Digital interventions to prevent HIV and other STIs

There is strong evidence that digital interventions decrease risky sexual behavior (Chandler 2022, Nguyen 2019, Daher 2017, Bailey 2015a) and increase knowledge about HIV and other sexually transmitted infections (STIs) among adults and adolescents (Chandler 2022, Nguyen 2019, Bailey 2015a, Guse 2012, Noar 2010, Cochrane-Bailey 2010).

Digital interventions can also increase testing for HIV and other STIs (Daher 2017), especially among young people (Swanton 2015). These inventions can increase condom use (Chandler 2022, Noar 2009), especially among young women (Swanton 2015), and decrease the number of sexual partners (Nguyen 2019, Noar 2009). Digital interventions, including text message and internet-based interventions, can improve antiretroviral therapy (ART) adherence in people living with HIV and increase clinic attendance (Daher 2017).

Among adolescents, digital interventions may also delay initiation of sex and increase pregnancy prevention knowledge (Guse 2012), however, additional evidence is needed to confirm these effects.

Digital interventions that are tailored to individual users tend to be most successful (Chandler 2022, Noar 2009, Noar 2010, Cochrane-Bailey 2010); those teaching behavioral skills may increase effectiveness among men who have sex with men (MSM) and may be especially effective in young people (Long 2016). Provision of individualized feedback, promotion of active learning, anonymity, and repeatability are also frequent components of effective digital interventions (Cochrane-Bailey 2010). In some cases digital interventions adapted from in person interventions can provide results similar to the original intervention (Marsch 2015), but in other cases adaptation may not work, such as an unsuccessful attempt to condense a lengthy group intervention into a two-hour computer program (Klein 2017b).

Digital interventions have been shown to be effective among MSM (Nguyen 2019) and Black and Hispanic women (Chandler 2022) and may be as effective in adolescent substance users as interventions delivered by a prevention specialist (Marsch 2015). There are gaps in evidence for young MSM who are transgender, have low incomes or are HIV positive (Knight 2017) and for other at-risk groups such as young women after pregnancy, youth in institutional care, young people experiencing sexual and domestic violence, young people with learning difficulties, and LGBT youth (Bailey 2015a).

Digital interventions can be easily disseminated and can be relatively inexpensive (Cochrane-Bailey 2010).

Digital interventions to reduce HIV and other STIs have the potential to decrease disparities in HIV and STI incidence, if they are designed for those most at risk of HIV and STI infection. Inequalities by sexuality, gender, race, geographical location, and economic status persist in HIV diagnosis and care (Taggart 2021). In 2021, 70% of new HIV infections where among men who have sex with men (MSM) (CDC-HIV incidence) and in 2019, 29% of new HIV infections were among Hispanic individuals (CDC-Hispanic/Latino HIV Incidence), most of them among MSM (CDC-Hispanic/Latino MSM HIV incidence), and 41% were in Black individuals (CDC-African American HIV Incidence). New HIV infections disproportionately affect Black MSM (who account for 26% of new HIV cases) (CDC-African American MSM HIV Incidence), Black heterosexual women, and Black transgender women (CDC-HIV and black discrimination). Chlamydia, gonorrhea, and syphilis also disproportionally affect racial and sexual minority groups. In 2021, almost a third of new infections were in Black individuals, MSM were diagnosed with around a third of gonorrhea cases and almost half of syphilis infections, and among women STI rates were highest for Black, American Indian and Alaska Native, and Native Hawaiian/Pacific Islander individuals (CDC-STI Surveillance).

Culturally tailored interventions can increase condom use, decrease risky sexual behavior, and increase knowledge among Black and Hispanic women (Chandler 2022). However, impacts among Black men were more mixed. A computer-based intervention designed for Black MSM did not change users’ engagement in risky sexual behavior (Klein 2017a), while an online intervention for young Black MSM and mobile optimized reduced risky sexual behavior in the short term (Hightow-Weidman 2019). Another online intervention, this one for Black bisexual men, found it reduced risky sexual behavior with male partners, but not with female partners (Fernandez 2016).

Overall, digital interventions can reduce risky sexual behaviors, increase testing, and increase use of condoms among MSM (Nguyen 2019). Among young MSM interventions can, in some circumstances, reduce risky sexual behavior and increase condom use and knowledge, but more research is needed on subgroup effects and particularly those from vulnerable groups, such as those who are transgender, have low incomes or are HIV positive, are unclear, with limited or no available research (Knight 2017). A brief online group intervention reduced risky sexual behavior in HIV positive gay and bisexual men (Cruess 2018). Few interventions are specifically for LGBT youth (Bailey 2015a), adolescent girls or women (Blackstock 2015).

Sexually transmitted infections (STIs) have carried stigma for centuries, shaped by negative views of poverty, women, and sex (McGough 2005). STIs are associated with promiscuity and deviant behavior for women, while STIs in men are treated merely as a medical condition (East 2012). Stigma has continued to shape how STIs are studied, diagnosed, and treated. The racist and unethical Tuskegee Syphilis Study, administered by the federal government, intentionally withheld syphilis treatment from Black men for decades without their knowledge, to study the natural course of the disease, ultimately sowing widespread mistrust of health systems and medical research (Tobin 2022).

When the AIDS epidemic began, federal response was slow to acknowledge and respond to it, in part because it primarily affected gay men in a time when many states still criminalized homosexuality. While the first case of HIV/AIDS in the U.S. was reported in 1981 (HIV.gov, Bennington-Castro 2020), major federal funding wasn’t allocated until 1985 (Bennington-Castro 2020). HIV criminalization laws were passed in many states criminalizing behavior such as non-disclosure, exposure, and/or transmission of HIV, or increasing sentence length for crimes based on someone’s HIV status (CDC HIV-Exposure), long before pharmaceuticals were available to treat or prevent transmission (CDC HIV-Criminalization). Today, HIV criminalization unjustly applies criminal law to nonmalicious behavior by people living with HIV and the laws are disproportionately applied to people from groups who have been marginalized (Bernard 2022), While 13 states have repealed or modernized their HIV criminalization laws, 34 states still have HIV/STI/communicable disease criminalization laws in place in 2023. Such laws can carry penalties up to life in prison (CDC HIV-Exposure).

Most digital interventions created for men who have sex with men (MSM) have been designed for more general audiences, while relatively few have been aimed at Black or rural MSM (Nguyen 2019, Klein 2016)

State and federal funding are important to address the rising incidence of STIs, however, historical trends show that funding has stagnated (NCSD-STD Funding).

• Who could benefit from digital interventions to reduce HIV and other STIs in your community? Are there groups in your community who might be better reached on their mobile phones or computers?
• Who can you partner with to communicate about digital interventions for HIV and other STIs in your community? Who has experience in communication and community outreach?
• How does stigma, and other systematic barriers, prevent people from accessing sexual health care and STI testing services in your community? What additional strategies can be implemented to overcome those barriers?

As of August 2023, the CDC’s Compendium of Evidence-based Interventions and Best Practices for HIV Prevention contains 46 interventions which are computer/technology-based; digital or mobile health, apps or media; or social media/internet/web-based (CDC Compendium). Examples include Keep It Up! 2.0, Positive Choices, and Care+. Keep It Up! 2.0, which is an online, interactive intervention for young men who have sex with men and includes booster sessions at 3 and 6 months (CDC Compendium-Keep It Up!). Positive Choices and Care+ are computer-based interventions for HIV positive patients that tailor their feedback (CDC Compendium-Positive choice, CDC Compendium-Care).

CDC Compendium - Centers for Disease Control and Prevention (CDC). Compendium of evidence-based interventions and best practices for HIV prevention.

* Journal subscription may be required for access.

Bailey 2015a - Bailey J, Mann S, Wayal S, et al. Sexual health promotion for young people delivered via digital media: A scoping review. Public Health Research. 2015;3(13):1-120.

Bennington-Castro 2020 - Bennington-Castro J. How AIDS remained an unspoken—but deadly—epidemic for years. History. 2020.

Bernard 2022 - Bernard, E. J., Symington, A., & Beaumont, S. (2022). Punishing vulnerability through HIV criminalization. American Journal of Public Health, 112(S4), S395–S397.

Blackstock 2015* - Blackstock OJ, Patel VV, Cunningham CO. Use of technology for HIV prevention among adolescent and adult women in the United States. Current HIV/AIDS Reports. 2015;12:489-499.

CDC Compendium - Centers for Disease Control and Prevention (CDC). Compendium of evidence-based interventions and best practices for HIV prevention.

CDC Compendium-Care - Centers for Disease Control and Prevention (CDC). Compendium of evidence-based interventions and best practices for HIV prevention: CARE+.

CDC Compendium-Keep It Up! - Centers for Disease Control and Prevention (CDC). Compendium of evidence-based interventions and best practices for HIV prevention: Keep it up! 2.0.

CDC Compendium-Positive choice - Centers for Disease Control and Prevention (CDC). Compendium of evidence-based interventions and best practices for HIV prevention: Positive choice interactive video doctor.

CDC HIV-Criminalization - Centers for Disease Control and Prevention (CDC). (2023). HIV criminalization and ending the HIV epidemic in the U.S. Retrieved April 7, 2026.

CDC HIV-Exposure - Centers for Disease Control and Prevention (CDC). (2023, March 3). HIV and STD criminalization laws. Retrieved April 7, 2026.

CDC-African American HIV Incidence - Centers for Disease Control and Prevention (CDC). HIV: HIV by group. HIV and African American People: HIV Incidence.

CDC-African American MSM HIV Incidence - Centers for Disease Control and Prevention (CDC). HIV: HIV by group. HIV and African American Gay and Bisexual Men: HIV Incidence.

CDC-Hispanic/Latino HIV Incidence - Centers for Disease Control and Prevention (CDC). HIV: HIV by group. HIV and Hispanic/Latino People: HIV Incidence.

CDC-Hispanic/Latino MSM HIV incidence - Centers for Disease Control and Prevention (CDC). HIV: HIV by group. HIV and Hispanic/ Latino Gay and Bisexual Men: HIV Incidence.

CDC-HIV and black discrimination - Centers for Disease Control and Prevention (CDC). HIV and Black/African American people in the U.S.

CDC-HIV incidence - Centers for Disease Control and Prevention (CDC). HIV Incidence.

CDC-STI Surveillance - Centers for Disease Control and Prevention (CDC). Sexually Transmitted Infections Surveillance.

Chandler 2022* - Chandler R, Guillaume D, Parker A, Wells J, Hernandez ND. Developing culturally tailored mHealth tools to address sexual and reproductive health outcomes among Black and Latina women: A systematic review. Health Promotion Practice. 2022;23(4):619-630.

Cochrane-Bailey 2010* - Bailey J, Murray E, Rait G, et al. Interactive computer-based interventions for sexual health promotion. Cochrane Database of Systematic Reviews. 2010;(9):CD006483.

Cruess 2018* - Cruess DG, Burnham KE, Finitsis DJ, et al. A randomized clinical trial of a brief internet-based group intervention to reduce sexual transmission risk behavior among HIV-positive gay and bisexual men. Annals of Behavioral Medicine. 2018;52(2):116-129.

Daher 2017 - Daher J, Vijh R, Linthwaite B, et al. Do digital innovations for HIV and sexually transmitted infections work? Results from a systematic review (1996-2017). BMJ Open. 2017;7:e017604.

East 2012* - East L, Jackson D, O’Brien L, Peters K. Stigma and stereotypes: Women and sexually transmitted infections. Collegian. 2012;19(1):15-21.

Fernandez 2016* - Fernandez MI, Hosek SG, Hotton AL, et al. A randomized controlled trial of POWER: An internet-based HIV prevention intervention for Black bisexual men. AIDS and Behavior. 2016;20:1951-1960.

Guse 2012* - Guse K, Levine D, Martins S, et al. Interventions using new digital media to improve adolescent sexual health: A systematic review. Journal of Adolescent Health. 2012;51(6):535-543.

Hightow-Weidman 2019* - Hightow-Weidman LB, LeGrand S, Muessig KE, et al. A randomized trial of an online risk reduction intervention for young Black MSM. AIDS and Behavior. 2019;23:1166-1177.

HIV.gov - HIV.gov. HIV and AIDS timeline.

Klein 2016* - Klein C, Lomonaco C. Real talk: Developing a computer-delivered sexual health program for Black men who have sex with men. AIDS Education and Prevention. 2016;28(6):455-471.

Klein 2017a* - Klein CH, Kuhn T, Huxley D, et al. Preliminary findings of a technology-delivered sexual health promotion program for Black men who have sex with men: Quasi-experimental outcome study. JMIR Public Health and Surveillance. 2017;3(4):e78.

Klein 2017b* - Klein CH, Kuhn T, Altamirano M, Lomonaco C. C-SAFE: A computer-delivered sexual health promotion program for Latinas. Health Promotion Practice. 2017;18(4):516-525.

Knight 2017 - Knight R, Karamouzian M, Salway T, Gilbert M, Shoveller J. Online interventions to address HIV and other sexually transmitted and blood-borne infections among young gay, bisexual and other men who have sex with men: A systematic review. Journal of the International AIDS Society. 2017;20(3):e25017.

Long 2016* - Long L, Abraham C, Paquette R, et al. Brief interventions to prevent sexually transmitted infections suitable for in-service use: A systematic review. Preventive Medicine. 2016;91:364-382.

Marsch 2015* - Marsch LA, Guarino H, Grabinski MJ, et al. Comparative effectiveness of web-based vs. educator-delivered HIV prevention for adolescent substance users: A randomized, controlled trial. Journal of Substance Abuse Treatment. 2015;59:30-37.

McGough 2005 - McGough LG. HIV/AIDS stigma: Historical perspectives on sexually transmitted diseases. Virtual Mentor: Ethics Journal of the American Medical Association. 2005;7(10):710-715.

NCSD-STD Funding - National Coalition of STD Directors (NCSD). As STD funding stagnates, rates rise to all-time highs.

Nguyen 2019 - Nguyen LH, Tran BX, Rocha LEC, et al. A systematic review of eHealth interventions addressing HIV/STI prevention among men who have sex with men. AIDS and Behavior. 2019;23:2253-2272.

Noar 2009 - Noar SM, Black HG, Pierce LB. Efficacy of computer technology-based HIV prevention interventions: a meta-analysis. AIDS. 2009;23(1):107-115.

Noar 2010* - Noar SM, Pierce LB, Black HG. Can computer-mediated interventions change theoretical mediators of safer sex? A meta-analysis. Human Communication Research. 2010;36(3):261-297.

Swanton 2015 - Swanton R, Allom V, Mullan B. A meta-analysis of the effect of new-media interventions on sexual-health behaviours. Sexually Transmitted Infections. 2015;91(1):14-20.

Taggart 2021 - Taggart T, Ritchwood TD, Nyhan K, Ransome Y. Messaging matters: Achieving equity in the HIV response through public health communication. Lancet HIV. 2021;8(6):e376-e386.

Tobin 2022 - Tobin MJ. Fiftieth anniversary of uncovering the Tuskegee syphilis study: The story and timeless lessons. American Journal of Respiratory and Critical Care Medicine. 2022;205(10):1145-1158.