Use and perceptions of the internet for sexual information and partners: a study of young men who have sex with men

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.

Latent Class Analysis of Online Platforms for Partner-Seeking and Sexual Behaviors Among Men Who Have Sex with Men from Central Kentucky

Little is known whether engagement in sexual behaviors associated with potential HIV risks differs by subgroups of men who have sex with men (MSM), who are distinct regarding patterns of use of online tools for partner-seeking. Using latent class analysis, we revealed four classes of app-using MSM (n = 181, 18-34 y.o., 82.4% identified as White and non-Hispanic) residing in Central Kentucky: the Grindr/Tinder class; the Poly App Use class of MSM-oriented apps; the General Social Media class, and the Bumble class. Unadjusted penalized logistic regressions showed associations of the Poly App Use class with increased numbers of receptive anal sex partners and reporting condomless receptive anal sex. Adjusting for other covariates, poly app users versus others were more likely to be older (25-34 vs. 18-24, AOR = 3.81, 95%CI = 1.70-9.03), to report past six-month illicit drug use (AOR = 2.93, 95%CI = 1.25-7.43) and to have ever used pre-exposure prophylaxis (AOR = 2.79, 95%CI = 1.10-7.12). Poly app users had behavior profiles associated with an elevated HIV risk and also reported HIV-related protective behaviors likely indicating increased risk awareness among this class. Our findings warrant differentiation of behavior profiles by patterns of app use and suggest not to generalize sexual behaviors associated with potential HIV risks to all app-using MSM.

Sexual Orientation and Infidelity-Related Behaviors on Social Media Sites

Little research has been focused on offline or online infidelity in GL dating relationships, especially in a post-communist socio-cultural context. Infidelity-related (IR) behaviors on social media sites might be as hurtful to relationships as offline infidelity, both in gay, lesbian (GL) and heterosexual romantic monogamous relationships. In this cross-sectional study, we aimed to examine the associations between dyadic satisfaction, attitudes toward infidelity, and problematic internet usage, with IR behaviors on social media sites among GL and heterosexual unmarried individuals in Romanian sexual minority communities. Results showed that GL respondents did not significantly differ from heterosexual participants regarding IR behaviors. Furthermore, we found the main effect of attitudes toward infidelity and problematic internet use on IR behaviors. Sexual orientation highlights the main effect of IR behaviors when analyzed with dyadic satisfaction. The current study may be a precursor to further research investigating correlations in online IR behavior among lesbian and gay individuals engaging in consensual nonmonogamy. Implications of the findings are discussed in the social context of a post-communist country where GL individuals may face discrimination and stigma because of their sexual orientation.

Performer Roles and Behaviors in Dyadic Sexually Explicit Media Featuring Men Who Have Sex with Men

Heterosexual gender roles are not directly relevant to gay romantic relationships, but gay men often take on different relationship roles depending on their sexual roles. In the present paper, we argue that gay men might draw on sexually explicit media (SEM) featuring men who have sex with men (MSM) to get information about how insertive sexual partners ("tops") and receptive sexual partners ("bottoms") typically behave. For this to be the case, however, we would have to reliably observe different behavior in SEM performers acting as tops vs. bottoms. We examined 220 of the most viewed online dyadic MSM SEM videos to determine whether performed verbal and physical intimacy, victimization, and sexual behaviors depended on the sexual role taken. We found that tops and bottoms engaged in similar amounts of intimacy behaviors, but that bottoms were depicted as initiating sexual activity more than tops. Tops enacted physical and psychological victimization more than bottoms, although these behaviors were rare. Tops were shown taking the insertive role across all sexual acts and versatile performers (i.e., those taking both insertive and receptive roles) were rarely depicted. The present study adds to the literature about the complexity of sexual-self-labels, and suggests that MSM SEM depictions of intimacy and sexual decision-making depend on the sexual role taken.

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.

The Inventory of Anal Sex Knowledge (iASK): A New Measure of Sexual Health Knowledge Among Adolescent Sexual Minority Males

INTRODUCTION

Knowledge about sexual health is a key determinant of sexual behavior among adolescent sexual minority males (ASMM). No measures exist to assess anal sex knowledge, even though anal sex is the primary route by which ASMM acquire sexually transmitted infections (STIs), including a disproportionate burden of human immunodeficiency virus (HIV).

AIM

We developed a new measure as a first step toward assessing the prevalence and correlates of anal sex knowledge and potential effects of interventions to improve knowledge.

METHODS

Two coders independently outlined domains of knowledge within 2 sex education videos designed to address anal sex knowledge among ASMM. An initial set of 56 items, some duplicative, encompassed all domains. A larger team, including a psychometrician, then iteratively revised and reduced the set of items, and assessed construct validity via cognitive testing among ASMM (N = 4, aged 16-17 years old, 75% identifying as racial/ethnic minorities). For the final set of 10 items, factor structure and convergent and divergent validity were assessed using baseline responses to an online survey within a randomized controlled pilot trial among 154 ASMM. Open-ended questions assessed their comprehension and the acceptability of items.

OUTCOMES

We examined correlates that we anticipated would be theoretically related (ie, the HIV Knowledge Questionnaire [HIV-KQ-18] and the STD-Knowledge Questionnaire [STD-KQ]) and theoretically distinct (ie, the Patient Health Questionnaire [PHQ-2], Generalized Anxiety Disorder scale [GAD-2], and employment status).

RESULTS

The one-factor model explained 42% of the items' common variance and demonstrated acceptable internal reliability (Cronbach's alpha = 0.72). The measure withstood tests of convergent and divergent validity when compared to current measures (HIV knowledge, r = 0.35 and STI knowledge, r = 0.24, both P < .05; internalizing mental health symptoms, r = -0.07 and employment status, r = 0.13, both P > .05). Few respondents found words unfamiliar or uncomfortable.

CLINICAL IMPLICATIONS

A method for assessing anal sex knowledge may offer opportunities to intervene to lessen harmful sequelae of a lack of knowledge.

STRENGTH & LIMITATIONS

We developed a brief, psychometrically valid measure of anal sex knowledge. The measure may neither generalize to all anal health knowledge nor to more sexually experienced, older SMM.

CONCLUSION

The resulting 10-item, single-factor measure, the Inventory of Anal Sex Knowledge (iASK), is psychometrically sound and addresses the lack of anal sex knowledge measures among ASMM. The iASK can function to assess the prevalence and sequelae of anal sex knowledge among ASMM as well as the impact of interventions targeting anal sex knowledge. Kutner BA, Perry N, Stout C, et al. The Inventory of Anal Sex Knowledge (iASK): A New Measure of Sexual Health Knowledge Among Adolescent Sexual Minority Males. J Sex Med 2022;19:521-528.

Intimacy in Dyadic Sexually Explicit Media Featuring Men Who Have Sex with Men

Sexually explicit material (SEM) featuring men who have sex with men (MSM) may be a source of information about intimacy in same-sex male relationships for MSM. However, little is known about how MSM SEM depicts intimacy between male performers. The current study examined the 220 most viewed dyadic scenes of MSM SEM videos for the presence of verbal intimacy (compliments, personal disclosure, and expressions of care) and physical intimacy (kissing, cuddling, affectionate touch, and genital touch before and after sex) between performers. At least one example of physical and verbal intimacy was present in the majority of videos (91% and 68% of videos, respectively). Most forms of physical and verbal intimacy occurred before or during sex, with intimacy being least evident post-sex. We also tested if the presence of intimacy was associated with viewer interactions with videos (likes and dislikes) and number of views. Only one of seven forms of intimacy, care (verbal), was associated with more interactions (i.e., likes and dislikes per 100,000 views), and there was no association with the number of views. Potential implications for MSM's understandings of intimacy are recognized and discussed with reference to sexual script theory.

Use of media sources in seeking and receiving sexual health information during adolescence among adults of diverse sexual orientations in a US cohort

The objective in this study was to examine the association between sexual orientation and seeking/receiving sexual and reproductive health (SRH) information from media sources during adolescence. We analysed data from male and female participants (aged 23-35 years) from the U.S.-based Growing Up Today Study (GUTS) in 2016. Sex-stratified, multivariable log-binomial models adjusted for age, cohort and race/ethnicity were used to examine sexual orientation differences in retrospective self-reported seeking/receipt of SRH media information before age 18. Sexual minority (e.g., mostly heterosexual, bisexual, gay) men and women were more likely than same-gender individuals who identified as completely heterosexual to seek/receive SRH information about contraceptive methods (e.g., condom use), sexually transmitted infections, and HIV and AIDS. Although lesbians were more likely than completely heterosexuals to seek/receive SRH information from media about each topic, they were the sexual minority subgroup with the smallest proportion seeking/receiving SRH information. Sexual minorities may passively and/or actively receive SRH information pertaining to a wide range of topics, including skills-based sex education, from media sources more frequently than heterosexuals, which may influence safe-sex decision-making. Lesbians in particular may benefit from media information dissemination focusing on their specific SRH needs, as current media sources do not seem to be well-utilised by this group.

Event-Level Association Between Daily Alcohol Use and Same-Day Nonadherence to Antiretroviral Therapy Among Young Men Who Have Sex With Men and Trans Women Living With HIV: Intensive Longitudinal Study

BACKGROUND

Young trans women (TW) and men who have sex with men (MSM) are disproportionately impacted by HIV. Optimizing adherence to antiretroviral therapy (ART) is one mechanism by which public health experts aim to achieve favorable HIV health outcomes while reducing disease transmission. However, alcohol use is prevalent among young TW and MSM and threatens optimal adherence. In addition, the daily variations in alcohol use and ART adherence and their association with each other are poorly understood, warranting more appropriate methodological approaches, such as analysis of ecological momentary assessment (EMA) data.

OBJECTIVE

The aim of this analysis is to characterize the association between daily alcohol use and same-day ART nonadherence captured by an EMA study of young MSM and TW living with HIV in San Francisco.

METHODS

Young MSM and TW enrolled in the Health eNav digital HIV care navigation intervention were included in the analytic sample (N=113). Data on alcohol and ART use were collected by daily EMA surveys administered via text messaging and were analyzed over 30 days of follow-up. A multivariable mixed-effects logistic regression model adjusting for baseline sociodemographic characteristics was specified to investigate whether daily alcohol use was associated with same-day ART nonuse.

RESULTS

Daily alcohol use was associated with higher same-day ART nonuse. On average, participants drank alcohol on 15.20 (SD 8.93) days and used ART on 15.19 (SD 10.16) days out of 30 days. Daily alcohol use was associated with 1.89 (95% CI 1.14-3.15) times the adjusted odds of same-day ART nonuse for each participant.

CONCLUSIONS

Results are consistent with other analyses of daily alcohol and ART use and underscore the importance of individually targeted interventions that are sensitive to each participant's dynamic risk environment.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/16406.

HIV prevalence, testing and treatment among men who have sex with men through engagement in virtual sexual networks in Kenya: a cross-sectional bio-behavioural study

INTRODUCTION

In Kenya, men who have sex with men (MSM) are increasingly using virtual sites, including web-based apps, to meet sex partners. We examined HIV testing, HIV prevalence, awareness of HIV-positive status and linkage to antiretroviral therapy (ART), for HIV-positive MSM who solely met partners via physical sites (PMSM), compared with those who did so in virtual sites (either solely via virtual sites (VMSM), or via both virtual and physical sites (DMSM)).

METHODS

We conducted a cross-sectional bio-behavioural survey of 1200 MSM, 15 years and above, in three counties in Kenya between May and July 2019, using random sampling of physical and virtual sites. We classified participants as PMSM, DMSM and VMSM, based on where they met sex partners, and compared the following between groups using chi-square tests: (i) proportion tested; (ii) HIV prevalence and (iii) HIV care continuum among MSM living with HIV. We then performed multivariable logistic regression to measure independent associations between network engagement and HIV status.

RESULTS

177 (14.7%), 768 (64.0%) and 255 (21.2%), of participants were classified as PMSM, DMSM and VMSM respectively. 68.4%, 70.4% and 78.5% of PMSM, DMSM and VMSM, respectively, reported an HIV test in the previous six months. HIV prevalence was 8.5% (PMSM), 15.4% (DMSM) and 26.7% (VMSM), p < 0.001. Among those living with HIV, 46.7% (PMSM), 41.5% (DMSM) and 29.4% (VMSM) were diagnosed and aware of their status; and 40.0%, 35.6% and 26.5% were on antiretroviral treatment. After adjustment for other predictors, MSM engaged in virtual networks remained at a two to threefold higher risk of prevalent HIV: VMSM versus PMSM (adjusted odds ratio 3.88 (95% confidence interval (CI) 1.84 to 8.17) p < 0.001); DMSM versus PMSM (2.00 (95% CI 1.03 to 3.87), p = 0.040).

CONCLUSIONS

Engagement in virtual networks is associated with elevated HIV risk, irrespective of individual-level risk factors. Understanding the difference in characteristics among MSM-seeking partners in different sites will help HIV programmes to develop subpopulation-specific interventions.

Acceptability and Preliminary Efficacy of an Online HIV Prevention Intervention for Single Young Men Who Have Sex with Men Seeking Partners Online: The myDEx Project

Prevention of new cases of HIV among young gay, bisexual and other men who have sex with men (YGBMSM; ages 18-24) remains a priority. We developed and pilot tested an online intervention (myDEx) using a pilot randomized trial design with 180 online-recruited single YGBMSM who reported recent unprotected anal intercourse, self-reporting as HIV negative or status-unaware, and who met sexual partners through online dating applications. myDEx participants reported higher overall satisfaction (d = 0.46) and willingness to recommend the intervention to friends (d = 0.48) than controls. myDEx participants were less likely to report foregoing condoms to achieve an emotional connection with a partner (d =0 .43), and more likely to report greater emotional regulation during their partner-seeking behaviors (d = 0.44). myDEx participants reported fewer partners with whom they had condomless receptive anal sex (d = 0.48). Our pilot results demonstrate the potential of the myDEx intervention, suggesting that a larger efficacy trial may be warranted in the future.

Social Inequity and Structural Barriers to Completion of Ecological Momentary Assessments for Young Men Who Have Sex With Men and Trans Women Living With HIV in San Francisco

Background

Ecological momentary assessments (EMAs) administered via text messaging facilitate real-time data collection. With widespread cell phone access, EMAs are becoming more available to even the most disenfranchised communities, such as those living with HIV. However, structural barriers disproportionately burden young men who have sex with men (MSM) and trans women (TW) living with HIV and threaten participation in HIV research.

Objective

We aim to identify structural barriers to completing EMA text surveys nested within a digital HIV care intervention for young MSM and TW living with HIV in San Francisco.

Methods

A total of 10,800 EMA text messages were delivered daily over 90 days to 120 participants enrolled in the Health eNav intervention (2017-2018) at the San Francisco Department of Public Health. EMA surveys inquired about participants’ daily affect, sexual behaviors, substance use, and treatment adherence. Survey completion was calculated after 30, 60, and 90 days of follow-up. We described characteristics of nonstarters (those who provided less than four complete responses to the first seven EMA surveys) and analyzed structural correlates of days to first weeklong or more EMA survey noncompletion using multivariable Cox proportional hazards regression. Qualitative interviews were used to evaluate the acceptability of EMA surveys.

Results

Participants completed 4384 of 10,800 (40.59%) EMA surveys. Completion of 70% or more of EMA surveys was attained by 56 of 120 participants (46.7%) at 30 days of follow-up, 40/120 (33.3%) at 60 days of follow-up, and 30/120 (25.0%) by the end of the 90-day study period. Twenty-eight participants (23.3%) were identified as nonstarters, and were more likely to be recently incarcerated (prevalence ratio [PR] 2.3, 95% CI 1.3-4.4), forego basic needs for HIV medications (PR 2.4, 95% CI 1.3-4.5), and be diagnosed with HIV in the last year (PR 2.2, 95% CI 1.1-4.1). Adjusting for nonstarters, young MSM and TW living in temporary/transitional housing (adjusted hazard ratio [aHR] 1.8, 95% CI 1.1-3.0), foregoing HIV medications to afford basic needs (aHR 1.7, 95% CI 1.1-2.7), and having less than a college education (aHR 3.5, 95% CI 1.4-9.0) had greater hazard of weeklong or more EMA survey noncompletion. Overall, there was high acceptability of the EMA surveys.

Conclusions

Although access to and use of technology is increasingly ubiquitous, this analysis demonstrates persisting gaps in EMA completion by socioeconomic factors such as incarceration, education level, housing, and competing needs for young MSM and TW living with HIV in San Francisco. Moreover, those recently diagnosed with HIV were more likely to experience an immediate drop-off in completing EMA surveys. EMAs are feasible for individuals not experiencing social inequity and structural barriers. HIV prevention technologies addressing these barriers and leveraging similar methodology may prove effective for young MSM and TW living with HIV.

Bareback Sexually Explicit Media Consumption and Men Who Have Sex with Men's Responses to Sexual Partners Who Prefer Anal Intercourse With or Without Condoms

This study investigated whether "bareback" (i.e., condomless) sexually explicit media (SEM) consumption is differentially associated with men who have sex with men's (MSM) concerns about, and willingness to have, condomless anal intercourse (CAI) versus anal intercourse with condoms. Participants were 659 Australian MSM who all reported their bareback SEM consumption and read a vignette in which they were propositioned for sex by a hypothetical male target. Participants were randomly assigned to one of four vignettes, in which the target exclusively preferred either CAI or anal intercourse with condoms, and either did or did not disclose that they took pre-exposure prophylaxis (PrEP). Perceived partner attractiveness was also measured as a potential moderator. Greater bareback SEM consumption was associated with reduced concerns about, and intentions to have, sex with a target who exclusively preferred CAI. Bareback SEM consumption, however, was not related to concerns about, or intentions to have, sex with a target who exclusively preferred anal intercourse with condoms. PrEP disclosure was not causally related to either concern about having, or intentions to have, sex with the target, nor did it moderate the relationship between bareback SEM consumption and these outcomes. Perceived partner attractiveness moderated the effect of bareback SEM consumption on general sexual intentions, such that bareback SEM was only associated with greater intentions to have sex when the partner was perceived to be highly attractive.

Cognitive and Emotional Factors Associated with Sexual Risk-Taking Behaviors Among Young Men Who Have Sex with Men

Young men who have sex with men (YMSM) between the ages of 13 and 24 account for a disproportionate number of new HIV infections in the U.S. Recognizing the unique developmental circumstances that YMSM face and building on the dual-process model, it is important to consider the role of cognitive and emotional factors as well as self-efficacy to negotiate safer sex when understanding experiences of sexual risk-taking among YMSM. This article used structural equation modeling to examine how the decisional balance to use condoms (a cognitive factor) and limerence (an emotional factor) are both directly and indirectly associated with sexual risk-taking behaviors (the number of insertive and receptive condomless anal intercourse partners), with indirect effects occurring via limited self-efficacy to negotiate safer sex. Data were from a cross-sectional online survey of YMSM (aged 18-24) in the U.S. who did not report being in a romantic relationship. Analysis included a sample of 1084 single YMSM who had never tested positive for HIV and who had engaged in anal intercourse in the previous 2 months. Results indicated that the decisional balance to use condoms was both directly and indirectly associated with reduced sexual risk-taking behaviors. Limerence was not directly associated with sexual risk-taking behaviors; however, it was indirectly associated with sexual risk-taking behavior through limited self-efficacy to negotiate safer sex. These findings highlight the importance of considering both cognitive and emotional factors, as well as self-efficacy to use condoms, in the development and implementation of HIV prevention interventions for YMSM.

Perspectives and preferences for a mobile health tool designed to facilitate HPV vaccination among young men who have sex with men

We sought to understand young men who have sex with men (YMSM) perspectives and preferred features for a mobile health (mHealth) tool designed to facilitate human papillomavirus (HPV) vaccination. YMSM were recruited on a popular social/sexual networking app to participate in online focus groups. Discussions were designed to elicit what the men would want in a mHealth tool specific for sexual health and HPV. Demographic data were analyzed using descriptive statistics and focus group data were analyzed using conventional content analysis. Forty-eight YMSM participated. Mean age was 23.4 years, and 70.0% reported their race as Black. Qualitative themes included general HPV knowledge and awareness, current patterns in technology use, desired app qualities, and desired app content. Youth described varying levels of HPV knowledge, utilized apps to engage socially, and for travel, banking, gaming, news and entertainment, and few used apps to facilitate personal health or engage with healthcare systems. Participants desired credible, relatable, secure, and easy to use interfaces that provided sexual health and HPV information in a positive context. They described ways to creatively engage and directly connect youth to health providers. We identified a culturally relevant youth driven approach to facilitate HPV vaccination and sexual health among YMSM.

Using internet search data to predict new HIV diagnoses in China: a modelling study

OBJECTIVES

Internet data are important sources of abundant information regarding HIV epidemics and risk factors. A number of case studies found an association between internet searches and outbreaks of infectious diseases, including HIV. In this research, we examined the feasibility of using search query data to predict the number of new HIV diagnoses in China.

DESIGN

We identified a set of search queries that are associated with new HIV diagnoses in China. We developed statistical models (negative binomial generalised linear model and its Bayesian variants) to estimate the number of new HIV diagnoses by using data of search queries (Baidu) and official statistics (for the entire country and for Guangdong province) for 7 years (2010 to 2016).

RESULTS

Search query data were positively associated with the number of new HIV diagnoses in China and in Guangdong province. Experiments demonstrated that incorporating search query data could improve the prediction performance in nowcasting and forecasting tasks.

CONCLUSIONS

Baidu data can be used to predict the number of new HIV diagnoses in China up to the province level. This study demonstrates the feasibility of using search query data to predict new HIV diagnoses. Results could potentially facilitate timely evidence-based decision making and complement conventional programmes for HIV prevention.

HIV incidence is rapidly increasing with age among young men who have sex with men in China: a multicentre cross-sectional survey

OBJECTIVES

The HIV epidemic is worsening among men who have sex with men (MSM) in China, especially among those who are younger than 25 years old [younger MSM (YMSM)]. The aim of the study was to compare the prevalences of HIV incidence and recent HIV infection as well as factors associated with recent HIV infection in YMSM and older MSM (OMSM).

METHODS

A multicentre cross-sectional survey was conducted among 4496 MSM recruited from seven Chinese cities. YMSM were defined as those aged < 25 years. Data on demographics and sexual behaviours were collected using structural questionnaires. Blood samples were tested for recent HIV infection and other sexually transmitted infections.

RESULTS

Among the participants, 1313 were YMSM and 3183 were OMSM. Compared with OMSM, YMSM had a higher prevalence of recent HIV infection [5.4% (71 of 1313) for YMSM vs. 3.6% (115 of 3175) for OMSM; P = 0.006] and a higher HIV incidence [11.8 per 100 person-years (PY) (95% confidence interval (CI) 9.0-14.5) for YMSM vs. 7.6 per 100 PY (95% CI 6.3-9.0) for OMSM]. The incidence increased with age among YMSM, especially between the ages of 16 and 21 years. In contrast, the incidence declined with age among OMSM. Anal bleeding, recreational drug use, syphilis and herpes simplex virus 2 (HSV-2) infection were independent risk factors for recent HIV infection among YMSM. The prevalence of all these risk factors increased with age between the ages of 16 and 21 years. Anal bleeding (19.8%) and recreational drug use (19.5%) had the highest adjusted population attributable fractions (aPAFs) among YMSM. The highest aPAFs of anal bleeding (27.4%) and syphilis infection (25.5%) were found between the ages of 19 and 21 years.

CONCLUSIONS

The HIV incidence in Chinese YMSM was significantly higher than that in OMSM. YMSM aged 16-21 years had an extremely high risk of recent HIV infection.

Spatial Distribution of Partner-Seeking Men Who Have Sex With Men Using Geosocial Networking Apps: Epidemiologic Study

Background

Geosocial networking apps have made sexual partner-seeking easier for men who have sex with men, raising both challenges and opportunities for human immunodeficiency virus and sexually transmitted infection prevention and research. Most studies on men who have sex with men geosocial networking app use have been conducted in large urban areas, despite research indicating similar patterns of online- and app-based sex-seeking among men who have sex with men in rural and midsize cities.

Objective

The goal of our research was to examine the spatial distribution of geosocial networking app usage and characterize areas with increasing numbers of partner-seeking men who have sex with men in a midsize city in the South.

Methods

Data collection points (n=62) were spaced in 2-mile increments along 9 routes (112 miles) covering the county encompassing the city. At each point, staff logged into 3 different geosocial networking apps to record the number of geosocial networking app users within a 1-mile radius. Data were collected separately during weekday daytime (9:00 AM to 4:00 PM) and weekend nighttime (8:00 PM to 12:00 AM) hours. Empirical Bayesian kriging was used to create a raster estimating the number of app users throughout the county. Raster values were summarized for each of the county's 208 Census block groups and used as the outcome measure (ie, geosocial networking app usage). Negative binomial regression and Wilcoxon signed rank sum tests were used to examine Census block group variables (eg, median income, median age) associated with geosocial networking app usage and temporal differences in app usage, respectively.

Results

The number of geosocial networking app users within a 1-mile radius of the data collection points ranged from 0 to 36 during weekday daytime hours and 0 to 39 during weekend nighttime hours. In adjusted analyses, Census block group median income and percent Hispanic ethnicity were negatively associated with geosocial networking app usage for all 3 geosocial networking apps during weekday daytime and weekend nighttime hours. Population density and the presence of businesses were positively associated with geosocial networking app usage for all 3 geosocial networking apps during both times.

Conclusions

In this midsize city, geosocial networking app usage was highest in areas that were more population-dense, were lower income, and had more businesses. This research is an example of how geosocial networking apps’ geospatial capabilities can be used to better understand patterns of virtual partner-seeking among men who have sex with men.

"It Was Supposed To Be a Onetime Thing": Experiences of Romantic and Sexual Relationship Typologies Among Young Gay, Bisexual, and Other Men Who Have Sex with Men

Young gay, bisexual, and other men who have sex with men (MSM) are at elevated risk for HIV infection, highlighting the need to understand the elements of prevention and risk associated with their relationships. We employed a phenomenological approach to explore how young MSM become involved in different romantic and sexual experiences. We analyzed 28 semi-structured interviews conducted with young MSM living in Michigan. Using a phenomenological approach, we analyzed the data using an inductive coding strategy and thematic analysis. Participants defined their romantic and sexual interactions with a limited set of partner classifications (e.g., dating, hooking up, friends-with-benefits), but recognized how these classifications were shifting, sometimes unexpectedly so (e.g., a date turning into a hook up and vice versa). Young MSM described relationships in transition that at times defied available typologies or hybridized elements of multiple partner types at once. Based on our analyses, we underscore the need to acknowledge the fluctuating and contextual nature of young MSM's romantic and sexual experiences. We discuss the relevance of our findings in terms of the developmental period of young adulthood and the implications our findings have HIV prevention efforts among young MSM.

"Blocking" and "Filtering": a Commentary on Mobile Technology, Racism, and the Sexual Networks of Young Black MSM (YBMSM)

While research investigates the role and influence of geo-social networking (GSN) applications on HIV, less is known about the impact of GSN functions on disease transmission. In our formative research on young Black men who have sex with men's (YBMSM) technology use patterns and preferences for a smartphone-based HIV prevention intervention, we found that study participants used GSN "block" and "filter" functions as protective mechanisms against racism and racial sexual discrimination. Yet, we suggest that these functions may unintentionally create restrictive sexual networks that likely increase their risk for disease transmission. As such, we contend that attention to the unintended effects of these protective mechanisms against racism on GSN applications is fundamentally a public health issue that requires more research and explicit intervention. Ultimately, we use this work to hypothesize the role of blocking and filtering as a strategy to avoid racism on GSN applications that may partly explain HIV disparities among YBMSM.

AIDS Service Organization Access Among African, Caribbean and Other Black Residents of an Average Canadian City

Due to heightened vulnerability to HIV/AIDS, African, Caribbean and Black (ACB) communities are priority groups for prevention and intervention services in Canada. However, it is not clear which factors may affect ACB communities' access to these services. We evaluated access to the local AIDS service organization (ASO) in Middlesex-London by using data from the Black, African and Caribbean Canadian Health Study. Modified Poisson regression was used to obtain prevalence risk ratios for factors associated with three measures of access: familiarity with the ASO, willingness to access, and realized access. In adjusted analyses, older ACB community members were more likely to be familiar with the ASO, willing to access it, and have actually gone there. Canadian-born participants were less likely to have been to the ASO than recent immigrants. These results have implications for reaching specific segments of ACB communities for HIV/AIDS-related services in Canada.

Sexually Explicit Media and Condomless Anal Sex Among Gay and Bisexual Men

Gay and bisexual men (GBM) have reported viewing significantly more sexually explicit media (SEM) than heterosexual men. There is some evidence that SEM depicting bareback anal sex may be linked to engagement in condomless anal sex (CAS) and thus HIV/STI transmission among GBM. A nationwide sample of HIV-negative GBM in the U.S. completed an online survey that included measures on SEM consumption (both overall frequency and percentage viewed depicting bareback sex) and reported on CAS in the past 3 months. Data showed that there was no main effect for the frequency of SEM watched in association on either the number of CAS acts with casual partners or the probability of engaging in CAS during a casual sex event. However, there was an interaction between amount of SEM consumed and percentage of bareback SEM consumed on both outcomes, such that men who reported both a high frequency of SEM consumption and a high percentage of their SEM being bareback reported the highest levels of risk behavior. These findings highlight the role that barebacking depicted in SEM may play in the normalization of sexual risk behaviors for GBM. Interventions looking to target the role SEM may play in the lives of GBM should examine what variables may help to mediate associations between viewing SEM and engaging in risk behavior.

The emergence of ethical issues in the provision of online sexual health outreach for gay, bisexual, two-spirit and other men who have sex with men: perspectives of online outreach workers

BACKGROUND

Mobile applications and socio-sexual networking websites are used by outreach workers to respond synchronously to questions and provide information, resources, and referrals on sexual health and STI/HIV prevention, testing, and care to gay, bisexual and other men who have sex with men (GB2M). This exploratory study examined ethical issues identified by online outreach workers who conduct online sexual health outreach for GB2M.

METHODS

Semi-structured individual interviews were conducted between November 2013 and April 2014 with online providers and managers (n = 22) to explore the benefits, challenges, and ethical implications of delivering online outreach services in Ontario, Canada. Interviews were digitally recorded and transcribed verbatim. Thematic analyses were conducted, and member-checking, analyses by multiple coders, and peer debriefing supported validity and reliability.

RESULTS

Four themes emerged on the ethical queries of providing online sexual health outreach for GB2M: (a) managing personal and professional boundaries with clients; (b) disclosing personal or identifiable information to clients; (c) maintaining client confidentiality and anonymity; and (d) security and data storage measures of online information. Participants illustrated familiarity with potential ethical challenges, and discussed ways in which they seek to mitigate and prevent ethical conflict.

CONCLUSIONS

Implications of this analysis for outreach workers, researchers, bioethicists, and policy-makers are to: (1) understand ethical complexities associated with online HIV prevention and outreach for GB2M; (2) foster dialogue to recognize and address potential ethical conflict; and (3) identify competencies and skills to mitigate risk and promote responsive and accessible online HIV outreach.

Social Anxiety and Loneliness in Adults Who Solicit Minors Online

This study examined the association of social anxiety, loneliness, and problematic Internet use (PIU) with the online solicitation of minors. Within a convenience sample of adult Internet users from Germany, Finland, and Sweden ( N = 2,828), we compared the responses of participants who had not interacted sexually with strangers online ( n = 2,049) with participants who sexually interacted with unknown adults online ( n = 642), and both groups with adults who sexually solicited unknown minors online ( n = 137). Online sexual interaction with adults was associated with higher levels of social anxiety, loneliness, and PIU compared with not sexually interacting with strangers online. Sexually soliciting minors online was associated with higher levels of social anxiety, loneliness, and PIU compared with sexually interacting with adults and not sexually interacting with strangers at all. Interestingly, compared with those with adult contacts, loneliness was specifically pronounced for participants who solicited children, whereas social anxiety and PIU were pronounced for participants soliciting adolescents. These findings suggest that social anxiety, loneliness, and PIU may be among the motivators for using the Internet to solicit individuals of different age groups for sexual purposes. These factors emerged as specifically relevant for adults who sexually solicited minors and who reported greater impairments compared with adults who sexually interacted with adults. These characteristics may thus be important to consider for assessment and treatment procedures for individuals soliciting minors online.

Sexually Explicit Online Media, Body Satisfaction, and Partner Expectations Among Men who have Sex with Men: a Qualitative Study

Limited research has investigated the perceived influence of sexually explicit online media (SEOM) on body satisfaction and partner expectations of men who have sex with men (MSM). Semi-structured qualitative interviews were conducted with 16 MSM, covering the perceived influence of MSM-specific SEOM. All nine men who broached the topics of body satisfaction and partner expectations reported that MSM-specific SEOM set unreasonably high physical appearance expectations for themselves and/or their potential partners. Although MSM-specific SEOM might be negatively affecting body satisfaction and partner expectations among MSM, its ubiquity may make it a useful tool to support body positivity.

Development of a Tailored HIV Prevention Intervention for Single Young Men Who Have Sex With Men Who Meet Partners Online: Protocol for the myDEx Project

Background

New cases of human immunodeficiency virus (HIV) among young men who have sex with men (YMSM), aged 18 to 24, underscore the importance of developmentally-informed HIV programs for YMSM. We developed an online intervention focused on risk reduction strategies across different sexual partner types. Intervention activities focus on assisting YMSM reflect on their partner-seeking behaviors, develop sexual decision-making rules to reduce their HIV risks, and consider the adoption of HIV prevention behaviors.

Objective

This pilot, randomized controlled trial (RCT) aims to examine the feasibility, acceptability, and preliminary efficacy of a tailored, Web-based HIV prevention intervention for single YMSM.

Methods

We designed a prospective RCT of online-recruited cis-gender men (N=180) who reported recent unprotected anal intercourse, self-report as HIV negative or are unaware of their HIV status, and meet sexual partners through online dating apps. Individuals in the control arm receive an attention-control condition that includes HIV/sexually transmitted infection (STI) information currently available on sex education websites. Individuals in the intervention arm receive a 6-session Web-based program tailored on their demographic information, partner-seeking behaviors and relationship desires, and prior sexual attitudes and behaviors. This tailored content will match HIV prevention messages and safer sex skills with YMSM’s outcome expectancies when meeting new partners and thereby help them consider how to integrate safer sex practices into different partner types. Study assessments are taken at baseline, 30-, 60-, and 90-day follow-ups. Intervention acceptability and preliminary efficacy will be explored in sexual risk behaviors and HIV/STI testing.

Results

The RCT launched in November 2016 and is ongoing. To date, 180 eligible individuals have been enrolled, consented, and randomized. Of the 120 individuals in the intervention arm, 51.7% (62/120) identify as non-Hispanic white and half of the control arm identifies as non-Hispanic white. There were no differences observed by arm for race and/or ethnicity, age, or sexual orientation.

Conclusions

Although there are in-person evidence-based interventions with proven efficacy for YMSM, few HIV/STI prevention interventions delivered online exist. Online interventions may ease access to comprehensive HIV/STI education among YMSM and allow personalized content to be delivered. The online intervention that we developed, myDEx, aims to alleviate the gaps within HIV prevention for YMSM by utilizing tailored, Web-based content with the goal of developing skills for same-sex dating and relationship building, while reducing their risks for HIV/STI.

Trial Registration

ClinicalTrials.gov NCT02842060; https://clinicaltrials.gov/ct2/show/NCT02842060 (Archived by WebCite at http://www.webcitation.org/6rcJdxF9v)

Preferences for Condomless Sex in Sexually Explicit Media Among Black/African American Men Who Have Sex with Men: Implications for HIV Prevention

Accumulating evidence suggests that viewing sexually explicit media (SEM; i.e., pornography) may be related to the sexual behaviors of men who have sex with men (MSM). Furthermore, stereotypical depictions of Black/African American MSM engaging in sexual risk behaviors in SEM may serve to normalize condomless sex, reinforce low peer norms around condom use, and facilitate HIV risk taking among Black/African American MSM. Despite this evidence, very little is known about the correlates of SEM consumption among Black/African American MSM, including HIV risk behaviors and their relation to preferences for viewing condomless sex in SEM. Participants were 653 HIV-seronegative Black-identified MSM ages 18-62 (M 33.58, SD 11.01) who completed a cross-sectional survey as a part of a HIV prevention trial in Atlanta, Georgia. Over three-quarters of the men (n = 514) reported a preference for condomless sex in SEM. In multivariate models, engaging in serodiscordant condomless sex was not significantly associated with preferences for condomless sex in SEM; however, men who self-identified as bisexual, engaged in transactional sex, and reported greater agreement with sexual risk cognitions (i.e., heat-of-the-moment thoughts about condom use) had significantly greater odds of reporting a preference for condomless sex in SEM. Study findings highlight the need for future research exploring the role of SEM in the sexual health of Black/African American MSM, including the extent to which SEM exposure alters norms and expectations about sexual behaviors among Black/African American MSM and how this might be addressed in HIV prevention programs.

Grindr, Scruff, and on the Hunt: Predictors of Condomless Anal Sex, Internet Use, and Mobile Application Use Among Men Who Have Sex With Men

In 2016, gay, bisexual, and other men who have sex with men (MSM) comprise more than half of all new HIV diagnoses in the United States, with the primary mode of infection being condomless anal sex (CAS). While studies report an association between use of Internet-based social networking sites and increased CAS, the research on the relationship between cell phone mobile applications (e.g., Grindr, Scruff, Jack'd) and CAS is much less developed. The present study examines whether the manner in which gay, bisexual, and other MSM find sexual partners predicts an increase in likelihood of engaging in CAS in an urban, noncoastal U.S. city. Conducting a secondary data analysis of the 2011 National HIV Behavioral Surveillance survey for Denver ( N = 546), the authors performed binary logistic regression analyses to assess the models that predict how MSM find sexual partners, and the odds of engaging in CAS. While the results suggest that age and race are associated with the mode of finding sexual partners, using the Internet or a mobile app to find sexual partners was not predictive of CAS ( ZWald = .41, p = .52; ZWald = .80, p = .37). In terms of HIV prevention, these findings suggest a need for intervention to address HIV prevention on multiple levels (e.g., individual, group, community).

Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research

Background

Black young men who have sex with men (BYMSM) experience higher human immunodeficiency virus (HIV) incidence than their white and Latino counterparts.

Objective

The aim of our study was to understand BYMSM’s preferences for mobile phone–based HIV prevention and treatment in order to inform culturally tailored interventions to reduce the spread of HIV and improve HIV treatment outcomes in this population.

Methods

Qualitative focus groups (N=6) with BYMSM aged 18-29 years (N=41; 46%, 19/41 HIV-positive) were conducted to elucidate their preferences for the design and delivery of mobile phone–based HIV prevention and treatment interventions. A modified grounded theory approach to data analysis was undertaken using ATLAS.ti textual analysis software.

Results

Participants preferred holistic health interventions that did not focus exclusively on HIV prevention and treatment. Issues of privacy and confidentiality were paramount. Participants preferred functionality that enables discreet connections to culturally competent health educators and treatment providers who can address the range of health and psychosocial concerns faced by BYMSM.

Conclusions

Mobile phone–based HIV prevention has the potential to increase engagement with HIV prevention and treatment resources among BYMSM. For these approaches to be successful, researchers must include BYMSM in the design and creation of these interventions.

Young sexual minority women's use of the internet and other digital technologies for sexual health information seeking

We know little about the online sexual health information seeking practices and needs specific to young sexual minority women. This is problematic as young sexual minority women report heightened negative sexual health outcomes in contrast to their heterosexual peers, which could be partially addressed through being able to access effective, relevant online sexual health information sources. This exploratory qualitative study employed a series of focus groups to understand more about what types of online resources young sexual minority women access, their motivations for using those resources, and what types of sexual health information they need. The focus group data were analyzed from a thematic analysis approach. Results indicate that participants used a wide range of online resources, such as apps, websites, blogs, and YouTube. The type of resource accessed often depended upon the information needed. Participants reported preferring online resources due to experiences or expectations of heteronormativity from their sexual health service providers, convenience and accessibility, the capacity to remain anonymous, and the lack of relevant sexual health information offline. These findings help begin to fill the gap on knowledge of young sexual minority women's sexual health information seeking practices, which can be used for the development of effective online sexual health information resources targeting young sexual minority women.

HIV Testing Among Internet-Using MSM in the United States: Systematic Review

Regular HIV testing enables early identification and treatment of HIV among at-risk men who have sex with men (MSM). Characterizing HIV testing needs for Internet-using MSM informs development of Internet-facilitated testing interventions. In this systematic review we analyze HIV testing patterns among Internet-using MSM in the United States who report, through participation in an online study or survey, their HIV status as negative or unknown and identify demographic or behavioral risk factors associated with testing. We systematically searched multiple electronic databases for relevant English-language articles published between January 1, 2005 and December 16, 2014. Using meta-analysis, we summarized the proportion of Internet-using MSM who had ever tested for HIV and the proportion who tested in the 12 months preceding participation in the online study or survey. We also identified factors predictive of these outcomes using meta-regression and narrative synthesis. Thirty-two studies that enrolled 83,186 MSM met our inclusion criteria. Among the studies reporting data for each outcome, 85 % (95 % CI 82-87 %) of participants had ever tested, and 58 % (95 % CI 53-63 %) had tested in the year preceding enrollment in the study, among those for whom those data were reported. Age over 30 years, at least a college education, use of drugs, and self-identification as being homosexual or gay were associated with ever having tested for HIV. A large majority of Internet-using MSM indicated they had been tested for HIV at some point in the past. A smaller proportion-but still a majority-reported they had been tested within the year preceding study or survey participation. MSM who self-identify as heterosexual or bisexual, are younger, or who use drugs (including non-injection drugs) may be less likely to have ever tested for HIV. The overall findings of our systematic review are encouraging; however, a subpopulation of MSM may benefit from targeted outreach. These findings indicate unmet needs for HIV testing among Internet-using MSM and identify subpopulations that might benefit from targeted outreach, such as provision of HIV self-testing kits.

The Relationship Between Self-Reported Sexually Explicit Media Consumption and Sexual Risk Behaviors Among Men Who Have Sex With Men in China

INTRODUCTION

Previous studies have indicated that viewing sexually explicit media (SEM) might be associated with sexual risk behaviors in men who have sex with men (MSM). However, most prior research has not explored this association cross-culturally or the potential influence that important covariates might have on the association.

AIM

To explore the association between self-reports of viewing SEM depicting various sexual risk behaviors and engagement in sexual risk behaviors after controlling for relevant covariates in MSM in China.

METHODS

Three hundred fourteen Chinese MSM participated in a web-based survey.

MAIN OUTCOME MEASURES

SEM consumption, sexual risk behavior, and measurements of covariates.

RESULTS

SEM consumption was frequent in MSM in China. Viewing a larger proportion of SEM depicting sexual risk behaviors was associated with a larger number of regular partners with whom MSM reported engaging in sexual risk behaviors, but not with the number of casual partners, after controlling for covariates. HIV-related knowledge and seeking male sex partners were associated with the number of regular partners with whom MSM had engaged in sexual risk behaviors. Seeking sexual sensation, HIV-related knowledge, and seeking male sex partners were associated with the number of casual partners with whom MSM had engaged in sexual risk behaviors.

CONCLUSION

Future research exploring the relation between SEM use and sexual health risk behaviors should consider theoretically important psychological and behavioral covariates. Xu Y, Zheng Y, Rahman Q. The Relationship Between Self-Reported Sexually Explicit Media Consumption and Sexual Risk Behaviors Among Men Who Have Sex With Men in China. J Sex Med 2017;14:357-365.

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

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

Drugs, Sex, and Condoms: Identification and Interpretation of Race-Specific Cultural Messages Influencing Black Gay and Bisexual Young Men Living with HIV

Black gay and bisexual young men carry a disproportionate burden of HIV in the United States. This study explored Black gay and bisexual young men living with HIV's identification and interpretation of race-specific cultural messages regarding substance use, sexual activity, and condom use. A total of 36 Black gay and bisexual young men living with HIV (ages 16-24, mean = 20.6 years) from four geographically diverse regions of the United States participated in qualitative in-depth interviews. Results from this study elucidate the ways in which these young men interpret various forms of race-specific cultural messages and experiences regarding substance use, sexual activity, and condom use. Participants discussed cultural messages and experiences promoting and discouraging condoms and substance use. Regarding sexual activity, only messages and experiences promoting sex were reported. Across all three categories, messages and experiences promoting risk were predominant. Data further revealed that socially transmitted cultural messages received by young men emanated from multiple sources, such as family, peers, sexual partners, community/neighborhood, and the broader society. Race-specific cultural messages and experiences should be addressed in interventions for this population, and programs should assist young men in developing a critical consciousness regarding these messages and experiences in order to promote health and well-being.

Sexuality and the Internet: A Study of the Perspectives of Turkish University Students

The purpose of this study was to determine Turkish university students' uses of and attitudes toward the Internet concerning sexuality. The study was conducted in two public universities in the Central Anatolia and Eastern Anatolia regions of Turkey. Among the students invited to take part in the study, 1,330 students agreed to do so. The study data were collected using a questionnaire designed by researchers to determine participants' personal characteristics, computer and Internet uses in general, and for sexual matters. The findings suggest that approximately half of the students (51%) reported using the Internet to obtain information about sexuality. Among the students, 30.5% said that they visit erotic and pornographic Web sites, 21.1% said that they chat on the Internet about sexuality, and 9.3% said that they bought sexual products online. Compared to the female students, the male students, statistically, more frequently show behaviors such as obtaining sexual information on the Internet, online sexual shopping, chatting on the Internet about sexuality, and visiting pornographic and erotic Web sites. In addition, female students have more negative attitudes toward using the Internet for sexual purposes. This study discusses its results along with the literature from Turkey and other countries.

How Best to Obtain Valid, Verifiable Data Online From Male Couples? Lessons Learned From an eHealth HIV Prevention Intervention for HIV-Negative Male Couples

Background

As interest increases in the development of eHealth human immunodeficiency virus (HIV)-preventive interventions for gay male couples, Web-based methods must also be developed to help increase the likelihood that couples enrolled and data collected from them represent true unique dyads. Methods to recruit and collect reliable and valid data from both members of a couple are lacking, yet are crucial for uptake of novel sexual health and HIV-prevention eHealth interventions. Methods to describe best practices to recruit male couples using targeted advertisements on Facebook are also lacking in the literature, yet could also help in this uptake.

Objective

The objective of our study was to describe challenges and lessons learned from experiences from two phases (developmental phase and online randomized controlled trial [RCT]) of an eHealth HIV-prevention intervention for concordant HIV-negative male couples in terms of (1) recruiting male couples using targeted advertisements on Facebook, (2) validating that data came from two partners of the couple, and (3) verifying that the two partners of the couple are in a relationship with each other.

Methods

The developmental phase refined the intervention via in-person focus groups, whereas the pilot-testing phase included an online RCT. For both phases, couples were recruited via targeted Facebook advertisements. Advertisements directed men to a study webpage and screener; once eligible, participants provided consent electronically. A partner referral system was embedded in the consenting process to recruit the relationship partner of the participant. Both men of the couple had to meet all eligibility criteria—individually and as a couple—before they could enroll in the study. Verification of couples’ relationships was assessed via the concurrence of predetermined screener items from both partners, done manually in the developmental phase and electronically in the pilot-testing phase. A system of decision rules was developed to assess the validity that data came from two unique partners of a couple.

Results

Several important lessons were learned from these experiences, resulting in recommendations for future eHealth studies involving male couples. Use of certain “interests” and types of images (eg, shirtless) in targeted Facebook advertisements should be avoided or used sparingly because these interests and types of images may generate adverse reactions from a broader audience. Development of a systematic approach with predetermined criteria and parameters to verify male couples’ relationships is strongly recommended. Further, researchers are encouraged to develop a system of decision rules to detect and handle suspicious data (eg, suspicious email addresses/names, multiple entries, same IP address used in multiple entries) to help validate the legitimacy of male couples’ relationships online.

Conclusions

These lessons learned combined with recommendations for future studies aim to help enhance recruitment efforts and the validity and reliability of collecting dyadic data from male couples for novel eHealth HIV-preventive interventions.

Get Checked… Where? The Development of a Comprehensive, Integrated Internet-Based Testing Program for Sexually Transmitted and Blood-Borne Infections in British Columbia, Canada

Background

Testing for sexually transmitted and blood-borne infections (STBBI) is an effective public health strategy that can promote personal control of one’s health and prevent the spread of these infections. Multiple barriers deter access to testing including fear of stigmatization, inaccurate health care provider perceptions of risk, and reduced availability of clinic services and infrastructure. Concurrent increases in sexually transmitted infection (STI) rates and demands on existing clinical services make this an even more pressing concern. Web-based testing offers several advantages that may alleviate existing clinical pressures and facilitate appropriate testing access.

Objective

This paper describes the planning, development, and usability testing of a novel Web-based testing service, GetCheckedOnline (GCO), as a complementary testing option integrated within existing sexual health services within British Columbia (BC).

Methods

From 2009 to 2014, we engaged a multidisciplinary team in the design and development of GCO. We conducted 3 initial research studies to ascertain the opinions of youth, men who have sex with men (MSM), and STI clinic clients regarding Web-based testing and elicited perspectives of sexual health care providers through focus groups. We developed an informed consent process, risk assessment questions, and test recommendations based on provincial and national guidelines and evaluated these through consultations with clinical and community stakeholders. We also conducted a preliminary health equity impact assessment whose findings also informed the GCO program mode. Finally, from April 2011 to December 2012 we gathered qualitative data from 25 participants on the functionality and usability of a GCO prototype and incorporated their recommendations into a final model.

Results

GCO launched in the fall of 2014 across 6 pilot sites in Vancouver, BC. The service involves 3 main steps: (1) create an account, complete an assessment, and print a laboratory requisition, (2) provide blood and urine specimens at participating laboratory locations, and (3) receive test results on the Internet or by phone. During this pilot phase, we promoted GCO to existing STI clinic clients and MSM in the Greater Vancouver region. A rigorous mixed-method evaluation of GCO’s uptake, acceptability, and health system impacts is currently underway.

Conclusions

GCO is the first comprehensive Web-based STBBI testing program in Canada that is integrated with existing sexual health services, with the potential to reduce pressures on existing clinical services and reach populations facing the greatest barriers to testing. Our experience highlights the facilitators and challenges of developing and implementing novel complex eHealth interventions within the health care system, and underscores the importance of considering broader implementation contexts.

The Internet's Multiple Roles in Facilitating the Sexual Orientation Identity Development of Gay and Bisexual Male Adolescents

One emerging avenue for the exploration of adolescents' sexual orientation identity development is the Internet, since it allows for varying degrees of anonymity and exploration. The purpose of this phenomenological study was to examine the role of the Internet in facilitating the sexual orientation identity development process of gay and bisexual male adolescents. Qualitative interviews were conducted with an ethnically diverse sample of 63 gay/bisexual male adolescents (ages 15-23). Participants reported using a range of Internet applications as they explored and came to accept their sexual orientation identity, with the intended purpose and degree of anonymity desired determining which applications were used. Youth reported that the Internet provided a range of functions with regard to the exploration and acceptance of their sexual orientation identity, including (1) increasing self-awareness of sexual orientation identity, (2) learning about gay/bisexual community life, (3) communicating with other gay/bisexual people, (4) meeting other gay/bisexual people, (5) finding comfort and acceptance with sexual orientation, and (6) facilitating the coming out process. Future research and practice may explore the Internet as a platform for promoting the healthy development of gay and bisexual male adolescents by providing a developmentally and culturally appropriate venue for the exploration and subsequent commitment to an integrated sexual orientation identity.

Sexual health information disparities between heterosexual and LGBTQ+ young adults: Implications for sexual health

Most studies on young adults' sources of sexual health information and confidence in sexual health practices have focused primarily on heterosexual university students. This study sought to bridge this gap in the literature by exploring where emerging adults, including LGBTQ+ individuals and those who do not pursue postsecondary education, obtain their sexuality information and how this relates to sexual self-efficacy. A total of 386 adults between the ages of 18 and 25 were divided into higher education (n=306) versus high school (n=80) groups and heterosexual (n=215) versus LGBTQ+ (n=171) emerging adults. Participants completed measures of sexual health information sources, as well as self-efficacy with regard to sexual health practices. Heterosexual participants obtained significantly more information from school/university courses and less from educational websites/news outlets than LGBTQ+ participants. Heterosexual participants were significantly more confident in their sexual health practices than LGBTQ+ participants. Different sources of information helped predict sexual self-efficacy across these four groups. Acquiring more information from significant others was the only significant predictor of sexual self-efficacy for all four groups. This study suggests that sexual health information should be discussed within a more relational or interpersonal framework, and that LGBTQ+ issues should be further incorporated and integrated in sex education curricula. Implications for healthcare providers, public health policy, sex educators, clinicians and future research are discussed.

Geosocial Networking App Use Among Men Who Have Sex With Men in Serious Romantic Relationships

Geosocial networking (GSN) mobile phone applications ("apps") are used frequently among men who have sex with men (MSM) to socialize and meet sexual partners. Though GSN apps are used by some MSM in partnered relationships, little is known about how the use of GSN apps among MSM in serious romantic relationships can influence couples' sexual and relationship health. MSM in serious relationships (N = 323; M age = 40 years) were recruited through a popular GSN app for MSM. Participants completed open-ended items regarding the costs and benefits of app use to their relationships, discussions of app use with their partners, and preferences for relationship education related to app use. Reported benefits of app use included improving sex and communication with one's primary partner and fulfilling unmet sexual needs. Although approximately half had not discussed app use with their partners, citing app use as a "non-issue," many cited various drawbacks to app use, including jealousy and being a distraction from the relationship. Few described sexual health concerns as a drawback to meeting partners through apps. Regarding relationship education preferences, most wanted help with general communication skills and how to express one's sexual needs to a partner. Although GSN app use can enhance relationships and sex among partnered MSM, unclear communication about app use may contribute to negative relationship outcomes and could prevent partners from having sexual needs met. Relationship and sexual health education programs for male couples should consider addressing social media and technology use in their curricula.

A National Study of Lesbian, Gay, Bisexual (LGB), and Non-LGB Youth Sexual Behavior Online and In-Person

Online and in-person sexual behaviors of cisgender lesbian, gay, queer, bisexual, heterosexual, questioning, unsure, and youth of other sexual identities were examined using data from the Teen Health and Technology study. Data were collected online between August 2010 and January 2011 from 5,078 youth 13-18 years old. Results suggested that, depending on sexual identity, between 4-35 % of youth had sexual conversations and 2-24 % shared sexual photos with someone online in the past year. Among the 22 % of youth who had oral, vaginal, and/or anal sex, between 5-30 % met one of their two most recent sexual partners online. Inconsistent condom use was associated with increased odds of meeting one's most recent partner online for heterosexual adolescent men. For gay and queer adolescent men, having an older partner, a partner with a lifetime history of sexually transmitted infections (STI), and concurrent sex partners were each significantly associated with increased odds of having met one's most recent sex partner online. None of the examined characteristics significantly predicted meeting one's most recent sexual partner online versus in-person for heterosexual; bisexual; or gay, lesbian, and queer women. The Internet is not replacing in-person exploration and expression of one's sexuality and meeting sexual partners online appears to be uncommon in adolescence across sexual identities. Healthy sexuality programming that acknowledges some youth are meeting partners online is warranted, but this should not be a main focal point. Instead, inclusive STI prevention programming that provides skills to reduce risk when engaging in all types of sex is critical.

Venues for Meeting Sex Partners and Partner HIV Risk Characteristics: HIV Prevention Trials Network (HPTN064) Women's HIV Seroincidence Study (ISIS)

Identifying venues where women meet sexual partners, particular partners who increase women's risk of acquiring HIV, could inform prevention efforts. We categorized venues where women enrolled in HPTN 064 reported meeting their last three sex partners as: (1) Formal, (2) Public, (3) Private, and (4) Virtual spaces. We used multinomial logistic regression to assess the association between these venues and women's individual characteristics and reports of their partners' HIV risk characteristics. The 2099 women reported meeting 3991 partners, 51 % at Public, 30 % Private, 17 % Formal and 3 % at Virtual venues. Women meeting partners at Formal venues reported more education and condom use than women meeting partners at other venues. Fewer partners met through Formal venues had "high" risk characteristics for HIV than through other venues and hence may pose less risk of HIV transmission. HIV prevention interventions can help women choose partners with fewer risk characteristics across all venue types.

"Hedge Your Bets": Technology's Role in Young Gay Men's Relationship Challenges

Technology is playing an increasingly pervasive role among young gay men in the process of meeting potential romantic or sexual partners. We investigated challenges posed by technology related to young gay men's relationships. Focus groups (n = 9) of young gay men aged 18-24 (n = 43) were transcribed verbatim, and thematic analysis was used to identify two major themes regarding challenges to relationship development and maintenance. Subthemes include unrealistic expectations of relationships, inauthentic self-presentation online, sexual primacy over romance, increased opportunities for infidelity, and jealousy. The implications of this study for sexual education and sexual health promotion are discussed.

Assessing Relationship and Sexual Satisfaction in Adolescent Relationships Formed Online and Offline

PURPOSE

Using the Internet to meet new people is becoming more common; however, such behavior is often considered risky, particularly for adolescents. Nevertheless, adolescents are meeting people through online venues and some are forming romantic/sexual relationships. The purpose of this study was to examine the relationship and sexual satisfaction reported by teens in online- and offline-initiated relationships.

METHODS

Data were collected from 273 13-19 year olds visiting a publicly funded clinic through 2010 and 2011. Questions included where respondents met the partner (online vs. offline), time between meeting and first sex, how well they knew the partner, and relationship and sexual (R&S) satisfaction. Analyses consisted of descriptive statistics, t tests, and path analysis, exploring R&S satisfaction in online- and offline-initiated relationships.

RESULTS

R&S satisfaction scores were moderate for adolescents who reported meeting partners online and in person but were statistically higher in offline-initiated relationships. There was an inverse relationship between having an online partner and both relationship and sexual satisfaction. Additionally, knowing partners for a longer period of time and feeling more knowledgeable about partners before having sex were statistically significantly related to higher R&S satisfaction.

CONCLUSIONS

Teens in this study reported more satisfying relationships with partners met offline compared with online. Results suggest that encouraging teens to wait longer and to get to know their partner(s) better before engaging in sex may improve satisfaction with, and quality of, those relationships. These findings provide an important contribution to sexual health promotion among young people, with whom technology use is ubiquitous.

Acceptability and preliminary efficacy of a tailored online HIV/STI testing intervention for young men who have sex with men: the Get Connected! program

Southeast Michigan accounts for over 70 % of all HIV/STI cases in the state, with young men who have sex with men (YMSM) between the ages of 13 and 24 encumbering the largest burden in HIV/STI incidence. Using community-based participatory research principles, we developed and pilot tested a web-based, randomized control trial seeking to promote HIV/STI testing ("Get Connected!") among YMSM (N = 130; ages 15-24). Randomized participants completed a baseline assessment and shown a test-locator condition (control) or a tailored, personalized site (treatment). At 30-day follow-up, we found high acceptability among YMSM in both conditions, yet higher credibility of intervention content among YMSM in the treatment group (d = .55). Furthermore, 30 participants reported testing by following, with the majority of these participants (73.3 %; n = 22) completing the treatment condition, a clinically meaningful effect (d = .34) suggesting preliminary efficacy for the intervention. These results demonstrate the potential of the intervention, and suggest that a larger efficacy trial may be warranted.

Acceptability and preliminary efficacy of a tailored online HIV/STI testing intervention for young men who have sex with men: the Get Connected! program

Southeast Michigan accounts for over 70 % of all HIV/STI cases in the state, with young men who have sex with men (YMSM) between the ages of 13 and 24 encumbering the largest burden in HIV/STI incidence. Using community-based participatory research principles, we developed and pilot tested a web-based, randomized control trial seeking to promote HIV/STI testing ("Get Connected!") among YMSM (N = 130; ages 15-24). Randomized participants completed a baseline assessment and shown a test-locator condition (control) or a tailored, personalized site (treatment). At 30-day follow-up, we found high acceptability among YMSM in both conditions, yet higher credibility of intervention content among YMSM in the treatment group (d = .55). Furthermore, 30 participants reported testing by following, with the majority of these participants (73.3 %; n = 22) completing the treatment condition, a clinically meaningful effect (d = .34) suggesting preliminary efficacy for the intervention. These results demonstrate the potential of the intervention, and suggest that a larger efficacy trial may be warranted.

Substance use homophily among geosocial networking application using gay, bisexual, and other men who have sex with men

Geosocial networking applications (GSN apps) represent important virtual contexts in which gay, bisexual, and other men who have sex with men (MSM) seek affiliation. These apps allow users to create and view public profiles, send photos, and text messages, and connect with other users based on shared interests and geographic proximity. The present study examined substance use homophily among a sample of 295 MSM recruited via a popular GSN app. Comparisons of social network members met via GSN app versus elsewhere and associations between both individual and network characteristics and recent binge drinking, marijuana use, and illicit substance use were explored using bivariate tests of association and multivariate logistic regression analyses. High rates of recent binge drinking (59 %), marijuana use (37 %), and illicit substance use (27 %) were observed among participants. GSN app use greater than 1 year and showing naked chest or abs in a profile picture were positively associated with recent illicit substance use. In multivariate analyses, the strongest predictors of binge drinking (AOR 3.81; 95 % CI 1.86-7.80), marijuana use (AOR 4.12; 95 % CI 2.22-7.64), and illicit substance use (AOR 6.45; 95 % CI 3.26-12.79) were the presence of a social network member who also engaged in these behaviors. Social network interventions that target binge drinking, marijuana use, and illicit substance use may be delivered via GSN apps to reduce the prevalence of substance use and related risks among MSM in these virtual contexts.