Text Messaging as an Effective HIV Prevention Intervention for Methamphetamine-using MSM

Men textingAs frequently addressed in this blog, new media is playing an ever-growing role as a tool in our response to HIV/AIDS. We often now see HIV prevention and anti-stigma messages—such as CDC’s several Act Against AIDS campaigns—delivered to the general public via websites, YouTube, and social media platforms such as Facebook, Twitter and others. We are also learning how new media tools can be effective in our work to develop HIV prevention interventions tailored for narrower, often harder-to-reach audiences.

In a CDC-supported study led by Dr. Cathy Reback in Los Angeles that I was associated with (see AIDS and Behavior Exit Disclaimer, October 2012, pp. 1993-2002), Dr. Reback and the study team found that text messaging can be an effective way to reduce high-risk behaviors associated with HIV transmission among methamphetamine-using men who have sex with men (MSM).

“Participants in Project Tech Support received a two-week intervention of social support and health education text messages in real time,” explains Dr. Reback. Real time texting interventions are those that occur at times when a person is most likely to consider engaging in high-risk behaviors and when face-to-face contact is often not feasible. In this case, participants received periodic health-promoting messages from the study managers and had the option to text replies to those messages, engaging in a conversation with a study staff member. Participants also could initiate texts to trained study staff for health education, information and/or support at times when they were considering risky drug-using or sexual behaviors.

After the intervention, the participants reported a reduction in high-risk behaviors for HIV transmission; specifically, significant decreases in the frequency of both methamphetamine use and unprotected sex while on methamphetamine. The intervention method—text messaging—was found to be both acceptable to the target audience and feasible to use.

Finding effective HIV prevention interventions for this population is important because MSM is the only risk group in the United States in which HIV infections have continued to steadily increase since the early 1990s.  Among this population, substance-using MSM—particularly methamphetamine-using MSM—are at significantly greater risk of HIV acquisition and transmission than any other behavioral risk group, as these men often engage in concurrent drug and sexual HIV risk behaviors. “We chose to explore a text messaging intervention partly because this population may not respond to or may be difficult to reach through more traditional face-to-face or site-based HIV prevention interventions,” reported Dr. Reback. “Further, many of the men already use various new media tools such as instant messaging, social networking sites, and websites to facilitate sexual and/or drug ’hook ups’. Given the use of these communication tools in their daily lives, a text messaging-based HIV prevention intervention seemed to be an appropriate strategy to reach and intervene with them.”

Pilot study findings suggest that text messaging and other technology-based interventions present promising new ways to reach MSM at high risk of HIV infection with prevention information in a manner that is timely, relevant, convenient, and confidential, and that can be carried out in real time. Thus, it is important to continue to investigate text messaging and other mobile health (mHealth) communication approaches as modes of delivery for HIV prevention interventions. Testing programs with one- and two-way communication capacity will show us how such interventions can most effectively foster the behavior changes needed to reduce the risk of HIV transmission.

Editor’s note: will continue to share occasional highlights from initiatives across the U.S. government that are studying the use of text messaging and other mobile technologies as interventions to improve HIV prevention, care and treatment.