Ian Holloway - US grants

DESCRIPTION (provided by applicant): Men who have sex with men (MSM) remain the group most affected by HIV infection in the United States with younger men at particular risk for new infection. Considerable attention has been devoted to developing intervention programs to prevent new infections among young MSM (YMSM);however, little research has been conducted on the social networks of YMSM and the social contexts where YMSM engage in high-risk behaviors that promote HIV risk, such as substance use (SU). Classical sociological theory and several prominent theories of health behavior, such as Social Cognitive Theory and the Theory of Reasoned Action, emphasize the importance of the social environment in influencing individual behavior. Yet little is known about the contexts in which YMSM gather to socialize and how these contexts facilitate engagement in SU and HIV risk behavior. The proposed study seeks to use a mixed-methods approach to examining social networks of YMSM in Los Angeles County and the contexts that are associated with varying levels of SU and HIV risk behavior among YMSM. Data from the NIDA-funded "Healthy Young Men" (HYM) study will be used to identify patterns in the social networks of YMSM in Los Angeles and the social contexts (e.g. bars, clubs, coffee shops, bookstores) where YMSM in Los Angeles gather. Using the Duality of Persons and Groups Theory, data on YMSM socialization patterns will be entered into matrices that can be analyzed as social networks (i.e., the shared contexts that YMSM nominate are regarded as "ties" between network members and network members who nominate a particular social context serve as ties between those contexts). Social networks will be analyzed with attention to sociodemographic characteristics (e.g., race/ethnicity, age, sexual identity). Attributes of individual YMSM, including SU behaviors and sexual risk behavior (SRB), will be associated with the social contexts that YMSM have nominated. During the second phase of the proposed study, qualitative methodologies (e.g., ethnographic observational data, semi-structured interviews) will be used to supplement quantitative findings in order to better understand the features of most popular social contexts among YMSM. Taken together, the sociometric network data and qualitative data will be used to inform the development of new or tailoring of existing interventions that are targeted to social contexts, which may be most conducive to the uptake of SU and HIV prevention messages among YMSM. PUBLIC HEALTH RELEVANCE: Young Men who have Sex with Men (YMSM) are disproportionately affected by HIV. This study will contribute to effective substance abuse and HIV risk behavior interventions for YMSM by understanding the social network and contextual influences that contribute to substance use and sexual risk in this population. Specifically, social network analysis coupled with qualitative fieldwork will elucidate characteristics of social networks and social contexts that are associated with varying levels of substance use and HIV risk behavior.

? DESCRIPTION (provided by applicant): HIV incidence among gay, bisexual and other men who have sex with men (hereafter MSM) continues to rise, driven in part by substance use. MSM are increasingly using social networking sites (SNS) to find substance use and sexual partners. However, no studies currently exist that use automated, real-time data collection and analysis procedures to monitor substance use and sexual partner seeking across the range of SNS platforms used by MSM to inform intervention development. This project will build on Routine Activities Theory to conduct research using SNS interactions to aid in understanding patterns of substance use and HIV risk behavior among MSM. During Phase 1, focus groups of MSM (n=~8/focus group; N=24) will be used to develop a lexicon for identifying substance use and sexual partner seeking among MSM via diverse SNS platforms. These findings will guide the development of a culturally congruent data collection and mining module (DCMM; internet software that systematically searches SNS to gather data in an analyzable format) with iterative feedback from a community advisory board (CAB) and pilot testing by MSM (n=6). During Phase 2, the DCMM will gather data from 50 MSM on SNS use (e.g., frequency, intensity) substance use and HIV risk/protective behaviors (e.g., content of profiles, postings). Risk behaviors will be assessed weekly via self- report and validated with biomarkers of risk behaviors to be collected at the end of the study period using a rapid oral HIV test and drug test via nail sample. This research will result in a subsequent R34 application to develop and test a just-in-time adaptive intervention (JTAI) using machine learning technology. The specific aims of the proposed research are to: (1) Develop and assess the utility of a culturally congruent DCMM to study the SNS use patterns, substance use and HIV risk and protective behaviors of MSM; (2) Determine associations between patterns of technology use, substance use and HIV risk behaviors among a sample of 50 MSM using a culturally congruent DCMM, self-report data collection and biomarkers for substance use and HIV; and (3) Evaluate the feasibility and the computational requirements of a just-in-time adaptive intervention to reduce substance use and HIV risk behavior among MSM. By devising and testing a culturally congruent DCMM to capture SNS data on MSM substance use and sexual partner seeking this study lays the building blocks to developing technology-based substance use and HIV prevention and treatment efforts tailored specifically for MSM.

Project Summary Gay, bisexual and other men who have sex with men (GBMSM) are disproportionately impacted by HIV in the U.S. Substance use is an important influence on HIV risk among GBMSM; and partner seeking for both sex and substance use have largely moved online and to geosocial networking platforms designed for GBMSM (e.g., Grindr). Technological advances in the collection and mining of ?big data? to inform behavioral health interventions have increased in recent years but have not been applied directly to HIV prevention and substance use harm reduction among GBMSM. At the same time, despite major advances in biomedical HIV prevention (i.e., pre-exposure prophylaxis [PrEP]) and substance use harm-reduction (i.e., medication assisted therapy [MAT]), these strategies are underutilized by GBMSM. My research team and I conducted formative research on social media data mining and machine learning through a NIDA A/START (R03) to identify patterns of technology use that are associated with HIV risk and substance use among GBMSM. We established computational functionality of a culturally tailored social media data mining program among substance using GBMSM. I now take an important scientific risk to use this technology to develop an HIV prevention intervention for GBMSM, tentatively titled uTECH, that leverages insights from machine learning to trigger personalized intervention content in order to increase biomedical HIV prevention and substance use harm reduction. Specifically, I propose to conduct a two-phase study. In Phase 1 I will conduct qualitative interviews with GBMSM to inform the iterative development and refinement of uTECH. In Phase 2, I will test the acceptability, appropriateness and feasibility of uTECH in a comparative implementation science trial. For this phase, I will (a) enroll racially diverse, HIV-negative, substance using GBMSM; (b) randomize them to either the uTECH intervention or a comparison group; and (c) measure acceptability, appropriateness and feasibility through 6 months post-intervention. My primary implementation science outcomes will be acceptability (i.e., Acceptability of Intervention Measure [AIM]), appropriateness (i.e., Intervention Appropriateness Measure [IAM]), and feasibility (i.e., Feasibility of Intervention Measure [FIM]). I believe that the power of ?big data? and new technologies can be harnessed for effective HIV prevention with substance using GBMSM. In the era of increasing HIV prevention fatigue among GBMSM, the ability to deliver quick, convenient and highly personalized interventions presents an opportunity to reinvigorate HIV prevention.