Global health 2.0: Youth, Internet, and the fight against HIV/AIDS

Towards the end of the last century, young people between the ages of 15-24 were among the worst affected by the HIV/AIDS epidemic and accounted for approximately 25% of the global disease burden. However, they were seldom included by the public health community while designing prevention and treatment programs and policies. Soon after 1999 when young leaders took it upon themselves and began championing HIV/AIDS efforts in different parts of the world, it was clear that the lack of synergy and coordination among these efforts was resulting in minimal overall impact. In 2004, a group of youth leaders conceived the Global Youth Coalition for HIV/AIDS (GYCA) to address this issue. The mission of the GYCA was to optimize the power of Information and Communication Technologies (ICTs) to synergize youth efforts globally, and empower young people with the knowledge, resources and skills to fight the epidemic. GYCA uses a range of Internet-based tools and activities such as online resources, a listserv, e-consultations and e-courses to achieve their mission. The performance and growth of online health movements such as GYCA is determined to a great extent by the participation of their members. This study examined the various factors that facilitated or impeded online participation of young people in GYCA's online activities.Perspectives from four conceptual domains---public health, social informatics, social movements and computer-mediated communication---informed this research. Together, these literatures suggest that a range of contextual factors at different levels of the social ecology influence online participation. The main focus of this study was to explore which intrapersonal, social psychological and technological factors influence participation in GYCA's online activities. In addition, I tested a trans-disciplinary conceptual framework which hypothesized a causal pathway: contextual factors influence online participation which enhances the perceived utility of online social networking leading to perceptions about program effects.In doing so, the study employed a mixed-methods design: qualitative in-depth interviews of GYCA leaders informed a cross-sectional online survey of GYCA's membership. The interviews were conducted through email and online chat while the online survey was administered on SurveyMonkey using stratified sampling based on region and tenure of membership with the coalition. Statistical analyses comprised chi-square tests and linear and logistic regression modeling using standardized weights. Overall, 275 GYCA members responded to the survey -- nearly 50% from Africa, and approximately 24% each from Americas/Europe & Asia. Nearly 75% of respondents reported participating in the listserv, 19% in the e-consultation and 25% in the e-course. Regression analyses showed that overall intrapersonal factors were least predictive of online engagement, social psychological factors were strong predictors, and technological factors were strongest. Social networking utility proved a critical mediator between online participation and perceived program effects.I concluded that contextual factors influence participation of young people in an online health social movement such as the GYCA. The influence of these factors on online participation may differ by the type of online activity. From a programmatic standpoint, it is important to recognize that a complex range of intrapersonal, social psychological and technological forces shape participation in online health movements that eventually aim to influence health outcomes. From an academic perspective, trans-disciplinary approaches are useful and essential to conducting robust, holistic inquiries into online health movements. Further research needs to be conducted on developing a conceptual framework such as the one tested in this study, for more thoroughly examining processes of causes and effects relating to the use of ICTs in public health.