title: Online Outreach Services Among Men Who Use the Internet to Seek Sex With Other Men (MISM) in Ontario, Canada: An Online Survey.
abstract: BACKGROUND
  Men who use the Internet to seek sex with other men (MISM) are increasingly using the Internet to find sexual health information and to seek sexual partners, with some research suggesting HIV transmission is associated with sexual partnering online. Aiming to "meet men where they are at," some AIDS service organizations (ASOs) deliver online outreach services via sociosexual Internet sites and mobile apps.
  
  
  OBJECTIVE
  To investigate MISM's experiences and self-perceived impacts of online outreach.
  
  
  METHODS
  From December 2013 to January 2014, MISM aged 16 years or older were recruited from Internet sites, mobile apps, and ASOs across Ontario to complete a 15-minute anonymous online questionnaire regarding their experience of online outreach. Demographic factors associated with encountering online outreach were assessed using backward-stepwise multivariable logistic regression (P<.05 was considered significant).
  
  
  RESULTS
  Of 1830 MISM who completed the survey, 8.25% (151/1830) reported direct experience with online outreach services. Encountering online outreach was more likely for Aboriginal versus white MISM, MISM from Toronto compared with MISM from either Eastern or Southwestern Ontario, and MISM receiving any social assistance. MISM who experienced online outreach felt the service provider was friendly (130/141, 92.2%), easy to understand (122/140, 87.1%), helpful (115/139, 82.7%), prompt (107/143, 74.8%), and knowledgeable (92/134, 68.7%); half reported they received a useful referral (49/98, 50%). Few MISM felt the interaction was annoying (13/141, 9.2%) or confusing (18/142, 12.7%). As a result of their last online outreach encounter, MISM reported the following: better understanding of (88/147, 59.9%) and comfort with (75/147, 51.0%) their level of sexual risk; increased knowledge (71/147, 48.3%); and feeling less anxious (51/147, 34.7%), better connected (46/147, 31.3%), and more empowered (40/147, 27.2%). Behaviorally, they reported using condoms more frequently (48/147, 32.7%) and effectively (35/147, 23.8%); getting tested for HIV (43/125, 34.4%) or STIs (42/147, 28.6%); asking for their partners' HIV statuses (37/147, 25.2%); and serosorting (26/147, 17.7%). Few MISM reported no changes (15/147, 10.2%) and most would use these services again (98/117, 83.8%). Most MISM who did not use online outreach said they did not need these services (1074/1559, 68.89%) or were unaware of them (496/1559, 31.82%).
  
  
  CONCLUSIONS
  This is the first online outreach evaluation study of MISM in Canada. Online outreach services are a relatively new and underdeveloped area of intervention, but are a promising health promotion strategy to provide service referrals and engage diverse groups of MISM in sexual health education.
authors.affiliation: University of Toronto, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada. david.brennan@utoronto.ca.
authors.forename: David J
authors.identifier: http://orcid.org/0000-0002-7663-9869
authors.initials: DJ
authors.lastname: Brennan
authors.forename: Nathan J
authors.identifier: http://orcid.org/0000-0002-6336-8780
authors.initials: NJ
authors.lastname: Lachowsky
authors.forename: Georgi
authors.identifier: http://orcid.org/0000-0001-9691-8657
authors.initials: G
authors.lastname: Georgievski
authors.forename: Brian R Simon
authors.identifier: http://orcid.org/0000-0001-8862-531X
authors.initials: BR
authors.lastname: Rosser
authors.forename: Duncan
authors.identifier: http://orcid.org/0000-0002-4450-525X
authors.initials: D
authors.lastname: MacLachlan
authors.forename: James
authors.identifier: http://orcid.org/0000-0002-3553-5123
authors.initials: J
authors.lastname: Murray
mesh_terms: D000328:Adult; D002170:Canada; D015658:HIV Infections / Q000517:prevention & control*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications / Q000706:statistics & numerical data*; D009864:Ontario; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: HIV prevention; HIV/AIDS; Internet; gay men; men who have sex with men; mobile technology and sexual health; online outreach; sexual health