Network Influences on the Sexual Risk Behaviors of Gay, Bisexual and Other Men Who Have Sex with Men Using Geosocial Networking Applications

Geosocial-networking App Use Among Men who Have Sex with Men in High HIV Community Viral Load Areas of Baltimore City

Geosocial networking applications (GSN apps) are important tools for HIV/sexually transmitted infection prevention among men who have sex with men (MSM). Strategies for identifying high transmission and acquisition among GSN app users are needed to prioritize public health response. Community viral load (CVL) is associated with HIV transmission and can be used to identify populations with behaviors/environment associated with HIV/STI risk. We sought to determine user profile characteristics and utilization patterns associated with GSN app use in high CVL census tracts (CT). We used routine HIV surveillance data from in-care individuals and their viral loads at the point of diagnosis to estimate CVL in 200 CTs across Baltimore City. CTs were ordered based on CVL and categorized into quantiles from high to low. Among GSN user profiles, multiple imputation methods were used to complete missing profile characteristics. We then used imputed datasets to explore the association between profile characteristics, app utilization times, and app use in high CVL CTs using a Poisson regression model with robust error variances. Data on 606 profiles were collected originally and imputed 50 times to create a complete data set for analysis. GSN app users were aged 18-65 years [mean = 33.9, 95% confidence interval (CI): 33.1-34.7], with 52.2% Black (95% CI: 47.9- 56.5%), 6.8% living with HIV (95% CI: 4.4- 9.2%), 39.1% in high CVL CTs (95% CI: 35.2- 43.0%), 50.6% use at nighttime (95% CI: 46.7- 54.6%) and 51.6% use during the weekend (95% CI: 47.6- 55.6%). Black MSM users [Relative risk (RR) = 1.12, 95% CI: 1.04-1.20] were associated with GSN app use in high CVL CTs. MSM with profiles listing versatile sex position preference (RR = 1.12, 95% CI: 1.02-1.23) and profiles listing top sex position preference (RR = 1.13, 95% CI: 1.03-1.23) were associated with GSN app use in high and medium CVL CTs. GSN app user profiles of people in high and medium CVL CTs, especially Black MSM and those who report top and versatile sexual positions, may benefit from online prevention messages and real-time notification of health resources presently available in their communities to reduce HIV transmission.

Predicting the Risk of HIV Infection and Sexually Transmitted Diseases Among Men Who Have Sex With Men: Cross-Sectional Study Using Multiple Machine Learning Approaches

BACKGROUND

Men who have sex with men (MSM) are at high risk for HIV infection and sexually transmitted diseases (STDs). However, there is a lack of accurate and convenient tools to assess this risk.

OBJECTIVE

This study aimed to develop machine learning models and tools to predict and assess the risk of HIV infection and STDs among MSM.

METHODS

We conducted a cross-sectional study that collected individual characteristics of 1999 MSM with negative or unknown HIV serostatus in Western China from 2013 to 2023. MSM self-reported their STD history and were tested for HIV. We compared the accuracy of 6 machine learning methods in predicting the risk of HIV infection and STDs using 7 parameters for a comprehensive assessment, ranking the methods according to their performance in each parameter. We selected data from the Sichuan MSM for external validation.

RESULTS

Of the 1999 MSM, 72 (3.6%) tested positive for HIV and 146 (7.3%) self-reported a history of previous STD infection. After taking the results of the intersection of the 3 feature screening methods, a total of 7 and 5 predictors were screened for predicting HIV infection and STDs, respectively, and multiple machine learning prediction models were constructed. Extreme gradient boost models performed optimally in predicting the risk of HIV infection and STDs, with area under the curve values of 0.777 (95% CI 0.639-0.915) and 0.637 (95% CI 0.541-0.732), respectively, demonstrating stable performance in both internal and external validation. The highest combined predictive performance scores of HIV and STD models were 33 and 39, respectively. Interpretability analysis showed that nonadherence to condom use, low HIV knowledge, multiple male partners, and internet dating were risk factors for HIV infection. Low degree of education, internet dating, and multiple male and female partners were risk factors for STDs. The risk stratification analysis showed that the optimal model effectively distinguished between high- and low-risk MSM. MSM were classified into HIV (predicted risk score <0.506 and ≥0.506) and STD (predicted risk score <0.479 and ≥0.479) risk groups. In total, 22.8% (114/500) were in the HIV high-risk group, and 43% (215/500) were in the STD high-risk group. HIV infection and STDs were significantly higher in the high-risk groups (P<.001 and P=.05, respectively), with higher predicted probabilities (P<.001 for both). The prediction results of the optimal model were displayed in web applications for probability estimation and interactive computation.

CONCLUSIONS

Machine learning methods have demonstrated strengths in predicting the risk of HIV infection and STDs among MSM. Risk stratification models and web applications can facilitate clinicians in accurately assessing the risk of infection in individuals with high risk, especially MSM with concealed behaviors, and help them to self-monitor their risk for targeted, timely diagnosis and interventions to reduce new infections.

Ehealth interactive intervention in promoting safer sex among men who have sex with men

Men who have sex with men (MSM) who use dating applications (apps) have higher rates of engaging in condomless anal sex than those who do not. Therefore, we conducted a two-arm randomized controlled trial to evaluate the effectiveness of an interactive web-based intervention in promoting safer sex among this population. The intervention was guided by the Theory of Planned Behavior and co-designed by researchers, healthcare providers, and MSM participants. The primary outcome was the frequency of condomless anal sex in past three months. Secondary outcomes included five other behavioral outcomes and two psychological outcomes. This trial was registered on ISRCTN (ISRCTN16681863) on 2020/04/28. A total of 480 MSM were enrolled and randomly assigned to the intervention or control group. Our findings indicate that the intervention significantly reduced condomless anal sex behaviors by enhancing self-efficacy and attitudes toward condom use among MSM dating app users, with the effects sustained at both three and six months.

Assessment of Sexual Violence Risk Perception in Men Who Have Sex With Men: Proposal for the Development and Validation of "G-Date"

BACKGROUND

Sexual violence (SV) is a significant problem for sexual minorities, including men who have sex with men (MSM). The limited research suggests SV is associated with a host of syndemic conditions. These factors tend to cluster and interact to worsen one another. Unfortunately, while much work has been conducted to examine these factors in heterosexual women, there is a lack of research examining MSM, especially their SV risk perception. Further, MSM are active users of dating and sexual networking (DSN) mobile apps, and this technology has demonstrated usefulness for creating safe spaces for MSM to meet and engage partners. However, mounting data demonstrate that DSN app use is associated with an increased risk for SV, especially given the higher likelihood of using alcohol and other drugs before sex. By contrast, some researchers have demonstrated that DSN technology can be harnessed as a prevention tool for HIV; unfortunately, no such work has progressed regarding SV.

OBJECTIVE

This study aims to (1) use qualitative and quantitative methods to tailor an existing laboratory paradigm of SV risk perception in women for MSM using a DSN mobile app framework and (2) subject this novel paradigm to a rigorous validation study to confirm its usefulness in predicting SV, with the potential for use in future prevention endeavors.

METHODS

To tailor the paradigm for MSM, a team of computer scientists created an initial DSN app (G-Date) and incorporated ongoing feedback about the usability, feasibility, and realism of this tool from a representative sample of MSM. We used focus groups and interviews to assist in the development of G-Date, including by identifying relevant stimuli, developing the cover story, and establishing the appropriate study language. To confirm the paradigm's usefulness, we are conducting an experimental study with web-based and face-to-face participants to determine the content, concurrent, and predictive validities of G-Date. We will evaluate whether certain correlates of SV informed by syndemics and minority stress theories (eg, history of SV and alcohol and drug use) affect the ability of MSM to detect SV risk within G-Date and how paradigm engagement influences behavior in actual DSN app use contexts.

RESULTS

This study received funding from the National Institute on Alcohol Abuse and Alcoholism on September 10, 2020, and ethics approval on October 19, 2020, and we began app development for aim 1 immediately thereafter. We began data collection for the aim 2 validation study in December 2022. Initial results from the validation study are expected to be available after December 2025.

CONCLUSIONS

We hope that G-Date will enhance our understanding of factors associated with SV risk and serve as a useful step in creating prevention programs for this susceptible population.

HIV Risk Behaviors and the Use of Geosocial Networking Dating Apps among Men Who have Sex with Men and Transgender Women in Lima, Peru: a Cross-Sectional Study

Geosocial networking dating apps (GSN apps) are an increasingly widespread technology used by populations throughout the world to facilitate sexual encounters. Studies from a variety of settings suggest a possible association between GSN app use and HIV risk behaviors, including among sexual and gender minority populations such as men who have sex with men (MSM) and transgender women (TW). However, it remains unclear to what extent GSN apps play a causal role. We explored the relationship between GSN app use and sexual risk behaviors among MSM and TW in Lima, Peru by analyzing data from a multi-site cross-sectional survey assessing both general and partner-specific sexual behaviors. We performed bivariate analysis to estimate the association of GSN app use with different individual and partner-specific factors, then fit multivariable regression models adjusting for age and education. Among 741 total participants (698 MSM, 43 TW), 64% met at least one sex partner in the prior three months using a GSN app. GSN app users were significantly more likely to report engaging in HIV risk behaviors in general, including condomless receptive anal sex, group sex, transactional sex, and sex under the influence of alcohol or drugs. Having condomless anal sex with a given partner was not associated with meeting that partner via GSN app. These findings highlight GSN app users as a particularly vulnerable subpopulation among MSM and TW in Lima. GSN apps could provide a useful vehicle for targeted HIV prevention efforts for priority populations in Peru.

Young Men Who Have Sex With Men and Substance Use: A Comparison of Venue-Based Sampling and Geosocial Networking Application Sampling

To compare the demographics, sexual risk behaviors, and substance use characteristics of two probability samples of young men who have sex with men (YMSM): one recruited using a geosocial networking application (GSNA) and one recruited using venues. In 2017 and 2018, a cross-sectional online survey was utilized with a sample of 122 YMSM recruited in Los Angeles, CA. Recruitment procedures included both venue-based (n = 68) and GSNA-based probability sampling (n = 54). Sample substance use, sexual risk behaviors (e.g., unprotected sex at last encounter), and demographics were compared using chi-square tests and t-tests. The samples significantly differed in demographics characteristics (e.g., race, education, employment, outness). Samples did not significantly differ in sexual risk variables. Regressions indicated significant differences (higher in the venue sample) in substance use (marijuana, prescription drugs, alcohol, and poppers) between the two samples. Results indicate that recruitment method impacts demographics and substance use prevalence levels for YMSM. GSNA- based recruitment appears to recruit samples from a broader range of social demographics. GSNA-based methods may be especially applicable to areas in which venues are not readily accessible (e.g., rural areas), allowing social research with the most marginalized sexual minority populations.

Exploring group differences in the response to a sexual risk reduction intervention to prevent hepatitis C virus reinfection in HIV-infected MSM: a mixed-methods study

To prevent hepatitis C virus (HCV) reinfection, within the Swiss HCVree Trial, a preventive risk reduction intervention was implemented alongside curative treatment. Formative qualitative research identified three response patterns to the intervention. This mixed-methods study's aim was to cross-validate group differences in (a) the content of sexual risk reduction goals set during intervention and (b) the extent of their behavioural change in condomless anal intercourse with non-steady partners (nsCAI), sexualised and intravenous drug use at start and six-month post-intervention. Qualitative thematic analysis was used to summarise goal setting domains. Quantitative descriptive analysis was used to evaluate group differences based on assumptions of the group descriptions. Results largely confirmed assumptions on inter-group response differences in goal setting and behaviour: as expected group 1 Avoid risks showed the lowest HCV risk profile with changes in nsCAI. Group 2 Minimize-risks and Group 3 Accept-risks showed unchanged nsCAI. Group 3 had the highest HCV risk profile. Differences in their goal preferences (1: condom use; 2 reduction blood exposure; 3 safer dating) highlight diversity in attitudes to behavioural change. Our results improve understanding of variability in intervention responses such as changes in attitudes and behaviour. This provides evidence for intervention tailoring and outcome measurement.

Alcohol, Sexual Arousal, and Partner Familiarity as Predictors of Condom Negotiation: An Experience Sampling Study

Numerous contextual factors contribute to risky sexual decision-making among men who have sex with men (MSM), with experimental laboratory-based studies suggesting that alcohol consumption, sexual arousal, and partner familiarity have the potential to impact condom negotiations during sexual encounters. The purpose of the current study was to extend this line of inquiry outside of the laboratory and into the everyday lives of MSM. We collected six weeks of daily data on alcohol consumption and sexual behaviors from 257 moderate- and heavy-drinking MSM to examine the within- and between-subjects effects of alcohol consumption, average daily sexual arousal, and partner familiarity on condom negotiation processes during sexual encounters. We hypothesized that alcohol consumption, higher levels of average daily sexual arousal, and greater partner familiarity would all contribute to a reduced likelihood of condom negotiation prior to sexual activity, and that they would also affect the difficulty of negotiations. Contrary to hypotheses, none of these three predictors had significant within-subjects effects on condom negotiation outcomes. However, partner familiarity and average daily sexual arousal did exert significant between-subjects effects on the incidence of negotiation and negotiation difficulty. These findings have important implications for risk-reduction strategies in this population. They also highlight the challenges of reconciling results from experimental laboratory research and experience sampling conducted outside of the laboratory on sexual risk behavior.

Characterizing Socioecological Markers of Differentiated HIV Risk Among Men Who Have Sex with Men in Indonesia

HIV prevention programs typically focus on changing individuals' risk behaviors, often without considering the socioecological factors that can moderate this risk. We characterized HIV risk among men who have sex with men (MSM) in Indonesia (n = 1314) using latent class analysis and used multinomial logistic regression to identify latent class relationships with demographics, social/sexual networks, and community-level socioecological indicators of HIV risk. Three HIV risk latent classes were identified-"Sexually Moderate" (n = 333), "Sexual Explorative" (n = 575), and "Navigating Complexities" (n = 406). Using "Sexually Moderate" (lowest risk) as the reference group, MSM in the "Sexual Explorative" class had additional social/sexual network-level risks (meeting partner(s) using both online and offline methods [RR = 3.8; 95%CI 1.7-8.6] or general social media and gay-specific online platforms [RR = 2.6; 95%CI 1.9-3.6] to meet partners, group sex [RR = 10.9; 95%CI 4.5-25.4], transactional sex [RR = 1.6; 95%CI 1.2-2.2]), and community-level risks (experiencing homosexual-related assaults [RR = 1.4; 95%CI 1.1-1.9]). MSM in the "Navigating Complexities" class had additional social/sexual network-level risks (low social support [RR = 1.6; 95%CI 1.1-2.5], less disclosure of their sexuality [RR = 1.4; 95%CI 1.0-1.9]) and community-level risks (higher internalized homonegativity scores [RR = 1.2; 95%CI 1.1-1.4], ever experiencing homosexual-related assaults [RR = 1.4:95%CI 1.1-1.9], less exposure to HIV/STI health promotion [RR = 0.7; 95%CI 0.5-0.9], attending STI-related services in the past 6 months [RR = 0.6; 95%CI 0.4-0.8]). Co-occurring individual and socioecological risk recommend holistic HIV prevention strategies tailored to consider the social and structural conditions of MSM in Indonesia are needed.

Gay App Use, Sexuality Traits, and High-Risk Sexual Behaviors Among Men Who Have Sex With Men in China: Mediation Analysis

BACKGROUND

Gay geosocial networking apps, also known as "gay apps," have gained increasing popularity in the men who have sex with men (MSM) community. Certain sexuality traits and gay app use are both associated with high-risk sexual behaviors among MSM. However, little is known about the underlying mechanism of such relationships.

OBJECTIVE

Based on the uses and gratifications theory, this study aimed to test the mediation effect of gay app use on the relationship between sexuality traits (sexual compulsivity and sexual sensation seeking) and high-risk sexual behaviors (multiple sexual partners and unprotected anal intercourse) among MSM.

METHODS

A cross-sectional, multicenter study was conducted in Wuhan and Changsha, China, from August to October 2020. A representative sample of 402 MSM was recruited through respondent-driven sampling. A self-administered web-based structured questionnaire was used to collect data on sociodemographic information, high-risk sexual behaviors, gay app use, sexual compulsivity, and sexual sensation seeking. Path analysis was conducted to assess the mediation effect.

RESULTS

Our study revealed that 67.42% (n=271) of MSM used gay apps for seeking potential sexual partners, with 37.06% (n=149) of them engaging in unprotected anal intercourse, and 45.42% (n=218) of them having multiple sexual partners. Of the participants, 17.16% (n=69) reported significant sexual compulsivity, while 29.10% (n=117) reported significant sexual sensation seeking. Notably, gay app usage partially mediated the relationship between sexual compulsivity and multiple sexual partners but fully mediated the relationship between sexual compulsivity and unprotected anal intercourse. Furthermore, gay app usage partially mediated the relationship between sexual sensation seeking and multiple sexual partners but fully mediated the relationship between sexual sensation seeking and unprotected anal intercourse.

CONCLUSIONS

High-risk sexual behaviors are common among MSM. Most MSM rely on gay apps to find sexual partners, which, when combined with higher levels of sexual compulsivity and sexual sensation seeking, can increase the likelihood of engaging in high-risk sexual behaviors. Therefore, interventions aimed at reducing these behaviors among MSM should focus on addressing the use of gay apps, while also considering the influence of their sexuality traits on gay app use.

Experiences of Stigma and HIV Status Associated with Awareness and Usage of Safer Sex Functions in Dating Apps Among MSM, 2019 American Men's Internet Survey (AMIS) Study

Dating apps represent opportunities to implement sexual health interventions among gay, bisexual, and other men who have sex with men (MSM), particularly those who may avoid traditional health services due to intersecting stigmas. We used multivariable models to explore whether stigma experience was associated with awareness and usage of safer sex functions in dating apps among 7700 MSM who completed a 2019 US nationwide online survey. Perceived community intolerance of gay and bisexual men was associated with reduced awareness of sexual health strategy profile options (adjusted prevalence ratio [aPR] 0.95; 95% confidence interval [95% CI] 0.93-0.98) and sexual health information and resources (aPR 0.97; 95% CI 0.94-0.99). Stigma from family and friends was associated with increased usage of app-based sexual health reminders (aPR 1.14; 95% CI 1.02-1.28) and sexual health information and resources (aPR 1.16; 95% CI 1.04-1.31). Stigma experience of MSM should be considered in optimizing app-based sexual health interventions.

Latent Profile Patterns of Network-Level Norms and Associations with Individual-Level Sexual Behaviors: The N2 Cohort Study in Chicago

Individual-level behavior can be influenced by injunctive and descriptive social network norms surrounding that behavior. There is a need to understand how the influence of social norms within an individual's social networks may influence individual-level sexual behavior. We aimed to typologize the network-level norms of sexual behaviors within the social networks of Black sexual and gender minoritized groups (SGM) assigned male at birth. Survey data were collected in Chicago, Illinois, USA, between 2018 and 2019 from Black SGM. A total of 371 participants provided individual-level information about sociodemographic characteristics and HIV vulnerability from sex (i.e., condomless sex, group sex, use of alcohol/drugs to enhance sex) and completed an egocentric network inventory assessing perceptions of their social network members' (alters') injunctive and descriptive norms surrounding sexual behaviors with increased HIV vulnerability. We used Latent Profile Analysis (LPA) to identify network-level norms based on the proportion of alters' approval of the participant engaging in condomless sex, group sex, and use of drugs to enhance sex (i.e., injunctive norms) and alters' engagement in these behaviors (i.e., descriptive norms). We then used binomial regression analyses to examine associations between network-level norm profiles and individual-level HIV vulnerability from sex. The results of our LPA indicated that our sample experienced five distinct latent profiles of network-level norms: (1) low HIV vulnerability network norm, (2) moderately high HIV vulnerability network norm, (3) high HIV vulnerability network norm, (4) condomless sex dominant network norm, and (5) approval of drug use during sex dominant network norm. Condomless anal sex, group sex, and using drugs to enhance sex were positively and significantly associated with higher HIV vulnerability social network norm profiles, relative to low HIV vulnerability norm profiles. To mitigate Black SGM's HIV vulnerability, future HIV risk reduction strategies can consider using network-level intervention approaches such as opinion leaders, segmentation, induction, or alteration, through an intersectionality framework.

Using a Geosocial Networking App to Investigate New HIV Infections and Related Risk Factors Among Student and Nonstudent Men Who Have Sex With Men in Chengdu, China: Open Cohort Study

BACKGROUND

In China, condomless sex among men who have sex with men (MSM) is the primary route of HIV infection in young people. Chengdu is a hotspot for reported HIV cases among young people nationwide. Extensive use of geosocial networking (GSN) smartphone apps has dramatically changed the pattern of sexual behavior among young MSM (YMSM). However, data on HIV incidence and the risk behavior of YMSM using the GSN app are still obscure.

OBJECTIVE

This study aims to analyze and understand the HIV incidence and its risk factors among YMSM using GSN apps in Chengdu, China.

METHODS

An open cohort study was conducted among YMSM aged 18-24 years through a gay GSN smartphone app in Chengdu, China, from July 2018 to December 2020. Every participant completed a web-based questionnaire on sociodemographic characteristics, sexual behaviors, and other related statuses; made a reservation for a web-based HIV testing; and then voluntarily got tested at the designated testing site. At least one additional HIV test was taken via the app during the study period, and participants were evaluated at the end of the study or at the time of HIV seroconversion. By dividing the sum of the observed HIV seroconversions by the observed person-years, HIV incidence was calculated and compared between the student and nonstudent MSM. Univariate and multivariate (Cox proportional hazards regression) analyses were used to discuss the risk factors for new HIV infections.

RESULTS

In the study cohort, 24 seroconversions occurred among 625 YMSM who took at least two HIV tests through the app during the study period, contributing to 505 observed person-years. The HIV incidence rate per 100 person-years was 4.75 (95% CI 2.89-6.61) among all MSM, 3.60 (95% CI 1.27-5.93) among student MSM, and 5.88 (95% CI 2.97-8.79) among nonstudent MSM. In addition, the HIV incidence per 100 person-years was 11.11 (95% CI 4.49-17.73) among those who had resided in the area for 6 months or less and 7.14 (95% CI 1.52-12.77) among those with senior high school or less education. Two or more sexual partners (adjusted hazards ratio [HR] 3.63, 95% CI 1.08-12.23) in the preceding 6 months was a risk factor for new HIV infections. Consistent condom use for anal sex (adjusted HR 0.38, 95% CI 0.16-0.88) and insertive anal sex only (adjusted HR 0.10, 95% CI 0.01-0.75) in the preceding 6 months were protective factors for new HIV infections.

CONCLUSIONS

The rate of new HIV infections among YMSM who actively used GSN smartphone apps was high, especially among migrant nonstudent MSM. Targeted interventions on GSN smartphone apps should be implemented to provide demand-adapted prevention and services to reduce the threat of HIV.

Awareness of HIV pre-exposure prophylaxis among men who have sex with men using apps for sexual encounters in Turkiye

Background

New HIV diagnoses are rising in Turkiye. Men who have sex with men (MSM) are estimated to be the main driver of the epidemic. Pre-exposure prophylaxis (PrEP) was proven to be effective in reducing new HIV diagnoses and PrEP recently became available in Turkiye.

Objective

To assess awareness of and willingness to use PrEP and the level of off-licence use among MSM.

Methods

An anonymous self-completed questionnaire was sent out over the Hornet Gay Social Network from December 2019 to February 2020, available in Turkish and Arabic. It included 20 questions on HIV and STI testing, PrEP awareness, PrEP use, willingness to use, chemsex and sexual happiness level.

Results

Overall 4761 respondents who responded to more than 1/3 of the questions were eligible for analyses; 5.5% was Arabic speaking. The mean age was 30.5 years, 31.4% had never tested for HIV, 40.5% knew what PrEP was, the most common source of knowledge was the internet (44.5%), 2.5% (120) had used PrEP in the last 12 months and 1.7% (83) was current users. PrEP users had accessed drugs over the internet (47.6%), pharmacy (23%), and friends (13.8%). Almost 40% were willing to use PrEP in the following 6 months. Younger and Arabic speaking respondents had lower rates of HIV testing ( p = .001) and lower awareness for PrEP than comparators ( p = .004).

Conclusion

Awareness and willingness to use PrEP is high among MSM in Turkiye. The recent availability of PrEP in the country is a big step forward in terms of prevention.

Associations of Social Network- and Individual-Level Factors with HIV Testing, Condom Use, and Interest in PrEP Among Young Black Women

To achieve the 2030 goal of ending the HIV epidemic, we must consider social network- along with individual-level factors related to HIV prevention among young Black women (YBW). This cross-sectional study examined egocentric social network- and individual-level data of 180 YBW aged 18-24. Multivariable logistic regression models were used to study social network characteristics and individual sexual behaviors related to HIV prevention behaviors (e.g., HIV testing, condom use, and interest in preexposure prophylaxis, or PrEP). On average, YBW nominated 11 social network members (SNMs; seven friends, two family members, and one sex partner). About 92% of YBW spoke to at least one SNM about condom use and 58% spoke to at least one SNM about HIV testing. Respondents who spoke to a sex partner about condom use had 70% lower odds of being interested in PrEP, but 2.99 times the odds of reporting condom use during last sex. Odds of being tested for HIV in the prior 3 months were significantly increased by 3.97 times for those who spoke to at least one sex partner about HIV testing. However, odds of being interested in PrEP were significantly decreased by 63% for YBW who were tested for HIV in the prior 3 months. Findings underscore that understanding network- and individual-level factors is crucial in increasing HIV testing, condom use, and interest in PrEP among YBW.

Online sex-seeking among Chinese heterosexual men who seek care in sexually transmitted infections clinics: a cross-sectional study

Background

The Internet has become an important virtual venue for men who have sex with men to seek sexual partners, with a high potential threat to spread sexually transmitted infections (STIs). However, the online sex-seeking use and its risk causing STIs spread remain unclear among heterosexual men. We conducted a cross-sectional study to investigate the use of online sex-seeking venues and the related risky sex activities (e.g. condomless sex, quick sex) in STIs clinics in Guangdong, China.

Methods

These STIs clinics were involved in the Guangdong governmental sentinel network and we recruited heterosexual men (age >  = 18) between March and August 2018. Multivariable logistic regression models were used to identify the factors associated with online sex-seeking use and risky sex activities with online sex partners.

Results

191 of 2,154 participants (8.9%) ever sought sex online. Among users,16.8% met their partners in-person within 24 h, 31.4% engaged in condomless sex with their last online partner. Online sex-seeking was positively associated with a) Ever been diagnosed with STIs (aOR = 3.0, 95%CI:2.0–4.6), and b) Had casual sex in the last three months (aOR = 3.3, 95%CI 2.4–4.6). Condomless sex with the last online partner was negatively associated with the correct answer of “Having only one partner can reduce the risk to infect HIV” (aOR = 0.3, 95%CI:0.1–0.8).

Conclusion

In China, online sex-seeking and its related risky sexual activities are not rare among heterosexual men. Future prevention strategies to reduce STIs incidence should especially target heterosexual men engaging in online sex-seeking.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00903-5.

Exploring community enabling factors associated with recent HIV testing in a regional sample of gay, bisexual, and other men who have sex with men

HIV testing and diagnosis are the gateway into treatment and eventual viral suppression. With gay, bisexual, and other men who have sex with men (GBMSM) persistently over-representing new HIV diagnoses in Canada, combined with the evolving nature of community social connection, an exploration of factors associated with recent HIV testing is warranted. As most studies of GBMSM rely on samples obtained from larger metropolitan regions, examining HIV testing from an under-researched region is necessary. With data collected from an online survey of LGBTQ+ persons 16 or older living, working, or residing in the Region of Waterloo, Ontario, Canada, we used multinomial logistic regression to explore socio-demographic, behavioural, and psychosocial factors associated with recent HIV testing for GBMSM. In the final multivariate multinomial logistic regression model: sense of belonging was associated with more recently testing, as was having an increasing proportion of LGBT friends, app use to find sex partners in the past 12 months, access to the local AIDS service organization, and general sense of belonging to local community, among other. This analysis highlights the continued importance of enabling and need factors when accessing testing, and suggests areas for further testing promotion in physical and virtual spaces frequented by GBMSM.

Using social and sexual networking mobile applications to promote HIV testing, medical care and prevention services among Latino men who have sex with men in Los Angeles County, California, USA

HIV disproportionately affects Latinos versus Whites, with Latinos having higher rates of HIV. Additionally, many HIV-positive Latinos are unaware of their infection. Proyecto Protégete, an HIV prevention intervention developed for Latino men who have sex with men (MSM), used social and sexual networking mobile applications (apps) to recruit individuals for HIV testing and linkage to medical care and prevention services. This study occurred in Los Angeles County, California, USA from December 18, 2015 to April 22, 2017. The study’s primary aim was to assess Proyecto Protégete‘s ability to successfully recruit Latino MSM involved in high-risk sexual activities. A secondary aim was to evaluate its capacity to promote HIV testing and linkage to HIV medical care and prevention services among this population by comparing it to two programs with similar samples. Comparisons using Fisher’s Exact Test were conducted between Proyecto Protégete and the HIV testing program of the agency in which Proyecto Protégete was located and the County-funded HIV testing programs to compare the samples’ rates of HIV-positive Latino MSM identified through HIV testing and linked to HIV medical care and prevention services. Participants were recruited through seven apps. In Proyecto Protégete, 9,573 individuals completed the screener, 4,657 were eligible, and 359 (7.7% of those eligible) enrolled. Among those enrolled, 79% reported anal sex without a condom in the previous twelve months; 51% reported anal sex under the influence of alcohol. The HIV positivity rates were as follows: Proyecto Protégete, 1.71%; the agency, 1.25% (p = .293, compared to Proyecto Protégete); and the County, 1.09% (p = .172, compared to Proyecto Protégete). The rates of those confirmed as new HIV-positives and linked to medical care within 30 days were as follows: Proyecto Protégete, 71.4%; the agency, 81.5% (p = .450, compared to Proyecto Protégete); and the County, 77.3% (p = .503, compared to Proyecto Protégete). Proyecto Protégete had a higher rate of linked referrals to prevention services than the agency’s testing program (19.5% versus 8.3%, p < .001). Proyecto Protégete experienced successes in some areas but not in others. Future research should build on Proyecto Protégete’s experiences to promote HIV-related services among Latino MSM.

A Latent Profile Analysis of Online Dating Patterns Among Single Young Men Who Have Sex with Men

Despite the increased use of geosocial networking applications for finding sexual partners among young men who have sex with men (YMSM), few studies have examined the intricate patterns of online dating behaviors. In order to advance understanding of online dating patterns among YMSM, various factors, including how frequently and how much time is spent within partner-seeking sites, need to be examined concurrently. Therefore, we used latent profile analysis to identify online dating patterns and logistic regressions to examine their associations with sexual behaviors and relationship characteristics among single YMSM (N = 180; ages 18-24). We found three online dating patterns: discouraged users (N = 93, 52%), date seekers (N = 67, 37%), and instant lovers (N = 20, 11%). Discouraged users were less likely to seek sexual sensational activities, while date seekers were more likely to seek sexual sensational activities. Moreover, instant lovers were less likely to pursue committed romantic relationships, while they reported a higher number of condomless anal intercourse. Given that online dating patterns are not homogeneous, HIV prevention interventions may benefit from tailored approaches based on YMSM's different online dating profiles.

Geosocial Networking Smartphone App Use and High-Risk Sexual Behaviors Among Men Who Have Sex With Men Attending University in China: Cross-sectional Study

BACKGROUND

Gay apps are smartphone-based geosocial networking apps where many men who have sex with men (MSM) socialize and seek sex partners. Existing studies showed that gay app use is associated with greater odds of high-risk sexual behaviors and potentially more HIV infections. However, little is known about this behavior among young MSM.

OBJECTIVE

We conducted this study to understand gay app use and its influencing factors among MSM attending university in China.

METHODS

From January to March 2019, participants were recruited from 4 regions with large populations of college students in China: Chongqing, Guangdong, Shandong, and Tianjin. The eligibility criteria were MSM aged 16 years or older, self-identified as a university student, and being HIV negative. A self-administered online structured questionnaire was used to collect data on sociodemographic information, sexual behaviors, gay app use, substance use, and HIV testing history. We performed multivariable log-binomial regression to assess correlates of seeking sex partners via gay apps.

RESULTS

A total of 447 MSM attending university with an average age of 20.4 (SD 1.5) years were recruited. Almost all participants (439/447, 98.2%) reported gay app use at some point in their life, and 240/439 (53.7%) reported ever seeking sex partners via gay apps. Blued (428/439, 97.5%) was the most popular gay app. Higher proportions of sexual risk behaviors (including seeking sex partners via apps [P<.001], engaging in group sex [P<.001], having multiple sex partners [P<.001], unawareness of sex partners' HIV status [P<.001], and using recreational drugs during sex [P<.02]) were positively associated with the increase in the frequency of gay app use. In multivariable analysis, participants who used gay apps to seek sex partners might be more likely to have multiple sex partners in the past 3 months (adjusted prevalence ratio [APR] 1.53, 95% CI 1.33-1.76; P<.001), engage in group sex in the past 3 months (APR 1.55, 95% CI 1.35-1.78; P<.001), and have sex partners with unknown or positive HIV status (APR 1.72, 95% CI 1.46-2.01; P<.001).

CONCLUSIONS

Seeking sex partners via gay apps may associate with the increased high-risk sexual behaviors among MSM attending university. The causality between seeking sex partners via gay apps and increased high-risk sexual behaviors should be further investigated so as to inform potential policies for HIV prevention.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR1900020645; http://www.chictr.org.cn/showprojen.aspx?proj=34741.

Linking Network Characteristics of Online Social Networks to Individual Health: A Systematic Review of Literature

Social networks have long been viewed as a structural determinant of health. With the proliferation of digital technologies, numerous studies have examined the health implications of online social networks (OSNs). However, the mechanisms through which OSNs may influence individual health are poorly understood. Employing a social network approach, this paper presents a systematic review of the literature examining how network characteristics of OSNs are linked to individuals' health behavior and/or status. Drawing on keyword searches in nine databases, we identified and analyzed 22 relevant articles from 1,705 articles published prior to 2017. The findings show that individual health is associated with a number of network characteristics, including both individual-level attributes (e.g., centrality) and network-level attributes (e.g., density, clustering). All of the included studies (n = 22) have focused on egocentric networks, and nine studies also collected whole network data of online health communities. Based on our review, we highlight three fruitful areas in the application of OSNs in public health: (1) disease and risk detection, (2) disease prevention and intervention, and (3) health behavior change. However, the precise mechanisms and causal pathways through which OSNs affect health remain unclear. More theoretically grounded, longitudinal, and mixed methods research is needed to advance this line of research.

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.

"What Are You Looking For?" Investigating the Association Between Dating App Use and Sexual Risk Behaviors

Introduction

Literature on the association between dating app use and sexual risk behaviors is still scant and inconclusive.

Aim

To investigate the association between dating app use and sexual risk behaviors, considering the role of motives for using them.

Methods

1,278 Italian respondents completed an online questionnaire assessing demographics, motives and patterns of dating app use, sexual behaviors and sexually transmitted infections (STIs) diagnoses. One-way ANOVA and Chi-squared analyses were used to investigate differences among the three subsamples (active vs former vs non-users). Multiple linear and logistic regression analyses were run to investigate the role of demographics, motives and patterns of dating app use on sexual risk taking and sexual health.

Main outcome measures

Number of protected and unprotected full sexual partners in the last year; frequency of hook-ups in the last year; STIs lifetime.

Results

Active users, even more than former app users, were more likely to report risky behaviors and STI diagnoses than non-users (χ² = 26.37, P < .001). Installing the apps to find friends or romantic partners was associated with less protected (find friends B = −0.364, P = .015; find romantic partners B = −0.300, P = .006) and unprotected (find friends B = −0.346, P = .016; find romantic partners B = −0.360, P < .001) sexual intercourses. Installing the apps to find sexual partners predicted higher odds of unprotected sexual activity (B = 0.193, P = .048), hook-ups (B = 0.496, P < .001) and STIs diagnoses (OR = 2.835, P = .025). Accessing apps more frequently and more years of usage was associated with reporting risky sexual behaviors and STI diagnoses among active users (app access frequency OR = 1.461, P = .003; usage years OR = 1.089, P = .013).

Conclusion

Installing the apps to search for sexual partners, using them at length since first installation and accessing them frequently are significant factors in influencing the association between dating app use and sexual risk behaviors. Flesia L, Fietta V, Foresta C, Monaro M. “What Are You Looking For?” Investigating the Association Between Dating App Use and Sexual Risk Behaviors. Sex Med 2021;9:100405.

Effects of internet exposure on sexual partners and sexual risk behavior among sexually experienced college males in China: evidence from an institutional-based cross-sectional study (Preprint)

Background

As a young subgroup, college students have become the main users of mobile social networks. Considering that people can indiscriminately access explicit sexual content on the internet, coupled with the increase of HIV infections in male college students, the role of the internet in meeting sexual partners and its correlation to risky sexual behavior has become an important topic.

Objective

The aim of this study is to explore the effects of internet exposure on sexual partners and sexual risk behavior among sexually experienced male college students.

Methods

An institution-based cross-sectional study design was used to collect data through a paper-based questionnaire administered to male college students recruited from colleges and gay organizations in Hangzhou, Zhejiang Province, China. A total of 1045 sexually experienced male students were incorporated in our analysis, with the following information collected: sociodemographic characteristics, sexual intercourse–related behaviors, and sexually transmitted disease (STD) knowledge. Mann-Whitney U and Kruskal-Wallis tests were used to examine differences regarding basic characteristics and sexual risk behaviors between male college students who meet sexual partners via the internet and those who do not. Sequential logistic regression models were employed to examine the influence of meeting sexual partners via the internet on risky sexual behaviors after controlling for other factors.

Results

The mean age of the sexually experienced male students was 21.6 (SD 2.0) years. The likelihood of risky sexual behavior was varied, yet it was the highest for those who aim to meet paid sexual partners (145/192, 75.5% to 19/22, 86.4%), followed by those seeking partners for love or romance (258/435, 59.3%). Compared to non-internet partner seekers, internet partner seekers tended to have more casual intercourse (292/542, 53.9% versus 51/503, 10.1%), paid intercourse (32/542, 5.9% versus 12/503, 2.4%), and intercourse with same-sex partners (349/542, 64.4% versus 41/503, 8.2%); they were also more likely to use psychoactive drugs (125/349, 35.8% versus 5/41, 12.2%) and have more than 2 partners. With the increase of HIV and STD knowledge, the probability of having unprotected intercourse decreased for non-internet partner seekers. However, it increased for internet partner seekers with a rising HIV knowledge score. Sequential logistic regression showed that meeting sexual partners on the internet was statistically associated with sexual risk behaviors with multiple sexual partners (odds ratio 4.434; P<.001).

Conclusions

Meeting sexual partners via the internet is a common behavior among sexually experienced male college students, and those who meet partners on the internet exhibited higher levels of risky sexual behaviors although they had sufficient HIV and STD knowledge; this is especially true for students who aimed to find partners for sexual intercourse. Thus, more attention should be paid to young adults to address the risky sexual behaviors that may contribute to STD spread among this population.

The Association between Dating Apps and Alcohol Consumption in an Italian Sample of Active Users, Former Users, and Non-Users

To date, the relationship between alcohol use and dating app use has been investigated mostly in conjunction with sexual activities and in homosexual men. For this reason, the aim of this study was to explore the association between dating app use and alcohol consumption among the general population. A cross-sectional study was conducted including app users, non-users, and former users: 1278 respondents completed an online ad hoc questionnaire assessing dating app use, motivations for installing dating apps, alcohol use, and demographics. Multiple logistic regression analysis was run to investigate the association between dating app use, demographic features, and alcohol consumption. Whereas educational level, age, and gender significantly contributed to the regular consumption of alcohol, dating app use did not account for a significant amount of variance between regular and not regular drinkers. However, people who installed and used dating apps with the motivation of searching for sexual partners were more likely to be regular drinkers. Among the active users, heavy app users were less likely to drink regularly. The study indicates that underlying factors (sexual aspects, motives for using the apps) and the intensity of using the apps may mediate the relationship between dating app use and alcohol use.

Leveraging Social Media Activity and Machine Learning for HIV and Substance Abuse Risk Assessment: Development and Validation Study

Background

Social media networks provide an abundance of diverse information that can be leveraged for data-driven applications across various social and physical sciences. One opportunity to utilize such data exists in the public health domain, where data collection is often constrained by organizational funding and limited user adoption. Furthermore, the efficacy of health interventions is often based on self-reported data, which are not always reliable. Health-promotion strategies for communities facing multiple vulnerabilities, such as men who have sex with men, can benefit from an automated system that not only determines health behavior risk but also suggests appropriate intervention targets.

Objective

This study aims to determine the value of leveraging social media messages to identify health risk behavior for men who have sex with men.

Methods

The Gay Social Networking Analysis Program was created as a preliminary framework for intelligent web-based health-promotion intervention. The program consisted of a data collection system that automatically gathered social media data, health questionnaires, and clinical results for sexually transmitted diseases and drug tests across 51 participants over 3 months. Machine learning techniques were utilized to assess the relationship between social media messages and participants' offline sexual health and substance use biological outcomes. The F1 score, a weighted average of precision and recall, was used to evaluate each algorithm. Natural language processing techniques were employed to create health behavior risk scores from participant messages.

Results

Offline HIV, amphetamine, and methamphetamine use were correctly identified using only social media data, with machine learning models obtaining F1 scores of 82.6%, 85.9%, and 85.3%, respectively. Additionally, constructed risk scores were found to be reasonably comparable to risk scores adapted from the Center for Disease Control.

Conclusions

To our knowledge, our study is the first empirical evaluation of a social media–based public health intervention framework for men who have sex with men. We found that social media data were correlated with offline sexual health and substance use, verified through biological testing. The proof of concept and initial results validate that public health interventions can indeed use social media–based systems to successfully determine offline health risk behaviors. The findings demonstrate the promise of deploying a social media–based just-in-time adaptive intervention to target substance use and HIV risk behavior.

HIV incidence among men who have sex with men using geosocial networking smartphone application in Beijing, China: an open cohort study

Background

Sexual transmission among men who have sex with men (MSM) is the dominant route of HIV transmission in China. Extensive use of geosocial networking (GSN) smartphone application (app) has dramatically changed the pattern of sexual behaviors and HIV risk among MSM, but data on HIV incidence and the changing risk behaviors of GSN app-using MSM are limited. We aims to assess the HIV incidence and its correlates among gay GSN app-using MSM in China.

Methods

We constructed an open cohort which was initiated and maintained using a GSN app to assess the HIV incidence among app-using MSM, recruited from June 2017 to December 2018. MSM completed an online questionnaire on their sociodemographic characteristics, sexual behaviors, recreational drug use and sexually transmitted infections status. Then each man had an HIV test, and those tested negatives were enrolled into the cohort. Participants completed follow-ups with additional HIV tests though the app during the study period, and were censored at HIV seroconversion or study end date. HIV incidence was calculated by dividing the sum of observed HIV seroconversions by the observed person-time. Univariate (Chi-square test and Fisher’s exact test) and multivariate (proportional hazards regression) analyses were used to examine correlates of HIV incidence.

Results

A total of 6957 HIV negative MSM were enrolled in the open cohort, 37 seroconversions occurred among 1937 men contributing 1065 observed person-years: HIV incidence was 3.47 per 100 person-years [95% confidence interval (CI): 2.37–4.57]. More than five sexual partners [hazard ratio (HR) = 2.65, 95% CI: 1.04–6.67], and sex with HIV positive partners (HR = 3.82, 95% CI: 1.16–12.64) in the preceding six months were positively associated with HIV seroconversion. Consistent condom use for anal sex (HR = 0.27, 95% CI: 0.07–0.96), and reporting insertive anal sex only (HR = 0.23, 95% CI: 0.08–0.62) in the preceding six months were protective factors for HIV seroconversion.

Conclusions

Tailored interventions targeting app-using MSM are urgently needed given their high risk of HIV. As a new tool for accessing MSM at higher HIV risk, GSN smartphone app could play an important role in HIV research among MSM.

Use of Geosocial Networking Apps and HIV Risk Behavior Among Men Who Have Sex With Men: Case-Crossover Study

Background

HIV disproportionately affects men who have sex with men (MSM) in China. The HIV epidemic is largely driven by unprotected anal sex (ie, sex not protected by condoms or HIV pre-exposure prophylaxis [PrEP]). The possible association between unprotected anal sex and the use of geospatial networking apps has been the subject of scientific debate.

Objective

This study assessed whether users of a gay geospatial networking app in China were more likely to use condoms when they met their partners online versus offline. A case-crossover analysis, with each person serving as his own control, was employed to address the potential bias that men looking for sex partners through an online dating medium might have inherently different (and riskier) patterns of sexual behavior than men who do not use online dating media.

Methods

A cross-sectional survey was administered in 2018 to adult male users of Blued—a gay geospatial networking app—in Beijing, Tianjin, Sichuan, and Yunnan, China. A case-crossover analysis was conducted among 1311 MSM not taking PrEP who reported engaging in both unprotected and protected anal sex in the previous 6 months. Multivariable conditional logistic regression was used to quantify the association between where the partnership was initiated (offline or online) and the act of unprotected anal sex, controlling for other interval-level covariates. Four sensitivity analyses were conducted to assess other potential sources of bias.

Results

We identified 1311 matched instances where a person reported having both an unprotected anal sex act and a protected anal sex act in the previous 6 months. Of the most recent unprotected anal sex acts, 22.3% (292/1311), were initiated offline. Of the most recent protected anal sex acts, 16.3% (214/1311), were initiated offline. In multivariable analyses, initiating a partnership offline was positively associated with unprotected anal sex (odds ratio 2.66, 95% CI 1.84 to 3.85, P<.001) compared with initiating a partnership online. These results were robust to each of the different sensitivity analyses we conducted.

Conclusions

Among Blued users in 4 Chinese cities, men were less likely to have unprotected anal sex in partnerships that they initiated online compared with those that they initiated offline. The relationship was strong, with over 2.5 times the likelihood of engaging in unprotected anal sex in partnerships initiated offline compared with those initiated online. These findings suggest that geospatial networking apps are a proxy for, and not a cause of, high-risk behaviors for HIV infection; these platforms should be viewed as a useful venue to identify individuals at risk for HIV transmission to allow for targeted service provision.

Sexual Health Communication Among Young Black Women and Their Social Network Members

OBJECTIVE

Young Black women (YBW) are at high risk of HIV infection. Although sexual health communication in social networks has been shown to help prevent HIV among high-risk populations, sexual health communication between YBW and their social network members (SNMs) has been insufficiently studied.

METHOD

Egocentric social-network-level and individual-level data were collected from 78 YBW ages 18-25 to examine their sexual health communication. Multilevel multivariable logistic regression models assessed the association among individual sexual risk behaviors, SNM characteristics, and sexual health communication.

RESULTS

Participants nominated an average of 14 SNMs (N = 1,068). Friends were most frequently nominated (55%). YBW communicated to 55% of their SNMs about sex, to 32% regarding condom use, and to 21% regarding HIV testing. If SNMs provided emotional support, YBW were 4 times more likely to talk with them about sex and HIV testing and 2 times more likely to talk about condom use.

CONCLUSIONS

These results indicate that before developing or adopting HIV interventions geared toward YBW, we need to assess how and with whom YBW are communicating about sexual health to better inform those interventions.

Comparing Web-Based Platforms for Promoting HIV Self-Testing and Pre-Exposure Prophylaxis Uptake in High-Risk Men Who Have Sex With Men: Protocol for a Longitudinal Cohort Study

BACKGROUND

The majority of those living with HIV in the United States are men who have sex with men (MSM), and young, minority MSM account for more new HIV infections than any other group. HIV transmission can be reduced through detection and early treatment initiation or by starting pre-exposure prophylaxis (PrEP), but rates of testing are lower than recommended among MSM, and PrEP uptake has been slow. Although promoting HIV testing and PrEP uptake by placing advertisements on web-based platforms - such as social media websites and dating apps - is a promising approach for promoting HIV testing and PrEP, the relative effectiveness of HIV prevention advertising on common web-based platforms is underexamined.

OBJECTIVE

This study aims to evaluate the relative effectiveness of advertisements placed on 3 types of web-based platforms (social media websites, dating apps, and informational websites) for promoting HIV self-testing and PrEP uptake.

METHODS

Advertisements will be placed on social media websites (Facebook, Instagram, and Twitter), dating apps (Grindr, Jack'd, and Hornet), and informational search websites (Google, Yahoo, and Bing) to recruit approximately 400 young (18-30 years old), minority (Black or Latino) MSM at elevated risk of HIV exposure. Recruitment will occur in 3 waves, with each wave running advertisements on 1 website from each type of platform. The number of participants per platform is not prespecified, and recruitment in each wave will occur until approximately 133 HIV self-tests are ordered. Participants will complete a baseline survey assessing risk behavior, substance use, psychological readiness to test, and attitudes and then receive an electronic code to order a free home-based HIV self-test kit. Two follow-ups are planned to assess HIV self-test results and PrEP uptake.

RESULTS

Recruitment was completed in July 2020.

CONCLUSIONS

Findings may improve our understanding of how the platform users' receptivity to test for HIV differs across web-based platforms and thus may assist in facilitating web-based HIV prevention campaigns.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04155502; https://clinicaltrials.gov/ct2/show/NCT04155502.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/20417.

Use of Geosocial Networking Applications Is Associated With Compulsive Sexual Behavior Disorder in an Online Sample

BACKGROUND

Geosocial networking applications (GNAs) are relatively new outlets through which individuals may find partners for sexual encounters. There has been a paucity of research on the associations between use of these platforms and measures of mental health and compulsive sexual behavior disorder (CSBD).

AIM

To examine associations between use of GNA, anxiety, and CSBD.

METHODS

Using data from a large nontargeted Web-based sample (N = 4,203), we examined demographics associated with the use of GNAs. Using multivariable logistic regression adjusting for demographic differences between users and non-users, we examined associations between GNA use, anxiety, and CSBD.

OUTCOMES

The outcomes are Generalized Anxiety Disorder-7 and a modified Hypersexual Behavior Inventory-19.

RESULTS

The percentage of participants that reported they used GNAs was 12.3%. Those who reported using the applications compared with those who did not were more likely to be young, male, and nonheterosexual. After adjusting for demographic variables, GNAs use was associated with CSBD (adjusted odds ratio = 1.62, 95% confidence interval: 1.09-2.37, P = .015) but not anxiety.

CLINICAL IMPLICATIONS

This study is an initial foray into the relationships between GNA and mental health, establishing a relationship between GNA use and CSBD. Future research is needed to better understand the relationships between GNA use, psychopathology, and CSBD.

STRENGTHS & LIMITATIONS

Strengths of the study include its large sample size and nontargeted recruitment design, which minimizes confirmation bias. Limitations include the cross-sectional nature of this study, which precludes determination of the direction of causation.

CONCLUSION

Use of GNAs was prevalent among our sample and associated with CSBD. GNA use may represent an important platform through which CSBD manifests. Conversely, GNA use may drive CSBD. Turban JL, Passell E, Scheuer L, et al. Use of Geosocial Networking Applications Is Associated With Compulsive Sexual Behavior Disorder in an Online Sample. J Sex Med 2020;17:1574-1578.

Resurgence of Syphilis in the United States: An Assessment of Contributing Factors

In the last decade, there has been a marked resurgence of syphilis in the United States despite the availability of effective treatments and previously reliable prevention strategies. The majority of cases are among the population of men who have sex with men (MSM); however, there has also been a recent increase among premenopausal women, coinciding with a concerning rise of congenital cases. The resurgence of syphilis can be largely attributed to changing social and behavioral factors, especially among young MSM. The biological association of syphilis with human immunodeficiency virus (HIV) transmission and acquisition is particularly alarming because of the increased individual and healthcare burden. In addition, some individual actions and public health efforts that are meant to reduce the risk of acquiring HIV may actually lead to risk compensation that facilitates the transmission of syphilis. Untreated syphilis is associated with detrimental health outcomes; therefore, both effective prevention strategies and treatment of this systemic disease have important short-term and long-term public health implications. This article offers a review of social and behavioral factors contributing to the current resurgence and recommendations for reducing syphilis incidence through medical and public health prevention strategies.

Disparities Between HIV Testing Levels and the Self-Reported HIV-Negative Status of Sexually Active College Students

The methodological issues of using self-reported human immunodeficiency virus (HIV) testing history to determine HIV infection status are understudied. This study aimed to assess the disparities between HIV testing history and self-reported HIV status, with a specific objective of estimating the prevalence of self-reported HIV-negative status in sexually active students who had never had an HIV test (inaccurate self-disclosure). Participants were recruited from four Hong Kong universities; 255 students were included in the analysis, with 16.1% of participants being men who have sex with men (MSM). Overall, 81.6% of participants reported they never had been tested for HIV, with inaccurate self-disclosure by 65.9% of participants. Among participants who used condoms inconsistently, only 20.2% had had HIV tests, with inaccurate self-disclosure by 66.7% of subjects. Among MSM students, only 36.6% had had HIV tests, with inaccurate self-disclosure by 61.0% of participants. Among MSM students who used condoms inconsistently, only 35.1% had had HIV tests, with inaccurate self-disclosure by 62.2% of participants. The findings raise concerns about the use of self-reported HIV status in clinical practice and research. The low prevalence of HIV testing found suggests that interventions to promote HIV testing should be continued.

Delay Discounting of Protected Sex: Relationship Type and Sexual Orientation Influence Sexual Risk Behavior

Sexual discounting, which describes delay discounting of later protected sex vs. immediate unprotected sex (e.g., sex now without a condom vs. waiting an hour to have sex with a condom), is consistently linked to sexual risk behavior. Estimates suggest that over two-thirds of HIV transmissions occur between individuals in committed relationships, but current sexual discounting tasks examine sexual discounting only with hypothetical strangers, leaving a gap in our understanding of sexual discounting with committed sexual partners. We used the Sexual Discounting Task (SDT) to compare discounting rates between men who have sex with men (MSM; n = 99) and heterosexual men (n = 144) and tested a new SDT condition evaluating sexual discounting with main partners. MSM in committed relationships discounted protected sex with their main partner at higher rates than heterosexual men, and discounting rates correlated with self-report measures of condom use, impulsivity/sensation seeking, and substance use. These findings suggest that sexual discounting is a critical factor potentially related to increased HIV transmission between MSM in committed relationships and may be an important target for intervention and prevention.

Infecções sexualmente transmissíveis e fatores associados ao uso do preservativo em usuários de aplicativos de encontro no Brasil

Resumo Objetivos Caracterizar os usuários brasileiros de aplicativos de encontro baseados em geolocalização, estimar a prevalência de Infecções Sexualmente Transmissíveis (ISTs) e fatores associados ao uso do preservativo. Métodos Estudo descritivo, transversal, com amostra de 2.250 homens que fazem sexo com homens (HSH) de todo o Brasil. Utilizou-se da rede social Facebook® para a coleta e divulgação da pesquisa, por meio de uma postagem impulsionada semanalmente, de novembro de 2016 a janeiro de 2017. Os dados foram analisados de forma uni e bivariada com o auxílio do software SPSS. Resultados Houve a predominância de participantes jovens (25 anos), com ensino superior completo (57,8%) e homossexuais (75,7%), que conheceram os seus parceiros através de aplicativos (64,1%), utilizando, principalmente, o Tinder ® (57,3%) e Grindr® (53,3%) para fins sexuais (69,7%). A prevalência de ISTs foi de 11,1%, sendo 7,1 de HIV. Foram fatores associados ao uso de preservativos: conhecer o parceiro pelo app (p=0,003), utilizar o Grindr ® (p=0,002), Scruff ® (p=0,027) ou Hornet ® (p<0,001), usar os apps para amizade (p<0,001), sexo (p<0,001) ou relacionamento (p<0,001), frequência de uso do aplicativo (p<0,001) e utilizar os apps durante à noite (p=0,003). Conclusão Os usuários são jovens, com alto nível educacional e que demonstram familiaridade com os apps pelo tempo de uso. A prevalência de ISTs foi elevada, sobretudo da infecção pelo HIV. Características sociodemográficas e particularidades do uso e consumo dos apps estão associadas a utilização consistente do preservativo, principalmente o motivo de uso, frequência, horário e aplicativo utilizado.

App use frequency and condomless anal intercourse among men who have sex with men in Beijing, China: a cross-sectional study

Gay dating applications (apps) are popular among men who have sex with men (MSM) in China. This study examined the relationship between gay dating app use frequency and condomless anal intercourse (CAI) in a sample of MSM in Beijing. In October 2017, a web-based, cross-sectional survey was conducted among MSM from Beijing, China. Demographics, frequency of app use, and sexual behaviors were collected and analyzed. Multivariable logistic regression and restricted cubic splines were used to evaluate the association between app use frequency and CAI. Of the 9280 participants, the proportion of CAI within one month prior to the survey was 43.3%, and 43.7% logged onto the app ≥11 times per week. In adjusted logistic regression analysis, logging onto the app 6–10 times per week and ≥11 times per week were inversely associated with CAI (adjusted odds ratio [AOR] =0.88 [95%CI, 0.78–0.99]; AOR = 0.88 [95%CI, 0.82–0.97], respectively). Among those 40 years of age or older, logging onto the app ≥11 times per week was associated with lower rates of CAI (AOR = 0.57 [95%CI, 0.40–0.81]). Results indicate that frequent app use was associated with lower odds of CAI among MSM in Beijing, China. Innovative interventions, which take advantage of this popular media platform, should be developed as such apps have been found to reduce the odds of CAI in Beijing.

Vulnerability to HIV among older men who have sex with men users of dating apps in Brazil

Introduction

The elderly population is increasingly benefiting from recent technological advances. In this scenario, geolocation-based dating applications provide a viable alternative for finding partners in a practical and timely manner, but may be accompanied by certain risk behaviors for HIV infection. Although there are considerable number of users over 50 on these applications, no studies have addressed this problem. The aim of the present study was to analyze factors of vulnerability to HIV/Aids among the population of men who have sex with men (MSM) age 50 years or older who use dating apps.

Methods

This was a cross-sectional, population-survey-based, analytical study, conducted exclusively online with a sample of 412 MSM. The data was collected from the following apps: Grindr®, Hornet®, Scruff® and Daddy Hunter®.

Results

Factors associated with a higher chance of having HIV were: sexual relations with an HIV-infected partner (ORa = 5.53; 95%CI = 2.23–13.73); chemsex (ORa = 3.97; 95%CI = 1.72–8.92); and, above all, having an HIV-infected partner (ORa = 8.02; 95%CI = 2.01–32.01). The belief that apps increase protection against sexually transmitted infections (ORa = 0.43; 95%CI = 0.19–0.95) and not being familiar with post-exposure prophylaxis (ORa = 0.43; 95%CI = 0.19–0.95) were associated with decreased chances of having HIV.

Conclusions

We highlight some important factors that structure the vulnerability of the MSM surveyed in relation to HIV infection. The findings should be used to customize care for this population, which could bring them in more for health care services.

The characteristics of mixing patterns of sexual dyads and factors correlated with condomless anal intercourse among men who have sex with men in Guangzhou, China

Background

The HIV prevalence among men who have sex with men (MSM) in China has increased yearly. This study aimed to explore the association between the characteristics of social communication and condomless anal intercourse (CAI) among MSM and the implications for prevention and control of HIV among MSM in China using an egocentric network framework.

Methods

The data were collected in Guangzhou between November 2016 and May 2017 through standardized face-to-face interviews. The participants were recruited among MSM who received voluntary counselling and testing services (VCT) provided by nongovernmental organizations (NGOs) and the local Centers for Disease Control and Prevention (CDC). We used the framework of the egocentric network analysis, the odd ratios of CAI were analyzed using generalized estimating equations (GEE).

Results

In total, 1073 MSM who nominated 2667 sexual partners were sampled. MSM who were approximately 30 years old and chose sexual partners of different age category were more likely to engage in CAI. Participants with high level education who were in partnerships with individuals with lower education levels had a higher risk of CAI. Participants who reported having a strong relationship with their sexual partners(AOR = 1.31) were associated with a higher probability of experiencing CAI during sex; while having sexual partners who were unmarried (OR = 0.56), and participants who reported meeting sexual partners online (AOR = 0.74) or, having sex with an occasional partner (AOR = 0.44)were less likely to engage in CAI.

Conclusion

Our study indicates that the strength of sexual dyadic relational ties and different social communication mixing patterns across ages, educational categories, and marital status were associated with CAI.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7082-9) contains supplementary material, which is available to authorized users.

The Association Between Condomless Anal Sex and Social Support Among Black Men Who Have Sex With Men (MSM) in Six U.S. Cities: A Study Using Data from the HIV Prevention Trials Network BROTHERS Study (HPTN 061)

We assessed how egocentric (i.e., self-generated descriptions of a person's social contacts) network structure and composition corresponded with reported instances of condomless receptive and insertive anal intercourse with men who were reportedly HIV-infected or of unknown HIV serostatus in a sample of black men who have sex with men (MSM) in six U.S. cities. Ratings showing a higher percentage of network members who provided social participation and medical support were positively associated with reporting condomless sex. There were also significant positive associations between stimulant use and condomless insertive and receptive anal sex. Future research should examine the social processes that underlie these associations and explore ways that social support can affect HIV prevention efforts for black MSM.

Recreational drugs and STI diagnoses among patients attending an STI/HIV reference clinic in Rome, Italy

BACKGROUND

An observational study was conducted to assess recreational drug use in association with recent STIs among clients of an STI/HIV reference centre in Rome, Italy.

METHODS

Attendees self-compiled a questionnaire concerning sexual behaviours and drug use, including the nine drugs used for sex (amphetamines, poppers, cocaine, ketamine, erectile dysfunction agent (EDA), steroids and the three chemsex drugs, ie, chems: γ-hydroxybutyric acid/γ-butyrolactone, crystal and Mcat).

RESULTS

Overall, 703 patients participated, with men who have sex with men (MSM) accounting for 50.4% of the total and 73.2% of HIV-positive patients. Apart from condylomatosis, whose prevalence was higher among females (38.8%) and non-MSM (45.8%) than MSM (14.4%), STIs were more frequent among MSM, particularly syphilis (14.1%), gonorrhoea (4.8%), urethritis (3.4%) and hepatitis A (6.5%). Recreational drug use was significantly more frequent among MSM (39.8% vs 17.6% in females and 22.7% in non-MSM). A total of 26.3% of MSM used at least one of the nine drugs and 5.1% at least one of the three chems. Cocaine (13.3%) and poppers (13.0%) were the most used sex drugs in MSM.The use of any of the nine drugs was associated with being MSM (adjusted OR (AOR): 1.94, 95% CI 1.05 to 3.58), sex with partner contacted online (1.99, 95% CI 1.14 to 3.45), group sex (4.08, 95% CI 2.40 to 6.93) and STI in the last year (1.65, 95% CI 1.05 to 2.61). Use of any of the nine chems among MSM was associated with condomless sex (2.24, 95% CI 1.21 to 4.14), group sex (2.08, 95% CI 1.01 to 4.31) and STI diagnosis in the last year (4.08, 95% CI 2.32 to 7.19).

CONCLUSIONS

Our data suggest that recreational drug use is quite common among MSM in Italy. No evidence of association with STI was found among non-MSM and females, where only cannabis and cocaine use was reported. The use of chems is still limited, but cocaine, poppers and EDA are widely used among MSM. Recreational drug use appears associated with high-risk sexual behaviours and a higher risk of STI.

Use of gay app and the associated HIV/syphilis risk among non-commercial men who have sex with men in Shenzhen, China: a serial cross-sectional study

OBJECTIVES

Geosocial networking application specific to men who have sex with men (MSM) (gay app) has revolutionised the social networking of MSM globally, much concern was raised over its linkage to HIV/syphilis risk. This study sought to examine the association between use of gay app and sexual behaviours and HIV/syphilis risk among Chinese MSM.

METHODS

Eligible MSM were recruited through combined offline methods from 2015 to 2017 in Shenzhen, China, with data collected including demographics, sexual behaviours, app use, recreational drug use and HIV testing. All participants are required to sign a written informed consent and take a confidential HIV and syphilis testing.

RESULTS

The prevalence of app use among non-commercial MSM (NcMSM) has rapidly increased from 12.5% in 2015 to 52.6% in 2017. The primary four apps used were Blued (97.2%), Aloha (18.4%), Jack'd (14.1) and Zank (14.1%). After controlling for confounders, HIV prevalence was still significantly lower among app users than non-app users (adjusted odds ratios [AOR]: 0.77, 95% CI 0.61 to 0.97), yet the lower prevalence of syphilis was not significant (AOR: 0.97, 95% CI 0.76 to 1.23). App-using NcMSM were more likely to be younger, unmarried, self-identified as homosexuality and having higher education level and income than non-app-using NcMSM. App-using NcMSM had higher rate of consistent condom use and HIV testing, higher level of knowledge on HIV/AIDS prevention and condom use; however, they were more likely to have multiple sexual partners, practice receptive role in anal sex and use recreational drug.

CONCLUSIONS

App-using NcMSM are more likely to have sexual risk behaviours as well as risk-reduction behaviours such as consistent condom use and HIV testing. Scaled-up and innovative venue-based HIV interventions are warranted for these high-risk MSM frequent social venues with less condom use and fewer HIV tests. Meanwhile, gay app should alternatively serve as an intervention and education platform for the MSM hard-to-reach via venue-based approaches.

Programmatic Mapping to Estimate Size, Distribution, and Dynamics of Key Populations in Kosovo

Background

The burden of an HIV epidemic in Kosovo lies among the key populations (KPs) of female sex workers (FSWs), men who have sex with men (MSM), and people who inject drugs (PWIDs). The available interventions for KPs are fragmented and lack sufficient and appropriate granularity of information needed to develop large-scale outreach programs.

Objective

The aim of this study was to estimate the size and distribution of these populations to create evidence for developing action plans for HIV prevention.

Methods

The programmatic mapping approach was used to collect systematic information from key informants, including geographic and virtual locations in 26 municipalities of Kosovo between February to April 2016. In level 1, information was gathered about KPs’ numbers and locations through 1537 key informant interviews within each municipality. Level 2 involved validating these spots by conducting another 976 interviews with KPs congregating at those spots. Population size estimates were calculated for each spot, and finally a national-level estimate was developed, which was corrected for duplication and overlaps.

Results

Of the estimated 6814 MSM (range: 6445 to 7117), nearly 4940 operate through the internet owing to the large stigma and discrimination against same-sex relationships. Geo-based MSM (who operate through physical spots) congregate at a few spots with large spot sizes (13.3 MSM/spot). Three-fourths of the MSM are distributed in 5 major municipalities. Fridays and Saturdays are the peak days of operation; however, the number only increases by 5%. A significant number are involved in sex work, that is, provide sex to other men for money. PWIDs are largely geo-based; 4973 (range: 3932 to 6015) PWIDs of the total number of 5819 (range: 4777 to 6860) visit geographical spots, with an average spot size of 7.1. In smaller municipalities, they mostly inject in residential locations. The numbers stay stable during the entire week, and there are no peak days. Of the 5037 (range: 4213 to 5860) FSWs, 20% use cell phones, whereas 10% use websites to connect with clients. The number increases by 25% on weekends, especially in larger municipalities where sex work is mostly concentrated. Other than a few street-based spots, most spots are establishments run by pimps, which is reflective of the highly institutionalized, structured, and organized FSW network.

Conclusions

This study provides valuable information about the population size estimates as well as dynamics of each KP, which is the key to developing effective HIV prevention strategies. The information should be utilized to develop microplans and effectively provide HIV prevention services to various KPs.

Differences in Partner Services Outcomes for Men Who Have Sex With Men Diagnosed With Primary and Secondary Syphilis by HIV Serostatus

BACKGROUND

Differences in partner services outcomes in men who have sex with men (MSM) by HIV serostatus have not been explored as a potential driver of differential early syphilis (ES) burden in this population.

METHODS

We compared partner services outcomes (number of partners named, notified, tested, diagnosed, and treated) between HIV-positive and HIV-negative MSM initiated for ES partner services in Texas from 2013 to 2016 using logistic regression and Wilcoxon-Mann-Whitney tests. Logistic regression was used to assess the relationship between HIV serostatus and having a no-partner-initiated (NPI) partner services interview controlling for demographic characteristics, prior partner services interactions, and geosocial phone application use.

RESULTS

A total of 4161 HIV-positive MSM and 5254 HIV-negative MSM were initiated for ES partner services. HIV-positive MSM named fewer partners than did HIV-negative MSM (mean, 1.2 vs. 1.9; P < 0.001) and had lower indices of partners notified, tested, diagnosed, and treated. HIV seropositivity was significantly associated with NPI. However, this association was not significant when limited to MSM with previous partner services interviews (adjusted risk ratio [aRR] 1.06; P = 0.38); in this subset of MSM, using geosocial phone application was negatively associated with having an NPI interview (aRR, 0.90), and having 1 (aRR, 1.33) or more than 1 previous NPI interview (aRR, 1.57) was associated with an NPI interview during the study period.

CONCLUSIONS

Suboptimal outcomes for syphilis partner service may result in missed opportunities for testing and treatment of sexual contacts, which could allow for propagation of syphilis. Implementation of innovative protocols is needed to ensure that partner services continue to be an effective and acceptable method of syphilis disease intervention in MSM.

Knowledge about HIV/AIDS and implications of establishing partnerships among Hornet® users

OBJECTIVE

To evaluate the knowledge of men, who have sex with men who use geolocation-based dating software, about HIV/AIDS, and the implications of establishing partnerships.

METHOD

Descriptive study with 30 Hornet® users. The statements generated had statistical treatment in the IRaMuTeQ software, analyzed through the Descending Hierarchical Classification.

RESULTS

The sexual frequency in the last 30 days was 2.9 partners, of which 2.1 were found by the application, of which 63.3% reported having sex without condoms. There were four classes: Knowledge about HIV/AIDS prevention measures; PrEP/truvada as a measure of HIV/AIDS prevention; Risky behaviors in relation to HIV infection; Establishment of sexual partnerships through applications.

CONCLUSION

Hornet users have insufficient knowledge about HIV prevention measures, especially when discarding the male condom. The relationships established through the application are permeated by high individual vulnerability and behaviors that have potential exposure to the risk of HIV infection.

The Effect of Using Geosocial Networking Apps on the HIV Incidence Rate Among Men Who Have Sex With Men: Eighteen-Month Prospective Cohort Study in Shenyang, China

Background

Men who have sex with men (MSM) frequently seek partners through mobile apps (geosocial networking [GSN] apps). However, it is unclear whether GSN apps’ use is associated with the increase in HIV incidence among MSM.

Objective

The aim of this study was to clarify the characteristics of GSN apps’ users and to determine the association and putative mechanisms between GSN apps’ use behavior and HIV incidence.

Methods

We conducted an 18-month prospective cohort study of MSM in Shenyang, China, and the participants were surveyed every 3 months from March 2015 to December 2016. An in-person interview collected information on sociodemographics, GSN apps’ use, recreational drug use, and sexual behaviors. In addition, blood was drawn to test for HIV and syphilis. We used a multivariable Cox regression model to determine possible predictors for increased HIV incidence.

Results

Of the enrolled 686 HIV-negative MSM, 431 (431/686, 62.8%) were GSN apps’ users. Compared with GSN apps’ nonusers, GSN apps’ users were younger; had an earlier age of sexual debut; and in the past 3 months, were more likely to have used recreational drugs, more likely to have had 5 or more casual partners (CPs), more likely to have had group sex with males, and more likely to have had condomless anal intercourse (CAI) with male steady partners (SPs). In addition, 59.4% (256/431) of the GSN apps’ users were willing to accept HIV and AIDS prevention information push services through GSN apps. In total, 19 MSM seroconverted to HIV during the follow-up period; the HIV incidence density rate was 8.5 (95% CI 5.0-13.5) per 100 person-years (PY) among GSN apps’ users and 2.0 (95% CI 0.4-5.8) per 100 PY among nonusers. New HIV infections were independently associated with ever using GSN apps to seek male sexual partners (P=.04) and in the past 3 months, using recreational drugs (P=.048), having group sex with males (P=.01), and having CAI with male CPs (P=.02).

Conclusions

GSN apps’ use is associated with higher HIV incidence and may be mediated through recreational drug use and having multiple CPs. Researchers must develop an intervention propagated through GSN apps to reach this high-risk population to mitigate the HIV epidemic in the MSM community.

The use of geosocial networking smartphone applications and the risk of sexually transmitted infections among men who have sex with men: a systematic review and meta-analysis

BACKGROUND

Geosocial networking smartphone applications (apps) are popular tools for seeking sexual partners among men who have sex with men (MSM). We evaluated app use and risk of sexually transmitted infections (STIs) in app-using MSM (app-users) by a systematic review and meta-analysis.

METHODS

A literature search for relevant studies was performed. We extracted date of STIs (ever being diagnosed with human immunodeficiency virus [HIV], syphilis, gonorrhea and chlamydia) and sexual behavior (e.g., number of app-met partners, unprotected anal/oral sex, HIV testing) from the eligible studies. Pooled proportions and odds ratios (ORs) with 95% confidence intervals (95% CIs) were estimated.

RESULTS

Twenty-five studies were included. The self-reported prevalence of prior diagnosis of HIV among app-users ranged from 2.2 to 37.7%, and the pooled prevalence of HIV infection was 6% (95% CI, 4-11%). Compared with non-users, app-users were more likely to have gonorrhea (OR = 2.36; 95% CI, 2.07-2.70) and chlamydia (OR = 2.22; 95% CI, 1.92-2.56). The two groups were similar in terms of diagnoses of HIV (OR = 0.89, 95% CI, 0.68-1.16) and syphilis (OR = 1.92; 95% CI, 0.91-4.03). However, when one study that caused substantial heterogeneity was omitted, the pooled OR for app-users to contract syphilis became 3.00 (95% CI, 1.84-4.91) .

CONCLUSIONS

MSM who seek sexual partners using apps may be more likely to have STIs as than are non-users.

Preferences for Sexual Health Smartphone App Features Among Gay and Bisexual Men

Given the popularity of geosocial networking applications ("apps") among gay, bisexual, and other men who have sex with men (GBMSM), this study sought to examine GBMSM's willingness to use sexual health and behavior tracking features if integrated within apps they are already using to meet sexual partners. Most GBMSM (91%) recruited on a popular app reported interest in one or more sexual health app features, including features to find LGBT-friendly providers (83%), receive lab results (68%), schedule appointment reminders (67%), chat with a healthcare provider (59%), and receive medication reminder alerts (42%). Fewer GBMSM were interested in tracking and receiving feedback on their sexual behavior (35%) and substance use (24%). Our data suggest that integrating sexual health and behavior tracking features for GBMSM who use apps could be promising in engaging them in HIV prevention interventions. Further research is needed on GBMSM's perspectives about potential barriers in using such features.

Minority Stressors Associated with Sexual Risk Behaviors and HIV Testing in a U.S. Sample of Transgender Individuals

The majority of published research on transgender health focuses on associations between external minority stressors (e.g., discrimination) and health. Little is known about how internal minority stressors (e.g., identity concealment and expecting rejection) might predict HIV disparities. The current study addresses this gap by examining the association between external and internal minority stressors and sexual risk behaviors and HIV testing history in a sample of 300 transgender adults across the U.S. Transgender-related discrimination and expecting rejection were associated with sexual risk behaviors. When controlling for covariates, none of the minority stressors were associated with HIV testing. Results illustrate how minority stress, both external and internal, may operate uniquely for transgender individuals.

Privacy, Trust, and Data Sharing in Web-Based and Mobile Research: Participant Perspectives in a Large Nationwide Sample of Men Who Have Sex With Men in the United States

Background

Modern research is heavily reliant on online and mobile technologies, which is particularly true among historically hard-to-reach populations such as gay, bisexual, and other men who have sex with men (GBMSM). Despite this, very little empirical research has been published on participant perspectives about issues such as privacy, trust, and data sharing.

Objective

The objective of our study was to analyze data from an online sample of 11,032 GBMSM in the United States to examine their trust in and perspectives on privacy and data sharing within online and mobile research.

Methods

Participants were recruited via a social networking site or sexual networking app to complete an anonymous online survey. We conducted a series of repeated measures analyses adjusted for between-person factors to examine within-person differences in the following: (1) trust for guarding personal information across different venues (eg, online research conducted by a university vs. an online search engine); (2) privacy concerns about 12 different types of data for three distinct data activities (ie, collection by app owners, anonymous selling to third parties, and anonymous sharing with researchers); and (3) willingness to share those 12 different types of data with researchers. Due to the large sample size, we primarily reported measures of effect size as evidence of clinical significance.

Results

Online research was rated as most trusted and was more trusted than online and mobile technology companies, such as app owners and search engines, by magnitudes of effect that were moderate-to-large (η_partial²=0.06-0.11). Responding about 12 different types of data, participants expressed more concerns about data being anonymously sold to third-party partners (mean 7.6, median 10.0) and fewer concerns about data being collected by the app owners (mean 5.8, median 5.0) or shared anonymously with researchers (mean 4.6, median 3.0); differences were small-to-moderate in size (η_partial²=0.01-0.03). Furthermore, participants were most willing to share their public profile information (eg, age) with researchers but least willing to share device usage information (eg, other apps installed); the comparisons were small-to-moderate in size (η_partial²=0.03).

Conclusions

Participants reported high levels of trust in online and mobile research, which is noteworthy given recent high-profile cases of corporate and government data security breaches and privacy violations. Researchers and ethical boards should keep up with technological shifts to maintain the ability to guard privacy and confidentiality and maintain trust. There was substantial variability in privacy concerns about and willingness to share different types of data, suggesting the need to gain consent for data sharing on a specific rather than broad basis. Finally, we saw evidence of a privacy paradox, whereby participants expressed privacy concerns about the very types of data-related activities they have likely already permitted through the terms of the apps and sites they use regularly.