Utilization of dating apps by men who have sex with men for persuading other men toward substance use

Sexualised drug use and chemsex in Italy: A questionnaire study based on a cohort of clients attending a STI outpatient service in Milan

BACKGROUND

Chemsex is a heterogeneous phenomenon with differences in distribution, setting, motivations and type of substances consumed between countries. The lack of data at national level of the Italian situation creates a perception of reduced need for intervention.

METHODS

Anonymous paper questionnaires were distributed to patients who had registered themselves at the STI Department IRCCS Ca' Granda Policlinico in Milan.

RESULTS

A significant association was demonstrated between use of sexualised drugs, chemsex and the following variables: (1). Number of partners: in the group of clients with more than five partners, sexualised drug users were more than twice compared with those in the group with less than five partners (35.2% vs 16.2%) p<0.0001. (2). Use of dating apps: more than one out of two persons who used drugs during sex affirmed looking for partners on internet, p = 0.0059. (3). Low condom uses with occasional partners: percentage of individuals who declared not to use condoms or devices during their sexual encounters with occasional partners is more than twice as high in the sexualised drug users group with respect to controls (44.6% vs 21.4%); p = 0.0006). (4). Use of post exposure prophylaxis (PEP): among the PEP users, more than half participants belonged to the sexualised drug users' group; p = 0.0021.

CONCLUSIONS

Sexualised drug use and chemsex are frequently practiced in Milan. This survey identified a specific population with higher-risk sexual behaviours and increased incidence of acute bacterial STIs.

Utilization of mental health services in relation to the intention to reduce chemsex behavior among clients from an integrated sexual health services center in Taiwan

INTRODUCTION

The intention of chemsex-practicing gay and bisexual men and other men who have sex with men (GBMSM) to reduce their drug use is an important factor for the utilization of harm reduction services. This study aimed to examine data from an integrated sexual health services center to understand the relationship between the intention to reduce chemsex behavior and chemsex-related utilization of mental health services among GBMSM who engage in chemsex.

METHOD

We used data collected from Healing, Empowerment, Recovery of Chemsex (HERO), an integrated health center in Taiwan, between November 2017 and December 2021. As the baseline, clients were asked to rate the current and ideal proportions of their sexual activities that involved the use of MDMA, ketamine, methamphetamine, GHB/GBL, or mephedrone. Having the intention to reduce chemsex was defined as having a lower proportion of ideal engagement compared to actual engagement. The data on the use of the services provided at HERO were linked to the survey responses and compared to information gathered during regular follow-up visits. Univariable and multivariable logistic regression analyses and a Poisson regression analysis were performed on the data.

RESULTS

A total of 152 GBMSM reported engaging in chemsex, of whom 105 (69.1%) expressed the intention to reduce their chemsex behavior. Service utilization ranged from 23.0% for participating in meetings of a chemsex recovery group, 17.1% for visiting a mental health clinic, and 10.5% for using both of these services. The intention to reduce chemsex behavior significantly associated with visiting a mental health clinic (aOR = 4.68, p < 0.05), but its association with attending meetings of a chemsex recovery group was only marginally significant (aOR = 2.96, p < 0.1). Other factors that remained significantly associated with service use were a high frequency of substance use and living with HIV.

CONCLUSION

Comprehensive harm reduction strategies, which touch on mental health, drug use management and recovery, are needed for those who want to reduce their chemsex behavior. Public health practitioners should endeavor to raise awareness of resources that are available for people who engage in chemsex and to minimize the barriers blocking their access to the appropriate services.

Assessment of U=U understanding, PrEP awareness, HIV risk behaviours and factors associated with low HIV knowledge among users of Hornet, an online dating application for LGBTQ, in Thailand

BACKGROUND

Over 50% of HIV infections in Thailand annually occur among men who have sex with men (MSM) and transgender women who use online applications to meet their sexual partners. We conducted a cross-sectional study assessing undetectable=untransmittable (U=U) understanding, pre-exposure prophylaxis (PrEP) awareness, sexual behaviours and factors associated with HIV knowledge among users of Hornet in Thailand.

METHODS

From November 2019 to January 2020, a survey was conducted using convenience sampling on Hornet in Thailand. HIV literacy was assessed via 22 questions, and multivariable linear regression was performed.

RESULTS

960 responses were assessed; median age was 34 years, the majority were MSM (80.4%), Thai (83.8%), had at least bachelor's degree (74.9%). Regarding the risk profiles, 39.1% reported inconsistent condom use, 15.0% used amphetamine-type stimulants, 56.9% had not taken PrEP in the last six months and 20.5% never had an HIV test. Only 22.8% thought that U=U was completely accurate. Lower HIV knowledge was associated with being from Africa (β -8.13, 95% CI -14.39 to -1.87), age of 25 years or younger (β -2.6, 95% CI -4.37 to -0.82), education less than bachelor's degree (β -2.58, 95% CI -3.98 to -1.19), having more than one sexual partners (β -2.41, 95% CI -4.13 to -0.69), paying three or more people to have intercourse (β -2.5, 95% CI -4.26 to -0.74), not knowing one's HIV status (β -3.56, 95% CI -5.45 to -1.68) and not answering about previous PrEP use (β -4.11, 95% CI -7.86 to -0.36). Higher HIV knowledge was associated with being from Europe (β 2.54, 95% CI 0.46 to 4.61), the Americas (β 3.37, 95% CI 0.44 to 6.30) and previous PrEP use (β 2.37, 95% CI 0.94 to 3.81).

CONCLUSION

Among Hornet users in Thailand, the U=U message was unclear, and PrEP use was suboptimal. Large HIV knowledge gaps and high-risk behaviours were concerning. Educational campaigns in online spaces are needed to promote awareness and HIV prevention strategies.

Prevalence of sexualized drug use and risk of HIV among sexually active MSM in East and South Asian countries: systematic review and meta-analysis

INTRODUCTION

Sexualized drug use (SDU), the use of psychoactive drugs in the context of sexual intercourse, has been identified as a risk factor for HIV among men who have sex with men (MSM) in Asia. Given the distinct social and cultural context of same-sex relationships and drug-using practice in Asia, we aimed to describe the prevalence of SDU in East and South Asian countries and its associations with condomless anal sex (CAI) and HIV status. Synthesizing SDU research in this region, including SDU definitions, prevalence and outcomes, provides insights to inform future research and improved programme planning, resourcing and advocacy.

METHODS

We systematically searched OVID Medline, OVID EMBASE, OVID Global Health, CINAHL, PsycINFO and SCOPUS publication databases for scientific articles published from 1990 to 2022 measuring SDU among MSM in East and South Asian countries. A narrative synthesis was utilized to describe key study attributes and findings, and meta-analyses using random pooled effect models were used to estimate SDU prevalence and its associations with CAI and HIV status. Subgroup meta-analyses, sensitivity analysis and assessment of publication bias examined potential sources of heterogeneity for the pooled SDU prevalence estimates.

RESULTS AND DISCUSSION

Of the 1788 publications screened, 49 publications met the selection criteria and 18 were suitable for meta-analyses. Findings highlight SDU definitions distinct from other regions but inconsistencies in the definition of SDU between studies that have been highlighted in research elsewhere. The pooled prevalence of recent SDU (past 12 months) was 13% (95% CI = 10-16%; I2 = 97.6) but higher when studies utilized self-administered surveys (15%; 95% CI = 12-19%; p<0.05). SDU was associated with greater odds of CAI (pooled odds ratio [OR] = 3.21; 95% CI = 1.82-5.66) and living with diagnosed HIV (OR = 4.73; 95% CI = 2.27-8.21).

CONCLUSIONS

SDU is common among MSM in East and South Asian countries, but varying SDU definitions limit between-study comparisons. Responses to SDU-related harms should consider local contexts, including specific drug types used and their relative risks.

Behind the Screens: A Systematic Literature Review of Quantitative Research on Mobile Dating

Mobile dating applications (MDAs) have become commonly used tools to seek out dating and sexual partners online. The current review aimed to systematically synthesize empirical findings in 72 quantitative studies on mobile dating, published in ISI-ranked journals between 2014 and 2020. This review focused on summarizing different approaches toward mobile dating, identity features of quantitative research on mobile dating, and hypothesized antecedents and outcomes of mobile dating. Our findings showed, first, that the literature diverges in how mobile dating is operationalized. Second, quantitative research on mobile dating predominantly consists of cross-sectional studies that draw on theoretical insights from multiple disciplines. Third, a variety of traits and sociodemographics were associated with MDA use. In particular, using MDAs for (1) relational goals related to being male, non-heterosexual, higher levels of sociosexuality, sensation seeking, extraversion, and holding more positive peer norms about using MDAs for relational goals; (2) intrapersonal goals related to being female and having more socially impairing traits; and (3) entertainment goals related to having higher levels of sociosexuality, sensation seeking, and antisocial traits. Outcomes significantly associated with general use of MDAs were scoring higher on sexual permissiveness and on engaging in casual (unprotected) sexual intercourse, as well as having higher risk at nonconsensual sex. MDA use was also connected with increased psychological distress and body dissatisfaction. Shortcomings of the existing research approaches and measures are discussed and six methodological and theoretical recommendations for future research are provided.

The sexualised use of cannabis among young sexual minority men: "I'm actually enjoying this for the first time"

The objective of this study was to identify how cannabis use features within the sexual lives of young sexual minority men who use substances, and how this might intersect with features of their contemporary socio-cultural contexts in a setting where non-medical cannabis was recently legalised: Vancouver, Canada. Forty-one sexual minority men ages 15 to 30 years were recruited between January and December 2018 to participate in in-depth, semi-structured 1-2 h interviews about their experiences of using substances (e.g. cannabis) for sex. Drawing on constant comparative analytic techniques, two themes emerged with regards to participants' perceptions of, and experiences with, the sexualised use of cannabis. First, participants described how they used cannabis for sex to increase sexual pleasure and lower inhibitions. Second, participants described using cannabis for sex to reduce feelings of anxiety and shame, and foster intimacy and connection with sexual partners. These findings identify how the sexualised use of cannabis functions as a 'strategic resource' for sexual minority men to deliberately achieve both physiological and psychoactive effects, while concurrently underscoring the extent to which the contexts, patterns and motivations associated with cannabis use for sex parallel those associated with this form of Chemsex.

The Experience of Using Dating Applications for Sexual Hook-Ups: A Qualitative Exploration among HIV-Negative Men Who Have Sex With Men in Hong Kong

Men who have sex with men (MSM) use dating applications (apps) to explore various romantic and sexual relationships. This qualitative study aimed to describe HIV-negative MSM's experiences with app usage, the sexual activities arranged accordingly and their experiences in using dating apps to arrange sexual encounters. Thirty-one MSM who were sexually active and who used dating apps were recruited. Individual semi-structured interviews were conducted. Qualitative data were thematically analyzed to outline significant phenomena and perceptions. The factors associated with matching on apps included sex roles, human immunodeficiency virus serostatus and availability of a venue for meetup. Facilitated by these apps, diverse types of sexual encounters were arranged. Condoms were typically used for safer intercourse, except by people who were younger and inexperienced or when drugs were consumed before or during sex (chemsex). Extensive interest in non-penetrative sexual behaviors was expressed by our sample. Searching for post-exposure prophylaxis methods and/or sexual health screenings was common after exposure to risk of infections. Sexually abusive encounters were followed by changes in sex-searching habits and lowered trust in relationship formation. The results of this study are important for the development of appropriate interventions to promote safer sexual practices among HIV-negative MSM dating app users.

Threats to Mental Health Facilitated by Dating Applications Use Among Men Having Sex With Men

In the last years, dating applications (DAs) have had a significant impact on the way in which people seek sexual and romantic relationships. Social groups, such as men having sex with men (MSM), who can experience discrimination and social isolation, find DAs especially engaging and helpful in finding sexual partners. Previous studies have provided evidence showing vulnerability to mental health problems among the MSM population-these problems can be potentially facilitated by DAs use. Excessive use of DAs is associated with lower well-being and life satisfaction, depression, higher substance use, and lower sleep quality. Therefore, there is a need for a better understanding of psychological functioning and risk factors associated with the use of DAs among MSM, which we focus on in this review. We also discuss two relatively new research areas: compulsive sexual behavior disorder and chemsex, and their relation to geosocial-networking mobile technologies. Finally, we point out the limitations of available studies on the mental health of MSM using DAs and propose further research directions.

Dating Apps and Their Sociodemographic and Psychosocial Correlates: A Systematic Review

The emergence and popularization of dating apps have changed the way people meet and interact with potential romantic and sexual partners. In parallel with the increased use of these applications, a remarkable scientific literature has developed. However, due to the recency of the phenomenon, some gaps in the existing research can be expected. Therefore, the objective of this study was to conduct a systematic review of the empirical research of the psychosocial content published in the last five years (2016–2020) on dating apps. A search was conducted in different databases, and we identified 502 articles in our initial search. After screening titles and abstracts and examining articles in detail, 70 studies were included in the review. The most relevant data (author/s and year, sample size and characteristics, methodology) and their findings were extracted from each study and grouped into four blocks: user dating apps characteristics, usage characteristics, motives for use, and benefits and risks of use. The limitations of the literature consulted are discussed, as well as the practical implications of the results obtained, highlighting the relevance of dating apps, which have become a tool widely used by millions of people around the world.

Online Dating and Problematic Use: A Systematic Review

Despite the constant growth in the use of online dating sites and mobile dating applications, research examining potential problematic use of online dating has remained scarce. Previous research has obviated problematic use of online dating in favour of users’ personality correlates and scams through online dating services. A systematic review was carried out using PsycINFO and Web of Science databases to gather previous findings that address potential problematic use of online dating by (i) identifying use and motivations, (ii) assessing users’ personality correlates, (iii) outlining negative correlates of use, (iv) examining sexual and impulsive behaviour, (v) exploring substance use and behavioural addictions in relation to online dating, and (vi) examining problematic use of online dating, resulting in 43 studies. Findings suggest that personality correlates such as neuroticism, sociability, sensation-seeking, and sexual permissiveness are related to greater use of online dating services. Sex-search and self-esteem enhancement are predictors of problematic use of online dating. Previous research coincides with online dating risks (e.g. fear of deception) and objectification tendency due to online dating services (sites and apps) design. Observations regarding methodological weaknesses and future research implications are included.

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

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

Chemsex among gay, bisexual, and other men who have sex with men in Singapore and the challenges ahead: A qualitative study

BACKGROUND

Sexualised substance use, or 'chemsex' has been shown to be a major factor driving the syndemic of HIV/AIDS in communities of gay, bisexual, and other men who have sex with men (GBMSM) around the world. However, there is a paucity of research on chemsex among GBMSM in Singapore due to punitive drug laws and the criminalisation of sexual behaviour between men. This qualitative descriptive study is the first to explore perceptions towards, motivators to engaging in, and the barriers to addressing the harms associated with chemsex among GBMSM in Singapore.

METHODS

We conducted 30 semi-structured in-depth interviews with self-identifying GBMSM between the ages of 18-39 in Singapore following a purposive sampling strategy. Interview topics included participants' perceptions of drug use among GBMSM in Singapore, perceptions towards chemsex, reasons for drug use and chemsex, and recommendations to address the harms associated with chemsex in Singapore. Interviews were audio-recorded, transcribed, coded, and analysed using thematic analysis.

RESULTS

Participants reported that it was common to encounter chemsex among GBMSM in Singapore as it could be easily accessed or initiated using social networking phone apps. Enhancement and prolongation of sexual experiences, fear of rejection from sexual partners and peers, and its use as a means of coping with societal rejection were three main reasons cited for engaging in chemsex. The impact of punitive drug laws on disclosure and stigmatisation of GBMSM who use drugs were reported to be key barriers towards addressing chemsex. Participants suggested using gay-specific commercial venues as avenues for awareness and educational campaigns, and social media to reach out to younger GBMSM.

CONCLUSIONS

This study highlights the complexities behind chemsex use among GBMSM in Singapore, and the range of individual to institutional factors to be addressed. We recommend that community-based organisations and policy-makers find ways to destigmatise discussion of chemsex and provide safe spaces to seek help for drug use.