Many individuals living with HIV in Peru already use or are open to using the Internet, cell phones, and personal digital assistants that might support intervention delivery for HIV treatment adherence and prevention of secondary HIV transmission (i.e., from HIV positive to HIV-negative partners). Clear advantages were seen to using these devices, among them greater confidentiality as compared to face-to-face interactions (which was mentioned as a plus by 7 out of 30 participants, as opposed to 3/30 who raised concerns about privacy related to use of these tools). In a similar resource-constrained setting, Simoes et al., reported that audio computer-assisted self-interview (ACASI) was perceived as providing the best protection of privacy of participants as compared with interviewer-administered questionnaires [23
Our study population perceived that HIV information is important to their health. Similar results were found in HIV-positive African American and Puerto Rican men who felt that HIV information is vital to their health yet is not readily available in minority communities [25
]. In Peru, Internet access is widely available through public centers such as Internet cafes (cabinas publicas
) – small-scale storefront operations that offer low-cost and reliable connections [15
]. We identified one Internet user among the 31 interviewed who didn't want to look for information on the Internet. He found the Internet to be cumbersome with too much, and potentially harmful, information (the patient reported feeling "psycho" when reading the adverse events of the medicine). This characteristic was previously reported by Hogan et al [26
]. They surveyed 662 HIV people and found that 31% of people living with HIV agreed that at times it was better not to seek information. In the same survey, Hogan et al. reported that 71% of respondents agreed or strongly agreed that it was easy to feel overwhelmed by HIV information [26
In general though, our study found that people found useful information on the Internet. Other researchers have reported that people living with HIV who use the Internet for health care indicated that they experienced improved knowledge about the illness, increased skills in coping, and support from others [27
]. For example, the anonymity provided by online groups allows discussion of potentially embarrassing topics or otherwise taboo; thus use of online groups increases the possibilities for self-disclosure and encourages honesty and intimacy.
There is great potential to improve health through the use of information and communication technologies in developing countries. The problems of low Internet diffusion and the digital divide are obstacles that resource-constrained countries face in using the Internet for health and development purposes. For those having access the Internet, searching for health information on the Internet can be a difficult experience. Literacy issues might be a problem, as many web pages are written in (often, English-language) text. People may find searching to be time consuming and difficult, and, most frustrating, information may not be in their language. For these reasons, use of scarce resources for information and communication technologies may not necessarily be seen as relevant or appropriate in all settings.
There are some organizations in Peru that offer sexual information via the Internet, suggesting that a user audience is present for information technology-delivered sexual health information. For example, the Peruvian Institute for Responsible Parenthood (INPPARES) has incorporated the Internet into its national sexuality information and counseling service. INPPARES provides information on contraceptive methods, STIs, HIV/AIDS, pregnancy, etc [28
]. Academic institutions such as the Universidad Peruana Cayetano Heredia (UPCH) have developed several websites. For example, the RED PREVEN website [29
] offers prevention information on HIV/STIs as well as a forum for frequent asked questions. Impulsa SIDA is a project of the Tropical Medicine Institute "Alexander von Humboldt" – UPCH [30
] that offers prevention information on HIV/STIs as well as information for people with HIV and their families. Unfortunately, those links did not come up during the interviews. Expansion of Internet and other technologies for partner notification [31
], HIV/STI risk reduction, and related sexual health approaches seems opportune. For example, in the recent years, technologies such as cell phones, Internet, email and text messaging have been adopted for partner notification [32
]. In the first study addressing the use of the Internet for online partner notification, participants of an Internet chat room were notified via e-mail messages about a syphilis cluster and encouraged to seek medical evaluation. As a result 42% of named partners were notified and tested [33
There are some limitations of the study. The current study was limited by its use of a convenience sample of people living with HIV/AIDS in an urban population of Lima. The participants in this study cannot be considered representative of people living with HIV/AIDS in Peru. We also assessed Internet use, cell-phone use and PDA use by self-report.
Finally, this is the first study to our knowledge that examined perceptions regarding Internet, cell phones and PDAs as a means for health promotion for people living with HIV in Peru. Therefore all of the study findings require replication.