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

• Type of Material: Article
• Authors: Justin Knox, Columbia University; Yi-No Chen, Emory University; Qinying He, Centers for Disease Control and Prevention; Guowu Liu, Centers for Disease Control and Prevention; Jeb Jones, Emory University; Xiaodong Wang, Chengdu Tongle Social Work Service Center; Patrick Sullivan, Emory University; Aaron Siegler, Emory University
• Language: English
• Date: 2021-01-01
• Publisher: JMIR PUBLICATIONS, INC
• Publication Version: Final Published Version
• Copyright Statement: ©Justin Knox, Yi-No Chen, Qinying He, Guowu Liu, Jeb Jones, Xiaodong Wang, Patrick Sullivan, Aaron Siegler.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.2196/17173
• Title of Journal or Parent Work: JMIR PUBLIC HEALTH AND SURVEILLANCE
• Volume: 7
• Issue: 1
• Start Page: 68
• End Page: 77
• Grant/Funding Information: This work was supported by the National Institute of Allergy and Infectious Diseases (R01AI143875) and the National Institute of Mental Health (R01MH114692). The work was facilitated by the Emory Center for AIDS Research (P30AI050409). Funding for Dr Knox’s contribution to the present study was supported by NIDA (T32DA031099; PI: Hasin).
• Keywords: CHINA IMPLICATIONS; Public, Environmental & Occupational Health; men who have sex with men; geosocial networking apps; HIV; TRANSMISSION RISK; sexual risk behavior; PARTNERS; Science & Technology; ANAL INTERCOURSE; MSM; Life Sciences & Biomedicine; dating apps; case-crossover study
• Research Categories: Environmental Sciences; Health Sciences, Immunology; Health Sciences, Public Health

Abstract

Background: HIV disproportionately affects men who have sex with men (MSM) in China. The HIV epidemic is largely driven by unprotected anal sex (ie, sex not protected by condoms or HIV pre-exposure prophylaxis [PrEP]). The possible association between unprotected anal sex and the use of geospatial networking apps has been the subject of scientific debate. Objective: This study assessed whether users of a gay geospatial networking app in China were more likely to use condoms when they met their partners online versus offline. A case-crossover analysis, with each person serving as his own control, was employed to address the potential bias that men looking for sex partners through an online dating medium might have inherently different (and riskier) patterns of sexual behavior than men who do not use online dating media. Methods: A cross-sectional survey was administered in 2018 to adult male users of Blued-a gay geospatial networking app-in Beijing, Tianjin, Sichuan, and Yunnan, China. A case-crossover analysis was conducted among 1311 MSM not taking PrEP who reported engaging in both unprotected and protected anal sex in the previous 6 months. Multivariable conditional logistic regression was used to quantify the association between where the partnership was initiated (offline or online) and the act of unprotected anal sex, controlling for other interval-level covariates. Four sensitivity analyses were conducted to assess other potential sources of bias. Results: We identified 1311 matched instances where a person reported having both an unprotected anal sex act and a protected anal sex act in the previous 6 months. Of the most recent unprotected anal sex acts, 22.3% (292/1311), were initiated offline. Of the most recent protected anal sex acts, 16.3% (214/1311), were initiated offline. In multivariable analyses, initiating a partnership offline was positively associated with unprotected anal sex (odds ratio 2.66, 95% CI 1.84 to 3.85, P<.001) compared with initiating a partnership online. These results were robust to each of the different sensitivity analyses we conducted. Conclusions: Among Blued users in 4 Chinese cities, men were less likely to have unprotected anal sex in partnerships that they initiated online compared with those that they initiated offline. The relationship was strong, with over 2.5 times the likelihood of engaging in unprotected anal sex in partnerships initiated offline compared with those initiated online. These findings suggest that geospatial networking apps are a proxy for, and not a cause of, high-risk behaviors for HIV infection; these platforms should be viewed as a useful venue to identify individuals at risk for HIV transmission to allow for targeted service provision.