt ID, Higgins JP. Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography. Int J Epidemiol 2007 Jun;36(3):666-676 [FREE Full text] [CrossRef] [Medline]
- Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Chichester, UK: Wiley-Blackwell; 2008.
- Adam BD, Murray J, Ross S, Oliver J, Lincoln SG, Rynard V. hivstigma.com, an innovative web-supported stigma reduction intervention for gay and bisexual men. Health Educ Res 2011 Oct;26(5):795-807 [FREE Full text] [CrossRef] [Medline]
- Baelden D, Van Audenhove L, Vergnani T. Using new technologies for stimulating interpersonal communication on HIV and AIDS. Telematics and Informatics 2012 May;29(2):166-176. [CrossRef]
- Brennan PF, Ripich S, Moore SM. The use of home-based computers to support persons living with AIDS/ARC. J Community Health Nurs 1991;8(1):3-14. [CrossRef] [Medline]
- Broaddus MR, Dickson-Gomez J. Text messaging for sexual communication and safety among African American young adults. Qual Health Res 2013 Oct;23(10):1344-1353 [FREE Full text] [CrossRef] [Medline]
- Bull SS, Levine DK, Black SR, Schmiege SJ, Santelli J. Social media-delivered sexual health intervention: a cluster randomized controlled trial. Am J Prev Med 2012 Nov;43(5):467-474 [FREE Full text] [CrossRef] [Medline]
- Dean AL, Makin JD, Kydd AS, Biriotti M, Forsyth BW. A pilot study using interactive SMS support groups to prevent mother-to-child HIV transmission in South Africa. J Telemed Telecare 2012 Oct;18(7):399-403. [CrossRef] [Medline]
- Divecha Z, Divney A, Ickovics J, Kershaw T. Tweeting about testing: do low-income, parenting adolescents and young adults use new media technologies to communicate about sexual health? Perspect Sex Reprod Health 2012 Sep;44(3):176-183 [FREE Full text] [CrossRef] [Medline]
- Dunbar PJ, Madigan D, Grohskopf LA, Revere D, Woodward J, Minstrell J, et al. A two-way messaging system to enhance antiretroviral adherence. J Am Med Inform Assoc 2003;10(1):11-15 [FREE Full text] [Medline]
- Eastham L. Living with HIV: Views through the Blog [dissertation]. Virginia: Virginia Common Wealth University; 2011.
- Feldacker C, Torrone E, Triplette M, Smith JC, Leone PA. Reaching and retaining high-risk HIV/AIDS clients through the Internet. Health Promot Pract 2011 Jul;12(4):522-528. [CrossRef] [Medline]
- Hightow-Weidman L, Beagle S, Pike E, Kuruc J, Leone P, Mobley V, et al. "No one's at home and they won't pick up the phone": using the Internet and text messaging to enhance partner services in North Carolina. Sex Transm Dis 2014 Feb;41(2):143-148. [CrossRef] [Medline]
- Hildebrand M, Ahumada C, Watson S. CrowdOutAIDS: crowdsourcing youth perspectives for action. Reprod Health Matters 2013 May;21(41):57-68. [CrossRef] [Medline]
- Kvasny L, Igwe C. An African American weblog community's reading of AIDS in Black America. J Comput-Mediat Comm 2008;13(3):569-592. [CrossRef]
- Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, et al. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. Lancet 2010 Nov 27;376(9755):1838-1845. [CrossRef] [Medline]
- Lou C, Zhao Q, Gao E, Shah IH. Can the Internet be used effectively to provide sex education to young people in China? J Adolesc Health 2006 Nov;39(5):720-728. [CrossRef] [Medline]
- Moskowitz DA, Melton D, Owczarzak J. PowerON: the use of instant message counseling and the Internet to facilitate HIV/STD education and prevention. Patient Educ Couns 2009 Oct;77(1):20-26. [CrossRef] [Medline]
- Pavlescak R. Spreading the Word on Safer Sex: Examination of an Internet Chat Room Based HIV Prevention Intervention [dissertation]. Cypress, CA: Turo University International; 2007.
- Pedrana A, Hellard M, Gold J, Ata N, Chang S, Howard S, et al. Queer as F**k: reaching and engaging gay men in sexual health promotion through social networking sites. J Med Internet Res 2013;15(2):e25 [FREE Full text] [CrossRef] [Medline]
- Reid MJ, Flam R, Tsiouris F. New models for medical education: Web-based conferencing to support HIV training in Sub-Saharan Africa. Telemed J E Health 2012 Sep;18(7):565-569. [CrossRef] [Medline]
- Rhodes SD. Hookups or health promotion? An exploratory study of a chat room-based HIV prevention intervention for men who have sex with men. AIDS Educ Prev 2004 Aug;16(4):315-327. [CrossRef] [Medline]
- Rhodes SD, Hergenrather KC, Duncan J, Vissman AT, Miller C, Wilkin AM, et al. A pilot intervention utilizing Internet chat rooms to prevent HIV risk behaviors among men who have sex with men. Public Health Rep 2010;125 Suppl 1:29-37 [FREE Full text] [Medline]
- Rice E, Tulbert E, Cederbaum J, Barman AA, Milburn NG. Mobilizing homeless youth for HIV prevention: a social network analysis of the acceptability of a face-to-face and online social networking intervention. Health Educ Res 2012 Apr;27(2):226-236 [FREE Full text] [CrossRef] [Medline]
- Rothpletz-Puglia P, Jones VM, Storm DS, Parrott JS, O'Brien KA. Building social networks for health promotion: Shout-out Health, New Jersey, 2011. Prev Chronic Dis 2013;10:E147 [FREE Full text] [CrossRef] [Medline]
- Skrajner MJ, Camp CJ, Haberman JL, Heckman TG, Kochman A, Frentiu C. Use of videophone technology to address medication adherence issues in persons with HIV. HIV AIDS (Auckl) 2009 Nov 1;1:23-30 [FREE Full text] [CrossRef] [Medline]
- Wicks P, Massagli M, Frost J, Brownstein C, Okun S, Vaughan T, et al. Sharing health data for better outcomes on PatientsLikeMe. J Med Internet Res 2010;12(2):e19 [FREE Full text] [CrossRef] [Medline]
- Yamauchi E. LoveLife, MYMsta, and Mizz B: Evaluating a Mobile Phone-Based Social Network to Prevent HIV Among Youth in South Africa [dissertation]. Chapel Hill, NC: University of North Carolina at Chapel Hill; 2010.
- Young SD, Jaganath D. Online social networking for HIV education and prevention: a mixed-methods analysis. Sex Transm Dis 2013 Feb;40(2):162-167 [FREE Full text] [CrossRef] [Medline]
- Zhuang J, Bresnahan M. HIV/AIDS stigma in Chinese Internet forums: a content analysis approach. Chinese Journal of Communication 2012 Jun;5(2):227-242. [CrossRef]
- Moorhead SA, Hazlett DE, Harrison L, Carroll JK, Irwin A, Hoving C. A new dimension of health care: systematic review of the uses, benefits, and limitations of social media for health communication. J Med Internet Res 2013;15(4):e85 [FREE Full text] [CrossRef] [Medline]
- Gilbert E, Karahalios K. Predicting tie strength with social media. New York, NY: ACM; 2009 Presented at: SIGCHI Conference on Human Factors in Computing Systems; April 4-9, 2009; Boston, MA. [CrossRef]
- Viswanath B, Mislove A, Cha M, Gummadi K. On the evolution of user interaction in Facebook. In: Proceedings of 2nd ACM Workshop on Online Social Networks. New York: ACM; 2009 Presented at: 2nd ACM Workshop on Online Social Networks; August 17, 2009; Barcelona, Spain. [CrossRef]
- Bajwa M. Emerging 21(st) century medical technologies. Pak J Med Sci 2014 May;30(3):649-655 [FREE Full text] [CrossRef] [Medline]
- Schoenberger Y, Phillips J, Mohiuddin MO, McNees P, Scarinci I. Acceptability of delivering and accessing health information through text messaging among community health advisors. JMIR Mhealth Uhealth 2013;1(2):e22 [FREE Full text] [CrossRef] [Medline]
- Magnani R, Sabin K, Saidel T, Heckathorn D. Review of sampling hard-to-reach and hidden populations for HIV surveillance. AIDS 2005 May;19 Suppl 2:S67-S72. [Medline]
- HIV/AIDS Bureau, Special Projects of National Significance Program. Training Manual: Innovative Approaches to Engaging Hard-to-Reach Populations Living with HIV/AIDS into Care. Rockville, MD: US Department of Health and Human Services, Health Resources and Services Administration; 2013 Jan. URL: https://careacttarget.org/sites/default/files/file-upload/resources/Outreach_trainingmanual_final.pdf [accessed 2015-02-16] [WebCite Cache]
- Cunningham WE, Sohler NL, Tobias C, Drainoni M, Bradford J, Davis C, et al. Health services utilization for people with HIV infection: comparison of a population targeted for outreach with the U.S. population in care. Med Care 2006 Nov;44(11):1038-1047. [CrossRef] [Medline]
- Christopoulos KA, Das M, Colfax GN. Linkage and retention in HIV care among men who have sex with men in the United States. Clin Infect Dis 2011 Jan 15;52 Suppl 2:S214-S222 [FREE Full text] [CrossRef] [Medline]
- Mugavero MJ, Amico KR, Horn T, Thompson MA. The state of engagement in HIV care in the United States: from cascade to continuum to control. Clin Infect Dis 2013 Oct;57(8):1164-1171 [FREE Full text] [CrossRef] [Medline]
- Chou WS, Hunt YM, Beckjord EB, Moser RP, Hesse BW. Social media use in the United States: implications for health communication. J Med Internet Res 2009;11(4):e48 [FREE Full text] [CrossRef] [Medline]
- Kontos EZ, Emmons KM, Puleo E, Viswanath K. Communication inequalities and public health implications of adult social networking site use in the United States. J Health Commun 2010;15 Suppl 3:216-235 [FREE Full text] [CrossRef] [Medline]
- Joint United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS World AIDS Day Report. Geneva: UNAIDS; 2012. URL: http://www.unaids.org/sites/default/files/en/media/unaids/contentassets/documents/epidemiology/2012/gr2012/JC2434_WorldAIDSday_results_en.pdf [WebCite Cache]
- Centers for Disease Control and Prevention. 2014. HIV Among Youth URL: http://www.cdc.gov/hiv/risk/age/youth/index.html?s_cid=tw_std0141316 [accessed 2015-02-06] [WebCite Cache]
- Joint United Nations Programme on HIV/AIDS (UNAIDS). HIV and Aging. Geneva: UNAIDS; 2013. URL: http://www.unaids.org/sites/default/files/media_asset/20131101_JC2563_hiv-and-aging_en_0.pdf [accessed 2015-02-06] [WebCite Cache]
- Noar SM. The utility of "old" and "new" media as tools for HIV prevention. In: HIV/AIDS: Global Frontiers in Prevention/Intervention. New York: Routledge; 2009:343-353.
- Webb TL, Joseph J, Yardley L, Michie S. Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res 2010;12(1):e4 [FREE Full text] [CrossRef] [Medline]
- Levine D, Madsen A, Wright E, Barar RE, Santelli J, Bull S. Formative research on MySpace: online methods to engage hard-to-reach populations. J Health Commun 2011 Apr;16(4):448-454. [CrossRef] [Medline]
- Bull S, Walker T, Levine D. Communities and technology: enhancements in HIV-prevention research practice among adolescents and young adults. In: Rhodes SD, editor. Innovations in HIV Prevention Research and Practice through Community Engagement. New York: Springer New York; 2014:183-214.
- Valdiserri RO. HIV/AIDS stigma: an impediment to public health. Am J Public Health 2002 Mar;92(3):341-342. [Medline]
- Chaudoir SR, Fisher JD, Simoni JM. Understanding HIV disclosure: a review and application of the Disclosure Processes Model. Soc Sci Med 2011 May;72(10):1618-1629 [FREE Full text] [CrossRef] [Medline]
- Derlega VJ, Winstead BA, Greene K, Serovich J, Elwood WN. Perceived HIV-related stigma and HIV disclosure to relationship partners after finding out about the seropositive diagnosis. J Health Psychol 2002 Jul;7(4):415-432. [CrossRef] [Medline]
- Vanable PA, Carey MP, Blair DC, Littlewood RA. Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS Behav 2006 Sep;10(5):473-482 [FREE Full text] [CrossRef] [Medline]
- Martinez J, Harper G, Carleton RA, Hosek S, Bojan K, Clum G, Adolescent Medicine Trials Network. The impact of stigma on medication adherence among HIV-positive adolescent and young adult females and the moderating effects of coping and satisfaction with health care. AIDS Patient Care STDS 2012 Feb;26(2):108-115 [FREE Full text] [CrossRef] [Medline]
- Wellman B. Computer networks as social networks. Science 2001;293(5537):2031-2034. [CrossRef]
- Adams SA. Blog-based applications and health information: two case studies that illustrate important questions for Consumer Health Informatics (CHI) research. Int J Med Inform 2010 Jun;79(6):e89-e96. [CrossRef] [Medline]
- Adams SA. Revisiting the online health information reliability debate in the wake of "web 2.0": an inter-disciplinary literature and website review. Int J Med Inform 2010 Jun;79(6):391-400. [CrossRef] [Medline]
- Fahy E, Hardikar R, Fox A, Mackay S. Quality of patient health information on the Internet: reviewing a complex and evolving landscape. Australas Med J 2014;7(1):24-28 [FREE Full text] [CrossRef] [Medline]
|AIDS: acquired immunodeficiency syndrome|
|HIV: human immunodeficiency virus|
|MSM: men who have sex with men|
|N/A: not applicable|
|PLWHA: people living with HIV/AIDS|
|PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses|
|SES: socioeconomic status|
|SMS: short message service|
|UNAIDS: Joint United Nations Programme on HIV/AIDS|
Edited by G Eysenbach; submitted 27.02.15; peer-reviewed by A Moorhead, C Hoving, H Sipsma; comments to author 29.07.15; revised version received 03.09.15; accepted 09.10.15; published 02.11.15
©Tamara Taggart, Mary Elisabeth Grewe, Donaldson F Conserve, Catherine Gliwa, Malika Roman Isler. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 02.11.2015.
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