Media literacy is an essential component of HIV prevention for young men who have sex with men

LETTER TO THE EDITOR

In today’s technology-driven society – where individuals increasingly turn to the Internet for health information – health literacy is inextricably linked to media literacy. This is particularly true for marginalized populations and stigmatized behaviors, where individuals may not have access to or feel comfortable asking for information from traditional sources (e.g., medical providers, health educators).

The intersection between health literacy and media literacy is especially pronounced for young men who have sex with men (YMSM). Because YMSM typically do not have access to developmentally-appropriate information that is tailored to their sexual orientation (Pingel, Thomas, Harmell, & Bauermeister, 2013), they often turn to the Internet for their sexual health education (Flores, Blake, & Sowell, 2011; Goodenow, Netherland, & Szalacha, 2002; Kubicek, Beyer, Weiss, Iverson, & Kipke, 2010; Mustanski, Lyons, & Garcia, 2011).

YMSM use the Internet to search for information (on sexuality, sexual attraction, and HIV/STIs) and to facilitate social connections with other YMSM, including romantic and sexual partners (Mustanski et al., 2011). In the absence of relevant sexual education, YMSM use sexually explicit online media (i.e., online pornography) to learn the mechanics of sex, confirm their sexual attractions, understand what they find arousing, and learn about gay culture (Arrington-Sanders et al., 2015; Kubicek et al., 2010; Mustanski et al., 2011). Given the anonymity of the Internet, the potential to connect with other YMSM, and the accessibility of online media, the Internet has proven to be particularly influential on the sexual health of YMSM (Kuper & Mustanski, 2014; Mustanski et al., 2011).

Unfortunately, not all sexual health information on the Internet is accurate. Many websites provide biased or incorrect information about YMSM-specific sexual health topics. Sexually explicit online media often portray sexual roles and behaviors that are not representative of the realities of male-male sexual relationships or that encourage sexual risk-taking. Lacking the media literacy skills necessary to evaluate the accuracy of the material presented online, YMSM may be misinformed about the dynamics of healthy same-sex relationships and may not receive the needed information to protect themselves from sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). Moreover, without the means to critically assess the sexually explicit online media they are consuming, YMSM often vicariously learn and subsequently adopt the risky sexual behaviors that they view (Arrington-Sanders et al., 2015).

Media literacy interventions have positively impacted many health behaviors. A recent meta-analysis of media literacy interventions found an overall positive effect (d = 0.37, 95% CI: 0.27, 0.47) on health beliefs, attitudes, self-efficacy, and behaviors across a variety of health factors (e.g., smoking, substance use; Jeong, Cho, & Hwang, 2012). Media literacy interventions specifically targeting the critical examination of sexual content among primarily heterosexual adolescents have been shown to positively affect determinants of sexual risk behavior, including sexual knowledge, perceived norms, expectancies, attitudes towards delaying sex, and self-efficacy for delaying sex (Pinkleton, Austin, Chen, & Cohen, 2013), as well as intentions for sexual communication and condom use (Scull, Malik, & Kupersmidt, 2014).

Media literacy interventions work by helping individuals become informed, active, and discriminating participants in the communication process rather than passive message targets. These interventions help individuals to strengthen their critical thinking skills and increase their understanding of the misrepresentations of reality that permeate online media. Essentially, media literacy interventions help people critically examine media messages which, in turn, reduces media influence on viewers’ attitudes, beliefs, perceived norms, and behaviors (Potter, 2013).

Effective media literacy interventions acknowledge the positive attributes of media while challenging media misinformation. This balanced approach is particularly crucial for YMSM who often see online media as providing a unique venue for exploration and acceptance of their sexual identity as well as a potential source of social support and connection (Mustanski et al., 2011).

Incorporating media literacy interventions into sexual health and HIV prevention programming has the potential to help YMSM critically examine the sexual health information available online and dispel myths or misinformation that may be available or portrayed. This will, in turn, increase YMSMs’ ability to identify information that is missing from the media, such as information regarding the consequences of engaging in sexual risk behaviors portrayed in sexually explicit online media (i.e., the risk levels of HIV/STI transmission of various sexual behaviors) and what the reality of those consequences involve (e.g., medication management, impact on relationships). Ultimately, incorporating media literacy into HIV prevention strategies will provide YMSM with the skills needed to effectively use online media as a way to learn and establish healthy sexual behaviors while disregarding misleading information.

HIV incidence among YMSM in the United States has been increasing in recent years (Centers for Disease Control and Prevention, 2012). This increase has been largely attributed to engagement in sexual risk behaviors (Everett, Schnarrs, Rosario, Garofalo, & Mustanski, 2014; Mustanski, Newcomb, Du Bois, Garcia, & Grov, 2011). As YMSM turn to the Internet for sexual health information it is crucial for HIV prevention strategies to address the effect online media is having on the sexual health of YMSM. Incorporating media literacy interventions into HIV prevention strategies will result in YMSM becoming more discriminating consumers of online sexual health-related media which has the potential to decrease sexual risk-taking and, ultimately, reduce the number of new HIV infections among YMSM.