A narrative analysis of the experiences of living with HIV for heterosexual men

The number of heterosexual men presenting with Human Immunodeficiency Virus (HIV) is steadily increasing in Australia. A paucity of literature currently exists surrounding the experience of living with HIV for heterosexual men, with most information targeted towards gay men, injecting drug users (IDUs) and women. This narrative literature review examines the body of knowledge concerning the experiences of heterosexual men living with HIV. The findings of this review indicate that for heterosexual men, HIV significantly impacts on their physical, psychological and social well being. In particular, they struggle with social and intimate relationships, negotiating disclosure, managing their stigmatised identity, and accessing both medical and non-medical services. A lack of understanding of the experience of heterosexual men living with HIV has undoubtedly constrained the development of appropriate interventions for this group. As HIV has developed into a chronic condition, it is crucial to identify the type of support services required by different populations presenting with HIV and target these services accordingly. Knowledge gained through this review will further guide decisions for service providers, policy makers, and health professionals concerned with meeting the needs of heterosexual men living with HIV. It will also assist heterosexual men themselves in understanding how to live with HIV. Over the past decade, Australia has witnessed a progressive increase in the number of new Human Immunodeficiency Virus (HIV) diagnoses, particularly amongst heterosexual men. While a considerable body of research has examined the experiences and service needs of HIV positive gay men, injecting drug users and women, there is a paucity of research examining the experiences of heterosexual men who are HIV positive. This paper presents the results of a phenomenological study which aimed to explore the experience of living with HIV for heterosexual men. In-depth interviews were conducted with five self-identifying heterosexual men who were HIV positive. Thematic analysis of interview data revealed three main themes in participants\u27 experiences: shock at receiving a positive diagnosis, struggling to accept and deal with positive diagnosis, and learning to live with HIV. The findings highlight the uniqueness of the experience of living with HIV for heterosexual men and support the need for more targeted services to be developed for these men. Knowledge gained from this study will further guide decisions for service providers, policy makers, and health professionals concerned with meeting the needs of heterosexual men living with HIV. It will also assist heterosexual men themselves in understanding how to live with HIV

Clinical care of pregnant and postpartum women with COVID-19: Living recommendations from the National COVID-19 Clinical Evidence Taskforce

To date, 18 living recommendations for the clinical care of pregnant and postpartum women with COVID-19 have been issued by the National COVID-19 Clinical Evidence Taskforce. This includes recommendations on mode of birth, delayed umbilical cord clamping, skin-to-skin contact, breastfeeding, rooming-in, antenatal corticosteroids, angiotensin-converting enzyme inhibitors, disease-modifying treatments (including dexamethasone, remdesivir and hydroxychloroquine), venous thromboembolism prophylaxis and advanced respiratory support interventions (prone positioning and extracorporeal membrane oxygenation). Through continuous evidence surveillance, these living recommendations are updated in near real-time to ensure clinicians in Australia have reliable, evidence-based guidelines for clinical decision-making. Please visit https://covid19evidence.net.au/ for the latest recommendation updates

Informing the development of an online self-management program for men living with HIV: a needs assessment

Background: The aim of this mixed methods study was to conduct a multifaceted needs assessment to inform the development of an online self-management program for men living with HIV. The objectives were to describe the health-related quality of life for men living with HIV, the impact of living with HIV, and the perceived problem areas and service and support needs of these men. The needs assessment was conducted in accordance with the PRECEDE model for health promotion program planning.Methods: A survey assessing the quality of life of men living with HIV (n = 72) was conducted and results were compared to Australian normative data. Focus groups were also undertaken with men living with HIV (n = 11) and a multidisciplinary team of service providers working in the area of HIV (n = 11). Focus groups enabled an in-depth description of the impact of HIV on quality of life and perceived problem areas in daily life.Results: HIV-positive men experience significantly lower quality of life when compared with Australian normative data, particularly in those domains concerned with social and emotional aspects of quality of life. Qualitative focus groups yielded an overarching theme ‘The psychosocial impact of HIV’ which contained three sub-themes; (1) Life before and after HIV – a changed identity and its repercussions; (2) Resilience and the importance of social support; (3) Negotiating the practicalities – intimate relationships and disclosure.Conclusions: The findings from this needs assessment highlight the need to target socio-emotional contexts of HIV positive men’s daily lives to improve quality of life and well-being. Intervention priorities for the proposed online self-management program include: (1) managing the emotional impact of HIV; (2) disclosing HIV status to family and friends; (3) maintaining social connectedness; (4) managing HIV within intimate relationships; and (5) disclosure of HIV status to intimate partners

HealthMap: a cluster randomised trial of interactive health plans and self-management support to prevent coronary heart disease in people with HIV

BACKGROUND: The leading causes of morbidity and mortality for people in high-income countries living with HIV are now non-AIDS malignancies, cardiovascular disease and other non-communicable diseases associated with ageing. This protocol describes the trial of HealthMap, a model of care for people with HIV (PWHIV) that includes use of an interactive shared health record and self-management support. The aims of the HealthMap trial are to evaluate engagement of PWHIV and healthcare providers with the model, and its effectiveness for reducing coronary heart disease risk, enhancing self-management, and improving mental health and quality of life of PWHIV. METHODS/DESIGN: The study is a two-arm cluster randomised trial involving HIV clinical sites in several states in Australia. Doctors will be randomised to the HealthMap model (immediate arm) or to proceed with usual care (deferred arm). People with HIV whose doctors are randomised to the immediate arm receive 1) new opportunities to discuss their health status and goals with their HIV doctor using a HealthMap shared health record; 2) access to their own health record from home; 3) access to health coaching delivered by telephone and online; and 4) access to a peer moderated online group chat programme. Data will be collected from participating PWHIV (n = 710) at baseline, 6 months, and 12 months and from participating doctors (n = 60) at baseline and 12 months. The control arm will be offered the HealthMap intervention at the end of the trial. The primary study outcomes, measured at 12 months, are 1) 10-year risk of non-fatal acute myocardial infarction or coronary heart disease death as estimated by a Framingham Heart Study risk equation; and 2) Positive and Active Engagement in Life Scale from the Health Education Impact Questionnaire (heiQ). DISCUSSION: The study will determine the viability and utility of a novel technology-supported model of care for maintaining the health and wellbeing of people with HIV. If shown to be effective, the HealthMap model may provide a generalisable, scalable and sustainable system for supporting the care needs of people with HIV, addressing issues of equity of access.<br /

The positive outlook study- a randomised controlled trial evaluating the effectiveness of an online self-management program targeting psychosocial issues for men living with HIV: a study protocol

Background: The emergence of HIV as a chronic condition means that people living with HIV are required to takemore responsibility for the self-management of their condition, including making physical, emotional and socialadjustments. This paper describes the design and evaluation of Positive Outlook, an online program aiming toenhance the self-management skills of gay men living with HIV.Methods/design: This study is designed as a randomised controlled trial in which men living with HIV in Australiawill be assigned to either an intervention group or usual care control group. The intervention group willparticipate in the online group program ‘Positive Outlook’. The program is based on self-efficacy theory and uses aself-management approach to enhance skills, confidence and abilities to manage the psychosocial issues associatedwith HIV in daily life. Participants will access the program for a minimum of 90 minutes per week over seven weeks.Primary outcomes are domain specific self-efficacy, HIV related quality of life, and outcomes of health education.Secondary outcomes include: depression, anxiety and stress; general health and quality of life; adjustment to HIV;and social support. Data collection will take place at baseline, completion of the intervention (or eight weeks postrandomisation) and at 12 week follow-up.Discussion: Results of the Positive Outlook study will provide information regarding the effectiveness of onlinegroup programs improving health related outcomes for men living with HIV

The 2021 WHO catalogue of Mycobacterium tuberculosis complex mutations associated with drug resistance: a genotypic analysis.

Background: Molecular diagnostics are considered the most promising route to achievement of rapid, universal drug susceptibility testing for Mycobacterium tuberculosis complex (MTBC). We aimed to generate a WHO-endorsed catalogue of mutations to serve as a global standard for interpreting molecular information for drug resistance prediction. Methods: In this systematic analysis, we used a candidate gene approach to identify mutations associated with resistance or consistent with susceptibility for 13 WHO-endorsed antituberculosis drugs. We collected existing worldwide MTBC whole-genome sequencing data and phenotypic data from academic groups and consortia, reference laboratories, public health organisations, and published literature. We categorised phenotypes as follows: methods and critical concentrations currently endorsed by WHO (category 1); critical concentrations previously endorsed by WHO for those methods (category 2); methods or critical concentrations not currently endorsed by WHO (category 3). For each mutation, we used a contingency table of binary phenotypes and presence or absence of the mutation to compute positive predictive value, and we used Fisher's exact tests to generate odds ratios and Benjamini-Hochberg corrected p values. Mutations were graded as associated with resistance if present in at least five isolates, if the odds ratio was more than 1 with a statistically significant corrected p value, and if the lower bound of the 95% CI on the positive predictive value for phenotypic resistance was greater than 25%. A series of expert rules were applied for final confidence grading of each mutation. Findings: We analysed 41 137 MTBC isolates with phenotypic and whole-genome sequencing data from 45 countries. 38 215 MTBC isolates passed quality control steps and were included in the final analysis. 15 667 associations were computed for 13 211 unique mutations linked to one or more drugs. 1149 (7·3%) of 15 667 mutations were classified as associated with phenotypic resistance and 107 (0·7%) were deemed consistent with susceptibility. For rifampicin, isoniazid, ethambutol, fluoroquinolones, and streptomycin, the mutations' pooled sensitivity was more than 80%. Specificity was over 95% for all drugs except ethionamide (91·4%), moxifloxacin (91·6%) and ethambutol (93·3%). Only two resistance mutations were identified for bedaquiline, delamanid, clofazimine, and linezolid as prevalence of phenotypic resistance was low for these drugs. Interpretation: We present the first WHO-endorsed catalogue of molecular targets for MTBC drug susceptibility testing, which is intended to provide a global standard for resistance interpretation. The existence of this catalogue should encourage the implementation of molecular diagnostics by national tuberculosis programmes. Funding: Unitaid, Wellcome Trust, UK Medical Research Council, and Bill and Melinda Gates Foundation

Skills Brokering: An Approach to Rural Regeneration

This dissertation demonstrates an approach to rural regeneration through the concept of 'Skills Brokering'. Whilst 'skills brokering' is a relatively new concept, the term 'Learning Brokerage' has been largely defined, and serves to explain skills brokering, whilst allowing for differences in the subject e.g. skills as opposed to learning. Two definitions of learning brokerage are shown below, 'Learning brokerage is best understood as a chain of activities, each with its own contribution to matching learners, and employers with learning providers: outreach; information, advice and guidance ; new courses; learner support; pathways for progression to employment or fiarther learning plus learning programmes themselves.' YamitM(2005) 'The essence of learning brokerage is effective mediation between learners or potential learners and learning providers. Learning brokerage seeks to negotiate and inform change - both in learners and in learning providers. It makes a distinctive contribution to widening adult participation by 'joining up' a range of activities. It stimulates change by looking for better ways to meet learners' needs. Thus, learning brokerage is a valuable tool for strategies aimed at widening participation.' Staffordshire University (2005) The pvirpose of the research is to develop and test a process for bringing together members of a local community to work cooperatively on local initiatives by matching existing local skills to ventures that have identified a support need. The research is intended to have a particular emphasis on adding value to the agricultural sector, through a community wide skills sharing process, otherwise known as SKILLS BROKERING. The study has been successful in developing a process for 'Skills Brokering' and has been able to identify key factors that determine success in this area. The dissertation concludes by outlining this process and highlighting the SOCIAL, and ECONOMIC benefits to developing an approach to skills brokering at a local level, and contributing to rural regeneration.FACULTY OF LAND FOOD AND LEISUR

The development and evaluation of an online self-management program for men living with HIV in Australia

Medical advances in the management of Human Immunodeficiency Virus (HIV) have improved health outcomes for people with HIV (PWHIV) and significantly reduced mortality. As such, the care of HIV positive individuals has transitioned into a chronic disease management model. PWHIV are required to adjust to changes to their physical and psychological health, social relationships and medication regimes. Additionally, the stigma experienced by PWHIV presents substantial issues surrounding disclosure, intimate relationships and service access. For men living with HIV, psychosocial aspects associated with a positive diagnosis substantially impact health, wellbeing and quality of life (QOL). Despite this, there are presently a lack of programs addressing such issues. Self-management based interventions have demonstrated beneficial outcomes for people adjusting to chronic illnesses and have also been trialled with PWHIV. In self-management interventions, patients are educated and supported to manage their condition, including the physical social and emotional aspects. Self-management involves three tasks: medical management, role management and emotional management, and encompasses six skills: problem solving, decision-making, resource utilisation, the formation of a patient-provider partnership, action planning and self-tailoring. Online interventions are becoming increasingly common in the chronic disease model of care and may offer several advantages for PWHIV. Furthermore, the past decade has seen a substantial increase in the number of HIV-specific websites and online delivery is increasingly being employed in HIV programming. However, there is little empirical evidence available regarding the efficacy of such programs in improving the health and well-being of PWHIV. The overarching goal of this thesis was to develop and evaluate the effectiveness of an online self-management Medical advances in the management of Human Immunodeficiency Virus (HIV) have improved health outcomes for people with HIV (PWHIV) and significantly reduced mortality. As such, the care of HIV positive individuals has transitioned into a chronic disease management model. PWHIV are required to adjust to changes to their physical and psychological health, social relationships and medication regimes. Additionally, the stigma experienced by PWHIV presents substantial issues surrounding disclosure, intimate relationships and service access. For men living with HIV, psychosocial aspects associated with a positive diagnosis substantially impact health, wellbeing and quality of life (QOL). Despite this, there are presently a lack of programs addressing such issues. Self-management based interventions have demonstrated beneficial outcomes for people adjusting to chronic illnesses and have also been trialled with PWHIV. In self-management interventions, patients are educated and supported to manage their condition, including the physical social and emotional aspects. Self-management involves three tasks: medical management, role management and emotional management, and encompasses six skills: problem solving, decision-making, resource utilisation, the formation of a patient-provider partnership, action planning and self-tailoring. Online interventions are becoming increasingly common in the chronic disease model of care and may offer several advantages for PWHIV. Furthermore, the past decade has seen a substantial increase in the number of HIV-specific websites and online delivery is increasingly being employed in HIV programming. However, there is little empirical evidence available regarding the efficacy of such programs in improving the health and well-being of PWHIV. The overarching goal of this thesis was to develop and evaluate the effectiveness of an online self-management intervention for men living with HIV in Australia. This research was conducted in three phases: (1) needs assessment; (2) intervention development and piloting; and (3) intervention implementation and evaluation. The primary objective of phase one was to conduct a multi-faceted needs assessment to underpin subsequent phases. The needs assessment was guided by relevant aspects of the PRECEDE-PROCEDE model of ecological health promotion program planning and involved four steps: First, the literature examining the epidemiology and impact of HIV on men was reviewed. Second, a survey assessing QOL of men living with HIV was conducted and results were compared to Australian normative data. The third step involved focus groups to obtain a more in-depth description of the impact of HIV on QOL and perceived problem areas in daily life. A focus group was also conducted with a multidisciplinary team of service providers working in the area of HIV to explore their perspectives on the impact of HIV and identify problem areas. Finally, a systematic literature review was conducted examining the effectiveness of existing HIV-specific self-management interventions. Findings from the needs assessment were used to inform the development of an intervention addressing the identified needs of gay men living with HIV in Australia. The overarching objective of phase two was to design and pilot a self-management group intervention for gay men living with HIV in Australia. This phase led to the development of the Positive Outlook Program. The Positive Outlook Program was a structured seven-week intervention accessed entirely online. It was the only online self-management program for PWHIV in Australia at that time. The specific intervention priorities targeted by the Positive Outlook Program included (1) managing the emotional impact of HIV; (2) disclosing HIV status to family and friends; (3) maintaining social connectedness; (4) managing HIV within intimate relationships; and (5) disclosure of HIV status to intimate partners. The conceptual framework on which the Positive Outlook Program was based drew from self-efficacy theory, the self-management approach and the group model of service delivery. The program was piloted to assess feasibility, acceptability and preliminary effectiveness. Two pilot studies were conducted. The first pilot employed a pre- and post-test design and included 10 men. This was followed by a pilot randomised study which evaluated within and between group differences in 37 participants randomly assigned to receive the Positive Outlook Program or usual care. Findings from the pilot study suggested that online self-management programs for PWHIV are feasible and acceptable to participants, and have the potential to enhance participants’ QOL, self-efficacy and health related outcomes. Overall, the data supported the conduct of a randomised trial with a sample size sufficient to assess the effectiveness of the Positive Outlook Program. In phase three, a randomised controlled trial (RCT) was employed to evaluate the effectiveness of the Positive Outlook Program (online self-management group intervention) compared to usual care controls. The sample comprised 132 gay men living with HIV in Australia, who were randomly allocated to the intervention (n=68) or usual care control group (n=64). Primary outcomes were evaluated at three time points (baseline, post intervention and 12-week post-intervention follow-up), and included HIV-related QOL (PROQOL-HIV), outcomes of health education (HeiQ) and HIV-specific self-efficacy (Positive Outlook Self-Efficacy Scale). Secondary outcomes were also evaluated at the three time points and included Depression Anxiety and Stress (DASS-21), Social Support (DSSI), Health-related QOL (SF-12), Generalised Self Efficacy (GSE) and Mental Adjustment to HIV (MAH). For the purposes of this PhD thesis, only the primary outcomes are reported. The results of the study indicated significant improvement by the intervention group in QOL, self-management skills and domain specific self-efficacy, with some diminution in treatment effect between eight and 12-week follow-up. The study therefore demonstrated that the Positive Outlook Program can significantly improve QOL, self-management skills and domain specific self-efficacy for gay men living with HIV in Australia and that online delivery is an effective approach to self-management support, enabling gay men with HIV to build confidence and skills to manage psychosocial issues associated with HIV and facilitating participant engagement while maintaining anonymity. Reducing the burden of HIV on the lives of gay men living with HIV in Australia is a priority. Substantial evidence demonstrates the pervasive impact stigma, limited HIV disclosure and social isolation have on the quality of life and well-being of PWHIV despite longstanding community-based face to face programs. It is critical that innovative programs are developed that enable PWHIV to address these ubiquitous issues. The research conducted as part of this PhD has increased our understanding of the effectiveness of online self-management in improving important outcomes for PWHIV. This knowledge can inform service design and future research concerned with improving the well-being of gay men living with HIV

The development and evaluation of an online self-management program for men living with HIV in Australia

Medical advances in the management of Human Immunodeficiency Virus (HIV) have improved health outcomes for people with HIV (PWHIV) and significantly reduced mortality. As such, the care of HIV positive individuals has transitioned into a chronic disease management model. PWHIV are required to adjust to changes to their physical and psychological health, social relationships and medication regimes. Additionally, the stigma experienced by PWHIV presents substantial issues surrounding disclosure, intimate relationships and service access. For men living with HIV, psychosocial aspects associated with a positive diagnosis substantially impact health, wellbeing and quality of life (QOL). Despite this, there are presently a lack of programs addressing such issues. Self-management based interventions have demonstrated beneficial outcomes for people adjusting to chronic illnesses and have also been trialled with PWHIV. In self-management interventions, patients are educated and supported to manage their condition, including the physical social and emotional aspects. Self-management involves three tasks: medical management, role management and emotional management, and encompasses six skills: problem solving, decision-making, resource utilisation, the formation of a patient-provider partnership, action planning and self-tailoring. Online interventions are becoming increasingly common in the chronic disease model of care and may offer several advantages for PWHIV. Furthermore, the past decade has seen a substantial increase in the number of HIV-specific websites and online delivery is increasingly being employed in HIV programming. However, there is little empirical evidence available regarding the efficacy of such programs in improving the health and well-being of PWHIV. The overarching goal of this thesis was to develop and evaluate the effectiveness of an online self-management Medical advances in the management of Human Immunodeficiency Virus (HIV) have improved health outcomes for people with HIV (PWHIV) and significantly reduced mortality. As such, the care of HIV positive individuals has transitioned into a chronic disease management model. PWHIV are required to adjust to changes to their physical and psychological health, social relationships and medication regimes. Additionally, the stigma experienced by PWHIV presents substantial issues surrounding disclosure, intimate relationships and service access. For men living with HIV, psychosocial aspects associated with a positive diagnosis substantially impact health, wellbeing and quality of life (QOL). Despite this, there are presently a lack of programs addressing such issues. Self-management based interventions have demonstrated beneficial outcomes for people adjusting to chronic illnesses and have also been trialled with PWHIV. In self-management interventions, patients are educated and supported to manage their condition, including the physical social and emotional aspects. Self-management involves three tasks: medical management, role management and emotional management, and encompasses six skills: problem solving, decision-making, resource utilisation, the formation of a patient-provider partnership, action planning and self-tailoring. Online interventions are becoming increasingly common in the chronic disease model of care and may offer several advantages for PWHIV. Furthermore, the past decade has seen a substantial increase in the number of HIV-specific websites and online delivery is increasingly being employed in HIV programming. However, there is little empirical evidence available regarding the efficacy of such programs in improving the health and well-being of PWHIV. The overarching goal of this thesis was to develop and evaluate the effectiveness of an online self-management intervention for men living with HIV in Australia. This research was conducted in three phases: (1) needs assessment; (2) intervention development and piloting; and (3) intervention implementation and evaluation. The primary objective of phase one was to conduct a multi-faceted needs assessment to underpin subsequent phases. The needs assessment was guided by relevant aspects of the PRECEDE-PROCEDE model of ecological health promotion program planning and involved four steps: First, the literature examining the epidemiology and impact of HIV on men was reviewed. Second, a survey assessing QOL of men living with HIV was conducted and results were compared to Australian normative data. The third step involved focus groups to obtain a more in-depth description of the impact of HIV on QOL and perceived problem areas in daily life. A focus group was also conducted with a multidisciplinary team of service providers working in the area of HIV to explore their perspectives on the impact of HIV and identify problem areas. Finally, a systematic literature review was conducted examining the effectiveness of existing HIV-specific self-management interventions. Findings from the needs assessment were used to inform the development of an intervention addressing the identified needs of gay men living with HIV in Australia. The overarching objective of phase two was to design and pilot a self-management group intervention for gay men living with HIV in Australia. This phase led to the development of the Positive Outlook Program. The Positive Outlook Program was a structured seven-week intervention accessed entirely online. It was the only online self-management program for PWHIV in Australia at that time. The specific intervention priorities targeted by the Positive Outlook Program included (1) managing the emotional impact of HIV; (2) disclosing HIV status to family and friends; (3) maintaining social connectedness; (4) managing HIV within intimate relationships; and (5) disclosure of HIV status to intimate partners. The conceptual framework on which the Positive Outlook Program was based drew from self-efficacy theory, the self-management approach and the group model of service delivery. The program was piloted to assess feasibility, acceptability and preliminary effectiveness. Two pilot studies were conducted. The first pilot employed a pre- and post-test design and included 10 men. This was followed by a pilot randomised study which evaluated within and between group differences in 37 participants randomly assigned to receive the Positive Outlook Program or usual care. Findings from the pilot study suggested that online self-management programs for PWHIV are feasible and acceptable to participants, and have the potential to enhance participants’ QOL, self-efficacy and health related outcomes. Overall, the data supported the conduct of a randomised trial with a sample size sufficient to assess the effectiveness of the Positive Outlook Program. In phase three, a randomised controlled trial (RCT) was employed to evaluate the effectiveness of the Positive Outlook Program (online self-management group intervention) compared to usual care controls. The sample comprised 132 gay men living with HIV in Australia, who were randomly allocated to the intervention (n=68) or usual care control group (n=64). Primary outcomes were evaluated at three time points (baseline, post intervention and 12-week post-intervention follow-up), and included HIV-related QOL (PROQOL-HIV), outcomes of health education (HeiQ) and HIV-specific self-efficacy (Positive Outlook Self-Efficacy Scale). Secondary outcomes were also evaluated at the three time points and included Depression Anxiety and Stress (DASS-21), Social Support (DSSI), Health-related QOL (SF-12), Generalised Self Efficacy (GSE) and Mental Adjustment to HIV (MAH). For the purposes of this PhD thesis, only the primary outcomes are reported. The results of the study indicated significant improvement by the intervention group in QOL, self-management skills and domain specific self-efficacy, with some diminution in treatment effect between eight and 12-week follow-up. The study therefore demonstrated that the Positive Outlook Program can significantly improve QOL, self-management skills and domain specific self-efficacy for gay men living with HIV in Australia and that online delivery is an effective approach to self-management support, enabling gay men with HIV to build confidence and skills to manage psychosocial issues associated with HIV and facilitating participant engagement while maintaining anonymity. Reducing the burden of HIV on the lives of gay men living with HIV in Australia is a priority. Substantial evidence demonstrates the pervasive impact stigma, limited HIV disclosure and social isolation have on the quality of life and well-being of PWHIV despite longstanding community-based face to face programs. It is critical that innovative programs are developed that enable PWHIV to address these ubiquitous issues. The research conducted as part of this PhD has increased our understanding of the effectiveness of online self-management in improving important outcomes for PWHIV. This knowledge can inform service design and future research concerned with improving the well-being of gay men living with HIV