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Martin K, Peh RWC, Tembo M, Mavodza CV, Doyle AM, Dziva Chikwari C, Dauya E, Bandason T, Azizi S, Simms V, Ferrand RA. Factors Associated With the Use of Digital Technology Among Youth in Zimbabwe: Findings From a Cross-Sectional Population-Based Survey. J Med Internet Res 2024; 26:e52670. [PMID: 39312390 PMCID: PMC11459104 DOI: 10.2196/52670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 03/18/2024] [Accepted: 07/08/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND Globally, the increasing use of digital technologies such as mobile phones and the internet has allowed for the development of innovative mobile health interventions, particularly for reaching and engaging with youth. However, there is a risk that using such technologies may exclude those who lack access to them. OBJECTIVE In this study, we investigated the sociodemographic factors associated with mobile phone ownership, internet use, and social media use among youth in Zimbabwe. METHODS A population-based prevalence survey was conducted in 24 urban and periurban communities across 3 provinces of Zimbabwe (Harare, Mashonaland East, and Bulawayo). Youths aged 18 to 24 years resident in randomly selected households in the study communities completed an interviewer-administered questionnaire. The primary outcomes were mobile phone ownership and current internet and social media use. A household wealth indicator was developed using principal components analysis, based on household asset ownership. Multivariable logistic regression was used to investigate the factors associated with each primary outcome. Age, sex, and province were considered a priori confounders. Household wealth, marital status, education level, employment status, time lived at current address, and HIV status were included in the final multivariable model if there was an age-, sex-, and province-adjusted association with a primary outcome on univariable analysis at a significance level of P<.10. RESULTS Of the 17,636 participants assessed for the primary outcome, 16,370 (92.82%) had access to a mobile phone, and 15,454 (87.63%) owned a mobile phone. Among participants with access to a mobile phone, 58.61% (9594/16,370) and 57.79% (9460/16,370), respectively, used internet and social media at least weekly. Older age (adjusted odds ratio [aOR] 1.76, 95% CI 1.55-2.00), increasing wealth (ranging from aOR 1.85, 95% CI 1.58-2.16, for wealth quintile 2 to aOR 3.80, 95% CI 3.00-4.80, for wealth quintile 5, with quintile 1 as reference), and higher education level (secondary: aOR 1.96, 95% CI 1.60-2.39; tertiary: aOR 8.36, 95% CI 5.29-13.20) were associated with mobile phone ownership. Older age, male sex, increasing wealth, having never been married, higher education level, being in education or formal employment, and having lived at the same address for ≥2 years were associated with higher levels of internet and social media use. CONCLUSIONS While mobile phone ownership was near-universal, over one-third of youths in urban and periurban settings did not have access to the internet and social media. Access to the internet and social media use were strongly associated with household wealth and education level. Mobile health interventions must ensure that they do not amplify existing inequalities in access to health care. Such interventions must be accompanied by alternative strategies to engage and enroll individuals without internet or social media access to prevent the exclusion of young people by sex and socioeconomic status.
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Affiliation(s)
- Kevin Martin
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Rachel Wei Chun Peh
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mandikudza Tembo
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Constancia Vimbayi Mavodza
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Aoife M Doyle
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Chido Dziva Chikwari
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ethel Dauya
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Steven Azizi
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Victoria Simms
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rashida A Ferrand
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
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Ibáñez-Tomás E, Gasch-Gallén Á. A Cross-Sectional Study of Spanish Grindr Users: Sociodemographic Characteristics, Sexual Health Trends, and Attitudes toward HIV Testing. Healthcare (Basel) 2024; 12:1722. [PMID: 39273746 PMCID: PMC11395104 DOI: 10.3390/healthcare12171722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Revised: 08/26/2024] [Accepted: 08/28/2024] [Indexed: 09/15/2024] Open
Abstract
Men who have sex with men are at an increased risk of acquiring sexually transmitted infections, and although behavioral and contextual interventions have improved, infections continue to spread. Therefore, a new focus on recent trends in sexual health in this population is needed. The aim of this study was to describe the relationship between sociodemographic and behavioral characteristics according to Grindr usage patterns, the prevalence of sexually transmitted infections (STIs), and attitudes toward HIV testing. In January 2020, a cross-sectional study was conducted using a sample of 881 men who have sex with men (MSM) who completed an online questionnaire. We evaluated their Grindr use patterns (moderate or intensive) and explored the associations of these with sociodemographic behavioral characteristics, STIs, and attitudes toward HIV testing. Of 881 participants in total, 587 (66.6%) were intensive Grindr users. Compared to moderate users, these participants reported significantly higher numbers of casual sexual partners (76.2% vs. 23.8%; p < 0.001), were more likely to participate in Chemsex (77.3% vs. 22.7%: p = 0.031), and had a higher self-reported number of STIs (69.9% vs. 30.1; p = 0.046). They also demonstrated better attitudes toward HIV testing (69.7% vs. 30.3%; p = 0.045) and perceived themselves to be at moderate risk of HIV (71.2% vs. 28.8%: p = 0.048). Moreover, intensive Grindr users were 1.36 times more likely than moderate users to test positive for STIs (95%CI = 1.15-1.91; p = 0.048). With some limitations, age, sexual partners, intensive Grindr users, and PrEP uses were associated with the risk of STIs in the sample of Spanish Grindr users studied. As Grindr users are vulnerable to sociodemographic and behavioral factors that determine STIs and HIV infection, mainly among intensive users, it is necessary to highlight the importance of new trends such as online dating apps, PrEP use, substance use in sex, and Chemsex, and these need to be incorporated into online public health strategies.
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Affiliation(s)
- Eduardo Ibáñez-Tomás
- Servicio Aragonés de Salud, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain
| | - Ángel Gasch-Gallén
- Departamento de Fisiatría y Enfermería, Universidad de Zaragoza, 50009 Zaragoza, Spain
- Grupo Enfermero de Investigación en Atención Primaria de Aragón (GENIAPA-GIIS094), Instituto Investigación Sanitaria Aragón-IISA, 50009 Zaragoza, Spain
- Grupo Aragonés de Investigación en Atención Primaria (GAIAP-GIIS011), Instituto Investigación Sanitaria Aragón-IISA, 50009 Zaragoza, Spain
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Adan MA, Psaros C, Chamberlin G, Zionts D, Iyer S, Platt L, Lopes MD, Medeiros S, O’Connor C, Bassett IV, Ard KL. Swiping right on PrEP: a qualitative study of MSM preferences for PrEP public health messaging on dating apps. AIDS Care 2024; 36:1135-1147. [PMID: 38648528 PMCID: PMC11364278 DOI: 10.1080/09540121.2024.2343761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
Men who have sex with men (MSM) are disproportionately affected by HIV. Given that over 70% of MSM meet sexual partners via dating apps, such apps may be an effective platform for promoting HIV pre-exposure prophylaxis (PrEP) use. We aimed to describe preferences among MSM for PrEP advertisements displayed on dating apps. We conducted individual in-depth interviews with 16 MSM recruited from a mobile sexual health unit in Boston, Massachusetts. Two focus groups were also held: one with mobile unit staff (N = 3) and one with mobile unit users (N = 3). Content analysis was used to identify themes related to advertisement content and integration with app use. Mean participant age was 28 (SD 6.8); 37% identified as White and 63% as Latinx. 21% of interviews were conducted in Spanish. Preferences were organized around four themes: (1) relevant and relatable advertisements, (2) expansion of target audiences to promote access, (3) concise and captivating advertisements, and (4) PrEP advertisements and services as options, not obligations. MSM are supportive of receiving information about PrEP on dating apps, but feel that existing advertisements require modification to better engage viewers. Dating apps may be an underutilized tool for increasing PrEP awareness and knowledge among MSM.
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Affiliation(s)
- Matthew A. Adan
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Grace Chamberlin
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Dani Zionts
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Surabhi Iyer
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Laura Platt
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | | | | | | | - Ingrid V. Bassett
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kevin L. Ard
- Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Zhang H, Sanchez T, Zlotorzynska M, Baral S, Hecht J. Experiences of Stigma and HIV Status Associated with Awareness and Usage of Safer Sex Functions in Dating Apps Among MSM, 2019 American Men's Internet Survey (AMIS) Study. AIDS Behav 2023; 27:3603-3611. [PMID: 37421546 DOI: 10.1007/s10461-023-04074-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2023] [Indexed: 07/10/2023]
Abstract
Dating apps represent opportunities to implement sexual health interventions among gay, bisexual, and other men who have sex with men (MSM), particularly those who may avoid traditional health services due to intersecting stigmas. We used multivariable models to explore whether stigma experience was associated with awareness and usage of safer sex functions in dating apps among 7700 MSM who completed a 2019 US nationwide online survey. Perceived community intolerance of gay and bisexual men was associated with reduced awareness of sexual health strategy profile options (adjusted prevalence ratio [aPR] 0.95; 95% confidence interval [95% CI] 0.93-0.98) and sexual health information and resources (aPR 0.97; 95% CI 0.94-0.99). Stigma from family and friends was associated with increased usage of app-based sexual health reminders (aPR 1.14; 95% CI 1.02-1.28) and sexual health information and resources (aPR 1.16; 95% CI 1.04-1.31). Stigma experience of MSM should be considered in optimizing app-based sexual health interventions.
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Affiliation(s)
- Haisu Zhang
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Travis Sanchez
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA.
| | - Maria Zlotorzynska
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Stefan Baral
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21215, USA
| | - Jen Hecht
- Building Healthy Online Communities, Springboard Health Lab, Richmond, USA
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Galvan FH, Liu H, Brooks RA, Chen YT, Mendoza Lepe R. Using social and sexual networking mobile applications to promote HIV testing, medical care and prevention services among Latino men who have sex with men in Los Angeles County, California, USA. PLoS One 2022; 17:e0268406. [PMID: 35560041 PMCID: PMC9106153 DOI: 10.1371/journal.pone.0268406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 04/28/2022] [Indexed: 11/18/2022] Open
Abstract
HIV disproportionately affects Latinos versus Whites, with Latinos having higher rates of HIV. Additionally, many HIV-positive Latinos are unaware of their infection. Proyecto Protégete, an HIV prevention intervention developed for Latino men who have sex with men (MSM), used social and sexual networking mobile applications (apps) to recruit individuals for HIV testing and linkage to medical care and prevention services. This study occurred in Los Angeles County, California, USA from December 18, 2015 to April 22, 2017. The study’s primary aim was to assess Proyecto Protégete‘s ability to successfully recruit Latino MSM involved in high-risk sexual activities. A secondary aim was to evaluate its capacity to promote HIV testing and linkage to HIV medical care and prevention services among this population by comparing it to two programs with similar samples. Comparisons using Fisher’s Exact Test were conducted between Proyecto Protégete and the HIV testing program of the agency in which Proyecto Protégete was located and the County-funded HIV testing programs to compare the samples’ rates of HIV-positive Latino MSM identified through HIV testing and linked to HIV medical care and prevention services. Participants were recruited through seven apps. In Proyecto Protégete, 9,573 individuals completed the screener, 4,657 were eligible, and 359 (7.7% of those eligible) enrolled. Among those enrolled, 79% reported anal sex without a condom in the previous twelve months; 51% reported anal sex under the influence of alcohol. The HIV positivity rates were as follows: Proyecto Protégete, 1.71%; the agency, 1.25% (p = .293, compared to Proyecto Protégete); and the County, 1.09% (p = .172, compared to Proyecto Protégete). The rates of those confirmed as new HIV-positives and linked to medical care within 30 days were as follows: Proyecto Protégete, 71.4%; the agency, 81.5% (p = .450, compared to Proyecto Protégete); and the County, 77.3% (p = .503, compared to Proyecto Protégete). Proyecto Protégete had a higher rate of linked referrals to prevention services than the agency’s testing program (19.5% versus 8.3%, p < .001). Proyecto Protégete experienced successes in some areas but not in others. Future research should build on Proyecto Protégete’s experiences to promote HIV-related services among Latino MSM.
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Affiliation(s)
- Frank H. Galvan
- Department of Research and Evaluation, Bienestar Human Services, Inc., Los Angeles, California, United States of America
| | - Honghu Liu
- Division of Public Health & Community Dentistry, School of Dentistry, University of California, Los Angeles, California, United States of America
- Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
- Department of Biostatistics, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, California, United States of America
| | - Ronald A. Brooks
- Department of Research and Evaluation, Bienestar Human Services, Inc., Los Angeles, California, United States of America
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
- * E-mail:
| | - Ying-Tung Chen
- Department of Research and Evaluation, Bienestar Human Services, Inc., Los Angeles, California, United States of America
| | - Ricardo Mendoza Lepe
- Department of Research and Evaluation, Bienestar Human Services, Inc., Los Angeles, California, United States of America
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