The Role of Online Support Groups in Helping Individuals Affected by HIV and AIDS: Scoping Review of the Literature

Background Online support groups provide opportunities for individuals affected by HIV and AIDS to seek information, advice, and support from peers. However, whether and how engagement with online support groups helps individuals affected by HIV and AIDS remains unclear, as does the nature of the evidence on this topic. Objective This scoping review sought to explore whether engagement with HIV and AIDS–related online support groups benefits members in terms of psychosocial well-being and illness management, whether members experienced any negative aspects of these groups, and what types of social support are exchanged within HIV and AIDS–related online support groups. Methods A scoping review of English-language articles (including both qualitative and quantitative studies) was undertaken using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The databases searched included MEDLINE, PubMed, EMBASE, CINAHL, PsycINFO, CENTRAL (Cochrane Register of Controlled Trials), and Scopus. Key findings were synthesized using a narrative and thematic approach. Results A total of 22 papers met the inclusion criteria from an initial pool of 3332 abstracts. These papers included 23% (5/22) quantitative studies, 9% (2/22) mixed methods studies, and 68% (15/22) qualitative studies published between 2007 and 2019. Cross-sectional evidence suggests that engagement with HIV and AIDS–related online support groups is empowering for members and may lead to a range of psychosocial benefits. Furthermore, qualitative evidence suggests that these groups provide an opportunity to connect with similar people and share experiences. This can help improve self-worth, reduce stigma, facilitate improved illness management, and gain greater confidence when interacting with health professionals. However, online support groups are not without their limitations as qualitative evidence suggests that users may encounter examples of interpersonal conflict between members as well as be exposed to challenging content. Finally, HIV and AIDS–related online support groups are avenues through which individuals can solicit support, most commonly informational or emotional. Conclusions HIV and AIDS–related online support groups may have some benefits for members, particularly in terms of providing social support. There is a need for a systematic review of this literature that includes an assessment of the methodological quality of the available evidence.


Background
According to the Joint United Nations Programme on HIV and AIDS, it is estimated that approximately 38 million people are living with HIV and AIDS worldwide [1]. Although there is currently no cure, it is possible to suppress the virus to levels that are undetectable using antiretroviral drugs. Nevertheless, a new diagnosis of HIV brings with it several challenges [2,3]. Individuals receiving a positive diagnosis of HIV will likely face a lifetime of medical treatment to combat the biomedical repercussions of the disease. Individuals also face many psychological challenges because of living with a long-term, highly stigmatized condition [4,5], which may lead to uncertainty about the future. Individuals living with HIV and AIDS may experience social isolation [6], fear of prejudice [7], and loneliness [8] as they learn to adjust to their diagnosis and a lifetime of daily multiple medications [9]. If individuals have problems adjusting to living with HIV and AIDS, clinical depression, anxiety, stress, and poor coping are common [10]. Of particular concern is the prevalence of depression and suicide among people living with HIV and AIDS [11][12][13].
Evidence suggests that individuals living with HIV and AIDS who are satisfied with the level of social support they receive are more likely to adjust positively, cope better, and experience a slower progression of HIV-related symptoms [14]. Furthermore, research has shown that social support plays a pivotal role in managing the stress associated with HIV and leads to better psychological and physical health outcomes among individuals living with the disease [15,16].
As global access to the internet continues to increase [17], recent technological advances have led to the development of diverse forms of electronic communication, which in turn have supported participation, collaboration, and information sharing between users. An example that illustrates the potential for users to interact with peers on the web is through the medium of online support groups. Such groups allow individuals to come together to share experiences, provide mutual support, and ask questions. Online support groups can be underpinned by different platforms such as discussion forums, chat rooms, social networking sites (eg, Facebook), blogs, microblogs (eg, Twitter), and virtual reality environments. Although such platforms may offer synchronous interaction (ie, live and in real time), most online support groups are asynchronous, where interaction and the exchange of user-generated content takes place over time (ie, hours, days, weeks, or months), and are predominantly text based.
In recent years, there has been an exponential increase in the number of online support groups that have been established to help those affected by long-term conditions, including HIV and AIDS. Similarly, the number of internet users accessing online support groups continues to increase, with recent estimates suggesting that between 7% and 28% of adults have accessed one [18,19].
Evidence suggests that there may be a range of factors that can lead individuals to engage with asynchronous text-based online support groups. In a review of the literature, Wright [20] described 4 broad factors evident within the studies. First, the convenience of computer-mediated communication may be attractive to individuals. For example, an asynchronous text-based online support group is potentially available 24 hours per day, 7 days per week and can be accessed whenever it is needed [21]. This flexibility in access permits individuals to seek support at times and places that are convenient to them and may be helpful to those with family, educational, or work commitments [22][23][24]. Second, individuals may have limited access to adequate social support within traditional social networks. This may be because people in an individual's social network have little or no experience or understanding of their condition. Indeed, their condition may not be well understood by health professionals, or it may be rare. Third, individuals may be living with a condition that is stigmatized and, therefore, online support groups may be regarded as a safe environment in which they can discuss personal or sensitive issues [25,26]. Fourth, individuals have reported the value of being able to interact with others who are similar and credible [27]. Taken together, it is evident that online support groups may be relevant and potentially beneficial for individuals living with HIV and AIDS.
However, it should be noted that online support groups are not without their limitations. For example, the asynchronous text-based nature of most online support groups means that social cues such as facial expressions, tone of voice, and body language are not available, and this may cause challenges for users [28]. In addition, the absence of physical proximity restricts the expression of physical affection (eg, hugs), and users may feel isolated and alone in their real lives after logging off [24]. There may also be delays in responses being posted to the group, and this may negatively affect the user experience and satisfaction with online support groups [21]. Concerns have also been expressed regarding both the quantity and quality of posts and information [29,30]. Finally, there may exist a dominance of negative content as users are more likely to post messages during times when their symptoms are especially problematic, and this may cause additional anxiety and concern for those reading these posts [24].

Rationale for the Study
The internet affords new opportunities to support those living with a stigmatized condition such as HIV and AIDS. Online support groups provide a convenient, anonymous, and increasingly popular way to reach out to similar people for information, advice, and support. In addition, increasing attention has been given to online support groups by policy makers [31]. However, there has been no attempt to review the evidence on the possible benefits (or limitations) of HIV and AIDS-related online support groups as well as the types of social support that may be exchanged between users. In this scoping review, both the quantitative and qualitative literature will be identified, described, and synthesized.

Aim and Review Questions
The primary aim of this scoping review was to describe the literature on the utility of online peer support groups for individuals affected by HIV and AIDS, and 3 key questions informed our review. We did not make any assumptions about whether quantitative or qualitative studies would ultimately be used to address each question. Rather, our scoping review set out to establish what types of evidence existed that could help address each of the research questions. Our questions were as follows: (1) Does engagement with online peer support groups improve psychosocial well-being and illness management among those living with HIV and AIDS? (2) Are there any negative aspects of online support groups experienced by individuals living with or affected by HIV and AIDS? If so, what are these? (3) What types of social support are exchanged within online support groups for individuals living with or affected by HIV and AIDS?

Search Strategy and Procedure
Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist, our search strategy protocol was published in PROSPERO (registration CRD42020161119). MEDLINE, PubMed, EMBASE, CINAHL, PsycINFO, CENTRAL (Cochrane Register of Controlled Trials), Scopus, and Google Scholar were searched electronically. The search strategy focused on 2 central concepts: the intervention (ie, online support groups) and the population (ie, individuals living with or affected by HIV and AIDS). It was developed using a combination of Medical Subject Headings and keywords with no study design filter. In addition, the references of the selected articles were hand searched for any additional relevant studies. The searches were conducted in April 2022 (for an example of the MEDLINE search and PRISMA checklist, see Multimedia Appendices 1 and 2).

Inclusion and Exclusion Criteria
To be eligible for inclusion in our scoping review, an article needed to (1) be peer-reviewed and (2) meet the inclusion criteria detailed in Textbox 1. These criteria were developed using the Population, Intervention, Comparator, Outcome, Setting, and Study Design model. We did not apply any restrictions with regard to date of publication. Our inclusion and exclusion criteria were developed such that we could focus solely on the unique contribution of text-based HIV and AIDS-related online support groups; therefore, we chose to exclude studies in which this support was combined with other forms of support.

Study design
• Inclusion: all quantitative designs, qualitative studies that explored participants' experiences of online support groups as reported directly from the users, and studies reporting the analysis of user-generated content • Exclusion: literature reviews and microanalysis of online discourse (eg, discourse or conversation analysis)

Study Selection
The 2 authors (NSC and HB) reviewed the titles and abstracts independently to identify potentially relevant articles. Abstracts not meeting the inclusion criteria were excluded. In cases where the abstract signaled potential eligibility, the full article was retrieved. Inclusion was based on agreement between both authors, and all reasons for exclusion were noted. In all instances of disagreement, discussion took place until the conflict was resolved.

Data Extraction and Data Synthesis
Predetermined study characteristics (ie, study aim, methods, data source, sample, and data analysis) as well as results (ie, quantitative findings, identified positive or negative outcomes, experiences or attributes, and types and frequencies of social support) were extracted by each of the 2 authors independently.
To support this process, the review tool Covidence was used, and the extraction template was modified to support the specific requirements of the scoping review. Each of the 2 authors independently extracted the study characteristics and findings before discussing and agreeing on the final extraction content, which was then entered into a specific section of the Covidence data extraction template. To address each of the research questions, we used both narrative (ie, tabulation of findings from individual primary studies) and thematic (ie, an inductive approach to generate descriptive or analytical themes) synthesis.

Included Studies
Our search strategy yielded 4786 studies, including 1454 (30.38%) duplicates. From the 3332 titles and abstracts reviewed, 2993 (89.83%) did not meet the inclusion criteria. The full texts of the remaining 57 studies were assessed, and a further 35 (61%) were excluded as they did not meet the inclusion criteria (Table 1) or were duplicates (n=11, 19%). Overall, there were 22 papers included in our review. Figure 1 presents the PRISMA flow diagram.

Study Characteristics
For those studies included in the review, further details are provided in Table 2. As indicated, of the 22 studies, 5 (23%) were quantitative studies, 2 (9%) were mixed methods studies, and 15 (68%) were qualitative studies. To study changes in the composition of socioemotional and informa-Guo and Goh [40] ing the first 10 weeks (n=1277) of the online platform moderated tional content in an HIV support group's exis-by the founding member and AIDS online support group over time tence and the last 10 weeks (n=966) of the data collection period To explore whether differences exist between lurkers and posters in their use of HIV and AIDS-related online support groups, experience of empowering processes, and outcomes and satisfaction Mo and Coulson [46] Classification of online support group users into (1) nonusers, (2)  To explore how an HIV and AIDS-related online support group delivers positive social support and builds community Peterson [50] Content analysis of all 7215 messages posted since its creation on January 18, 2011, as of September 14, 2012 Not specified Retrieval of usergenerated messages Qualitative Public, asynchronous, Sina Weibo microblogging platform To explore the types of social support observed within a Chinese HIV and AIDS-related online support group Shi and Chen [51] Of the 6 quantitative designs (n=5, 83% quantitative studies and n=1, 17% mixed methods studies), only 1 (17%) was longitudinal and measured changes in HIV-related stigma over time [37]. The other 83% (5/6) of the quantitative studies were cross-sectional, measuring engagement with online support groups at only 1 time point [42,[46][47][48][49]. The qualitative studies and the qualitative component of the mixed methods studies undertook an analysis of user-generated content [14,[32][33][34]36,37,[39][40][41][43][44][45]50,51] or interviewed online support group members [35,38], with 6% (1/17) of the studies analyzing the content of responses to open-ended questions [29].
As can be seen in Table 2

Overview
To address this research question, data were extracted and synthesized from 100% (5/5) of the quantitative studies [42,[46][47][48][49] and the quantitative data from 50% (1/2) of the mixed methods studies [37]. These data are presented in Table 3 synthesized into a single theme (Positive and negative associations between engagement and psychosocial outcomes). Next, we extracted data from 27% (4/15) of the qualitative studies [14,35,38,39] and the qualitative data from 50% (1/2) of the mixed methods studies [29]. We synthesized this into a single theme (Connecting with similar others) capturing the positive impact of engagement on psychosocial well-being and illness management.  [37] a mean change of −3.9 (95% CI −8.1 to 0.2), but it was not statistically significant (P=.06). Among those who posted, posters of content unrelated to stigma had a mean change in stigma scores of −3.3 (SD 12.7) compared with −5.1 (SD 17.2) for posters of stigma-related content. There was a trend toward more improvement in stigma scores with posting vs not posting and with posting about stigma vs other content, though these differences were not statistically significant (P=.50 and P=.72, respectively; 1-way ANOVA F test).

Cross-sectional
Perceived online social support was associated with employment status (employed people had higher levels of OSG a use: length of use (years) and frequency of Weibo use; health information: date of HIV diagnosis, recent CD4 Han et al [42] support compared with unemployed people), CD4 cell cell counts, and HIV status disclosure; enacted giving social counts (those with lower CD4 cell counts perceived more support: 5 items; enacted receiving social support: 4 items; support), and perceived offline support (higher offline perceived offline social support: 12-item Multidimensional support was associated with higher online support). People Scale of Perceived Social Support; perceived online social living with HIV and AIDS perceived higher levels of social support: 8-item modified Multidimensional Scale of Persupport from Weibo than from offline support (from family and friends). ceived Social Support; subjective well-being: 5-item Satisfaction with Life Scale; adherence to ART b : 6 items; risky sexual behavior: 5 items Compared with posters, members who only read the messages ("lurkers") scored lower in receiving social support OSG use: length of use (months) and days and hours per average week; satisfaction with online support group expe-Mo and Coulson [46] and receiving useful information in empowering processes rience: 4 items; empowering processes: 43-item scale, 4 and lower in satisfaction with their relationship with group processes (receiving useful information, receiving social members. They also scored higher in distraction and lower support, finding positive meaning, and helping others); in planning on the Brief COPE. In addition, they scored self-care self-efficacy: 29-item Strategies Used by People lower in social function and higher in energy. There were to Promote Health Scale; loneliness: 10-item UCLA c no significant differences in self-care self-efficacy, loneli-Loneliness Scale; optimism: 10-item Life Orientation Testness, depression, or optimism between posters and "lurkers." Revised; coping: 28 [47] in planning, active coping, instrumental support, and emo-month; health status: 36 [48] useful information and finding positive meaning were re-(receiving useful information, receiving social support, lated to higher levels of adaptive coping and lower levels finding positive meaning, and helping others); self-care of maladaptive coping, whereas receiving social support self-efficacy: 29-item Strategies Used by People to Promote and helping others were related to higher levels of self-care Health Scale; coping: 28-item Brief COPE; quality of life: 35-item Medical Outcome Study HIV Health Survey self-efficacy, which in turn was related to higher levels of adaptive coping and lower levels of maladaptive coping. Finally, higher levels of adaptive coping and lower levels of maladaptive coping were related to better quality of life.
Online support group use was positively related to empowering processes, which in turn was positively related to

Summary of key findings Variables and measures Study type and study
Members of the group shared their personal conditions, thoughts, and feelings related to HIV with others as well as expressing gratitude or sending congratulations. This disclosure and actions served to promote reciprocal disclosure and promote group ties. Consequently, members felt better about themselves.

N/A e Coursaris and Liu [14]
The community message board helped individuals connect with others going through a similar experience and fostered a sense of universality. The mutual exchange of support between members was also described as beneficial, with both informational and emotional support being particularly helpful in terms of outlook. N/A Flickinger et al [35] Sharing experiences of stigma and memories of shame, guilt, and pain promoted a sense of camaraderie that mitigated the negative impacts of both felt and enacted stigma. N/A Gadgil et al [38] Participation in an online support group helped members feel like they were being treated as an equal.

Positive and Negative Associations Between Engagement and Psychosocial Outcomes
Of the 6 quantitative studies, only 1 (17%) was a longitudinal investigation. Flickinger et al [37] examined changes in HIV-related stigma over time (ie, at baseline and after 12 months). Although there was a reduction in HIV-related stigma, this was not significant.
A total of 23% (5/22) of the studies adopted a cross-sectional approach when considering the relationship between engagement with online support groups and psychosocial well-being and illness management. Using the same data set, 9% (2/22) of the studies [46,49] found that engagement with online support groups was positively associated with greater exposure to a number of "empowering processes." These, in turn, were positively associated with adaptive coping, self-care self-efficacy, optimism, and quality of life [46] and lower levels of loneliness and depression [49]. A paper from this data set [46] considered whether these differences would exist when engagement was viewed in terms of "lurking" (ie, not posting any messages) versus "posting," but no differences were found in terms of self-care self-efficacy, loneliness, depression, or optimism. Similarly, no differences were found between frequent and infrequent users of online support groups in relation to perceived social support [47]. However, other sociodemographic and medical factors were predictive of perceived online support in 5% (1/22) of the studies [42]. Indeed, this study found that people living with HIV and AIDS perceived higher levels of social support from their online support group than from their offline networks.

Connecting With Similar Others
This theme captured the way in which engagement with HIV and AIDS-related online support groups was considered beneficial to individuals in terms of improving their psychosocial well-being and illness management. The qualitative studies illuminated how online support groups provided an opportunity to meet and interact with other individuals who were currently experiencing or had in the past experienced similar issues and challenges [14,29,35,38,39]. Through the sharing of personal experiences, thoughts, and feelings as well as messages offering congratulations, gratitude, and acknowledgment, a sense of camaraderie and group cohesion was developed. In addition, 5% (1/22) of the studies described how the exchange of informational and emotional support was helpful to group members [35]. Together, the ability to connect and engage in mutually supportive interaction helped individuals in terms of their self-worth [14,39] and outlook as well as mitigating the negative impacts of stigma [38]. A total of 5% (1/22) of the studies [29] described how this mutually supportive interaction also benefited individuals in terms of better illness management and improved confidence when communicating with health care professionals.

Overview
To address this research question, data were extracted and synthesized from 33% (5/15) of the qualitative studies [29,32,35,36,39] and the qualitative data from 50% (1/2) of the mixed methods studies [37]. Three themes capturing the negative aspects of online support groups experienced by users were generated from the findings (Table 4): (1) challenging behavior, (2) difficult content, and (3) negative consequences of the web-based platform.

Challenging Behavior
This theme was concerned with behavior of group members that was considered inappropriate. Some studies (2/6, 33%) described how members felt that the behavior of others was inappropriate, unkind, disrespectful, or attacking or was trying to ridicule others [29,39].

Negative Content
Several studies (4/6, 67%) reported how the content posted to the online support groups was negative or difficult to deal with. For example, Flickinger et al [35] reported instances of complaining, vulgarity, bad language, taboo topics, excessive personal information, and religiosity. Furthermore, the challenge of being exposed to posts that were disturbing or disruptive to the community, such as posts expressing suicidal thoughts or mental health concerns, was highlighted [36]. Asiri et al [32] also reported instances in which some of the content posted on the web appeared to be judging or ascribing blame to individuals for their HIV status.

Negative Consequences of the Web-Based Platform
A range of issues was identified that reflected the negative consequences arising from the platform underpinning the online support group. For example, 33% (2/6) of the studies noted the difficulties arising from the fact that group members were not physically copresent [35], and this presented challenges in terms of forming web-based relationships [29]. However, some concerns were also expressed regarding overreliance on these web-based relationships and the potential for a decline in real-world relationships as a possible consequence [29]. Concerns were also expressed regarding the quantity and quality of information exchanged between group members. For example, Flickinger et al [35] noted the difficulties experienced by individuals when trying to keep up with conversations on the web, whereas other studies (1/6, 17%) reported difficulties regarding both information overload and accuracy [29]. Flickinger et al [35] described problems concerning a lack of activity or immediacy of feedback on members' posts. In addition, they noted concerns regarding the lack of anonymity in group participation. Asiri et al [32] also identified concerns regarding privacy and disclosure in their study.

Research Question 3: What Types of Social Support Are Exchanged Within Online Support Groups for Individuals Affected by HIV or AIDS?
To address this research question, data were extracted and synthesized from 73% (11/15) of the qualitative studies [14,[33][34][35][39][40][41][43][44][45]51], which analyzed user-generated content for evidence of social support exchange. These are presented in Table 5. Most studies (8/11, 73%) included sufficient detail to populate Table 5 but, in some instances, we undertook a simple calculation from the available data to report support requests or provision. All studies used the message as the level of analysis except for the study by Maestre et al [44], which used the utterance. All studies (11/11, 100%) used a deductive analytical approach, with 55% (6/11) of the studies [14,33,35,39,44,45] using the Social Support Behavior Code developed by Cutrona and Suhr [52] as their underpinning coding framework. From the remaining studies, 9% (1/11) [41] combined the Social Support Behavior Code with interaction process analysis, 9% (1/11) [43] used a social support conceptual framework developed by House and Kahn [53], and 9% (1/11) [51] were guided by the typology described by Wright et al [54]. A further 18% (2/11) of the studies [34,41] stated that researchers with experience in public health developed the categories of social support to be coded.

Principal Findings
Online support groups offer new opportunities for those living with HIV and AIDS to access information, advice, and mutual peer support. To our knowledge, this is the first scoping review to synthesize the evidence regarding HIV or AIDS-related online support groups. Our review had three aims; we sought to determine (1) whether engagement with online peer support groups improved psychosocial well-being and illness management for those living with HIV and AIDS; (2) whether there existed any negative aspects of online support groups experienced by individuals living with or affected by HIV and AIDS and, if so, what were they; and (3) what types of social support were exchanged within online support groups for individuals living with or affected by HIV and AIDS. We addressed the first research question by synthesizing the findings of a range of published quantitative, mixed methods, and qualitative studies. The second and third research questions were answered by synthesizing the findings of published qualitative studies.
In terms of our first research question, no randomized controlled trials of the impact of engagement with HIV and AIDS-related online support groups on psychosocial well-being and illness management were identified. However, we did extract relevant findings from quantitative and qualitative studies as well as the quantitative component of a mixed methods study. There was limited quantitative evidence that engagement with online peer support groups improves psychosocial well-being. Indeed, the only longitudinal study conducted over a 12-month period [37] reported no changes in HIV-related stigma. All the cross-sectional studies (5/22, 23%) reported an association between engagement with HIV or AIDS-related online support groups and psychosocial well-being and illness management [42,[46][47][48][49]; however, it is difficult to make any causal inference owing to the cross-sectional nature of the studies. In terms of qualitative evidence, benefits arising from engagement with HIV and AIDS-related online support groups were reported across all the studies (15/22, 68%), in particular the psychosocial benefits of individuals coming together on the web and sharing their experiences together with the mutual exchange of support. Mo and Coulson [29] described a range of "active ingredients" that may benefit individuals who engage with HIV or AIDS-related online support groups. These included exchanging information, sharing experiences, connecting with others, encountering emotional support, finding recognition, and understanding and helping others. In turn, they identified several psychosocial outcomes that may arise from engagement, including increased optimism and control over the future, improved emotional and social well-being, being better informed, improved coping, and feeling more confident in their relationship with health care professionals.
In relation to our second research question, there were 27% (6/22) of studies reporting qualitative data on the negative aspects of engagement with online support groups. We identified 3 key problematic issues. The first revolved around the challenging behavior of other group members, particularly in terms of interpersonal conflict. Next, we identified the challenge of negative content and how group members could be exposed to online material that was difficult to read. Finally, we noted negative experiences that may arise from the unique features (eg, text-based and asynchronous) of the web-based platforms used to support the online support groups. Specifically, we noted difficulties in forming online relationships but also instances of overreliance on these relationships, which may then negatively affect offline relationships. We also identified concerns regarding both information quantity and quality. These various concerns have been reported elsewhere in the literature [24,27,55] and are potentially serious in nature. However, we currently have little understanding of the long-term impact of these negative experiences on group members. Moving forward, these findings do suggest that online support group moderators or administrators may play a crucial role in achieving the aims of the support group and safeguarding its membership.
Half of the studies included in our review (11/22, 50%) addressed the third research question, which considered the types of social support exchanged within online support groups for individuals living with or affected by HIV and AIDS. In total, 100% (11/11) of the qualitative studies used a deductive analytic approach with a social support framework (or typology) to guide the analysis, with most studies (6/11, 55%) using the Social Support Behavior Code developed by Cutrona and Suhr [52]. There were more studies reporting a higher proportion of support provision than of requests. This may be explained by the asynchronous text-based platforms that were used in the studies. On these platforms, conversational threads are developed by individual group members posting a message and other group members posting replies. Our findings also revealed that emotional and informational support were the types most frequently requested but, in terms of provision, informational support was the most common type of support reported. These findings are consistent with the results of a meta-analytic review of 41 published studies that reported informational and emotional support messages as the most prevalent within health-related online support groups [56].

Strengths and Limitations of This Review
It is important to highlight the strengths of this scoping review.
Most notably, we identified, described, and synthesized data from quantitative, qualitative, and mixed methods studies and considered the guidance set out by Booth et al [57] to support this process. In doing so, we believe this has provided the reader with a richer and more holistic insight into the role of online support groups for individuals affected by HIV and AIDS. However, there are also some limitations that should be considered. First, although we searched 7 databases, it is possible that we failed to identify some relevant studies. However, to mitigate this, we also searched Google Scholar as well as hand searching the reference lists of all the included studies. This yielded additional studies that were included in our review. Second, our review may have introduced bias through the inclusion of only studies published in English; thus, we may have overlooked studies published in other languages. Finally, our review identified a few quantitative studies, and those that were included were mostly cross-sectional surveys. Therefore, it becomes difficult to draw definitive conclusions, particularly in relation to the psychosocial benefits arising from engagement with HIV and AIDS-related online support groups.

Recommendations for Future Research
This scoping review has revealed that there exists a growing and diverse body of literature that considers the role of online support groups for people affected by HIV and AIDS. This literature includes quantitative, qualitative, and mixed methods research designs. However, our review also pinpointed specific areas for future research to advance our understanding of the role and impact of online support groups for individuals affected by HIV and AIDS. First, to assess the impact of engagement more fully, future research efforts should seek to develop more robust research designs, including randomized controlled trials and longitudinal studies on both the benefits and harms of engagement. This work should also seek to consider a broader array of psychosocial as well as illness-related outcome measures. Second, as these online support groups may be supported by a range of platforms, future research should seek to explore how the affordances of each platform may influence both engagement and outcomes. Third, our review noted that online support group moderators may play a pivotal role in promoting the aims of the group as well as safeguarding its membership. Therefore, further research examining the function and effectiveness of moderator web-based behavior is warranted. Fourth, as the exchange of informational support appears widespread within online support groups for HIV and AIDS, future work may seek to determine the accuracy of any medical-related information shared and the extent to which it may affect the coping strategies and behaviors of members.

Conclusions
Online support groups provide an opportunity for individuals affected by HIV and AIDS to engage in mutual support. This engagement may be associated with improved illness management as well as a range of beneficial psychosocial outcomes. However, members may experience negative aspects of the online support groups, particularly in terms of interpersonal conflict with other members and content that is challenging. Online support groups for HIV and AIDS can provide a valuable opportunity to both seek and provide social support, notably informational and emotional support.

Conflicts of Interest
None declared.

Multimedia Appendix 1
Example