Minority young men who have sex with men (YMSM) are at the forefront of Human Immunodeficiency Virus (HIV) epidemic in the United States. It is estimated that one third of new U.S. HIV infections are among youth and young adults; 50% of these new infections among youth are among YMSM 1
with a disproportionate burden on African American and Latino YMSM. 2,3
A study of young urban MSM from seven metropolitan centers found HIV prevalence among 3% of white YMSM compared with 7% of Latino YMSM and 16% of Black YMSM.4
Given that these groups are particularly at risk to contract HIV, there have been numerous calls for developing culturally appropriate targeted and flexible interventions for these groups.5–8
The extremely rapid increase in the use of mobile devices for communication, especially among youth and particularly among minority youth may provide an outstanding opportunity to leverage such technology for sexual health communication and prevention efforts.9,10
Adolescents and young adults are increasingly using information and communication technology applications such as text-messaging, Facebook
, and other social networking sites. 11
Such usage creates both a more complex risk environment since it may allow more HIV-infected sex partners to meet in different ways but also the potential for more “just in time” interventions to occur.12
The new risk in this environment can be attributed to how people communicate and interact differently, mediated by a host of different communication technologies. Interventions that target sexual behavior need to accommodate for such changes.
Cell phones are a technology whose usage has substantially increased in the U.S. In 2011, there were 322.9 million wireless users, signifying a 102% penetration of the total U.S. population, with nearly 30% of households using only cell phones. 13
There are some racial differences in usage of cell phones, with nearly half of African Americans and Latinos accessing the internet on their mobile phones as compared to a little over a quarter of the White Americans, signifying the former two groups’ relative lack of home-based broadband access13
Text messaging, as a means of communication, has seen a tremendous increase from 81 billion texts sent in 2005 to 2.12 trillion texts in 2011, a 2617 % increase over 6 years. 14
The use of text messaging is higher among racial minorities, specifically African American (79%) and English-speaking Latinos (83%) as compared with White Americans (68%) and among young adults aged 18 – 29 (95%).15
Consequently, it is important to explore the uses of text messaging among young people, and particularly among minority youth, especially with regards to potential use in health interventions.
Among three general categories of mobile phone users, the 18 – 24 year olds have been classified as the “cellular generation” as compared to the “transitioners” (25 – 34 year olds) and the “adult adopters” (35 and older). 16
Whereas the adult adopters tend to use cell phones as a tool for functional purposes, a means to an end, these devices are more seamlessly integrated and embedded in the lives of the cellular generation, who have grown up with cell phones and text messaging. Therefore, in order to develop appropriate sexual health promotion interventions that can be targeted and more easily integrated into the daily lives of at-risk members of the cellular generation, it is essential to understand better the general contexts and circumstances in which they use text messaging.
Unlike other channels of mass communication for the delivery of health promotion and intervention, mobile phones with texting capabilities are unique in a number of ways. They have immediate two- way, response capabilities; they are wearable and always on – a ubiquitous and pervasive form of communication; they are relatively low cost; they offer a relatively confidential form of communication, particularly given the potential stigma associated with sexual health communication among YMSM; they can offer instant access to health information and cues for action that promote behavioral intervention and change; they could be a tool for social support; and a data collection and feedback tool. 17
Cell-phone based short messaging service (SMS), or text messaging has been increasingly utilized to support various types of health intervention efforts, including: diabetes management 18
; weight loss 19
; and smoking cessation 20
. A recent review of non-STD/HIV text-message intervention RCTs (focused primarily on diabetes, but also on hypertension, smoking, and obesity) concluded that 13 of the 14 trials had positive short-term behavioral outcomes.21
There is also research that specifically shows the acceptability of text messaging used in HIV related health interventions, including improving HAART adherence among HIV positive youth 9
and more recently STI prevention and health promotion among youth22
, young adults 23
, and hard to reach populations at high risk for HIV and other STIs 24
While there is some research that shows the acceptability of text messaging used in health interventions among youth 18,25
, including as a means of providing sexual health information 7,10,22,26–28
, there is no research to date that focuses on the feasibility and acceptability of such interventions among YMSM and particularly at-risk minority YMSM. Previous research has found that YMSM do communicate about sexual health with their friends but that there were misconceptions within their sexual health communication, which may impede communication about safer sex behaviors. 29
Given the potential stigma around same-sex sexual activity, YMSM may be less comfortable receiving sexual health information via text messaging. The widespread availability of mobile phones and text messaging presents a novel consumer health informatics opportunity “to develop mobile-mediated incentives and reinforcers and create new ways of providing support” to at risk populations, especially of the cellular generation.17
But in order to do so, we need to understand cell phone use in their everyday lives and the acceptability of using this medium for sexual health promotion. This paper is a first effort to address this gap in our understanding of their current texting practices and the feasibility and acceptability of text messaging in sexual health communication and promotion among minority YMSM.