May/June 2017 Issue

Social Services Innovations: HIV Prevention Using Web-Based Tools
By Susan A. Knight
Social Work Today
Vol. 17 No. 3 P. 6

Much of the general public views HIV/AIDS as no longer being a major health issue. This misperception has carried over to men who have sex with men, a segment of the population for whom HIV infection rates continue to be high, particularly among those men who identify as black or Hispanic.

"We've done a great job medically in treating HIV, so it isn't the death sentence that it used to be decades ago," says Scott Edward Rutledge, PhD, MSW, an associate professor of social work at and associate dean for faculty affairs of the College of Public Health at Temple University in Philadelphia. But this progress may have lessened the seriousness with which the disease is viewed. "Younger people haven't seen large numbers of people dying from AIDS," Rutledge says. "So their attitudes are likely to be different from in past decades. They're more apt to view it as not being such a big deal, and they might be more inclined to put off HIV testing." Further complicating matters is the continued stigma around the disease, which discourages many of these men from accessing available resources.

As a result, attention has turned to how modern web-based technologies can be leveraged in a targeted way to support HIV prevention efforts and better serve the populations most at risk. A key strength of these technology-based approaches is the ability to address the stigma around HIV by establishing connections in ways that are perceived as comfortable and safe.

At-Home HIV Testing With Video Chat Peer Counseling
A variety of video conferencing and video chat technologies have made it possible to deliver real-time counseling and support services virtually. Services that would normally be provided in person in a local health clinic or some other formal health care environment can be delivered to someone in the comfort and privacy of their home.

Utilizing these communication tools, researchers from the University of Connecticut conducted a study to explore the feasibility of using video chat support to promote at-home HIV testing among the target population of men who have sex with men. Given that HIV testing and counseling is viewed as a critical entry point to engagement in HIV care, increased accessibility in this regard would undoubtedly have a positive impact on related health outcomes.

As part of the study, participants received web-based HIV counseling with a peer counselor via video chat, and they completed at-home HIV testing using test kits sent by mail. The study outcomes were largely positive, with the majority of men expressing a preference to have their next HIV testing and counseling experience conducted in this format, rather than visiting an office or clinic setting for testing.
The ability to complete testing at home effectively addressed the many psychosocial issues associated with visiting a clinic for testing, such as fear of discrimination, concern around the disclosure of one's sexual identity, a lack of trust in the medical community, and desire to keep one's test taking private.

Renee Garett, LCSW, a Los Angeles-based therapist in private practice and part-time lecturer at the UCLA social welfare department, believes that the study's model of at-home testing combined with video chat peer counseling support has potential for future implementation. "There's definitely room for this," she says, explaining that people often feel a lot of discomfort leaving their homes and going out in public to a clinic where others can see them. "Going into a clinic for testing can be a very stigmatizing experience for people. This type of home-based approach makes getting tested much less intimidating."

Technology as Part of Intervention Strategies
The video chat study demonstrates the growing level of comfort that people have with allowing technology to play a central role in interventions, particularly when it affords them an added measure of privacy. "People are using cell phones and iPads daily," Rutledge says, "and they're connecting regularly on social networks like Snapchat and Instagram. These technologies can all be used as part of intervention strategies."

Like Rutledge, Garett believes that the people's comfort with online social networking sites provides a great opportunity for outreach to target populations. "Many people don't feel comfortable seeking out information in traditional ways," she says, "whereas social media is part of their routine. They're using these platforms on a daily basis." She adds that studies and anecdotal evidence both indicate that at-risk populations use social networking platforms extensively. "They use social media both for the purpose of socializing and for acquiring relevant health information," she says, making these platforms ideal for use as part of outreach interventions.

The sense of anonymity in online social networks and other online meeting spaces helps to create an environment that is conducive to connecting and engaging, making them ideal for HIV outreach and education efforts. "When people are connecting in these spaces, whether for friendship or dating purposes, health and safety might not always be top of mind," Rutledge says. Therefore, the ability to reach target populations where they're at in order to provide them with relevant health information, while still allowing people to feel like they can protect their identities, is a double benefit.

Tailoring Information to the Target Population
Rutledge is well acquainted with the use of mobile apps as part of HIV education and prevention efforts and sees them as particularly valuable due to their flexibility and the myriad ways in which they can be designed to support treatment and information sharing. He explains that apps offer the ability to "tailor information to the target population; you can deliver information in a manner they can identify with and that will resonate with them."

In the case of gaming technology, for example, avatars can be adapted to be more relatable to their target audience. This helps eliminate the barrier that someone within an at-risk group might face if they were to visit a health care setting and meet with people who don't look and sound like they do.

Apps can also be designed to deliver information in ways that actively engage users, prompting self-reflection and decision making. For instance, in cases where someone realizes they need to take action but is struggling with following through, an app can help with motivation. "An app can be used as a way to help people address their excuses for not taking action," Rutledge says. "It can be used to show someone how easy it is to move forward, by outlining individual steps that need to be taken."

Integrating Technology Into Social Work Practice
While technology brings a number of benefits, Garett points out that care must be taken when integrating these tools into social work practice. For instance, certain types of activities and exchanges will require that the technology used needs to be HIPAA compliant. She also cautions that social networking needs to be managed carefully. "There's room for social workers to leverage social networking in their work with clients," she says, "but there are ethical issues and confidentiality issues that need to be taken into consideration."

In a broader sense, there's the challenge of integrating technology when so much of social work focuses on working directly with individuals. "It's sometimes felt that technology can create a barrier," Garett says. She notes that there is active discussion and debate around this, due to concerns that the use of technology might inadvertently separate workers from clients.

In spite of the challenges, Garett is optimistic about the capacity for modern technologies to reach people in ways that are comfortable and convenient for them, which is so critical when it comes to HIV education and prevention efforts. "Several studies have shown how online technologies and peer support can be used to disseminate information to at-risk populations," she says, adding that many of these models have been successfully replicated in other countries.

Rutledge shares Garett's optimism and references his own past experience delivering HIV counseling by phone. This approach increased people's comfort level in engaging, it was convenient for them, and it proved to be just as effective as in-person counseling. He believes today's modern technologies offer an opportunity to expand on this, while being just as effective.

Rutledge also notes that the prevalence of publicly available web-based tools offers plenty of room for social workers to play an active role in supporting HIV education and prevention efforts, even if this isn't their area of expertise. "The social worker might not be equipped to address specific questions or issues that a client has," he says, "but they can refer the client to web-based resources to serve as an adjunct to the core services being provided."

Given the ubiquity of web-based technologies today and men's comfort with using these technologies, Rutledge believes they have the potential to play an instrumental role in HIV prevention efforts going forward. "HIV is not over," he says. "There are some populations that we have not been effective in reaching, and the HIV rate among some of these populations continues to be alarming. We need to do a far better job of reaching these groups."