Sullivan Patrick S, Khosropour Christine M, Luisi Nicole, Amsden Matthew, Coggia Tom, Wingood Gina M, DiClemente Ralph J
Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA 30322, USA.
J Med Internet Res. 2011 May 13;13(2):e38. doi: 10.2196/jmir.1797.
The Internet has become an increasingly popular venue for men who have sex with men (MSM) to meet potential sex partners. Given this rapid increase in online sex-seeking among MSM, Internet-based interventions represent an important HIV (human immunodeficiency virus) prevention strategy. Unfortunately, black and Hispanic MSM, who are disproportionately impacted by the HIV epidemic in the United States, have been underrepresented in online research studies.
Our objective was to examine and quantify factors associated with underrecruitment and underretention of MSM of color in an online HIV behavioral risk research study of MSM recruited from an online social networking site.
Internet-using MSM were recruited through banner advertisements on MySpace.com targeted at men who reported in their MySpace profile their age as at least 18 and their sexual orientation as gay, bisexual, or unsure. Multivariable logistic regression models were used to estimate the odds stratified by race and ethnicity of the MySpace user clicking through the banner advertisement. To characterize survey retention, Kaplan-Meier survival curves and multivariable Cox proportional hazards models identified factors associated with survey dropout.
Over 30,000 MySpace users clicked on the study banner advertisements (click-through rate of 0.37%, or 30,599 clicks from 8,257,271 impressions). Black (0.36% or 6474 clicks from 1,785,088 impressions) and Hispanic (0.35% or 8873 clicks from 2,510,434 impressions) MySpace users had a lower click-through rate compared with white (0.48% or 6995 clicks from 1,464,262 impressions) MySpace users. However, black men had increased odds of click-through for advertisements displaying a black model versus a white model (adjusted odds ratio [OR] = 1.83, 95% confidence interval [CI] 1.72 - 1.95), and Hispanic participants had increased odds of click-through when shown an advertisement displaying an Asian model versus a white model (adjusted OR = 1.70, 95% CI 1.62 - 1.79). Of the 9005 men who consented to participate, 6258 (69%) completed the entire survey. Among participants reporting only male sex partners, black non-Hispanic and Hispanic participants were significantly more likely to drop out of the survey relative to white non-Hispanic participants (hazard ratio [HR] = 1.6, 95% CI 1.4 - 1.8 and HR = 1.3, 95% CI 1.1 - 1.4, respectively). Men with a college-level of education were more likely to complete the survey than those with a high-school level of education (HR = 0.8, 95% CI 0.7 - 0.9), while men who self-identified as heterosexual were more likely to drop out of the survey compared with men who self-identified as gay (HR = 2.1, 95% CI 1.1 - 3.7).
This analysis identified several factors associated with recruitment and retention of MSM in an online survey. Differential click-through rates and increased survey dropout by MSM of color indicate that methods to recruit and retain black and Hispanic MSM in Internet-based research studies are paramount. Although targeting banner advertisements to MSM of color by changing the racial/ethnic composition of the advertisements may increase click-through, decreasing attrition of these study participants once they are engaged in the survey remains a challenge.
互联网已成为男男性行为者（MSM）寻找潜在性伴侣越来越常用的途径。鉴于男男性行为者在线寻求性行为的情况迅速增加，基于互联网的干预措施成为预防艾滋病毒（人类免疫缺陷病毒）的一项重要策略。不幸的是，在美国受艾滋病毒流行影响尤为严重的黑人及西班牙裔男男性行为者在在线研究中所占比例一直较低。
我们的目的是在一项从在线社交网站招募男男性行为者的艾滋病毒行为风险在线研究中，研究并量化与有色人种男男性行为者招募不足和留用率低相关的因素。
通过在MySpace.com上投放横幅广告招募使用互联网的男男性行为者，这些广告针对在MySpace个人资料中报告年龄至少为18岁且性取向为同性恋、双性恋或不确定的男性。使用多变量逻辑回归模型来估计按MySpace用户的种族和族裔分层后点击横幅广告的几率。为了描述调查留用情况，采用Kaplan-Meier生存曲线和多变量Cox比例风险模型来确定与调查退出相关的因素。
超过30000名MySpace用户点击了研究横幅广告（点击率为0.37%，即8257271次展示中有30599次点击）。黑人（1785088次展示中有0.36%或6474次点击）和西班牙裔（2510434次展示中有0.35%或8873次点击）MySpace用户的点击率低于白人（1464262次展示中有0.48%或6995次点击）MySpace用户。然而，与展示白人模特的广告相比，展示黑人模特广告的点击率，黑人男性有所增加（调整后的优势比[OR]=1.83，95%置信区间[CI]为1.72 - 1.95）；与展示白人模特的广告相比，展示亚洲模特广告的点击率，西班牙裔参与者有所增加（调整后的OR = 1.70，95% CI为1.62 - 1.79）。在同意参与的9005名男性中，6258名（69%）完成了全部调查。在仅报告有男性性伴侣的参与者中，非西班牙裔黑人及西班牙裔参与者相对于非西班牙裔白人参与者退出调查的可能性显著更高（风险比[HR]=1.6，95% CI为1.4 - 1.8和HR = 1.3，95% CI为1.1 - 1.4）。具有大学教育水平的男性比具有高中教育水平的男性更有可能完成调查（HR = 0.8，95% CI为0.7 - 0.9），而自我认定为异性恋的男性与自我认定为同性恋的男性相比，更有可能退出调查（HR = 2.1，95% CI为1.1 - 3.7）。
该分析确定了在线调查中与男男性行为者招募和留用相关的几个因素。有色人种男男性行为者不同的点击率和更高的调查退出率表明，在基于互联网的研究中招募和留用黑人及西班牙裔男男性行为者的方法至关重要。虽然通过改变广告的种族/族裔构成将横幅广告针对性投放给有色人种男男性行为者可能会提高点击率，但减少这些研究参与者参与调查后的损耗仍然是一项挑战。
