Considerations for Online Recruitment of Men Who Have Sex With
Men Living in Geographical Areas Not Included in the NHBS
Considerations for Online Recruitment of Men Who Have Sex With Men Living in Geographical Areas Not Included in the NHBS
Master's Thesis (207 pages)
Committee Chair / Thesis Adviser: Sullivan, Patrick S
Research Fields: Health Sciences, Epidemiology
Partnering Agencies: Does not apply (no collaborating organization)
Keywords: HIV; MSM; Rural
Program: Rollins School of Public Health, Epidemiology (Global Epidemiology)
Background: Recently, surveillance of the HIV epidemic in
the U.S. has expanded. The
current behavioral surveillance system uses venue-based sampling methodology and is
only inclusive of certain metropolitan statistical areas. With the expansion of web-based
research, MSM may be more accessible for inclusion in surveillance systems.
Objective: This study aims to evaluate the feasibility, usefulness, and cost effectiveness
of recruiting men online from states where data are not collected as part of the National
HIV Behavioral Surveillance System (NHBS) and determine if special strategies are
needed to reach rural MSM.
Methods: Data on HIV risk behaviors, testing history, and use of prevention services
were collected through an online survey targeted towards MSM over 18 years of age in
three states not included in the NHBS (Iowa, Minnesota, and South Carolina).
Participant characteristics were modeled with three outcomes (unprotected anal
intercourse (UAI) with most recent male sex partner, disclosure male-male sex to a
provider, and having an HIV test in the past year) using logistic regression. Cost per
completed interview was compared to cost for general US surveys of MSM; usefulness
will be evaluated with a 6-month follow-up evaluation with participating health
Results: A total of 516 men completed the survey. 206 (47%) were from rural areas.
Rural men had decreased odds of disclosing male-male sex to their provider (aOR=0.37).
Those who disclosed having sex with men to their provider had increased odds of ever
testing for HIV (aOR=3.06) and receiving a hepatitis C test in the past year (aOR=4.05).
73% of rural MSM and 65% of urban MSM engaged in UAI in the past year. 89% of
participants (n=403) were white, non-Hispanic. The average cost per completed survey
was $10.82 overall and was highest ($16.25) in South Carolina.
Discussion: Rural MSM engaged in high-risk behavior and were less likely to discuss
their sexual behaviors with a provider. These disparities demonstrate the need to include
these areas in national surveillance systems to monitor trends in behavior and assess
prevention efforts. The high cost of recruiting MSM from these areas demonstrates the
need for developing and evaluating new online recruitment methodology.
Table of Contents
LIST OF TABLES
APPENDIX A: Survey Instrument and State Questions
APPENDIX B: SAS Code
APPENDIX C: State Report -- Iowa
APPENDIX D: State Report - Minnesota
APPENDIX E: State Report - South Carolina
APPENDIX F: IRB Approval
APPENDIX G: Banner Advertisements