Social Media Interventions to Promote HIV Testing

To the Editor—We commend Rhodes et al [1] for using a social media intervention to promote human immunodeficiency virus (HIV) testing. The authors rightly point out that social media may be able to engage high-risk key populations who fail to access in-person services, but frequently visit online sites that could be adapted to facilitate HIV testing and downstream HIV service provision. However, there are several important points to clarify related to the use of social media interventions promoting HIV testing. First, contrary to the study's claims, there have been several social media interventions focused on increasing HIV testing among men who have sex with men (MSM) and transgender individuals [2–6]. This literature includes 2 earlier Cochrane systematic reviews demonstrating that mass media interventions similar to the one described have been effective in promoting HIV/sexually transmitted infection testing [3, 4]. While the authors advanced these interventions into the current social media landscape, the basic approach of exposing a target group to a media intervention is largely unchanged. In addition, more recent reviews have identified several social media interventions intended to increase HIV testing among MSM, including Project HOPE (HIV/AIDS Outreach Prevention Education) and iPOL (Effects of Internet Popular Opinion Leaders) [5, 6]. This social media intervention literature suggests the need for comparing types of social media interventions, rather than comparing social media to no intervention. Second, the study did not capture exposure to other HIV testing social media messages over the year-long period. As the authors point out, many public health agencies are rolling out their own social media interventions intended to increase HIV testing. Third, given that the intervention was a social media intervention, a wider array of social media–related secondary outcomes would be useful to corroborate effectiveness. Although social media interventions are relatively new, there are established methods for capturing social media usage and related process measures [2]. For example, both meta-usage data from respective HIV profiles on social media platforms and self-reported engagement with the social media beyond seeing/communicating with health educators would be useful. Finally, we believe that the most powerful part of social media interventions promoting HIV testing is not the media component (technological innovations), but rather the social component (providing innovative ways of directing social forces toward HIV testing). For example, crowdsourcing can be used to design a social media intervention promoting HIV testing. Crowdsourcing transfers a task from an individual to a group, assisted by multisectoral input [7]. Our randomized controlled trial showed that crowdsourcing can be an effective tool to promote HIV testing through social media [8].