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DESCRIPTION: This section will highlight relevant works published in English, with a special emphasis on those that are available in the Ryerson University Library collection. Check for these using Proquest Dissertations and Theses. Alderson, Kevin George

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Men who use the Internet to seek sex with other men MISM are increasingly using the Internet to find sexual health information and to seek sexual partners, with some research suggesting HIV transmission is associated with sexual partnering online. To investigate MISM's experiences and self-perceived impacts of online outreach. From December to JanuaryMISM aged 16 years or older were recruited from Internet sites, mobile apps, and ASOs across Ontario to complete a minute anonymous online questionnaire regarding their experience of online outreach.

Of MISM who completed the survey, 8. As a result of their last online outreach encounter, MISM reported the following: Online outreach services are a relatively new and underdeveloped area of intervention, but are a promising health promotion strategy to provide service referrals and engage diverse groups of MISM in sexual health education.

Globally, the HIV epidemic continues to disproportionately burden sexual minority men. These figures have not changed much since Bisexual canada eastern in man only ontario sex 1 ]. GB2M have been using the Internet and online mobile technologies for well over 20 years to connect with one another for social and sexual relations [ 4 ].

Because of advancements in these technologies, men who use the Internet to seek sex with other men MISM have adapted to evolving technology that provides new options for connecting and obtaining sexual health information [ 4 ]. Even though many jurisdictions have advanced human rights for lesbian, gay, and bisexual people, many GB2M live, work, and socialize in contexts where same sex activity is stigmatized, and sexuality and sexual behavior are restricted or met with disapproval [ 5 ]; thus, many resort to online and mobile technologies to communicate and interact with other GB2M [ 6 ].

In a telephone interview study, These two figures likely provide the bounds of the true estimate. Regardless, the Internet is the most frequently used resource for sex eg, one-third of Ontario GB2M surveyed in used the Internet at least once a week to look for sex [ 9 ]. In particular, these technologies offer what Cooper has referred to as the Triple A Engine effect [ 10 ].

That is, using online and mobile technologies for communication with other MISM for social and sexual reasons is appealing and common because of three factors: Affordability, Accessibility, and Anonymity. GB2M use electronic media to look for sex, friendship, and connection online.

GB2M who seek sexual partners online report high rates of behaviors associated with HIV risk eg, unprotected anal intercourse [UAI] with a serodiscordant partner [ 14 ]. Among a community-based sample of GB2M in British Columbia, Canada, men who sought partners online were more likely to report 10 or more sexual partners in the past year compared with those who did not seek partners online [ 15 ]. Previous research has shown that the majority of MISM hold favorable attitudes toward online health promotion [ 1417 - 19 ].

Online sexual health promotion can be Bisexual canada eastern in man only ontario sex effective and low-cost method to educate MISM [ 182021 ]. Online interventions have demonstrated a reduction Bisexual canada eastern in man only ontario sex UAI [ 23 ], particularly Bisexual canada eastern in man only ontario sex unknown or serodiscordant partners [ 24 ]. As participants, MISM expect online health promotion to respect the online culture, build trust, and deliver well-crafted and focused messages [ 16 ].

A recent systematic literature review [ 26 ] on Internet and mobile app use for sexual health promotion among MISM in Canada highlighted the need for more research that examines this phenomenon and its implications. Specifically, though agencies are offering online outreach services, we know very little about how these online outreach services are understood, accessed, or relevant for the sexual health of MISM in Bisexual canada eastern in man only ontario sex. The ASO and sexual health sectors, as well as public health providers and public health scientists, have suggested a need to reconceptualize online media as vital tools for HIV prevention [ 427 ].

It is important to note that for resource reasons, most of this online outreach is conducted at Bisexual canada eastern in man only ontario sex times of the day, including weekends, weekdays, and weeknights, depending on the provider's Bisexual canada eastern in man only ontario sex and availability.

It is not a hour service and it is not available through all apps or websites. Some app or website providers prohibit this type of service on their sites as it interrupts the user experience.

In Ontario, online outreach providers are generally either trained sexual health outreach workers or public health staff. Online outreach has become a key tool in the delivery Bisexual canada eastern in man only ontario sex sexual health information and services affecting MISM [ 38222829 ]. In light of the predominance of the Internet as a social and sexual venue for GB2M in Ontario, outreach in physical venues is no longer sufficient; online outreach can help reach more GB2M.

This study developed out of consultations with community providers who were conducting online outreach to MISM. Often these providers were doing this outreach because they were aware that this is where the men they wished to reach were located, or because physical venues were not available or less popular. Given the numerous calls for more research directed at understanding how online tools can benefit sexual health promotion [ 2630 ], few of these articles focused specifically on online outreach.

Therefore, there is little evidence of the reach, depth, impact, or effectiveness of this type of outreach. Though ASOs and public health practitioners have developed apps specific to HIV prevention, these are infrequently downloaded and often poorly rated, suggesting that these apps may not be useful or that MISM prefer accessing information within the apps they use [ 31 ].

Several agencies report an increased demand for online outreach services [ 3 ]. Taken collectively, there is great interest in improving online outreach, but also some challenges conceptualizing, sustaining, and evaluating online media as effective learning environments. That is, whether they find it useful, relevant, and applicable to their sexual health.

The aim of this study was to assist in the development of tools that would be useful for sexual health online outreach for MISM. A community advisory board composed of MISM met quarterly to inform and provide feedback on the research process, data collection tools, and knowledge translation activities. All study protocols were granted ethics clearance from the University of Toronto Research Ethics Board. Between December and Januaryparticipants were recruited from across Ontario using electronic advertisements on sociosexual websites eg, Squirt.

Participants were asked to complete an anonymous online Bisexual canada eastern in man only ontario sex regarding their technology use, online behavior sociosexual and health relatedexperience of online outreach, and demographics see Table 1. To be eligible, participants must have sought sexual partners or sexual health information online in the past 6 months or had an interest in doing so ; identify as a gay, bisexual, two-spirit, straight, queer, or questioning cis- or transgender man; had in the past had sex with another man or an interest in doing so ; be at least 16 years old; and either lived or worked in Ontario or had visited Ontario at least three times in the past year.

Sample demographics and the prevalence of, and factors associated with, online outreach experience. Our primary dependent variable was participants having experienced online outreach or not. Participants were prompted with the following definition: Those who were contacted by online outreach services were asked if they were told why they were being contacted, whether a photo was used agency logo, personal, unsureand whether they were comfortable being contacted.

All participants who had experienced online outreach rated several aspects of their last experience see Table 2 for items on a 5-point Likert scale from 1 disagree to 5 agreewhich were dichotomized into agree 4 or 5 or not Participants were asked to indicate any changes that resulted from their last online outreach encounter see Table 3 for itemsif they would use online outreach services again yes or Bisexual canada eastern in man only ontario sexand to explain why or why not through an open-ended text response.

Those participants who had not encountered online outreach were asked to indicate why: All participants were asked to provide qualitative feedback on any difficulties they had trying to access these online outreach services if these services were of interest to them. Further, geographic location was grouped into major provincial regions Toronto, Central Ontario, Southwestern Ontario, Eastern Ontario, and Northern Ontario using participants' forward sortation areas ie, first three characters of a Canadian postal code.

Data were analyzed to determine the prevalence of online outreach experience and associated factors. Descriptive statistics of the overall sample and for those participants who experienced online outreach were prepared. Independent factors associated with experience of online outreach were determined using logistic regression.

Univariate analyses were conducted to screen independent variables using a liberal P value of. A final multivariate model was built using a manual backward-stepwise elimination approach [ 32 ]. Nonsignificant likelihood ratio tests were used to confirm removal of any categorical variables. A research assistant manually coded qualitative data, which were collected through open-ended text responses, with iterative consultations with the first and second author DJB, NJL and to resolve unclear coding questions.

Of the Bisexual canada eastern in man only ontario sex who completed the online questionnaire, men 8.

Table 1 provides the descriptive statistics of the overall sample and the prevalence of, and univariate associations with, reporting online outreach experience. Two factors Bisexual canada eastern in man only ontario sex were significant at the univariate level, but that were not included in the multivariable analysis, were HIV status and being two-spirited. Also, two-spirit participants were more likely to have also experienced online outreach compared with those who were not two-spirit OR 3.

Aboriginal men were more likely than white men to have experienced online outreach adjusted odds ratio [AOR] 2. Finally, men who were receiving some form of social assistance eg, disability or Bisexual canada eastern in man only ontario sex insurance were more likely to have experienced online outreach than those who were not receiving social assistance AOR 3.

Participants rated their last online outreach experiences very positively see Table 2. Table 3 shows the number and proportion of men who self-reported a variety of impacts as a result of their last online outreach experience.

Online outreach connected some men with a variety of referral services for men: Men also reported changes in their sexual partnering decisions with respect to HIV status: Overall, the men who accessed online outreach services rated the services as helpful and several explained how these services were becoming important sources of community and service information. First, even among those who had accessed online outreach services, several men expressed that these services were not readily visible or available.

My responses often had a long delay like a day or two. All participants were asked to comment on any difficulties they had in trying to access online outreach services. Of men, Others indicated geographic difficulties with accessing these services. This will not help accessing services as who wants to run into a friend or acquaintance when seeking assistance? This is the first study to examine the perceptions, expressed need, and self-reported impact of online outreach services for MISM GB2M in a Canadian context.

It is significant that participants are encountering these services in a space online where they are not necessarily going to seek health information and services.

Most importantly, our analyses showed online services to be disproportionately used by GB2M who are hard to reach using other means, including HIV-positive men and Aboriginal men. Though several other studies focused primarily on youth [ 2225 ], our findings suggest that there were no differences based on age.

It would be useful to ensure broad age ranges for studies examining GB2M and online use. In univariate analyses, two-spirit men and HIV-positive men were significantly more likely to access online outreach, and for trans-identified men this analysis approached significance. However, in multivariable analysis, Aboriginal participants not necessarily those who identified as two-spirit were more likely to access online outreach compared with white men.

This may be a useful distinction for agencies serving Aboriginal men, because regardless of how they identify—gay, bisexual, two-spirit—this suggests Aboriginal men of all identities—gay, bisexual, two-spirit—are more likely to access resources available online. Like non-Aboriginal communities, stigma among Aboriginal populations regarding sexual minorities [ 34 ] may leave some two-spirit men feeling that online outreach is the preferred place to encounter the Triple A Engine effect of service usage because it is accessible, affordable, and anonymous.

Those in Southwestern and Eastern Ontario were less likely than those in Toronto to access outreach. This may be a result of the numerous agencies providing online outreach in Toronto, whereas Bisexual canada eastern in man only ontario sex communities may likely have only one if any agency providing such outreach.

However, there were no differences in online outreach uptake between men in Northern Ontario, which has more rural and remote regions, and men in Toronto; this indicates the utility of these services to reach men who may be more geographically isolated [ 25 ] from both physical communities and in-person health and social services that are often clustered within large urban centers.

Those on social assistance were more likely Bisexual canada eastern in man only ontario sex access online outreach than those who were not. These factors are important considerations for programming and policy implications when developing strategies in a variety of local jurisdictions and with specific populations.

Indeed, a diverse array of singular and multiple outcomes were noted, including a decrease in anxiety, an increase in condom use, and even a better connection to community. These outcomes suggest online outreach has the capacity to address a comprehensive and integrated approach to care and services. Clearly, the needs go beyond specific condom use issues to those involving access to testing, pre- and post-HIV exposure treatment, and issues related to mental health and social well-being.

These findings suggest the use of the Internet and other mobile technologies is a yet unrealized potential tool to link GB2M to rapidly evolving HIV-prevention information, such as the meaning of an undetectable viral load in relation to HIV transmission, and care, such as pre- and postexposure treatment. In addition, these online tools can also be formulated to address the underlying psychosocial factors impacting syndemics among GB2M [ 27 ].

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