Reconsidering the internet as an HIV/STD risk for men who have sex with men

The association between egocentric sexual networks and sexual meeting venues with PrEP conversation and encouragement for use among Latinx men who have sex with men

Despite the increasing availability of pre-exposure prophylaxis (PrEP), Latinx men who have sex with men (LMSM) are not receiving PrEP-related information. To understand the influence of LMSM sexual networks on PrEP-related conversations and encouragement to use PrEP, this cross-sectional egocentric network study characterized the PrEP-related communication of 130 LMSM egos with 507 sexual partners (alters). Participants were recruited using respondent-driven sampling methods from a Miami-Dade County community-health organization. Egocentric-level data were collected from 2018-2019 and analyzed using multilevel modeling. Of egos, 30% reported using PrEP. Closeness between participants and sexual partners played a role in PrEP conversation and encouragement. Participants believed they would have less success convincing sexual partners to use PrEP if partners were older. Participants perceived higher likelihood to talk about PrEP or success in encouraging alters to use PrEP if, relative to meeting sexual partners on Grindr, they met at a friend's party, gay-centric community event, or school/work. Given that increased closeness and in-person sexual partner meeting venues are associated with PrEP information dissemination and encouragement, social network-based interventions can capitalize on PrEP navigators who run network visualizations, and with this information develop a longitudinal plan to increase PrEP conversation and encouragement as needed for each network.

Gay Dating App Users Support and Utilize Sexual Health Features on Apps

Men who have sex with men (MSM) frequently meet sex partners through dating apps. Research has demonstrated an association between app use and greater number of sex partners and STIs, but dating apps also pose an opportunity for intervention. By advocating for sexual health features on dating apps, Building Healthy Online Communities (BHOC) aims to increase communication about sexual health among app users. In partnership with Emory University, BHOC added questions to an annual survey of MSM. The questions assessed awareness and uptake of profile fields and sexual health features on the dating apps. Among survey participants, 67% (6737/10,129) reported using dating apps to meet a partner in the past year. Among this group, 77% (4993/6525) reported awareness of sexual health features. 61% of app users (2866/4721) who were aware of them reported using one or more sexual health features. BHOC continues to advocate for increased uptake of these features.

Correlates of Geosocial Networking Applications (GSN Apps) Usage among Gay, Bisexual, and Other Men Who Have Sex with Men in Nigeria, Africa

Geosocial networking applications (GSN apps) are widely utilized by gay, bisexual, and other men who have sex with men (GBMSM) to meet potential sexual/romantic partners, foster friendships, and build community. However, GSN apps usage has been linked to elevated levels of HIV sexual risk behavior among GBMSM. Little is known about how GSN apps can facilitate HIV sexual risk behaviors, especially among GBMSM in Africa. To fill this gap in research, the present study aimed to characterize the frequency of GSN apps usage and its association with sociodemographic characteristics, sexual health, healthcare access, psychosocial problems, and substance use in a large multicity sample of community-recruited GBMSM in Nigeria (N = 406). Bivariate and multivariable ordinal logistic regression procedures were used to examine factors associated with GSN apps usage. We found that 52.6% of participants reported recent (≤ 3 months) GSN apps use to meet sexual partners. Factors associated with increased odds of GSN apps usage included: being single, having a university degree or higher, reporting higher recent receptive anal sexual acts, being aware of PrEP, having a primary care provider, and reporting higher levels of identity concealment. HIV-related intervention delivered through GSN apps may help curb the spread of HIV among Nigerian GBMSM.

Patterns of Online and Offline Partnering, Partnership Characteristics, and Condomless Sex Among Adolescent Sexual Minority Males in the USA

Online partner-seeking among adolescent sexual minority males (ASMM) has been associated with condomless anal sex. Two hypotheses may explain this association: that online venues facilitate HIV transmission risk behavior more than offline venues (accentuation), or that individuals who tend to engage in these behaviors are more likely to seek partners online (self-selection). We examined these hypotheses in 700 13-18 year-old ASMM who completed the baseline survey of an effectiveness trial of an HIV prevention program in 2018-2020. The survey assessed demographic, sexual, and venue characteristics of male anal sex partnerships in the past 3 months. Many participants (83%) reported ≥ 1 online-met partner; most were met via sexual networking applications and were older than offline-met partners. Having met partners online, but not whether a particular partner was met online, was associated with greater odds of receptive condomless sex. Findings support the self-selection hypothesis, which has implications for HIV prevention in ASMM.

Geosocial Networking Application Use, Characteristics of App-Met Sexual Partners, and Sexual Behavior Among Sexual and Gender Minority Adolescents Assigned Male at Birth

Although many sexual and gender minorities (SGM) assigned male at birth (AMAB) use sexual networking applications intended for adult sexual minority men, little is known about adolescents' use of these technologies and characteristics of their online-met partners. We conducted an online survey of 219 sexually experienced SGM AMAB adolescents in the USA aged 15-17 (39.3% racial/ethnic minority; 74.9% gay; 94.1% cisgender male). Questions assessed app use patterns, partner-seeking behaviors on sexual minority male-specific apps vs. social media/other dating apps, app-met partner characteristics, and sexual behavior with app-met partners. Most (70.3%) used apps for sexual minority men, 14.6% used social media/other apps to meet partners, and 15.1% used neither. Nearly 60% of adolescents who used any type of app reported having met people from the apps in person, and nearly 90% of these reported at least one online-met sexual partner. Most partners were reportedly older than participants, and participants were more likely to report condomless receptive anal sex with older (vs. younger) online-met partners. Although partnerships were primarily sexual in nature, a minority reported friendships or serious partnerships. Meeting same-sex/gender partners via applications for adults may be common among SGM AMAB adolescents, which has implications for their sexual health and well-being.

Is Tinder-Grindr Use Risky? Distinguishing Venue from Individuals' Behavior as Unique Predictors of Sexual Risk

Geosocial networking apps (GSN; e.g., Tinder, Grindr) have rapidly increased in popularity, showing associations with greater sexual risk-taking. This study sought to distinguish between risks associated with intensive partner-seeking (i.e., individuals seeking out casual sex frequently across many venues) and risks associated with specific venues (e.g., GSNs, dating websites, offline activities). Expanding upon a literature predominantly focused on the population of men who have sex with men (MSM), we recruited a broader range of sexual identities. A convenience sample of 3180 participants from the U.S. (18-75 years old, 69% female, 75% Caucasian, 68% heterosexual) completed an anonymous, cross-sectional online survey. Logistic regressions yielded adjusted odds ratios highlighting the unique links between each predictor and sexual risk-taking. MSM/WSW indicators, quantity of partner-seeking and specific venues-particularly GSN use-emerged as robust predictors of sexual risk, increasing the odds of reporting all six outcomes examined: (1) having three or more sex partners in the last year, (2) having hookups in the last 2 months, (3) having hookups involving alcohol or (4) drug use, (5) condomless sexual activity with new partners in the last 2 months, and (6) ever having had a sexually transmitted infection. Although a large portion of risk originated from the proclivities of the individuals seeking casual sex, both online and offline methods of partner-seeking also contributed significant risk, suggesting that specific venues like GSN apps could be used as methods of targeting higher-risk behaviors. The results also highlight the importance of moving beyond MSM when addressing sexual risk.

Sexualized drug use in virtual space: A scoping review of how gay, bisexual and other men who have sex with men interact online

The purpose of this article is to review the scope of the current literature on sexualized drug use (SDU) among gay, bisexual and other men who have sex with men (GBMSM), particularly in online spaces. Over the last decade, there has been a rapid emergence of online venues for GBMSM to interact for sexual purposes. These spaces have also been infused with various substances that influence or shape the sexual interactions among GBMSM. Employing a scoping review methodology, we explored the interplay between GBMSM, SDU, and online dating and hookup apps. This scoping review presents four themes emerging from the literature: the connection between social networking apps (SNAs) and SDU, the planning and coordination of sex parties, accessing drugs through SNAs, and the coded language that emerges on SNAs. These findings synthesize the important relationship between GBMSM and SDUs, and identify the implications for health promotion.

Genetic Network Analysis to Assess the Risk of Human Immunodeficiency Virus Transmission Among Men Who Have Sex With Men Seeking Partners on the Internet

BACKGROUND

Online partner seeking (OPS) among men who have sex with men (MSM) is associated with increased risk behavior including frequency of unprotected anal intercourse, number of partners, and incidence of sexually transmitted infections (STIs). However, the impact on transmission of human immunodeficiency virus (HIV) is uncertain.

METHODS

MSM diagnosed with acute and early HIV infection were recruited from the Primary Infection Resource Consortium. HIV transmission events in the year following infection were inferred using estimated date of infection combined with genetic network analysis with linked sequences defined as ≤0.015 sequences/site difference in the HIV type 1 (HIV-1) pol coding region. Participants completed a detailed baseline questionnaire including reported methods of meeting sexual partners, including OPS, in the prior 3 months, and regression was performed with inferred transmission as the outcome.

RESULTS

From 147 MSM who completed the questionnaire, there were an associated 20 inferred HIV transmissions. No association with OPS was found (odds ratio, 0.64 [95% confidence interval, .24-1.69]; P = .37), though individuals who reported OPS were more likely to have reported a greater number of partners (P = .003) and prior STIs (P = .002). Geospatial analysis did not indicate that OPS was associated with increased geographical reach of the user (P = .68).

CONCLUSIONS

Individuals reporting OPS did not have increased odds of inferred HIV-1 transmission in the year following infection using genetic linkage analysis despite apparently increased risk behavior. OPS also did not increase the geographic distance between genetically clustered HIV infections, suggesting that individuals mainly use the internet to meet partners in their local region.

As through a glass, darkly: the future of sexually transmissible infections among gay, bisexual and other men who have sex with men

The trajectory of sexually transmissible infection (STI) incidence among gay and other men who have sex with men (MSM) suggests that incidence will likely remain high in the near future. STIs were hyperendemic globally among MSM in the decades preceding the HIV epidemic. Significant changes among MSM as a response to the HIV epidemic, caused STI incidence to decline, reaching historical nadirs in the mid-1990s. With the advent of antiretroviral treatment (ART), HIV-related mortality and morbidity declined significantly in that decade. Concurrently, STI incidence resurged among MSM and increased in scope and geographic magnitude. By 2000, bacterial STIs were universally resurgent among MSM, reaching or exceeding pre-HIV levels. While the evidence base necessary for assessing the burden STIs among MSM, both across time and across regions, continues to be lacking, recent progress has been made in this respect. Current epidemiology indicates a continuing and increasing trajectory of STI incidence among MSM. Yet increased reported case incidence of gonorrhoea is likely confounded by additional screening and identification of an existing burden of infection. Conversely, more MSM may be diagnosed and treated in the context of HIV care or as part of routine management of pre-exposure prophylaxis (PrEP), potentially reducing transmission. Optimistically, uptake of human papillomavirus (HPV) vaccination may lead to a near-elimination of genital warts and reductions in HPV-related cancers. Moreover, structural changes are occurring with respect to sexual minorities in social and civic life that may offer new opportunities, as well as exacerbate existing challenges, for STI prevention among MSM.

The Association between Use of Online Social Networks to Find Sex Partners and Sexually Transmitted Infection Diagnosis among Young Men Who Have Sex with Men and Transgender Women Living with HIV

We conducted a cross-sectional analysis of baseline data from the Adolescent Trials Network for HIV/AIDS Interventions to examine the association between the use of social media sites to find sex partners and recent diagnosis of sexually transmitted infections (STIs) among 13- to 24-year-old men who have sex with men and transgender women living with HIV. We used linear regression to determine the relationship between the number of STIs and the number of social media sites used to find sex partners with each type of sex act included in the analysis. Secondary analyses substituted frequency of social media site use for number of social media sites. Among 741 participants, for every 1 social media account used to find sex partners, there was a 2.53% (95% confidence interval: 0.28-5.54) increase in STIs. This association was mediated through condomless receptive anal intercourse or condomless insertive anal intercourse but not barrierless oral intercourse. Similar but attenuated associations were found when frequency of social media site use was substituted for number of social media sites. Future research should examine innovative interventions on these social media sites with respect for its users.

A Narrative Review of Internet Use, Interpersonal Connectedness, and Sexual Behaviour Among Gay, Bisexual and Other Men Who Have Sex With Men

Researchers have often considered the impact that online dating has had on gay communities; with some arguing that changes in social behavior may impact the spread of HIV. However, these conclusions are based on the premise that the Internet has fundamentally changed the way gay and bisexual men connect with their communities. Addressing this issue, we searched the PubMed and Web of Science databases for studies examining Internet use and interpersonal connectedness among gay and bisexual men to determine whether those who used the Internet to find sexual partners exhibited different patterns of community connectedness. Though sporadic, findings suggest that Internet use may be associated with lower gay identity, community attachment, and social embeddedness. However, recent reports have suggested that online sex seeking might be associated with greater, not less, interpersonal connectedness. We conclude that additional longitudinal analyses and consistent measurement of gay men's social behavior are needed to draw more definite conclusions.

Patterns of Online and Offline Connectedness Among Gay, Bisexual, and Other Men Who Have Sex with Men

This study examined patterns of connectedness among 774 sexually-active gay, bisexual, and other men who have sex with men (GBM), aged ≥ 16 years, recruited using respondent-driven sampling in Metro Vancouver. Latent class analysis examined patterns of connectedness including: attendance at gay venues/events (i.e., bars/clubs, community groups, pride parades), social time spent with GBM, use of online social and sex seeking apps/websites, and consumption of gay media. Multinomial regression identified correlates of class membership. A three-class LCA solution was specified: Class 1 "Socialites" (38.8%) were highly connected across all indicators. Class 2 "Traditionalists" (25.7%) were moderately connected, with little app/website-use. Class 3 "Techies" (35.4%) had high online connectedness and relatively lower in-person connectedness. In multivariable modelling, Socialites had higher collectivism than Traditionalists, who had higher collectivism than Techies. Socialites also had higher annual incomes than other classes. Techies were more likely than Traditionalists to report recent serodiscordant or unknown condomless anal sex and HIV risk management practices (e.g., ask their partner's HIV status, get tested for HIV). Traditionalists on the other hand were less likely to practice HIV risk management and had lower HIV/AIDS stigma scores than Socialites. Further, Traditionalists were older, more likely to be partnered, and reported fewer male sex partners than men in other groups. These findings highlight how patterns of connectedness relate to GBM's risk management.

Sexual Partner Concurrency Among Partners Reported by MSM with Recent HIV Infection

We examined concurrency among sexual partners reported by men who have sex with men (MSM) with recent (acute or early) HIV infection in San Diego, California (2002-2015). Partners overlapping in time in the past 3 months were considered concurrent. Logistic generalized linear mixed models were used to identify factors associated with concurrency at the partner-level. 56% (388/699) of partners were concurrent to ≥1 other partner. The odds of concurrency were higher among partners >10 years younger than the participant (vs. within 10 years of age) [adjusted odds ratio (AOR) = 2.22, 95% confidence interval (CI) 1.09-4.52], longer term partners (AOR per month = 1.02, 95% CI 1.01-1.03), and partners met online (AOR = 1.56, 95% CI 0.98-2.48). Concurrency is common among partners of recently HIV-infected MSM. Tailored HIV prevention strategies for MSM with older partners, longer term partners, and partners met online may help minimize the potential impact of concurrency on HIV transmission.

Finding sexual partners online: prevalence and associations with sexual behaviour, STI diagnoses and other sexual health outcomes in the British population

OBJECTIVES

Online venues might facilitate sexual encounters, but the extent to which finding partners online is associated with sexual risk behaviour and sexual health outcomes is unclear. We describe use of the internet to find sexual partners in a representative sample in Britain.

METHODS

The third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) was a cross-sectional probability survey of 15 162 adults (aged 16-74 years) undertaken 2010-2012. We estimated prevalence of, and identified factors associated with, finding sexual partners online among those reporting ≥1 new sexual partners in the past year.

RESULTS

Finding sexual partners online in the past year was reported by 17.6% (95% CI 15.6 to 19.9) of men and 10.1% (8.5-11.9) of women, and most common among those aged 35-44 years. After age-adjustment, those reporting a non-heterosexual identity were more likely to report this. Finding partners online was also associated with reporting sexual risk behaviours: condomless sex with ≥2 partners (adjusted OR (aOR) men: 1.52 (1.03 to 2.23); women: 1.62 (1.06 to 2.49)), concurrent partnerships (aOR men: 2.33 (1.62 to 3.35); women: 2.41 (1.49 to 3.87)) and higher partner numbers (reporting ≥5 partners aOR men: 5.95 (3.78 to 9.36); women: 7.00 (3.77 to 13.00)) (all past year). STI diagnoses and HIV testing were more common among men reporting finding partners online (adjusted for age, partner numbers, same-sex partnerships), but not women.

CONCLUSIONS

Finding partners online was associated with markers of sexual risk, which might be important for clinical risk assessment, but this was not matched by uptake of sexual health services. Online opportunities to find partners have increased, so these data might underestimate the importance of this social phenomenon for public health and STI control.

The Role of Sex Work Pay in Moderating the Effect of Mobile Phone Solicitation on Condom Practices: An Analysis of Female Sex Workers in India

Mobile phones remain a largely untapped resource in the ongoing challenge to address Female Sex Worker (FSW) health, including HIV prevention services, in India. An important step towards designing effective mobile phone-based initiatives for FSWs is clarifying the contextual influences of mobile phone solicitation on sexual risk behavior. In this paper, we extend previously identified associations between mobile phone solicitation and condom practices by examining whether this association is moderated by sex work pay and offer key considerations for future research and implementation. Specifically, we conducted an analysis among 589 Indian FSWs, where FSWs who did not use mobile phones to solicit clients had the lowest mean sex work pay (INR 394/ USD 6.54) compared to FSWs who used both mobile and traditional strategies (INR 563/ USD 9.34). Our analysis indicate low paid FSWs who used mobile phones concurrently with traditional strategies had 2.46 times higher odds of inconsistent condom use compared to low paid FSWs who did not use mobile phones for client solicitation. No such effect was identified among high paid FSWs. These findings also identified group level differences among FSWs reporting different mobile phone solicitation strategies, including violence, client condom use and HIV status. Our results indicate that low pay does moderate the association between mobile phone solicitation and condom practices, but only among a sub-set of low paid FSWs. These findings also demonstrate the utility of classification by different mobile phone solicitation strategies for accurate assessment of sexual risk among mobile phone soliciting FSWs. In turn, this paves the way for novel approaches to utilize mobile phones for FSW HIV prevention. We discuss one such example, a mobile phone-based rapid screening tool for acute HIV infection targeting Indian FSWs.

Global travel and HIV/STI epidemics among MSM: what does the future hold?

Infectious disease epidemics occur within dynamic systems and environments that shape risk and, ultimately, the spread of infectious diseases. Gay men and other men who have sex with men (MSM) are disproportionately impacted by HIV everywhere in the world. Several emerging trends present risks for sustained or increased HIV acquisition and transmission, and the growth of global travel in the context of emerging online platforms for social/sexual networking is discussed here. Four factors associated with travel that could potentiate HIV transmission are highlighted: different patterns of sexual risk behaviours during travel; the growth of online tools to meet sex partners more efficiently; the global heterogeneity of HIV strains; and the potential for diassortative mixing of men from high- and low-HIV prevalence areas. Prevention tools and services must rise to these challenges, and innovative mobile applications and programs have played, and will continue to play, an important role in supporting MSM at risk for or living with HIV during their periods of travel.

Sex Partner Meeting Places Over Time Among Newly HIV-Diagnosed Men Who Have Sex With Men in Baltimore, Maryland

BACKGROUND

Sex partner meeting places may be important locales to access men who have sex with men (MSM) and implement targeted HIV control strategies. These locales may change over time, but temporal evaluations have not been performed.

METHODS

The objectives of this study were to describe the frequency of report of MSM sex partner meeting places over time and to compare frequently reported meeting places in the past 5 years and past year among newly HIV-diagnosed MSM in Baltimore City, Maryland. Public health HIV surveillance data including partner services information were obtained for this study from the Baltimore City Health Department from May 2009 to June 2014.

RESULTS

A total of 869 sex partner meeting places were reported, including 306 unique places. Bars/clubs (31%) and Internet-based sites (38%) were the most frequently reported meeting place types. Over the 5-year period, the percentage of bars/clubs decreased over time and the percentage of Internet-based sites increased over time. Among bars/clubs, 4 of 5 of those most frequently reported in the past 5 years were also most frequently reported in the most recent year. Among Internet-based sites, 3 of 5 of those most frequently reported in the past 5 years were also in the top 5 most frequently reported in the past year.

CONCLUSION

This study provides a richer understanding of sex partner meeting places reported by MSM over time and information to health departments on types of places to access a population at high risk for HIV transmission.

Online Hookup Sites for Meeting Sexual Partners Among Men Who Have Sex with Men in Rhode Island, 2013: A Call for Public Health Action

Frequent use of websites and mobile telephone applications (apps) by men who have sex with men (MSM) to meet sexual partners, commonly referred to as "hookup" sites, make them ideal platforms for HIV prevention messaging. This Rhode Island case study demonstrated widespread use of hookup sites among MSM recently diagnosed with HIV. We present the advertising prices and corporate social responsibility (CSR) programs of the top five sites used by newly diagnosed HIV-positive MSM to meet sexual partners: Grindr, Adam4Adam, Manhunt, Scruff, and Craigslist. Craigslist offered universal free advertising. Scruff offered free online advertising to selected nonprofit organizations. Grindr and Manhunt offered reduced, but widely varying, pricing for nonprofit advertisers. More than half (60%, 26/43) of newly diagnosed MSM reported meeting sexual partners online in the 12 months prior to their diagnosis. Opportunities for public health agencies to promote HIV-related health messaging on these sites were limited. Partnering with hookup sites to reach high-risk MSM for HIV prevention and treatment messaging is an important public health opportunity for reducing disease transmission risks in Rhode Island and across the United States.

Online dating among Australian gay and bisexual men: romance or hooking up?

Increasingly, gay and bisexual men (GBM) meet casual sex partners online and this has been associated with sexual risk behavior. How do GBM meet regular partners? This online anonymous survey of 4215 GBM included 2562 men with a primary regular partner (PRP) who were included in these analyses. Mean age of the sample was 38.1 years. 60.3 % had met their PRP at least 2 years earlier. Meeting their PRP online increased from 14.0 % before 2001 to 79.9 % in 2013-2014. At all time points, men who met their PRP online were somewhat older than those who met their PRP offline. Regardless of how they met their PRP, most men met casual sex partners online. Among GBM, meeting sexual and romantic partners online has replaced other methods, for all age groups. The population of GBM who use the internet for this purpose is now equivalent to all sexually active GBM.

Outcomes associated with anxiety and depression among men who have sex with men in Estonia

BACKGROUND

Evidence supports that gay, lesbian, and transgender populations are at increased risk for mental health problems. The current study was conducted to estimate the prevalence of anxiety and depressive symptoms and related factors among men who have sex with men (MSM) in Estonia. This is the only known study of its type in the Eastern European region.

METHODS

In 2013, an Internet-based survey was conducted among men who have sex with men, collecting data on socio-demographics, sexuality, drug and alcohol use, mental health, suicidality, and internalized homonegativity.

RESULTS

265 MSM completed the questionnaire (median age 31 years, 90% Estonian, 71% from the capital; 73% employed full-time, 42% with at least college education; 44% in a steady relationship; 72% gay, 23% bisexual; 23% reported illegal drug use in the last 12 months). One third met criteria for problem drinking and depressive symptoms with one quarter for anxiety symptoms. Suicidality was 44% reported lifetime suicidal thoughts and 11% with at least one suicide attempt.

LIMITATIONS

The study instruments, EST-Q and CAGE, only measure symptoms and are not diagnostic tests. A non-random sample which could possibly include persons with easier internet access. Self-reported data and cross-sectional study design are prone to issues with recall bias and temporality.

CONCLUSIONS

With demonstrated high rates of anxiety, depression, drinking, and drug use among MSM which is consistent with similar studies in Western countries, further research could help determine effective MSM focused interventions to address the broad spectrum of issues among MSM.

The HIV Risk Profiles of Latino Sexual Minorities and Transgender Persons Who Use Websites or Apps Designed for Social and Sexual Networking

The use of websites and GPS-based mobile applications ("apps") designed for social and sexual networking has been associated with increased HIV risk; however, little is known about Latino sexual minorities' and transgender persons' use of these websites and apps and the risk profiles of those who use them compared with those who do not. Data from 167 participants who completed the baseline survey of a community-level HIV prevention intervention, which harnesses the social networks of Latino sexual minorities and transgender persons, were analyzed. One quarter of participants (28.74%, n = 48) reported using websites or apps designed for social and sexual networking, and 119 (71.26%) reported not using websites or apps designed for social and sexual networking. Those who used websites or apps were younger and reported more male sex partners, a sexually transmitted disease diagnosis, and illicit drug use other than marijuana. HIV prevention interventions for those who use websites or apps should consider addressing these risks for HIV.

Meeting sexual partners online: associated sexual behaviour and prevalent chlamydia infection among adolescents in Norway: a cross-sectional study

OBJECTIVES

Evidence is mixed as to whether meeting sexual partners online ('internet-partners') is associated with risky sexual behaviour and/or sexually transmitted infection transmission. Accordingly, we sought to estimate the prevalence of reporting various online romantic and sexual activities among Norwegian adolescents, including internet-partners, and the reason for meeting them and to examine differences in sexual behaviour, partnership characteristics and chlamydia infection prevalence among those reporting internet-partners versus those reporting only offline partners.

METHODS

Population-based cross-sectional survey among sexually experienced girls and boys, 15-20 years, using electronic questionnaires and collecting urine samples for Chlamydia trachomatis PCR testing (79% provided both, n=1023). We used logistic regression to examine associations, adjusting for potentially confounding variables.

RESULTS

Overall, 30% of both genders reported internet-partners (ever). Boys (but not girls) with internet-partners had higher chlamydia prevalence than those reporting meeting sexual partners only offline (8.1%, 95% CI 4.3% to 13.7% vs 1.6%, 0.5% to 3.7%). Two-thirds of girls and 37% of boys reported meeting their most recent internet-partner to start a romantic relationship, while the remainder did so with the specific intention of having sex. Among both genders, reporting sexual (vs romantic) reasons for meeting their most recent internet-partners was associated with reporting several risky sexual behaviours, including multiple recent sex partners (adjusted OR girls: 3.27, boys: 2.48) and three-fold higher chlamydia prevalence.

CONCLUSIONS

This population-based study suggests that internet-partners are common among adolescents in Norway, and the reason for meeting them was more strongly associated with additionally reporting sexual risk behaviours and prevalent chlamydia infection than the internet itself as a meeting venue.

Meeting sex partners through the Internet, risky sexual behavior, and HIV testing among sexually transmitted infections clinic patients

The Internet has now become a popular venue to meet sex partners. People who use the Internet to meet sex partners may be at a higher risk for contracting HIV and STIs. This study examined the association between meeting sex partners from the Internet, and HIV testing, STI history, and risky sexual behavior. Data were obtained from the Virginia Department of Health STD Surveillance Network. Logistic regression models were used to obtain crude and adjusted odds ratios, and 95 % confidence intervals for the associations between meeting sex partners through the Internet and ever tested for HIV, HIV testing in the past 12 months, STI history, and risky sexual behavior. Logistic regression was also used to determine if gender and men who have sex with men interaction terms significantly improved the model. Women who met a sex partner from the Internet were more likely to have had an HIV test in the past 12 months than women who did not meet a partner in this way. On the other hand, men who met a sex partner through the Internet were more likely to have ever had an HIV test than other men, but this was only seen for heterosexual men. All populations who met a sex partner from the Internet were more likely to take part in risky sexual behavior. HIV prevention strategies should emphasize annual testing for all populations.

Online Social Networking, Sexual Risk and Protective Behaviors: Considerations for Clinicians and Researchers

Online social networking refers to the use of internet-based technologies that facilitate connection and communication between users. These platforms may be accessed via computer or mobile device (e.g., tablet, smartphone); communication between users may include linking of profiles, posting of text, photo and video content, instant messaging and email. This review provides an overview of recent research on the relationship between online social networking and sexual risk and protective behaviors with a focus on use of social networking sites (SNS) among young people and populations at high risk for sexually transmitted infections (STIs). While findings are mixed, the widespread use of SNS for sexual communication and partner seeking presents opportunities for the delivery and evaluation of public health interventions. Results of SNS-based interventions to reduce sexual risk are synthesized in order to offer hands-on advice for clinicians and researchers interested in engaging patients and study participants via online social networking.

Use of a Google Map Tool Embedded in an Internet Survey Instrument: Is it a Valid and Reliable Alternative to Geocoded Address Data?

Background

Men who have sex with men (MSM) in the United States are at high risk for human immunodeficiency virus (HIV) and poor HIV related outcomes. Maps can be used to identify, quantify, and address gaps in access to HIV care among HIV-positive MSM, and tailor intervention programs based on the needs of patients being served.

Objective

The objective of our study was to assess the usability of a Google map question embedded in a Web-based survey among Atlanta-based, HIV-positive MSM, and determine whether it is a valid and reliable alternative to collection of address-based data on residence and last HIV care provider.

Methods

Atlanta-based HIV-positive MSM were recruited through Facebook and from two ongoing studies recruiting primarily through venue-based sampling or peer referral (VBPR). Participants were asked to identify the locations of their residence and last attended HIV care provider using two methods: (1) by entering the street address (gold standard), and (2) “clicking” on the locations using an embedded Google map. Home and provider addresses were geocoded, mapped, and compared with home and provider locations from clicked map points to assess validity. Provider location error values were plotted against home location error values, and a kappa statistic was computed to assess agreement in degree of error in identifying residential location versus provider location.

Results

The median home location error across all participants was 0.65 miles (interquartile range, IQR, 0.10, 2.5 miles), and was lower among Facebook participants (P<.001), whites (P<.001), and those reporting higher annual household income (P=.04). Median home location error was lower, although not statistically significantly, among older men (P=.08) and those with higher educational attainment (P=.05). The median provider location error was 0.32 miles (IQR, 0.12, 1.2 miles), and did not vary significantly by age, recruitment method, race, income, or level of educational attainment. Overall, the kappa was 0.20, indicating poor agreement between the two error measures. However, those recruited through Facebook had a greater level of agreement (κ=0.30) than those recruited through VBPR methods (κ=0.16), demonstrating a greater level of consistency in using the map question to identify home and provider locations for Facebook-recruited individuals.

Conclusions

Most participants were able to click within 1 mile of their home address and their provider’s office, and were not always able to identify the locations on a map consistently, although some differences were observed across recruitment methods. This map tool may serve as the basis of a valid and reliable tool to identify residence and HIV provider location in the absence of geocoded address data. Further work is needed to improve and compare map tool usability with the results from this study.

Acceptability of smartphone application-based HIV prevention among young men who have sex with men

Young men who have sex with men (YMSM) are increasingly using mobile smartphone applications ("apps"), such as Grindr, to meet sex partners. A probability sample of 195 Grindr-using YMSM in Southern California were administered an anonymous online survey to assess patterns of and motivations for Grindr use in order to inform development and tailoring of smartphone-based HIV prevention for YMSM. The number one reason for using Grindr (29 %) was to meet "hook ups." Among those participants who used both Grindr and online dating sites, a statistically significantly greater percentage used online dating sites for "hook ups" (42 %) compared to Grindr (30 %). Seventy percent of YMSM expressed a willingness to participate in a smartphone app-based HIV prevention program. Development and testing of smartphone apps for HIV prevention delivery has the potential to engage YMSM in HIV prevention programming, which can be tailored based on use patterns and motivations for use.

Social networking smartphone applications and sexual health outcomes among men who have sex with men

Several smartphone applications (apps) designed to help men who have sex with men (MSM) find casual sexual partners have appeared on the market recently. Apps of this nature have the potential to impact sexual health and behavior by providing constant access to a large supply of available partners. In this study, the sexual health history, behavior, and personality of MSM who use these apps was compared to MSM who meet partners in other ways. A sample of 110 adult MSM was recruited online to complete a cross-sectional survey. All participants were either single or involved in a non-exclusive romantic relationship. There were no statistically significant differences between app users and non-users in frequency of insertive or receptive anal sex without a condom. However, app users reported significantly more sexual partners and had a higher prevalence of ever being diagnosed with an STI than did non-users. App users did not differ from non-users on any demographic or personality variables (including erotophilia, sensation seeking, and self-control); however, when adjusting lifetime total sex partners for those met specifically through apps, app users still had significantly more partners. This pattern of results suggests that app users may be more sexually active in general. More work is needed to fully understand the association between this emerging technology and potential sexual health risks.

Gay and bisexual men's use of the Internet: research from the 1990s through 2013

We document the historical and cultural shifts in how gay and bisexual men have used the Internet for sexuality between the 1990s and 2013-including shifting technology as well as research methods to study gay and bisexual men online. Gay and bisexual men have rapidly taken to using the Internet for sexual purposes: for health information seeking, finding sex partners, dating, cybersex, and pornography. Men have adapted to the ever-evolving technological advances that have been made in connecting users to the Internet-from logging on via dial-up modem on a desktop computer to geo-social-sexual networking via handheld devices. In kind, researchers have adapted to the Internet to study gay and bisexual men. Studies have carefully considered the ethics, feasibility, and acceptability of using the Internet to conduct research and interventions. Much of this work has been grounded in models of disease prevention, largely as a result of the ongoing HIV/AIDS epidemic. The need to reduce HIV in this population has been a driving force to develop innovative research and Internet-based intervention methodologies. The Internet, and specifically mobile technology, is an environment gay and bisexual men are using for sexual purposes. These innovative technologies represent powerful resources for researchers to study and provide outreach.

Syndemic and other risk factors for unprotected anal intercourse among an online sample of Belgian HIV negative men who have sex with men

Men who have sex with men (MSM) are confronted with different health problems. Next to a higher HIV prevalence and a higher reporting of depressive symptoms and other mental health problems, there is also evidence of substance dependence and sexual compulsivity occurring simultaneously. Using a sample of 591 HIV-negative Belgian MSM, we examine the relationships between depressive symptoms and other risk factors of unprotected anal intercourse (UAI) practice with casual partners. These risk factors include depressive symptoms, sexual behavioural indicators, individual risk perception of UAI, intrapersonal factors measured by the sexual sensation seeking scale, substance use, sources of social support and social norming regarding condom use and finally the location where or media through which men find sex partners. Our findings show that multifactorial, intertwined factors contribute to the explanation of UAI among MSM at risk for HIV infection. These findings underline the need for an integrated sexual health approach for MSM.

Sociodemographic and sexual behavior characteristics of an online MSM sample in Guangdong, China

Public health research and interventions often assume that men who have sex with men (MSM) who use the Internet in China have similar characteristics to those in Western countries, though with little empirical evidence. This study aimed to describe and examine the sociodemographic and basic sexual behavioral characteristics of an online sample of MSM in Guangdong, China. In 2010, a total of 1100 MSM were recruited from an lesbian, gay, bisexual, and transgender (LGBT)-oriented website and were asked about their sociodemographic and sexual behavior characteristics. The majority of the participants (77.9%) self-identified as homosexual, and the mean age was 30.0 years (SD = 6.7). About 80% of the participants had attained a college degree and only 4.8% were unemployed. About 60% had a monthly salary of more than CNY 3000 (476 USD), and more than 10% were married. The majority (71.7%) had used condoms in the last anal sex. Nearly half of the participants have never been tested for HIV or other sexually transmitted infections (STIs) (47.3% and 47.7%, respectively). More than 80% were willing to be contacted by researchers after the survey. Findings indicate that the sociodemographic characteristics of Chinese MSM who use the Internet are relatively similar to those in the Western countries. However, Chinese MSM are less likely to self-identify as homosexual and be tested for HIV and other STIs than Western MSM. On a positive note, Chinese MSM would be likely to engage in e-technology research showing potential feasibility of an online HIV/STI intervention.

Overcoming biological, behavioral, and structural vulnerabilities: new directions in research to decrease HIV transmission in men who have sex with men

Men who have sex with men (MSM), including transgender women, comprise a heterogeneous group of individuals whose sexual behaviors and gender identities may vary widely between cultures and among individuals. Their sources of increased vulnerability to HIV are diverse, including the increased efficiency of HIV transmission via unprotected anal intercourse, sexual role versatility, asymptomatic sexually transmitted infections, and behavioral factors that may be associated with condomless sex with multiple partners. Societal stigmatization of homosexual behavior and gender nonconformity may result in internalized negative feelings that lead to depression, other affective disorders, and substance use, which in turn are associated with increased risk-taking behaviors. Social stigma and punitive civil environments may lead to delays in seeking HIV and sexually transmitted disease screening, and later initiation of antiretroviral therapy. The iPrEX study demonstrated that chemoprophylaxis can decrease HIV acquisition in MSM, and the HIV prevention trials network 052 study established the biological plausibility that earlier initiation of highly active antiretroviral therapy can decrease HIV transmission to uninfected partners. Despite these advances, MSM remain among the most significantly HIV-affected population in resource-rich and limited settings. New studies will integrate enhanced understanding of the biology of enhanced rectal transmission of HIV and the focused use of antiretrovirals for prevention with culturally tailored approaches that address the potentiating social and behavioral factors associated with enhanced HIV spread among MSM.

Sex, drugs (methamphetamines), and the Internet: increasing syphilis among men who have sex with men in California, 2004-2008

OBJECTIVES

We examined primary and secondary syphilis cases among men who have sex with men (MSM) in California, and the association of methamphetamine use and Internet use to meet sex partners (Internet use) with number of sex partners.

METHODS

We analyzed California surveillance data for MSM who were diagnosed with syphilis between 2004 and 2008, to assess differences in the mean number of sex partners by methamphetamine use and mutually exclusive groups of patients reporting Internet use (Internet users).

RESULTS

Large proportions of patients reported methamphetamine use (19.2%) and Internet use (36.4%). From 2006 through 2008, Adam4Adam was the most frequently reported Web site statewide, despite temporal and regional differences in Web site usage. Methamphetamine users reported more sex partners (mean = 11.7) than nonmethamphetamine users (mean = 5.6; P < .001). Internet users reported more sex partners (mean = 9.8) than non-Internet users (mean = 5.0; P < .001). Multivariable analysis of variance confirmed an independent association of methamphetamine and Internet use with increased numbers of sex partners.

CONCLUSIONS

Higher numbers of partners among MSM syphilis patients were associated with methamphetamine and Internet use. Collaboration between currently stand-alone interventions targeting methamphetamine users and Internet users may offer potential advances in sexually transmitted disease control efforts.

Involvement in Specific HIV Risk Practices among Men Who Use the Internet to Find Male Partners for Unprotected Sex

Purpose. Men who have sex with other men (MSM) account for more than one-half of all new HIV infections in the USA. This study reports on the prevalence of a variety of HIV risk behaviors in one specific subpopulation of risk-seeking MSM. Methods. The study was based on a national sample of 332 MSM who use the Internet to find partners for unprotected sex. Data collection was conducted via telephone interviews between January 2008 and May 2009. Results. Unprotected oral and anal sex was commonplace among study participants. Men engaged in a large number of other risky behaviors as well, including having had multiple recent sex partners (mean number = 11), simultaneous double-penile penetration of the anus (16%), eating semen out of another man's anus (17%), engaging in multiple-partner sexual encounters (47%), engaging in anonymous sex (51%), and having sex while "under the influence" (52%). Conclusions. HIV intervention and prevention programs need to address numerous behaviors that place MSM at risk for contracting/transmitting HIV. Merely focusing on unprotected anal sex does a disservice to members of this community, who typically engage in many types of behavioral risks, each of which requires addressing if HIV transmission rates are to be reduced.

"A safe way to explore": Reframing risk on the Internet amidst young gay men's search for identity

Internet use provides a vital opportunity for sexual minority youth to learn about sexual desires and pursue partnerships otherwise publically stigmatized. Researchers, however, have portrayed the Internet as an inherently risky venue for HIV/STI transmission among young gay men (YGM). We therefore investigated how YGM use the Internet during adolescence and emerging adulthood. In the course of 34 in-depth, semi-structured interviews with a sample of self-identified YGM, 18-24 years of age, we inquired about initial experiences of online dating. We found that YGM benefit online through exploration of their sexual identities, while simultaneously encountering and negotiating sources of risk. In examining YGM's perceptions of risk, we hope to reach a greater understanding of the opportunities for HIV prevention and health promotion among YGM.

Online sex-seeking, substance use, and risky behaviors in Taiwan: results from the 2010 Asia Internet MSM Sex Survey

We conducted an online behavioral survey to estimate the prevalence of online sex-seeking and substance use behaviors and to compare risky behaviors among men using different venues to seek sex with men. A cross-sectional online survey, the Asia Internet MSM Sex Survey, was conducted online from January 1 to February 28, 2010. Of the 1,645 participants enrolled from Taiwan, 72.4% reported the Internet as the main way of seeking sexual partners, 73.9% had had sex with partners found online, and 16% had used recreational drugs in the previous 6 months. There was no evidence to suggest that men who looked for sex through the Internet were more likely to engage in unprotected anal intercourse with their casual partners than those using other gay venues. Having had online sex partners in the previous 6 months was significantly associated with being young [adjusted odd ratio (AOR) = 0.97, 95% CI: 0.95-0.99], having had no steady partners in the previous year (AOR = 0.24, 95% CI: 0.15-0.39), having had more than five partners in the previous 6 months (AOR = 4.57, 95% CI: 2.95-7.11), having used recreational drugs in the previous 6 months (AOR = 2.24, 95% CI: 1.30-3.87), and having had an STI in the previous 6 months (AOR = 4.24, 95% CI: 1.59-11.30). In conclusion, because the Internet is a popular meeting place for MSM in Taiwan, effective and targeted prevention programs should be developed to minimize the HIV transmission risk in the Internet era.

Virtual versus physical channel for sex networking in men having sex with men of sauna customers in the City of Hong Kong

Background

Advances in communication technology may affect networking pattern, thereby influencing the dynamics of sex partnership. The aim of the study is to explore the impacts of partner sourcing through internet and related channels on exposure risk to sexually transmitted infections (STI) including HIV.

Methods

Using venue-based sampling, a cross-sectional questionnaire survey was conducted at saunas frequented by men having sex with men (MSM) in Hong Kong. Comparison was made between MSM sourcing partners through physical venues alone versus concomitant users of physical and virtual channels, the latter referring to internet and smart-phone applications, using bivariate logistic regression.

Results

Over a 7-week study period, 299 MSM were recruited from 9 saunas. Three main types of sex partners were distinguished: steady (46.8%), regular (26.4%) and casual (96.0%) partners. Users of sauna (n = 78) were compared with concomitant users of saunas and virtual channels (n = 179) for partner sourcing. Sauna-visiting virtual channel users were younger and inclined to use selected physical venues for sourcing partners. Smart-phone users (n = 90) were not different from other internet-users in terms of age, education level and single/mixed self-identified body appearance. Classifying respondents into high risk and low risk MSM by their frequency of condom use, concomitant use of both sauna and virtual channels accounted for a higher proportion in the high risk category (71.6% vs. 58.2%, OR = 1.81, p<0.05). In virtual channel users, partner sourcing through smart-phone was not associated with a higher practice of unprotected sex.

Conclusion

MSM sauna customers commonly use virtual channels for sex partner sourcing. Unprotected sex is more prevalent in sauna customers who use virtual channel for sex partner sourcing. While the popularity of smart-phone is rising, its use is not associated with increased behavioural risk for HIV/STI transmission.

Participation in online and offline HIV prevention among men who have sex with men who use the internet to meet sex partners in New York City

This report presents data on participation in online or offline prevention activities among a sample of New York City men who have sex with men (MSM) recruited online between April-August of 2007 who use the Internet to meet sex partners. The analysis focuses on the 1,124 men who reported sex with a main or casual partner in the past 12 months. Over half (53%) of the MSM reported unprotected anal intercourse (UAI) in the past year. Data from our multivariate analysis indicate that MSM who participate in online or offline prevention activities were less likely to engage in UAI.

Novel use of surveillance data to detect HIV-infected persons with sustained high viral load and durable virologic suppression in New York City

BACKGROUND

Monitoring of the uptake and efficacy of ART in a population often relies on cross-sectional data, providing limited information that could be used to design specific targeted intervention programs. Using repeated measures of viral load (VL) surveillance data, we aimed to estimate and characterize the proportion of persons living with HIV/AIDS (PLWHA) in New York City (NYC) with sustained high VL (SHVL) and durably suppressed VL (DSVL).

METHODS/PRINCIPAL FINDINGS

Retrospective cohort study of all persons reported to the NYC HIV Surveillance Registry who were alive and ≥12 years old by the end of 2005 and who had ≥2 VL tests in 2006 and 2007. SHVL and DSVL were defined as PLWHA with 2 consecutive VLs ≥100,000 copies/mL and PLWHA with all VLs ≤400 copies/mL, respectively. Logistic regression models using generalized estimating equations were used to model the association between SHVL and covariates. There were 56,836 PLWHA, of whom 7% had SHVL and 38% had DSVL. Compared to those without SHVL, persons with SHVL were more likely to be younger, black and have injection drug use (IDU) risk. PLWHA with SHVL were more likely to die by 2007 and be younger by nearly ten years, on average.

CONCLUSIONS/SIGNIFICANCE

Nearly 60% of PLWHA in 2005 had multiple VLs, of whom almost 40% had DSVL, suggesting successful ART uptake. A small proportion had SHVL, representing groups known to have suboptimal engagement in care. This group should be targeted for additional outreach to reduce morbidity and secondary transmission. Measures based on longitudinal analyses of surveillance data in conjunction with cross-sectional measures such as community viral load represent more precise and powerful tools for monitoring ART effectiveness and potential impact on disease transmission than cross-sectional measures alone.

Differences in risk behaviors and partnership patterns between younger and older men who have sex with men in New York City

BACKGROUND

Men who have sex with men (MSM) account for a higher proportion of HIV diagnoses than any other risk group in the United States. Given that in NYC MSM younger than 30 years represent a growing proportion of new diagnoses among MSM, we examined differences between MSM by age.

METHODS

We analyzed NYC surveillance and partner services (PS) data for MSM newly diagnosed with HIV from January 2007 to December 2008. We compared demographics, HIV-related risk behaviors, and sexual partner characteristics between younger MSM (<30 years old) (YMSM) and MSM ≥30 years old.

RESULTS

Three hundred and thirty-six MSM were interviewed for PS (180 YMSM and 156 older MSM). MSM were mostly black or Hispanic (91%). YMSM were more likely than older MSM to report gay sexual identity (70% vs. 58%, P < 0.01), and a recent sexually transmitted infection (29% vs. 15%, P < 0.01). More YMSM named ≥1 male partner for HIV notification (66% vs. 36%, P < 0.01). YMSM were more likely than older MSM to name partners who were 5 or more years older (42% vs. 25%, P < 0.01). More YMSM tested for HIV at least once in the past 2 years than older MSM (66% vs. 40%, P < 0.01).

DISCUSSION

Our study has identified important differences in HIV risk behaviors and sexual partnerships between YMSM and older MSM newly diagnosed with HIV. YMSM were more willing to provide the names of male sex partners for the purposes of partner notification than were older MSM, suggesting that PS may be particularly effective at identifying new cases of HIV.