Online 'Soap Opera' Helps Curb STI Rates in Young Men Who Have Sex with Men

Brian Mustanski, PhD, director of the Institute for Sexual and Gender Minority Health and Wellbeing at Northwestern

Brian Mustanski, PhD

A new online HIV prevention program is showing promising results in its ability to decrease sexually transmitted infections (STIs) among a critical population: young gay men.

Researchers at Northwestern University developed an online program called “Keep It Up!” targeted at men ages 18 through 29 who have sex with men. The program includes a soap opera, interviews with patients, and interactive games and is designed to reflect the real lives of users and thereby make meaningful connections between their behaviors and the risk of STIs.

The double-blinded study included 901 young men in New York, Chicago, and Atlanta, and took place between 2013 and 2017. Using an eHealth platform, participants were randomly assigned either the prevention program or a control.

After 1 year, patients who were enrolled in Keep It Up! had a 40% lower rate of chlamydia and gonorrhea.

Brian Mustanski, PhD, director of the Institute for Sexual and Gender Minority Health and Wellbeing at Northwestern, said the reduction in those 2 STIs suggests the program is also effective at preventing HIV transmission.

“Gonorrhea and chlamydia are biomarkers for HIV risk because the same behaviors that transmit HIV also transmit these bacterial STIs to the rectum and urethrae,” he told MD Mag. “Bacterial STIs also biologically increase the risk of HIV transmission. The [US Centers for Disease Control and Prevention] estimates a rectal STI nearly triples the per act HIV transmission risk of anal sex.”

The targeted nature of the program was key, Mustanski said. Young men who have sex with men make up just 2% of the population, but they account for 70% of HIV diagnoses. In order to break through to the group, Mustanski said members of the target audience were intricately involved in the development of Keep It Up!

“The program design was conceptualized through qualitative interviews with diverse young gay/bisexual men on how they used the internet to find information about HIV and the issues and experiences they see as important in their lives,” he said. “As the content was being developed we continuously obtained feedback from diverse young gay/bisexual men.”

Reactions from the users make clear the impact. An unnamed study participant said he didn’t think much about his own sexual behavior until he watched the soap opera.

“When I saw those characters, I was judging them, but then I realized I was doing the same (risky) thing,” said the study participant, in a quote provided to MD Mag by the university.

In addition to lower rates of STI transmission, the study also showed rates of condomless anal sex decreased.

Mustanski is hoping to expand the program. He is currently seeking funding in hopes of testing out Keep It Up! in 50 US counties. More broadly, Mustanski said the interactive program is a cost-effective strategy that can easily be deployed alongside other prevention methods.

“Online eHealth programs like Keep It Up! can help address some of the major gaps in school sex education so that young gay/bisexual men are armed with the knowledge and skills to protect themselves,” he said.

The study is titled, “Biomedical and Behavioral Outcomes of Keep It Up!: An eHealth HIV Prevention Program RCT.” It was published June 28 in The American Journal of Preventive Medicine.