The development and implementation of a Web‐based survey targeting MSM in Peru is feasible. In our study, the inclusion of free HIV and syphilis testing and condoms in one of the banners increased the frequency of participation, indicating that MSM were interested in these types of incentives. We provided neither monetary compensation for participation nor additional resources to cover the cost of transportation to our site. Previous studies conducted in the United States usually provided monetary compensation to participants in the form of electronic funds, e‐gift certificates, or traditional funds via cheque.8
In developing countries, economic restrictions as well as institutional review board regulations that restrict the amount of money that can be given to participants are major issues when considering compensation for participation. Using a health compensation, such as an HIV test, provided for free only at a very limited number of STI clinics in Peru, proved to be useful in our study.
While the inclusion of a health incentive increased the overall frequency of completed surveys, those who clicked on the banner offering testing sent a significantly lower proportion of surveys compared with those who clicked on the banner that did not offer free tests. This could be due to different expectations from those clicking on the banner offering free testing.
The banner ad that offered free tests as a compensation increased the frequency of participation of MSM not tested for HIV and MSM who had a higher frequency of anal receptive unprotected intercourse. This finding is important because, in the MSM population, those who are the receptive partner have the highest HIV prevalence (16.6%) compared with either versatile (both insertive and receptive, 12.9%) or insertive (6.5%) MSM and, therefore, will benefit the most from being tested (personal communication with Goodreau S, October 20, 2006).
Overall, MSM self‐reported a high frequency of anal insertive (50.3%), and anal receptive unprotected intercourse (52.2%). These frequencies are higher than what has been reported in previous internet studies: Evans et al
found 45% of unprotected anal intercourse (UAI) on MSM recruited through gay websites in Great Britain,14
and Chiasson et al
found 23% of UAI on MSM recruited on US and Canadian gay websites.15
Compared with participants previously tested, untested MSM had a higher frequency of risk behaviours, such as anal receptive and vaginal unprotected intercourse, as well as sex with partners of unknown status. Since our study design is cross‐sectional and we cannot establish temporality, this difference could be attributed to either the effect of HIV counseling and testing on the subsequent decrease in risk behaviours, or the existence of a high‐risk population less likely to seek HIV testing.16,17
Our study participants had the opportunity to present themselves to our study clinic to be tested. Eleven per cent of participants who self‐reported having completed the online survey with incentive attended our clinic. The low percentage of attendance may be explained by the untailored nature of the invitation for the HIV/syphilis testing, the lack of online engagement dialogue with study personnel, the absence of email reminders, fear of a positive test result, perception of low risk for HIV infection, fear of breaching of confidentiality and location outside the city.8,18,19,20
Of note, the individuals who followed through with testing tended to be more engaged in their health (ie, had been previously tested, as opposed to those who had not been previously tested) engaged in insertive anal sex as opposed to receptive anal sex. This may be explained by a possible higher self‐marginalisation of receptive MSM, greater fear among this group of receiving a positive test, or other factors unknown to us. Understanding how best to reach the latter higher‐risk group with testing services is our goal with future research.
Our study has some limitations; first, our sample is not representative of the MSM population from Lima or Peru, and also may not represent the entire online population of MSM who visit all available Peruvian gay websites. Second, our sampling is likely to be biased in terms of educational background and age. Third, we cannot establish temporality of events, since this is a cross‐sectional study. Fourth, we were not able to collect data about participants who attended other clinics to receive testing. Fifth, we may have self‐misrepresentation of some participants. Sixth, we may have duplicate entries from the same individual. Strengths include the effectiveness design (ie, no financial incentives offered for study participation).
In conclusion, this project has demonstrated that in Peru it is feasible to collect online data about risk behaviours for HIV/STI on high‐risk MSM populations. The inclusion of free HIV/syphilis tests as a compensation for participation without any additional monetary payment increased the frequency of participation in our online survey, attracting high‐risk MSM not tested for HIV but interested in a wide variety of preventive Web‐based interventions. Future studies should develop and test tailored online interventions to increase both HIV/STI testing and delivery of other prevention services to Peruvian MSM.