American Men s Internet Survey (AMIS) Travis Sanchez, DVM, MPH Associate Research Professor Rollins School of Public Health Emory University April 17, 2014 Disclaimer: The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the views of the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention.
Background Annual cross-sectional online HIV behavioral survey of MSM in US Objective: Assess trends in HIV risk behavior, use of HIV testing services, and access to prevention services Online survey powered by SurveyGizmo Goal of ~10,000 completed surveys per cycle Funded by MAC AIDS Fund
CDC surveillance study of MSM, IDU and highrisk heterosexuals MSM recruited every 3 years in 22 jurisdictions In-person survey AMIS collects many of the same indicators annually Internet vs. venuebased sampling National HIV Behavioral Surveillance (NHBS)
Methods - Recruitment Eligibility: 15 and over Male Self-reported oral and/or anal sex with males ever Residence in US (late 2015, expanded to Mexico) Recruited via web banner ads and email blasts: General social networking: Facebook, Instagram, Twitter General gay interest: Queerty, Project Q Gay social networking: Squirt Geospatial networking: Grindr, Scruff
Indicators Assessed Demographics: age, race, health insurance, income Sexual behavior: male and female partners Drug and alcohol use HIV testing and self reported HIV status STI testing, HPV and hepatitis vaccinations HIV prevention services uptake, including PrEP and npep Experiences of stigma and discrimination Special topic modules sometimes randomized
Previous AMIS Data Collection Cycles AMIS-2013 N=10,377 HIV prevalence=10.7% AMIS-2014 N=9,248 HIV prevalence=11.3% AMIS-2015 N=10,217 HIV prevalence=9.3% Number of MSM participants in the American Men s Internet Survey by state, 2015.
AMIS-2016 Data Collection Cycle (current) Launched August 2016, completed February 2017 N = 10,166 New for 2016 Questions on health insurance changes, PrEP for STIs, social network profile and HIV prevention Explored possible procedures for limited interaction cohort OraQuick self-test kits given out for free and linked to surveys
Table 1. Characteristics of participants in an online survey of MSM, United States, American Men's Internet Survey (AMIS), 2016 N % Race/ethnicity* Black, non-hispanic 879 8.6 Hispanic 1311 12.9 White, non-hispanic 7073 69.6 Other or multiple races 903 8.9 Age (years) 15-24 2718 26.7 25-29 1693 16.7 30-39 1414 13.9 40 or older 4341 42.7 Education < HS diploma 391 3.8 HS diploma or equivalent Some college or technical degree College degree or postgraduate education 1068 10.5 3336 32.8 5214 51.3 Income $0-19999 1272 12.5 $20000-39999 1669 16.4 $40000-74999 2290 22.5 $75000 or more 2987 29.4 NCHS Urban/Rural category Urban 4288 42.2 Suburban 2200 21.6 Medium/small metro 2790 27.4 Rural 884 8.7 Self-reported HIV status Positive 1098 10.8 Negative 7089 69.7 Unknown 1979 19.5
Table 2. Sexual behaviors with male partners of participants in an online survey of MSM, United States, American Men's Internet Survey (AMIS), 2016
Table 3. Substance using behaviors of participants in an online survey of MSM, United States, American Men's Internet Survey (AMIS), 2016
Preliminary data on willingness to engage in procedures for limited interaction prospective cohort, AMIS-2016 Half of participants were likely to agree to: Upload a picture of themselves to the study website (54%) Allow us to use software to analyze the uploaded photo (72%) Sign into Facebook to verify identity (49%) Allow access to public Facebook data (70%) Receive an at-home HIV test kit (69%) Report an HIV test result no incentive (85%) Report an HIV test result $10 incentive (84%) Report an HIV test result $25 incentive (85%) Participate in an online HIV prevention counseling session (62%) Of subset asked to submit a photo 29% did so Of subset (N=1181) who were mailed an HIV test kit, 63% returned the test result offering $100 return incentive seemed to influence return rate (83%), but other incentive amounts ($0- $40) did not
Preliminary data on use of social medial profiles for HIV prevention, AMIS-2016 100 Do you think your chances of meeting a partner are increased or decreased by putting the following in your profile? 90 80 70 60 50 40 30 20 10 0 I prefer condoms I'm undetectable I like to bareback I'm on PrEP Indicating my HIV status Increased About the Same Decreased
AMIS Dissemination Annual national reports published in peer-reviewed journal - JMIR Public Health and Surveillance State and NHBS city reports Jurisdictions with >100 participants eligible for key indicators report 2013: 27 states, 13 NHBS cities 2014: 27 states, 16 NHBS cities 2015: 28 states, 14 NHBS cities 2013-2014 combined dataset: 16 states, 3 NHBS cities Deidentified datasets made available for each jurisdiction Shared de-identified datasets with academic collaborators and CDC CFAR writing competition Multiple papers in various stages of production
Future Directions Trend analyses City-focused data releases Additional collaborations with public health and academia Launching a new website for dissemination Development of an online prospective cohort of MSM Surveys with other high-risk groups such as transwomen Expansion to Mexico (Canada?)
Contact Principal Investigator Travis Sanchez, DVM, MPH Rollins School of Public Health, Emory University Travis.Sanchez@Emory.edu 404-727-8403 Project Manager Maria Zlotorzynska, PhD, MPH Rollins School of Public Health, Emory University Maria.Zlotorzynska@emory.edu 404-727-8799