Internet use and sexual health of young men who have sex with men: a mixed-methods study

A Social Network Theory-Based Investigation into the Characteristics of MSM in Virtual Communities

Social networks significantly influence MSM's HIV prevention behaviors, with virtual communities serving as key interaction platforms. Using a Python web crawler, we analyzed 960 user profiles from Baidu Tieba's "Gay Bar" forum. The social network within this community exhibits a core-periphery structure, where a densely connected core facilitates effective information dissemination, while the majority of users reside in peripheral positions with limited and isolated connections. Relationships within the network are primarily formed based on shared interests rather than geographical proximity, fostering homophilous interactions that enhance peer support and community cohesion. Despite the fragmented nature of peripheral connections, the tightly knit core enables the strategic targeting of key individuals to optimize the spread of health-related information and interventions. These findings highlight the importance of leveraging the network's core structure to implement efficient and inclusive public health strategies, ensuring that resources reach all members of the MSM community effectively. In addition, interest-based connections are essential in promoting a fair and supportive virtual environment, which is essential to address stigma and promote broad participation in HIV prevention.

Use of Behavior Change Techniques in Digital HIV Prevention Programs for Adolescents and Young People: Systematic Review

BACKGROUND

HIV infections have caused severe public health and economic burdens to the world. Adolescents and young people continue to constitute a large proportion of newly diagnosed HIV cases. Digital health interventions have been increasingly used to prevent the rising HIV epidemic. Behavior change techniques (BCTs) are intervention components designed to modify the underlying processes that regulate behavior. The BCT taxonomy offers a systematic approach to identifying, extracting, and coding these components, providing valuable insights into effective intervention strategies. However, few reviews have comprehensively identified the use of BCTs in digital HIV interventions among adolescents and young people.

OBJECTIVE

This study aimed to synthesize existing evidence on the commonly used BCTs in effective digital HIV prevention programs targeting adolescents and young people.

METHODS

In total, 4 databases (PubMed, Embase, Cochrane Library, and APA PsycINFO) were searched, and studies from January 2008 to November 2024 were screened. Reference lists of relevant review studies were reviewed to identify any additional sources. Eligible randomized controlled trials with 1 of 3 HIV prevention outcomes (ie, HIV knowledge, condom-use self-efficacy, and condom use) were included. Basic study characteristics, intervention strategies, and study results were extracted and compared for data analysis. For the included interventions, BCTs were identified according to the BCT taxonomy proposed by Abraham and Michie in 2008, and the frequencies of BCTs used in these interventions were counted.

RESULTS

Searches yielded 383 studies after duplicates were removed, with 34 (8.9%) publications finally included in this review. The most frequently used BCTs included prompting intention formation (34/34, 100%), providing information about behavior-health link (33/34, 97%), providing information on consequences (33/34, 97%), and providing instruction (33/34, 97%). Interventions with significant improvements in HIV knowledge (11/34, 32%) more frequently used BCTs with a provision nature, such as providing information about behavior-health link (11/11, 100%), information on consequences (11/11, 100%), encouragement (10/11, 91%), and instruction (10/11, 91%). Those with significant increases in condom-use self-efficacy (7/34, 20%) used BCTs toward initiating actions, such as prompts for intention formation (7/7, 100%), barrier identification (7/7, 100%), and practice (5/7, 71%). In addition, studies showing significant improvements in condom use (14/34, 41%) included BCTs focused not only on provision and initiation but also on behavioral management and maintenance, such as use follow-up prompts (5/14, 36%), relapse prevention (4/14, 29%), prompt self-monitoring of behavior (3/14, 21%), and prompt review of behavioral goals (3/14, 21%).

CONCLUSIONS

This is the first systematic review that examined the use of BCTs in digital HIV prevention interventions for adolescents and young adults. The identified BCTs offer important reference for developing more effective digital interventions, with implications for enhancing their HIV knowledge, condom-use self-efficacy, and condom use in youth.

Barriers and Facilitators to Implementing Keep It Up!, A Digital Health Intervention, in Community-Based Organizations

Despite ongoing investments in the development and testing of new digital interventions for HIV prevention, the widespread use of interventions with proven effectiveness remains limited. This study assessed real-world implementation of a digital HIV prevention intervention, Keep It Up!. The study aimed to identify barriers and facilitators to implementing Keep It Up! within community-based organizations (CBOs) serving racially diverse sexual and gender minoritized populations. The Keep It Up! trial is a type III effectiveness-implementation hybrid trial to compare two delivery approaches: direct-to-consumer and CBO-based implementation. This manuscript focuses on the CBO-based approach through interviews with CBO staff members before and during implementation (n = 37 and n = 25, respectively). Interviews were coded according to the Consolidated Framework for Implementation Research and thematically analyzed. Staff highlighted adaptability, leadership engagement, compatibility, and organizational culture as facilitators of Keep It Up! implementation. Identified barriers included self-efficacy, motivation, staff turnover, and partnerships and connections. CBO infrastructure, capacity, research experience, and processes influenced the relative importance of these barriers and facilitators. This study is one of the first to detail barriers and facilitators experienced by staff implementing a digital HIV prevention intervention in CBOs. Interviews illuminated the need for interventions like Keep It Up! for young men who have sex with men and detailed the need for additional strategies to assist CBOs unfamiliar with implementing digital health interventions. Trial Registration Number: NCT03896776.

The HIV Environmental Riskscape: The Roles of HIV Sexual Risk and Resilience Factors among Black Men Who Have Sex with Men: Findings from the Real Talk Project

Black and African American men who have sex with men (Black MSM) experience the greatest proportion of new HIV infections in the United States. To address this challenge, a better understanding of the HIV environment riskscape including both risk and resilience factors is warranted among Black MSM. Research indicates that stress is associated with increased HIV sexual risk behaviors. Further, behavioral factors such as serosorting and community level factors including social support and community connection are resilience factors that protect against risk behaviors. The present study examines whether everyday stress is associated with HIV sexual risk behavior, as well as the role of risk and resilience factors among 125 Black MSM recruited in the Real Talk study. The Real Talk project examined the relationships between resilience, HIV risk behaviors, and HIV prevention strategy among a sample of Black MSM. Using generalized estimating equations, our results indicate a positive association between everyday stress and engaging in condomless anal intercourse only after adjusting for risk, resilience, and correlate variables. Similarly, having multiple sex partners and using substances during sex also show positive associations with condomless anal intercourse. Resilience factors of engaging in serosorting and being connected to both the Black and gay communities were negatively associated with condomless anal intercourse. Future prevention research and programming should focus on both risk and resilience factors to mitigate new HIV infections among Black MSM.

Structural disadvantage and HIV risk - comparing risk factors between trans women's partnerships with cis men and trans women sexual partners

Introduction

Little is known about differences in HIV risk for trans women by partner gender, particularly with respect to social determinants and partner-level circumstances that affect behavior. We examined differences in demographic, social determinants, and HIV-related risk behaviors for trans women with cis men and trans women sexual partners.

Materials and Methods

Data are from a cross-sectional survey of trans women and their sexual partners conducted between April 2020 and January 2021. Interviews were held remotely during shelter-in-place due to Covid-19 via videoconference. Analysis characterizedassociations between HIV risk and protective behaviors comparing trans women with cisgender men partners to trans women with non-cisgender sexual partners.

Results

A total of 336 sexual partners were identified from 156 trans women. Trans women with cis men partners had significantly less education and employment and more incarceration and recidivism than trans women with trans women partners. Trans women and their cisgender men partners had shared experiences of unstable housing, incarceration, and HIV. Trans women with cisgender men partners reported significantly more sex exchange partners, receptive condomless sex, receptive or insertive condomless sex while using substances, and HIV infection compared to trans women with trans women partners.

Conclusions

Trans women with cisgender men sexual partners faced higher HIV risk than trans women with trans women sexual partners. These risks may be related to the social and economic drivers that both trans women and their cis men partners faced, including barriers to education and employment, along with incarceration and recidivism. Interventions focused on economic stability, workforce development and post incarceration re-entry support for housing and employment for trans women with cis men partners and the cisgender men partners as well may have the most impact on reducing HIV risk and incidence.

Trends in Sexual Health of Gay, Bisexual, and Other Men Who Have Sex with Men, and Transgender Individuals: Apps Driven Testing Program for HIV and Other STIs in Barcelona, Spain (2016-2023)

Gay, bisexual and other men who have sex with men (GBMSM) and transgender individuals face heightened risks of HIV and other sexually transmitted infections (STIs). Surveillance within these populations is critical, and community testing services play a pivotal role in preventing and controlling HIV and STIs. This study investigates the trends in HIV, syphilis and hepatitis C (HCV) infections among participants in an apps-driven rapid test program from 2016 to 2023 in Barcelona, Spain, examining associated factors. Trend analysis utilized Wilcoxon-type test and associated factors were determined through multivariate logistic analysis. The prevalence of new HIV diagnosis was 1.81% (CI 1.18-2.64), active syphilis was 3.37% (CI 2.46-4.50) and acute HCV was 0.40% (CI 0.11-1.02). While infection rates showed no significant changes, there was significant increasing in sex work and chemsex and decreasing in condom use. Additionally, a peak in dating apps use for sex and a specific reduction in number of sexual partners were observed in 2020. Factors associated with HIV diagnoses included migrant status (aOR = 11.19; CI 2.58-48.53) and inconsistent condom use during the previous 12 months (aOR = 3.12; CI 1.02-9.51). For syphilis, associated factors were migrant status (aOR = 2.46; CI 1.14-5.29), inconsistent condom use (aOR = 3.38; CI 1.37-8.36), and chemsex practice during the previous 12 months (aOR = 2.80; CI 1.24-6.30). Our findings emphasize the need for tailored interventions, including culturally sensitive outreach for migrants and comprehensive strategies addressing substance use in sexual contexts. Technological innovations and targeted educational initiatives could reduce the burden of HIV and STIs within the GBMSM and transgender communities, providing valuable insights for public health strategies.

Examination of Gender Differences in Depression, Relationship Satisfaction, and Problematic Pornography Use Among Romanian Gay Men and Lesbian Women

This study investigates factors influencing the psychological well-being of gay and lesbian individuals in Romania. Participants (N = 172) included 61.6% gay and 38.4% lesbians, currently in relationships, aged between 18 and 62 years (M = 28.28; SD = 9.53). Surveys assessed relationship satisfaction, depression, and problematic pornography use. Significant associations were found among these variables, with gender differences observed. We tested a regression model for problematic pornography use, where depression provided additional explanatory power to the initial model. Age, gender, and depression accounted for 18% of the variance in problematic pornography use. The theoretical and practical implications are discussed.

Sexual Behaviors and Aggression in Gay Pornography

Previous studies have suggested a substantial number of men who have sex with men (MSM) have consumed and used pornography to learn about same-sex sexual behaviors. Yet, past research has focused almost exclusively on condom-use in the category of Gay pornography and ignored the types of sexual behaviors and aggression depicted within the content. This study examined aggression and sexual behaviors depicted in Gay online pornography (N = 415). We found fellatio and anal sex were the most common behaviors, occurring in roughly two-thirds of scenes, while kissing occurred in less than a third of scenes. Additionally, sexual aggression occurred in 31% of scenes, with spanking being the most common, occurring in 20% of scenes. Anal sex and forced fellatio were found to be predictors of physical aggression. These findings point to normalization of aggression and narrow sexual behaviors in Gay pornography, which may have implications for MSM's norm perceptions related to sexuality.

Preferred Characteristics for mHealth Interventions Among Young Sexual Minoritized Men to Support HIV Testing and PrEP Decision-Making: Focus Group Study

BACKGROUND

Epidemiological trends in the United States have shown an increase in HIV cases among young sexual minoritized men. Using mobile health (mHealth), which refers to health services and information delivered or enhanced through the internet and related technologies, is a crucial strategy to address HIV disparities. However, despite its potential, the practical implementation of mHealth remains limited. Additionally, it is important to consider that young individuals may become accustomed to, distracted from, or lose interest in these apps, highlighting the need for regular updates and monitoring of relevant content.

OBJECTIVE

In this study, we sought to highlight the voices of young sexual minoritized men aged 17-24 years and explored preferred mHealth intervention characteristics and willingness to adopt these technologies among a diverse, nationwide sample of young sexual minoritized men.

METHODS

From April to September 2020, we recruited participants through web-based platforms such as social media and geosocial networking apps for men. These individuals were invited to participate in synchronous web-based focus group discussions centered around topics pertaining to HIV testing and prevention and their preferences for mHealth technologies.

RESULTS

A total of 41 young sexual minoritized men, aged between 17 and 24 years, participated in 9 focus group discussions spanning April to September 2020, with 3-7 participants in each group. The findings shed light on three key insights regarding young sexual minoritized men's preferences: (1) the need for personalized and representative content, (2) a preference for mobile and web-based simulation of prevention scenarios, and (3) a preference for digital software with individually tailored content. As expected, preference for mHealth apps was high, which supports the potential and need to develop or adapt interventions that use smartphones as a platform for engaging young sexual minoritized men in HIV prevention. This study expands on previous research in multiple meaningful ways, delving into the use and perceptions of mHealth information amid the COVID-19 pandemic. This study also highlighted the importance of streamlined access to health care providers, especially in light of the barriers faced by young people during the COVID-19 pandemic. In terms of presentation and navigation, participants favored a user-friendly design that was easy to use and appropriate for their age, which was effectively addressed through the implementation of web-based simulations.

CONCLUSIONS

Ultimately, this study provides valuable insight into the preferences of young sexual minoritized men when it comes to mHealth interventions and highlights the need for further research in order to develop effective and tailored HIV prevention tools. A future direction for researchers is to evaluate how best to address participants' desire for personalized content within mHealth apps. Additionally, as technology rapidly evolves, there is a need to re-assess the effectiveness of web-based simulations, particularly those that are used in HIV prevention.

"I Was Always Trying to Figure It Out… on My Own Terms": Structural Barriers, the Internet, and Sexual Identity Development among Lesbian, Gay, Bisexual, and Queer People of Different Generations

Recognizing the historical grounding of sexual identity development, we examined the spontaneous narration of the internet's significance among a diverse sample of three distinct birth cohorts of sexual minority adults (n = 36, ages 18-59) in the United States. Thematic analysis revealed two structural barriers and four roles of the internet in sexual identity development. Structural barriers were being in a heterosexual marriage (exclusive to members of the older cohort), and (2) growing up in a conservative family, religion, or community (which cut across cohorts). Roles of the internet included: learning about LGBQ+ identities and sex; watching pornography (which appeared only in narratives of the younger cohort); finding affirming community; and facilitating initial LGBQ+ romantic and sexual experiences (which appeared mostly in narratives of the younger cohort). Most participants who described the internet as playing a role in sexual identity development were members of the younger (ages 18-25) and middle (ages 34-41) cohorts. We discuss how the internet has assumed a unique role in history in the development of sexual minority people. Further, our findings highlight that sexual identity development occurs across the lifespan, and how that process and the roles of the internet vary by generation and structural realities.

'My sex ed teacher was extremely averse to talking about sex': Massachusetts students' experiences with and recommendations for sex education

This qualitative interview study investigated the opinions of 28 high school-attending youth in Massachusetts related to the content of their sexuality education, what they wished they could learn from a sex education class, and whether and how pornography was addressed. Participants felt that the sex education they received was not in-depth and did not provide them with the information they needed. Further, participants indicated that their instructors were not engaging, approachable, or credible sources of sex-related information. There was strong support for including healthy relationships education as part of sex education, and including multiple subtopics related to pornography (e.g., body image and pornography, compulsive pornography use, misogyny and pornography). Although there was no clear consensus on whether the ideal modality for delivering sex education is in-person or self-delivered, there was enthusiasm for the 'gamification' of sex education content.

Keep It Up! 3.0: Study protocol for a type III hybrid implementation-effectiveness cluster-randomized trial

BACKGROUND

Despite evidence that eHealth approaches can be effective in reducing HIV risk, their implementation requirements for public health scale up are not well established, and effective strategies to bring these programs into practice are still unknown. Keep It Up! (KIU!) is an online program proven to reduce HIV risk among young men who have sex with men (YMSM) and ideal candidate to develop and evaluate novel strategies for implementing eHealth HIV prevention programs. KIU! 3.0 is a Type III Hybrid Effectiveness-Implementation cluster randomized trial designed to 1) compare two strategies for implementing KIU!: community-based organizations (CBO) versus centralized direct-to-consumer (DTC) recruitment; 2) examine the effect of strategies and determinants on variability in implementation success; and 3) develop materials for sustainment of KIU! after the trial concludes. In this article, we describe the approaches used to achieve these aims.

METHODS

Using county-level population estimates of YMSM, 66 counties were selected and randomized 2:1 to the CBO and DTC approaches. The RE-AIM model was used to drive outcome measurements, which were collected from CBO staff, YMSM, and technology providers. Mixed-methods research mapped onto the domains of the Consolidated Framework for Implementation Research will examine determinants and their relationship with implementation outcomes.

DISCUSSION

In comparing our implementation recruitment models, we are examining two strategies which have shown effectiveness in delivering health technology interventions in the past, yet little is known about their comparative advantages and disadvantages in implementation. The results of the trial will further the understanding of eHealth prevention intervention implementation.

"I don't see myself represented:" Strategies and considerations for engaging gay male Native Hawaiian and Other Pacific Islander teens in research and HIV prevention services

Significant efforts have been applied to the development of sexual health programs for minority young gay males. Given the absence of research with Native Hawaiian and other Pacific Islander (NHOPI) gay teen males, this study was done to assess how to reach them. Interviews were conducted with 20 NHOPI gay males ages 19-24 as near peers that can inform reaching teens. Data was analyzed using the Reflexive Thematic Analysis method. Three themes were identified: (1) Culture is a crucial factor for recruitment and engagement-whether participants realized it or not; (2) Confidentiality is key in recruitment to provide a safe space for NHOPI gay teen male research participation; and (3) NHOPI gay teen males experience multiple identity conflicts that must be considered for recruitment and engagement initiatives. Online recruitment efforts are optimal and should reflect distinct NHOPI cultures. More research is needed when it comes to understanding the cultural acceptance and understanding of homosexuality in NHOPI communities and how to integrate cultural education into recruitment methods and interventions.

"I wish I actually had known what the heck sex was:" What adolescent sexual minority males knew and wish they knew prior to sexual debut with a male partner

Introduction

Understanding the sexual health needs of adolescent sexual minority males (ASMM) at the time of sexual debut will inform programs seeking to decrease sexual health inequities experienced by ASMM.

Methods

In 2020, sexually active, cisgender ASMM (n=102, age 14-17) in the United States completed the baseline assessment of an online sexual health intervention pilot trial. Participants responded to closed- and open-ended questions about their sexual debut with a male partner, including sexual behavior, skills and knowledge they knew and wish they knew at the time of their debut, and sources of said skills and knowledge.

Results

On average, participants were 14.5 years old (SD=1.4) at their debut. Participants reported knowing how to say no to sex (80%) and wishing they knew how to talk with partners about what they would (50%) and would not (52%) like to do sexually. Open-ended responses indicated that participants desired sexual communication skills at sexual debut. Personal research (67%) was the most common knowledge source prior to debut, and open-ended responses suggest that Google, pornography, and social media were the most frequently used websites and phone applications to find information about sex.

Conclusions

Results suggest sexual health programs for ASMM should occur prior to sexual debut, teach sexual communication skills, and teach media literacy skills to help youth deduce credible sexual health resources.

Policy Implications

Incorporating the sexual health needs and wants of ASMM into sexual health programs will likely improve acceptability and efficacy, and ultimately decrease sexual health inequities experienced by ASMM.

Differences in the sexual health information parents/guardians give their adolescent sexual minority sons by outness

Introduction

Parents and guardians are a potentially valuable source of sexual health information for adolescent sexual minority males (ASMM). The current study examines what sexual health topics ASMM report discussing with a parent/guardian and whether topics differ by outness about sexual attraction to other males.

Methods

ASMM (N=154; ages 14-17) in the United States completed the baseline of an online sexual health intervention pilot in 2020. They reported which of twelve sexual health topics they discussed with a parent/guardian and if they had disclosed their sexual attraction to other males. Associations between topics discussed and outness to a parent/guardian were examined with Firth logistic regression.

Results

Eighty-eight (57%) participants reported being out to a parent/guardian. Six sexual health topics were significantly more likely to be discussed if participants were out. The three categories with the largest differences by outness were how to: discuss with a partner what they would not like to do sexually (aOR = 7.0, 95% CI: 2.0-24.6), use condoms (aOR = 5.9, 95% CI: 2.3-15.1), and prevent HIV/AIDS (aOR = 3.5, 95% CI = 1.4-8.7).

Conclusions

Interventions on parental/guardian provision of sexual health information are needed to ensure ASMM receive relevant sexual health knowledge.

Uptake of Human Papillomavirus Vaccination by HIV Status and HIV Pre-exposure Prophylaxis (PrEP) Care Engagement Among Young Sexual Minority Men 17-24 Years Old in the USA

Introduction

HIV and human papillomavirus (HPV) are common sexually transmitted infections among young sexual minority men (YSMM) that are prevented by pre-exposure prophylaxis (PrEP) and HPV vaccination, respectively. We sought to determine the association between a history of PrEP use and HPV vaccination uptake among YSMM.

Methods

Data were collected from an online survey of YSMM (n = 287; M age = 20.6 years, range: 17-24; 58% Black or Latinx) recruited from social media and men-for-men geosocial networking apps in 2020 and analyses were conducted using chi-squared comparisons and Poisson regression using STATA (IC) version 15.1.

Results

About half (45.0%) of YSMM reported receiving at least one dose of the HPV vaccine. Controlling for other factors, YSMM who were living with HIV or had used PrEP were significantly more likely to have received at least one dose of an HPV vaccine (PR = 2.48, 95% CI = 1.52-4.07; PR = 1.70, 95% CI = 1.26-2.31, respectively).

Conclusions

YSMM living with HIV or with PrEP use experience reported higher rates of HPV vaccination compared to their counterparts, potentially due to greater utilization of health care or contacts with providers attuned to their health needs. Nevertheless, HPV vaccination uptake is suboptimal given the high prevalence of high-risk HPV genotypes among YSMM.

Policy Implications

Standard of care for YSMM should include revisiting HPV vaccination status and discussion of PrEP and other HIV prevention methods given suboptimal rates of HPV and PrEP uptake among this priority population for HPV vaccination, anal cancer, and HIV prevention.

"Whenever you're ready to talk about it": Prompts and barriers to inclusive family sex communication with gay, bisexual, and queer sons

Despite growing evidence that parent-child sex communication (PCSC) is a positive strategy for adolescent sexual health outcomes, there is little research about what prompts and impedes these conversations among parents of gay, bisexual, and queer (GBQ) adolescent sons. Using interview data from a multi-method qualitative study, we analyzed parental perspectives (N=15) on non-heteronormative sex communication with GBQ adolescent sons. Our results revealed that parents are most likely to engage in sex communication if they established open communication with their child, accepted their child's sexual orientation, encouraged safe sex practices, and were knowledgeable about LGBTQ issues. Conversely, parents who experience communication discomfort were unable to engage in inclusive and comprehensive sex conversations, thus creating a barrier to effective sex-positive communication. These findings have implications for future research and interventions that promote parents' ability to successfully facilitate conversations about sexual health with their sexuality diverse children.

C. Differences in Sexual Health of Mexican Gay and Bisexual Youth and Adults During the COVID-19 Pandemic

Objective: compare and analyze the implications of COVID-19 on the sexual health of Mexican gay and bisexual young and adult men (GBM). Method: an online survey with 1001 GBM participants. Information was collected on sexual desire, use of mobile applications, sexual practices during the pandemic, and prevention of sexually transmitted infections (STIs) from August to October 2020. Young participants were compared with adults. Results: Young GBM reported more challenges to their sexual health in the pandemic. There was an increase in sexual desire, mobile applications, and a decrease in access to STIs prevention supplies. Discussion: Implications for sexual health policies for these groups during health contingencies are discussed.

Evidence and implication of interventions across various socioecological levels to address HIV testing uptake among men who have sex with men in the United States: A systematic review

Objectives

Strengthening HIV testing uptake is critical to curtail the HIV epidemics among men who have sex with men in the United States. Despite the implementation of various interventions to promote HIV testing among men who have sex with men, few aggregated evidence is presented to reflect the "lessons learned" and inform future directions. The objective of this systematic review is to comprehensively summarize published studies that described, tested, and evaluated outcomes (e.g. efficacy, effectiveness, acceptability, feasibility and/or qualitative opinions) associated with an HIV testing intervention and identify gaps as well as opportunities to inform the design and implementation of future interventions to enhance HIV testing uptake among men who have sex with men in the United States.

Methods

We followed the PRISMA guidelines and conducted a systematic review of articles (published by 23 July 2021) by searching multiple databases (PubMed, MEDLINE, Web of Science and PsycINFO).

Results

Among the total number of 3505 articles found through multiple databases, 56 papers were included into the review. Interventional modules that demonstrated acceptability, feasibility and efficacy to improve HIV testing uptake among men who have sex with men include: HIV self-testing, interpersonal-level (e.g. peer-led, couple-based) interventions, personalized interventions and technology-based interventions (e.g. mHealth). Aggregated evidence also reflects the lack of individualized interventions that simultaneously address time-varying needs across multiple socioecological levels (e.g. individual, interpersonal, community, structural and societal).

Conclusion

Development of interventions to improve HIV testing rates and frequency of men who have sex with men has proliferated in recent years. Our review presents important implications in sustaining and improving interventions to address HIV testing uptake among men who have sex with men in the United States.

A mixed methods study of sexuality education experiences and preferences among bisexual, pansexual, and queer (bi+) male youth

Introduction

Bisexual male youth are more likely to engage in certain behaviors that contribute to HIV/STI transmission (e.g., substance use) than are heterosexual and gay male youth. However, sexuality education rarely addresses the unique needs of sexual minority youth, especially bisexual, pansexual, and queer (bi+) youth, and little is known about their sexuality education experiences and preferences. As such, the goal of this study was to examine bi+ male youth's experiences learning about sex and their preferences for sexuality education.

Methods

In 2019, 56 bi+ male youth ages 14-17 were surveyed and interviewed about their sexuality education experiences and preferences. Participants identified as bisexual (64%), pansexual (27%), and queer (9%), were racially/ethnically diverse (39% white, 32% Latinx, 20% Black, 9% other races), and included cisgender (79%) and transgender (21%) male youth.

Results

Participants described varied experiences with school-based sexuality education (e.g., none, abstinence only, covered sexual health in some way), but it rarely addressed their unique needs. They typically learned about sex by searching for information online and from sexually explicit media. Participants identified several topics they wanted to learn more about (e.g., sex with same-gender partners, anal sex, consent), but they typically believed they were prepared to have sex. Finally, some participants described benefits of tailoring sexuality education to their unique needs, while others described benefits of more inclusive programs.

Conclusions and Policy Implications

Findings suggest that bi+ male youth do not receive adequate sexuality education to make informed decisions about safer sex, highlighting the critical need for reform.

Dating in Motion: Online Dating Through the Lives of Different Generations of Men Who Have Sex with Men

From the early years of the internet, its key importance was recognized as a site for sexual minorities to explore and express their identity and sexuality. Gay men were quick to connect online, first in chat rooms and subsequently on an ever-expanding array of sites and apps, culminating in geolocation apps such as Grindr. Although a lot of research has investigated the uses of these services, the focus is mostly on younger users, disregarding the experiences of older people. Moreover, the life stage of users is not sufficiently addressed, nor are their evolving uses throughout the life course. The current paper aims to contribute to this knowledge by reporting on a study involving four generations of Belgian men who have sex with men (MSM), combining insights gained in an exploratory survey (N = 684) with in-depth interviews (N = 80). The results show how men from different generations got access to dating sites and apps at different times in their lives, in a shifting balance with offline dating practices. Moreover, at the time of the research, participants were in different stages of their lives, which led to a variety of online dating practices. The end picture is one of dating "in motion", both shifting between generations and changing with the life course of individuals. This paper contributes to the literature on MSM online dating by adding a non-Anglophone perspective, studying a broad age range including older users, disclosing clear intergenerational differences, and transcending a static view of online dating among a single age cohort.

Validated HIV Knowledge Scales for Use with Adults and Adolescents: A Systematic Review

HIV knowledge - the information a person possesses about HIV - is essential for the prevention and management of HIV. Therefore, the accurate measurement of HIV knowledge is important for both science and practice. This systematic review identifies extant HIV knowledge scales that have been validated with adolescent and adult populations and summarizes the state of this research. We searched seven electronic databases, which resulted in 6,525 articles. After title/abstract and full-text review, 27 studies remained and underwent qualitative review of reported scale psychometric properties. Many studies were conducted in the last decade (n = 12), reflecting advances in scientific knowledge of HIV. Five were exclusively adolescent-based studies (sample age ≤ 18). Most studies reported reliability (n = 25) or at least one form of validity (n = 21). Future studies should develop or refine HIV knowledge scales so that they reflect recent scientific developments, use rigorous psychometric testing, and target samples that include those persons at highest risk for HIV.

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.

'Bringing testing closer to you': barriers and facilitators in implementing HIV self-testing among Filipino men-having-sex-with-men and transgender women in National Capital Region (NCR), Philippines - a qualitative study

OBJECTIVES

Our study identified barriers and facilitators in implementing HIV self-testing (HIVST), including the perceptions of men-having-sex-with-men (MSM) and transgender women (TGW) on HIVST. Furthermore, we explored the current knowledge, practices and potential of HIVST among the MSM and TGW populations.

DESIGN

Qualitative in-depth key informant interviews were administered using semistructured interviews administered in both English and Filipino. Thematic analysis of the findings was done after transcribing all audio recordings.

SETTING

The study was done in the National Capital Region (NCR), Philippines using online video conferencing platforms due to mobility restrictions and lockdowns caused by the COVID-19 pandemic.

PARTICIPANTS

All study participants were either MSM or TGW, 18-49 years old and residing/working in NCR. Exclusion criteria include biologically born female and/or currently on pre-exposure prophylaxis, antiretroviral therapy medications or an HIV-positive diagnosis.

RESULTS

Twenty informants were interviewed, of which 75% were MSM, and most of them preferred the use of HIVST. Facilitators and barriers to the use of HIVST were grouped into three main themes: Acceptability, distribution and monitoring and tracking. Convenience and confidentiality, overcoming fears and normalisation of HIV testing services (HTS) in the country were the participants' perceived facilitators of HIVST. In contrast, lack of privacy and maintenance of confidentiality during kit delivery were perceived as barriers in HIVST implementation. Moreover, social media was recognised as a powerful tool in promoting HIVST. The use of a welcoming tone and positive language should be taken into consideration due to the prevalent HIV stigma.

CONCLUSIONS

The identified facilitators and barriers from the study may be considered by the Philippine HTS programme implementers. The HIVST strategy may complement the current HTS. It will be very promising to involve the MSM and TGW communities and other key populations to know their HIV status by bringing testing closer to them.

Using online spaces to recruit Kenyan queer womxn and trans men in restrictive offline settings

BACKGROUND

Understanding and addressing healthcare and service delivery inequalities is essential to increase equity and overcome health disparities and service access discrimination. While tremendous progress has been made towards the inclusion of sexual and gender minorities in health and other research, gaps still exist. Innovative methods are needed to close these. This case study describes and reflects on using online-based data collection to ascertain sexual health decision-making and health service utilisation among Kenyan queer womxn and trans men.

METHODS

Case study The study used a mixed-methods approach in two phases with triangulated quantitative and qualitative elements. Both elements used web-based technology to gather data.

RESULTS

Using online spaces to recruit and collect data from queer womxn and trans men exceeded expectations. A total of 360 queer womxn and trans men responded to the digitally distributed survey, and 33 people, queer womxn and trans men, as well as key informants, participated in the interviews, which were primarily conducted on Zoom and Skype. The case study analyses the risks and benefits of this approach and concludes that online sampling approaches can mitigate risks and enable effective and safe sampling of a marginalised group in a restrictive legal setting: Kenyan queer womxn and trans men.

CONCLUSION

Using online spaces when researching marginalised populations could effectively overcome risks around stigma, discrimination and violence. It could be an effective way to understand these populations' healthcare needs better. Factors contributing to success included building trusting relationships with key members of the community, strategic and opportune timing, a nuanced understanding of the mobile landscape, and carefully chosen safety and security measures. However, it should be noted that conducting research online could increase the risk of further marginalising and excluding those without access to web-based technology.

The Young Men and Media Study: A Pilot Randomized Controlled Trial of a Community-Informed, Online HIV Prevention Intervention for 14-17-Year-Old Sexual Minority Males

The Young Men and Media study developed and pilot tested a community-informed, online HIV prevention program for adolescent sexual minority males (ASMM) in the United States. The developed intervention uses nine interactive modules to increase sexual health knowledge, promote critical examination of pornography, and decrease sexual risk among ASMM. Participants (N = 154, age 14-17 years) were recruited online in Spring 2020 and randomized to the intervention (n = 77) or other existing HIV websites (n = 77). Of the 65 intervention participants who logged in to the website, most completed all nine modules and found the content useful (average module score 4.3 out of 5 stars). The intervention also showed improved HIV/STI knowledge, increased pornography knowledge, and reduced beliefs that pornography is an accurate depiction of male-male sex. Results indicate that the Young Men and Media intervention is feasible, acceptable, and may positively impact sexual health outcomes.

Mapping and size estimation of men who have sex with men in virtual platforms in Delhi, India

Introduction

In India, the HIV epidemic is concentrated among Key Populations (KPs), such as men who have sex with men (MSM), who bear a disproportionate burden of HIV disease. Conventional targeted interventions (TI) mitigate HIV transmission among MSM by focusing on physical hotspots. As increasingly, there is a shift within India’s MSM community to connect with sex partners online, novel approaches are needed to map virtual platforms where sexual networks are formed. The objective of this study was to estimate the number of MSM in Delhi using virtual platforms to connect for sex and to describe patterns of their use.

Methods

The study was conducted in the state of Delhi among MSM over 18 years of age who used virtual platforms to look for sexual partners. Virtual platforms were identified through community consultations. Size estimation was carried out by enumerating the number of online users, accounting for duplication across sites and time and based on interviews with 565 MSM.

Results

28,058 MSM (95% CI: range 26,455–29,817) use virtual sites to find sexual partners. We listed 14 MSM specific virtual sites, 14 general virtual sites, 19 social networking pages and 112 messenger groups, all used by MSM. Five virtual sites met feasibility criteria to be included in the virtual mapping. Of the MSM on these sites, 81% used them at night and 94% used them on Sundays, making these the peak time and day of use. Only 16% of users were aware of organizations providing HIV services and 7% were contacted by peer educators in the preceding three months. Two-fifths (42%) also visited a physical location to connect with sexual partners in the month prior to the study.

Discussion

TI programs that focus on physical hotspots do not reach the majority of MSM who use virtual sites. MSM active on virtual sites have a low awareness of HIV services. Virtual mapping and programmatic interventions to include them must be incorporated into current public health interventions to reach MSM at risk of HIV.

Improving methods of primary prevention of STIs and HIV infection among young people

Background. The article considers the possibility of raising awareness among young people about STIs and HIV infection. It presents the development of the mobile application Personal Sexual Health, which includes the following sections: Sexual Infections, Protect Yourself, Frequently Asked Questions, Get help and etc. Aim. Improving methods of primary prevention of STIs and HIV infection among young people using a mobile app. Materials and Methods. The mobile application (Personal Sexual Health) was developed taking into account previously conducted scientific (sociological) research on the level of awareness of STIs and HIV infection among young people in Novosibirsk. The development of the mobile application was carried out using Agile (agile software development) methodology. Results. It was found that young people trust online information and view the Internet as a reliable source of sexual health advice. In fact, the Internet is a useful tool for spreading the reliable information about sexual health and different events detecteded to prevention of STIs and HIV-infection. The concept of the mobile application Personal Sexual Health implies raising the awareness of young people on the prevention of STIs and HIV infection. The informational component of the mobile application Personal Sexual Health was developed taking into account the previously obtained results from a sociological survey of young people. Conclusion. The modern generation of young people is forming a new ethics of communication, and the Internet is a basic source of information about sexual health for most teens and young adults. However, the information from Internet is not always correct or sufficient. Using modern, relevant, and still gaining in popularity technology (mobile apps and social media) will help to better absorb information about STIs and HIV prevention programms among young people. Personal Sexual Health is the first mobile application in Russia dedicated to sexual health and primary prevention programms of STIs and HIV-infection among young people. Background. The article considers the possibility of raising awareness among young people about STIs and HIV infection. It presents the development of the mobile application Personal Sexual Health, which includes the following sections: Sexual Infections, Protect Yourself, Frequently Asked Questions, Get help and etc. Aim. Improving methods of primary prevention of STIs and HIV infection among young people using a mobile app. Materials and Methods. The mobile application (Personal Sexual Health) was developed taking into account previously conducted scientific (sociological) research on the level of awareness of STIs and HIV infection among young people in Novosibirsk. The development of the mobile application was carried out using Agile (agile software development) methodology. Results. It was found that young people trust online information and view the Internet as a reliable source of sexual health advice. In fact, the Internet is a useful tool for spreading the reliable information about sexual health and different events detecteded to prevention of STIs and HIV-infection. The concept of the mobile application Personal Sexual Health implies raising the awareness of young people on the prevention of STIs and HIV infection. The informational component of the mobile application Personal Sexual Health was developed taking into account the previously obtained results from a sociological survey of young people. Conclusion. The modern generation of young people is forming a new ethics of communication, and the Internet is a basic source of information about sexual health for most teens and young adults. However, the information from Internet is not always correct or sufficient. Using modern, relevant, and still gaining in popularity technology (mobile apps and social media) will help to better absorb information about STIs and HIV prevention programms among young people. Personal Sexual Health is the first mobile application in Russia dedicated to sexual health and primary prevention programms of STIs and HIV-infection among young people.

"Safe Behind My Screen": Adolescent Sexual Minority Males' Perceptions of Safety and Trustworthiness on Geosocial and Social Networking Apps

Dating and social media application ("app") use for sexual and romantic partner-seeking is increasingly ubiquitous among adolescent sexual minorities assigned male at birth (ASMM). Previous work suggests that ASMM use the Internet, including apps, for normative aspects of sexual identity exploration and development. However, there may be risks associated with their use of sexualized apps designed for adults and with sexual interaction with adult app users. Little is known about how they assess and mitigate risk or gauge the trustworthiness of potential partners on such apps. We recruited ASMM in the U.S. (N = 268; ages 15-18 years, mean age = 16.9) to complete an online survey with open- and closed-ended questions about their perceptions of safety and trustworthiness of others while using apps to find partners. Participants perceived various risks on apps (e.g., physical harm, being "catfished") but did not appear to have clear strategies for measuring or mitigating it. They often assessed trustworthiness by observing other users' behavior or profiles. Participants frequently described interacting with older app users as risky or untrustworthy. Sexual health risks were seldom mentioned and the legal risks of sexual interaction with adults were never mentioned. Although app use may meet some of ASMM's sexual development needs, they may lack the knowledge and skills to do so safely in sexualized online adult spaces. These findings suggest that sex education for sexual minority adolescents should address online sexual safety.

Feasibility of a Web-Accessible Game-Based Intervention Aimed at Improving Help Seeking and Coping Among Sexual and Gender Minority Youth: Results From a Randomized Controlled Trial

PURPOSE

To address the gap in interventions for improving sexual and gender minority youth (SGMY; e.g., lesbian, gay, bisexual, and transgender youth) health, we tested the feasibility of a game-based intervention for increasing help-seeking, productive coping skills, resource knowledge/use, and well-being.

METHODS

We conducted a 2-arm randomized controlled trial testing a theory-based, community-informed, Web-accessible computer role-playing game intervention. Control condition received a list of resources. Primary hypotheses were high levels of implementation success, game demand, and game acceptability.

RESULTS

We randomized 240 SGMYs aged 14-18 years into the intervention (n = 120) or control (n = 120) conditions. Participants completed baseline (100%), 1-month follow-up (T2; 73.3%), and 2-month follow-up (T3; 64.4%) surveys. Among intervention participants, 55.8% downloaded and played the game. Of those who played, 46.2% reported a desire to play it again, and 50.8% would recommend it. Game acceptability exceeded hypothesized benchmarks, wherein participants reported high positive affect (M = 2.36; 95% confidence interval [CI]: 2.13, 2.58), low negative affect (M = 2.75; 95% CI: 2.55, 2.95), low tension/annoyance (M = 3.18; 95% CI: 2.98, 3.39), and high competence (M = 2.23; 95% CI: 2.04, 2.43) while playing the game. In multivariable intent-to-treat analyses of 38 secondary/tertiary outcomes, intervention participants reported significantly larger reductions than control participants in cyberbullying victimization (T2 b = -.28; 95% CI: -.56, -.01), binge drinking frequency (T2 b = -.39; 95% CI: -.71, -.06), and marijuana use frequency (T3 b = -2.78; 95% CI: -4.49, -1.08).

CONCLUSIONS

We successfully implemented a Web-accessible game trial with SGMY. The game-based intervention was feasible and acceptable to SGMY, and preliminary results show it improved several health-related behaviors. A larger scale trial is needed to test whether the game-based intervention can reduce health inequities for SGMY.

Online STI information seeking behaviour and condom use intentions among young Facebook users in Malaysia

The Internet has opened pathways for youth to find sexual health information which was not easily available to them in the past. Studies have shown that seeking sexual health information online may potentially influence an individuals' decision-making to change their sexual health behaviours. However, there is a gap in research on the associations of seeking online sexually transmitted infection (STI) information with STI prevention among young people, particularly in Malaysia. This study investigated the associations of seeking STI information online with the intentions of condom use among young adult online users in Malaysia. A cross-sectional online survey was conducted among Malaysian youth aged 18-25 years old who were recruited through Facebook. In total, 1530 respondents completed the survey, identifying 874 respondents who had sought STI information online. The majority of respondents had intentions to use condoms as protection against STI. Respondents who sought online STI information were significantly more likely to have the intention to use condoms compared to respondents who did not seek online STI information (OR = 1.33, 95% CI = 1.01-1.76, p = 0.040). Online STI information has the potential to increase access to STI information among young online users in Malaysia amid the stigma surrounding sex-related issues. Providing accurate STI information online from reliable sources may equip young people who have Internet access with awareness of sexual health protective behaviours such as condom use. It is recommended to facilitate Internet access to reach sectors of the population that currently do not have access, as the Internet is useful in STI prevention.

Using Machine Learning to Predict Young People's Internet Health and Social Service Information Seeking

Machine learning creates new opportunities to design digital health interventions for youth at risk for acquiring HIV (YARH), capitalizing on YARH's health information seeking on the internet. To date, researchers have focused on descriptive analyses that associate individual factors with health-seeking behaviors, without estimating of the strength of these predictive models. We developed predictive models by applying machine learning methods (i.e., elastic net and lasso regression models) to YARH's self-reports of internet use. The YARH were aged 14-24 years old (N = 1287) from Los Angeles and New Orleans. Models were fit to three binary indicators of YARH's lifetime internet searches for general health, sexual and reproductive health (SRH), and social service information. YARH responses regarding internet health information seeking were fed into machine learning models with potential predictor variables based on findings from previous research, including sociodemographic characteristics, sexual and gender minority identity, healthcare access and engagement, sexual behavior, substance use, and mental health. About half of the YARH reported seeking general health and SRH information and 26% sought social service information. Areas under the ROC curve (≥ .75) indicated strong predictive models and results were consistent with the existing literature. For example, higher education and sexual minority identification was associated with seeking general health, SRH, and social service information. New findings also emerged. Cisgender identity versus transgender and non-binary identities was associated with lower odds of general health, SRH, and social service information seeking. Experiencing intimate partner violence was associated with higher odds of seeking general health, SRH, and social service information. Findings demonstrate the ability to develop predictive models to inform targeted health information dissemination strategies but underscore the need to better understand health disparities that can be operationalized as predictors in machine learning algorithms.

The Influence of Online Experiences: The Shaping of Gay Male Identities

Although research has documented that technological advances via online avenues have impacted the way LGBT individuals gain social capital, less is known about how these online experiences influence the coming out processes for gay men. Using a qualitative approach, this study seeks to understand how the online experiences of gay men either enhanced or inhibited the coming out process. Clustered themes revealed four insights: 1. Online experiences catalyzed the coming out process, 2. Early milestones about the realization of homosexuality came largely from online experiences, 3. Pornography was a tool often utilized for sexual knowledge, and 4. Online experiences helped affirm homosexual identity. Generally, data show that online experiences may manifest offline experiences (i.e., meeting up with another individual, talking about their sexual orientation with others), and that technological communication expedites the coming out process.

Unnamed Partners From Syphilis Partner Services Interviews, 7 Jurisdictions

BACKGROUND

Reducing transmission depends on the percentage of infected partners treated; if many are missed, impact on transmission will be low. Traditional partner services metrics evaluate the number of partners found and treated. We estimated the proportion of partners of syphilis patients not locatable for intervention.

METHODS

We reviewed records of early syphilis cases (primary, secondary, early latent) reported in 2015 to 2017 in 7 jurisdictions (Florida, Louisiana, Michigan, North Carolina, Virginia, New York City, and San Francisco). Among interviewed syphilis patients, we determined the proportion who reported named partners (with locating information), reported unnamed partners (no locating information), and did not report partners. For patients with no reported partners, we estimated their range of unreported partners to be between one and the average number of partners for patients who reported partners.

RESULTS

Among 29,719 syphilis patients, 23,613 (80%) were interviewed and 18,581 (63%) reported 84,224 sex partners (average, 4.5; 20,853 [25%] named and 63,371 [75%] unnamed). An estimated 11,138 to 54,521 partners were unreported. Thus, 74,509 to 117,892 (of 95,362-138,745) partners were not reached by partner services (78%-85%). Among interviewed patients, 71% reported ≥1 unnamed partner or reported no partners; this proportion was higher for men who reported sex with men (75%) compared with men who reported sex with women only (65%) and women (44%).

CONCLUSIONS

Approximately 80% of sex partners were either unnamed or unreported. Partner services may be less successful at interrupting transmission in networks for men who reported sex with men where a higher proportion of partners are unnamed or unreported.

Mapping virtual platforms to estimate the population size of men who have sex with men (MSM) who use internet to find sexual partners: implications to enhance HIV prevention among MSM in Kenya

Introduction: Men who have sex with men (MSM) in Kenya face a disproportionate HIV disease burden. Over the last few years, the use of virtual platforms and internet sites to seek male sexual partners has increased manyfold in Kenya. New approaches are required to map, estimate and profile MSM who operate through virtual platforms to design interventions for them. Methods: This study was conducted in three counties in Kenya: Kiambu, Kisumu and Mombasa with MSM who use virtual platforms such as geosocial networking (GSN) and social networking applications to find and connect with male sex partners. The platforms were profiled through a multi-stage approach and the number of MSM associated with these platforms were estimated. In the final stage, 435 respondents randomly selected from the virtual platforms were interviewed in a secure location after informed consent. Data analysis focused on calculating an estimate of MSM for each virtual platform in each site, adjusting for duplicate profiles and multiple registrations. Results: We identified 24 GSN apps, 18 Facebook accounts/pages and 18 WhatsApp groups across the three counties, with Facebook being the preferred platform. Kiambu had the highest number of estimated MSM at 3,635 (95%CI = 3,335 to 3,990) followed by Kisumu at 1,567 (95%CI = 1,480 to 1,665) and Mombasa at 1,469 (95%CI = 1,335 to 1,604) who used virtual platforms to find other male sexual partners. On average, each MSM had 3.7 profiles on multiple platforms, with an average of 2.1 profiles used in the past month. Conclusions: The use of conventional population size estimation approaches that focus on physical sites alone may underestimate the total number of MSM in a geography. Virtual mapping should be used in conjunction with conventional hot spot based size estimation methodologies to estimate numbers of MSM to set programmatic targets.

Effectiveness, Acceptability, and Feasibility of Digital Health Interventions for LGBTIQ+ Young People: Systematic Review

BACKGROUND

Young people (aged 12-25 years) with diverse sexuality, gender, or bodily characteristics, such as those who identify as lesbian, gay, bisexual, transgender, intersex, or queer (LGBTIQ+), are at substantially greater risk of a range of mental, physical, and sexual health difficulties compared with their peers. Digital health interventions have been identified as a potential way to reduce these health disparities.

OBJECTIVE

This review aims to summarize the characteristics of existing evidence-based digital health interventions for LGBTIQ+ young people and to describe the evidence for their effectiveness, acceptability, and feasibility.

METHODS

A systematic literature search was conducted using internet databases and gray literature sources, and the results were screened for inclusion. The included studies were synthesized qualitatively.

RESULTS

The search identified 38 studies of 24 unique interventions seeking to address mental, physical, or sexual health-related concerns in LGBTIQ+ young people. Substantially more evidence-based interventions existed for gay and bisexual men than for any other population group, and there were more interventions related to risk reduction of sexually transmitted infections than to any other health concern. There was some evidence for the effectiveness, feasibility, and acceptability of these interventions overall; however, the quality of evidence is often lacking.

CONCLUSIONS

There is sufficient evidence to suggest that targeted digital health interventions are an important focus for future research aimed at addressing health difficulties in LGBTIQ+ young people. Additional digital health interventions are needed for a wider range of health difficulties, particularly in terms of mental and physical health concerns, as well as more targeted interventions for same gender-attracted women, trans and gender-diverse people, and people with intersex variations.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42020128164; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=128164.

“I just trust what Google says, it’s the Bible”: Exploring young, Black gay and other men who have sex with men’s evaluation of sexual health information sources in Toronto, Canada

While sexual health literature identifies youths’ sexual health information sources and its impact on their sexual practices, little is known about the way youth evaluate the credibility of this information. This knowledge gap is significant among young, Black gay and other men who have sex with men (YBGM) who belong to intersectional populations disproportionately impacted by HIV and other STIs. We conducted a qualitative study using constructivist grounded theory to explore YBGM’s approaches to evaluating sexual health information sources’ credibility. Intersectionality and the socioecological model informed our analysis. We explored connections between social locations (e.g., race, sexual orientation) and socio-ecological environments and how their impact shaped YBGM’s evaluation of sexual health information. Findings revealed evaluation strategies varied by source: friends, the internet and healthcare providers. Friends’ information was deemed credible if they were older, shared social locations and provided embodied testimonials. Testimonials mirrored oral-traditions specific to Black populations where oral narratives help disseminate sensitive information in a culturally relevant way. Website selection was informed by YBGM’s social locations and ranged from being implicitly trusted to assessed by its association with established healthcare organizations. Many participants’ acceptance of healthcare providers’ information revealed patient-client power imbalances and a perception that providers’ actions reflected their institutions’ sexual health policies. Findings highlight a need for sexual health services to create culturally effective ways to disseminate information that accounts for the histories, contexts, and approaches YBGM use to identify credible sources of sexual health information.

A Picture is Worth 1000 Messages: Investigating Face and Body Photos on Mobile Dating Apps for Men Who Have Sex with Men

The present study investigated the way men visually self-present on MSM-specific mobile dating app profiles, as well as the connection between visual self-presentation strategies, demographic variables, and psychosocial attitudes about masculinity and the body. In particular, emphasis was placed on two aspects of men's visual self-presentation: face-disclosure and body-disclosure. Using a selective self-presentation framework, findings indicated that the majority of men presented their face in their profile photo and that nearly one in five presented their unclothed torso. Face-disclosure was connected to higher levels of app usage, longer-term app usage, and levels of outness. The use of shirtless photos was related to age, a higher drive for muscularity, more self-perceived masculinity, and stronger anti-effeminacy attitudes. The findings are discussed in relation to both strategic self-presentation, and the distinct meanings of face and body photos within MSM online culture.

Worry and Permissive Parenting in Association with the Development of Internet Addiction in Children

The Internet has experienced a rapid increase in use globally. Specifically, more than 90% of Hong Kong’s citizens use the Internet, and 70% of children in the age group of 6–17 years have daily access to it. However, internet addiction could pose serious social and health issues. Therefore, conducting research to investigate its causes and risk factors is fundamental. The current study examined the relationship between worry and Internet addiction among children in Hong Kong and investigated the moderating effect of the permissive parenting style on such a relationship. The participants consisted of 227 fourth- and fifth-grade students (120 males, 52.9%) with a mean age of 9.55 (standard deviation (SD) = 0.58) in Hong Kong. Each participant was asked to complete the questionnaires, including the Internet Addiction Test for Internet addiction, the Penn State Worry Questionnaire for Children for worry, and the Parental Authority Questionnaire for the permissive parenting style. The results indicated that worry was related to greater Internet addiction among children. Furthermore, there was a moderating effect of the permissive parenting style such that the positive association between worry and Internet addiction was stronger when the permissive parenting style was higher. Our findings imply that parenting styles are influential in the prevention of Internet addiction.

Cyberintimacy: A Scoping Review of Technology-Mediated Romance in the Digital Age

With a swipe, click, or delete, people are now able to seek and sustain romance in unprecedented ways. The emerging research shows that cyberintimacy, or the phenomenon of technology-mediated communication between partners and potential romantic interests, significantly impacts the way we form, maintain, and even extinguish romantic relationships. Hence, this scoping review aims to (a) delineate how our use of technology-mediated communication is associated with specific outcomes (e.g., satisfaction and quality) throughout the romantic relationship lifecycle, and (b) identify emerging themes in the research. Adhering to Arksey and O'Mayley's six-step framework methodology, we performed a systematic database search, literature screening, and qualitative synthesis of the findings. Seventy-two studies were selected from a pool of 4,062 articles derived from a systematic search of six academic databases. The findings show that cyberintimacy has a profound impact on outcomes in three crucial stages of the relationship lifecycle-from the way people find and field partners online through the process of initiation; to the means by which partners use technology to perform relationship maintenance; and finally, the ways in which people cope with the process of dissolution by using technology to reclaim a sense of agency.

Mapping virtual platforms to estimate the population size of men who have sex with men (MSM) who use internet to find sexual partners: implications to enhance HIV prevention among MSM in Kenya

Introduction: Men who have sex with men (MSM) in Kenya face a disproportionate HIV disease burden. Over the last few years, the use of virtual platforms and internet sites to seek male sexual partners has increased manyfold in Kenya. New approaches are required to map, estimate and profile MSM who operate through virtual platforms to design interventions for them. Methods: This study was conducted in three counties in Kenya: Kiambu, Kisumu and Mombasa with MSM who use virtual platforms such as geosocial networking (GSN) and social networking applications to find and connect with male sex partners. The platforms were profiled through a multi-stage approach and the number of MSM associated with these platforms were estimated. In the final stage, 435 respondents randomly selected from the virtual platforms were interviewed in a secure location after informed consent. Data analysis focused on calculating an estimate of MSM for each virtual platform in each site, adjusting for duplicate profiles and multiple registrations. Results: We identified 24 GSN apps, 18 Facebook accounts/pages and 18 WhatsApp groups across the three counties, with Facebook being the preferred platform. Kiambu had the highest number of estimated MSM at 3,635 (95%CI = 3,335 to 3,990) followed by Kisumu at 1,567 (95%CI = 1,480 to 1,665) and Mombasa at 1,469 (95%CI = 1,335 to 1,604) who used virtual platforms to find other male sexual partners. On average, each MSM had 3.7 profiles on multiple platforms, with an average of 2.1 profiles used in the past month. Conclusions: The use of conventional population size estimation approaches that focus on physical sites alone may underestimate the total number of MSM in a geography. Virtual mapping should be used in conjunction with conventional hot spot based size estimation methodologies to estimate numbers of MSM to set programmatic targets.

Evaluation of a Text Messaging-Based Human Papillomavirus Vaccination Intervention for Young Sexual Minority Men: Results from a Pilot Randomized Controlled Trial

BACKGROUND

Men who have sex with men (MSM) are at high risk for human papillomavirus (HPV) infection and HPV-related anal cancer. Although a safe and effective vaccine is available to prevent HPV infection, HPV vaccine uptake among young MSM remains low.

PURPOSE

This pilot randomized controlled trial tested the acceptability, feasibility, and preliminary efficacy of a text messaging-based HPV vaccination intervention for young sexual minority men.

METHODS

In 2018, unvaccinated sexual minority men aged 18-25 years were recruited from Chicago to participate in a 9 month sexual health program called txt2protect. Participants (N = 150) were randomized to the intervention or control condition. Intervention condition messages focused primarily on HPV vaccination, with only a brief mention of other sexual health practices (e.g., condom use and HIV testing), while control condition messages focused on a variety of sexual health practices with only a brief mention of HPV vaccination. Participants received daily text messages for the first 3 weeks and monthly text messages for the remaining ~8 months of the trial. Participants completed surveys at baseline and 3 week and 9 month follow-ups.

RESULTS

Participants reported high satisfaction with the intervention. Although trial retention was high (with over 88% completing the 9 month survey), the study fell short of meeting its recruitment goal. HPV vaccine series initiation was significantly higher among intervention participants (19.4%) compared to control participants (6.6%), odds ratio = 3.43, 95% confidence interval: 1.17, 10.08.

CONCLUSIONS

Findings suggest that txt2protect is an acceptable and potentially promising intervention for increasing HPV vaccine initiation among young sexual minority men.

CLINICAL TRIAL REGISTRATION

NCT02994108.

Design Considerations for Implementing eHealth Behavioral Interventions for HIV Prevention in Evolving Sociotechnical Landscapes

PURPOSE OF REVIEW

Despite tremendous potential for public health impact and continued investments in development and evaluation, it is rare for eHealth behavioral interventions to be implemented broadly in practice. Intervention developers may not be planning for implementation when designing technology-enabled interventions, thus creating greater challenges for real-world deployment following a research trial. To facilitate faster translation to practice, we aimed to provide researchers and developers with an implementation-focused approach and set of design considerations as they develop new eHealth programs.

RECENT FINDINGS

Using the Accelerated Creation-to-Sustainment model as a lens, we examined challenges and successes experienced during the development and evaluation of four diverse eHealth HIV prevention programs for young men who have sex with men: Keep It Up!, Harnessing Online Peer Education, Guy2Guy, and HealthMindr. HIV is useful for studying eHealth implementation because of the substantial proliferation of diverse eHealth interventions with strong evidence of reach and efficacy and the responsiveness to rapid and radical disruptions in the field. Rather than locked-down products to be disseminated, eHealth interventions are complex sociotechnical systems that require continual optimization, vigilance to monitor and troubleshoot technological issues, and decision rules to refresh content and functionality while maintaining fidelity to core intervention principles. Platform choice and sociotechnical relationships (among end users, implementers, and the technology) heavily influence implementation needs and challenges. We present a checklist of critical implementation questions to address during intervention development. In the absence of a clear path forward for eHealth implementation, deliberate design of an eHealth intervention's service and technological components in tandem with their implementation plans is critical to mitigating barriers to widespread use. The design considerations presented can be used by developers, evaluators, reviewers, and funders to prioritize the pragmatic scalability of eHealth interventions in research.

Sexual and Reproductive Health Web Sites: An Analysis of Content for Sexual and Gender Minority Youth

PURPOSE

Sexual and gender minority (SGM) youth face risks for negative sexual and reproductive health (SRH) outcomes; it is critical to provide these populations with health education that is both inclusive of and specific to their needs. We sought to characterize the strengths and weaknesses of SGM-related messages from web sites that address SRH for young people. We considered who is included, what topics are discussed, and how messages are framed.

METHODS

A systematic Google search and screening process was used to identify health promotion web sites with SRH content for adolescents and young adults. Using MAXQDA, we thematically coded and analyzed SGM content qualitatively.

RESULTS

Of 32 SRH web sites identified, 23 (71.9%) contained SGM content. Collectively, the sites included 318 unique SGM codes flagging this content. Approximately two-thirds of codes included messages that discussed SGM youth in aggregate (eg, lesbian, gay, bisexual, and transgender)-specific content about the diverse subpopulations within this umbrella term (eg, transgender youth) was more limited. In addition to SRH topics, most web sites had messages that addressed a broad array of other health issues including violence, mental health, and substance use (n = 17, 73.9%) and SGM-specific topics, for example coming out (n = 21, 91.3%). The former were often risk-framed, yet affirmational messages were common. Most web sites (n = 16; 69.6%) presented information for SGM youth both in stand-alone sections and integrated into broader content. Yet, integrated information was slightly more common (56.6% of all codes) than stand-alone content.

CONCLUSIONS

Challenges of developing SRH content related to SGM youth include: (1) aggregate terms, which may not represent the nuances of sexual orientation and gender, (2) balancing risk versus affirmational messages, and (3) balancing stand-alone versus integrated content. However, SGM-related content also offers an opportunity to address diverse topics that can help meet the needs of these populations.

A theoretical examination using governmentality to understand gay men’s risk and sexual behaviours

This article explores the link between Foucault’s (1991) governmentality theory, specifically as it relates to gay men’s sexual practices and perceptions of HIV risk. Foucault’s (1991) theory of governmentality elucidates the means through which individual behaviours and norms (at a micro level) are governed through the production of disciplinary norms and structures that are instantiated at a broader structural and institutional level (the macro-level). Foucauldian theoretical conversations pertaining to what is meant by conceptions and definitions of HIV/STI risk are furthered through this paper’s theoretical contributions as they relate to gay men. From a Foucauldian perspective, we assess how gay men may alter or monitor their sexual practices through governmental scripts produced at a state level and manifested through micro- and macro-level behavioural and ideological shifts based on dominant socio-sexual norms. A model of the interrelationship between governmentality, scripting, the micro/macro levels, and the situation-specific is presented for future consideration when examining gay men’s sexual practices. Historical oppression and segregation of gay men are considered when exploring these theories from a critical social scientific lens.

Sexually Explicit Media Use Among 14-17-Year-Old Sexual Minority Males in the U.S

Adolescent sexual minority males (ASMM; < 18 years old) do not typically receive sexual education that addresses male-male relationships from traditional sources (i.e., school, parents). Therefore, many rely on sexually explicit online media (SEOM; i.e., pornography) to find sexual health information. The current study describes SEOM use by ASMM in the U.S. and examined the association between exposure to condomless anal sex (CAS) in SEOM and engagement in CAS. In 2017, ASMM (N = 206; M age = 16, range: 14-17; 51% racial/ethnic minorities) from across the U.S. completed an online sexual health survey, including questions about SEOM use and sexual behaviors. Most (86%) reported that they had viewed SEOM. Engagement with SEOM was frequent (86% reported viewing ≥ one time per week) and lengthy (70% reported viewing for ≥ 15 min per session). Youth perceived that SEOM influenced how they, and other ASMM, think and behave sexually. Further, exposure to risky sexual behavior in SEOM appeared to be associated with youths' dyadic sexual behavior. To support the healthy sexual development of ASMM, it is important to acknowledge the near-universal use of SEOM by ASMM, to identify ways to maximize its potential value, and to minimize potential harms.

The multiplex social environments of young Black men who have sex with men: How online and offline social structures impact HIV prevention and sex behavior engagement

In the United States, young Black men who have sex with men (YBMSM) remain disproportionately affected by HIV. The social networks in which YBMSM are embedded are generally understood to be critical factors in understanding their vulnerability. In this study, we acknowledge the relational richness of YBMSMs' social environments (what we define as multiplexity) and their increasing prioritization of online social networking sites (SNS). Specifically, we investigate whether protective and/or risky features of YBMSMs' Facebook friendships and group affiliations are related to their HIV prevention and sex behavior engagement, while also accounting for features of their offline confidant (or support) and sex networks. Using data from a population-based cohort study of YBMSM living in Chicago (N=268), we perform a series of multiple logistic regression analyses to examine associations between features of YBMSMs' Facebook, confidant, and sexual networks with three prevention outcomes and three sex behavior outcomes, while also controlling for factors at the individual and structural levels. Results show that network features play a more significant role in predicting engagement in sex behaviors than prevention behaviors. Specifically, having more confidants, having confidants who are family members, meeting sex partners online, having more YBMSM Facebook friends, belonging to Facebook groups with an LGBTQ focus, and having greater subject diversity in one's Facebook group affiliations were significantly associated with one or more sex behavior outcomes. We conclude with a discussion of the implications of our findings for HIV prevention intervention efforts.