JFR JMIR Form Res JMIR Formative Research 2561-326X JMIR Publications Toronto, Canada v9i1e81845 40952781 10.2196/81845 Research Letter Research Letter Use of and Attitudes Toward Technology Among Young People Living With HIV in San Francisco: Cross-Sectional Study Mavragani Amaryllis Abua Joseph Meena Lalit Arayasirikul Sean PhD 1
The Legacy Center Joe C Wen School of Population and Public Health University of California, Irvine 856 Health Sciences Quad Irvine, CA, 92697-3957 United States 1 949 824 2680 sean.arayasirikul@uci.edu
https://orcid.org/0000-0001-7698-6206 Turner Caitlin MPH 2 https://orcid.org/0000-0003-2894-2318 Trujillo Dillon MPH 3 https://orcid.org/0000-0001-7990-1909 Maycott Jarett MPH 4 https://orcid.org/0000-0002-3123-4470 The Legacy Center Joe C Wen School of Population and Public Health University of California, Irvine Irvine, CA United States Department of Epidemiology and Biostatistics University of California, San Francisco San Francisco, CA United States Fielding School of Public Health Department of Community Health Sciences University of California, Los Angeles Los Angeles, CA United States Center for Public Health Research San Francisco Department of Public Health San Francisco, CA United States Corresponding Author: Sean Arayasirikul sean.arayasirikul@uci.edu 2025 15 9 2025 9 e81845 4 8 2025 11 8 2025 12 8 2025 30 8 2025 ©Sean Arayasirikul, Caitlin Turner, Dillon Trujillo, Jarett Maycott. Originally published in JMIR Formative Research (https://formative.jmir.org), 15.09.2025. 2025

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Digital technology is an important tool for engaging and delivering care to and for young people living with HIV. This research letter examines how 120 out-of-care young people living with HIV in San Francisco use digital technology, the attitudes they have toward technology, and the anxiety they feel about being without technology. Our findings emphasize the importance of being aware of the unintended consequences of digital health interventions.

 HIV/AIDS young people living with HIV digital health mental health technology use Introduction

The COVID-19 pandemic catalyzed a digital shift in our work and social engagements. Our online world has expanded immensely, with smartphone use increasing from 15% before the pandemic to 36% and tablet/PC use from 2% to 22% [1]. Concerns about this increased screentime and adverse mental health outcomes, especially among young adults, persist despite research in the 1990s and early 2000s [2]. The scientific literature around technology and mental health offers mixed support [2]. Research on the effectiveness of digital and mobile health interventions continues to increase, and the results are promising for many health conditions, especially among young adults with chronic conditions [3]. In this research letter, we present findings on digital technology use among a sample of young people living with HIV and describe their attitudes toward technology and anxiety about being without technology.

 Methods Study Design and Participants

We conducted a secondary data analysis of baseline data from a digital HIV navigation intervention study that used text messaging to improve HIV care linkage, retention, and viral suppression among 120 out-of-care young people living with HIV in San Francisco, California. Participants were eligible if they identified as a man who has sex with men or a trans woman, were aged between 18 and 34 years, resided in San Francisco, and were not engaged in HIV care. A digital navigator delivered motivational interviewing, social support, health education, and referrals to participants through text messaging over a period of 6 months. Study procedures were described in a prior manuscript [4].

 Measures and Analysis

We analyzed the following sociodemographic information: age, gender identity, race/ethnicity, education, employment status, and current living situation. To assess use of the internet, mobile phones, and social networking sites [5], participants were asked how often (once a week or less, several times a week, once a day, or several times a day or more) they used email, text messaging, or apps; searched for information; checked social media; or sought out sexual partners or relationships on social networking sites. Positive and negative attitudes toward technology and dependence on technology [5] were assessed using 6, 4, and 4 dichotomous (yes/no) items, respectively. For each of these 3 constructs, items were summed (1/0) and high and low categories created using the median score as a cutoff. To measure psychological distress [6], a composite score was created by summing responses to items ranging from “none of the time” (0) to “all of the time” (5), detailing the frequencies of the following in the last month: feeling calm and peaceful, having a lot of energy, feeling downhearted and blue, and physical health or emotional problems interfering with social activities. Descriptive statistics were used to characterize variables. No missing data were recorded.

 Ethical Considerations

The study protocol was approved by the Institutional Review Board of the University of California, San Francisco (16-19675). Participants provided signed informed consent and were remunerated US $50 for completing the baseline assessment. Data for this secondary analysis were deidentified to protect participants’ privacy and confidentiality.

 Results

The sample was racially and ethnically diverse, with a majority of participants reporting some college or more, unstable housing, and unemployment (56.7%, 67.5%, and 64.2%, respectively). A majority of participants (87.5%) reported using text messaging several times a day or more, followed by mobile phone apps, searching for information on a mobile phone, checking social media, and seeking sexual partners and or relationships on social networking sites (80.8%, 80.0%, 61.7%, and 25.8%, respectively). While most participants (93.3%) reported high levels of positive attitudes toward technology, more than a third (39.2%) reported high levels of negative attitudes toward technology. Many (63.3%) reported high levels of anxiety being without technology. A majority of participants reported being anxious without their cell phone and without internet access (74.2% and 66.7%, respectively). Slightly more than half (53.3%) reported feeling anxious about their personal health information being available online, and nearly two-thirds (65.0%) reported being dependent on technology.

Demographic characteristics and use of the internet, mobile phones, and social networking sites of a study sample of young people living with HIV in San Francisco, 2016-2019 (N=120; mean age 27.8, SD 4.1 years).

Participants, n (%)
Demographics
Gender identity
Trans woman 17 (14.2)
Cisgender man 103 (85.8)
Race/ethnicity
Black, non-Hispanic/Latinx 22 (18.3)
Hispanic/Latinx 38 (31.7)
Multiple races, non-Hispanic/Latinx 28 (23.3)
White, non-Hispanic/Latinx 32 (26.7)
Education
High school/GEDa or less 52 (43.3)
Some college or more 68 (56.7)
Employment status
Unemployed 77 (64.2)
Part-time employed 24 (20.0)
Full-time employed 19 (15.8)
Current living situation
Unstable 81 (67.5)
Stable 39 (32.5)
Use of the internet, mobile phones, and social networking sites
How often do you send, receive and read e-mails (not including spam or junk mail)? (Choose one)
Once a week or less 24 (20.0)
Several times a week 23 (19.2)
Once a day 14 (11.7)
Several times a day or more 59 (49.2)
How often do you send and receive text messages on a mobile phone?
Once a week or less 8 (6.7)
Several times a week 3 (2.5)
Once a day 4 (3.3)
Several times a day or more 105 (87.5)
How often do you use apps (for any purpose) on a mobile phone?
Once a week or less 12 (10.0)
Several times a week 6 (5.0)
Once a day 5 (4.2)
Several times a day or more 97 (80.8)
How often do you search for information with a mobile phone?
Once a week or less 9 (7.5)
Several times a week 10 (8.3)
Once a day 5 (4.2)
Several times a day or more 96 (80.0)
How often do you check your social media page from your smartphone?
Once a week or less 27 (22.5)
Several times a week 12 (10.0)
Once a day 7 (5.8)
Several times a day or more 74 (61.7)
How often do you seek sexual partners and or relationships on social networking sites?
Once a week or less 72 (60.0)
Several times a week 16 (13.3)
Once a day 1 (0.8)
Several times a day or more 31 (25.8)

aGeneral Educational Development.

Attitudes toward technology and anxiety about being without technology among young people living with HIV in San Francisco, 2016-2019 (N=120).

Participants, n (%)
Positive attitudes toward technology
I feel it is important to be able to find any information whenever I want online.
No 15 (12.5)
Yes 105 (87.5)
I feel it is important to be able to access my personal health information whenever I want online.
No 16 (13.3)
Yes 104 (86.7)
I feel it is important to be able to access the Internet any time I want.
No 12 (10.0)
Yes 108 (90.0)
I think it is important to keep up with the latest trends in technology.
No 29 (24.2)
Yes 91 (75.8)
Technology will provide solutions to many of our problems.
No 34 (28.3)
Yes 86 (71.7)
With technology anything is possible.
No 34 (28.3)
Yes 86 (71.7)
I feel that I get more accomplished because of technology.
No 31 (25.8)
Yes 89 (74.2)
Mean composite score (mean score 5.6, SD 1.8)
Low 8 (6.7)
High 112 (93.3)
Negative attitudes toward technology
New technology makes people waste too much time.
No 68 (56.7)
Yes 52 (43.3)
New technology makes life more complicated.
No 80 (66.7)
Yes 40 (33.3)
New technology makes people more isolated.
No 56 (46.7)
Yes 64 (53.3)
Mean composite score (mean score 1.3, SD 1.2)
Low 73 (60.8)
High 47 (39.2)
Anxiety about being without technology
I get anxious when I don’t have my cell phone.
No 31 (25.8)
Yes 89 (74.2)
I get anxious when I don't have the Internet available to me.
No 40 (33.3)
Yes 80 (66.7)
I am anxious about having my personal health information available online.
No 64 (53.3)
Yes 56 (46.7)
I am dependent on my technology.
No 42 (35.0)
Yes 78 (65.0)
Mean composite score (mean score 2.5, SD 1.5)
Low 44 (36.7)
High 76 (63.3)
Discussion

We found that many young people living with HIV used mobile phones, social media, apps, and social networking sites on a regular basis. This high use may be a factor in participants’ experience of anxiety being without these digital technologies. Other research has found that technology dependence is an important consideration to shape the care of young people [7]. Furthermore, technology can exacerbate isolation, negative social comparison, loneliness, and other poor mental health outcomes [8]. This study has limited generalizability due to its study design and its focus on HIV care engagement among young people living with HIV. Despite this, it is critical to consider not only how digital technology can improve health, but also its influence on technology dependence and anxiety as unintended consequences [9].

The authors would like to thank all participants in the study. This work was funded by the Health Resources and Services Administration (award H97HA28895).

 Data Availability

The datasets generated or analyzed during this study are not publicly available as they contain details that could be used to identify participants but are available from the corresponding author on reasonable request.

None declared.

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