Population Size Estimation of Gay and Bisexual Men and Other Men Who Have Sex With Men Using Social Media-Based Platforms

• Type of Material: Article
• Authors: Stefan Baral, Johns Hopkins Bloomberg School of Public Health; Rachael M. Turner, Johns Hopkins Bloomberg School of Public Health; Carrie E. Lyons, Johns Hopkins Bloomberg School of Public Health; Sean Howell, Hornet Gay Social Network; Brian Honermann, FOUNDATION FOR AIDS RESEARCH; Alex Garner, Hornet Gay Social Network; Robert Hess, Johns Hopkins Bloomberg School of Public Health; Daouda Diouf, Enda Santé; George Ayala, Global Forum on MSM and HIV; Patrick S Sullivan, Emory University; Greg Millett, The Foundation for AIDS Research
• Language: English
• Date: 2018-02-01
• Publisher: JMIR Publications
• Publication Version: Final Published Version
• Copyright Statement: ©Stefan Baral, Rachael M Turner, Carrie E Lyons, Sean Howell, Brian Honermann, Alex Garner, Robert Hess III, Daouda Diouf, George Ayala, Patrick S Sullivan, Greg Millett. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 08.02.2018.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.2196/publichealth.9321
• Title of Journal or Parent Work: JMIR
• ISSN: 1438-8871
• Volume: 20
• Issue: 2
• Start Page: e15
• End Page: e15
• Grant/Funding Information: Population Size Estimation of Gay and Bisexual Men and Other Men Who Have Sex With Men Using Social Media-Based Platforms; The funders had no role in study design, data collection and analyses, decision to publish, or preparation of the manuscript.; SB’s effort was supported by the Johns Hopkins University Center for AIDS Research, a National Institutes of Health-funded program (P30AI094189), which is supported by the following NIH Cofunding and Participating Institutes and Centers: National Institute of Allergy and Infectious Diseases, National Cancer Institute, National Institute of Child Health and Human Development, National Heart, Lung, and Blood Institute, National Institute on Drug Abuse, National Institute of Mental Health, National Institute on Aging, Fogarty International Center, National Institute of General Medical Sciences, National Institute of Diabetes and Digestive and Kidney Diseases, and the Office of AIDS Research.
• Keywords: social media; key populations; HIV; men who have sex with men; AIDS; estimates
• Research Categories: Health Sciences, Epidemiology

Abstract

Gay, bisexual, and other cisgender men who have sex with men (GBMSM) are disproportionately affected by the HIV pandemic. Traditionally, GBMSM have been deemed less relevant in HIV epidemics in low- and middle-income settings where HIV epidemics are more generalized. This is due (in part) to how important population size estimates regarding the number of individuals who identify as GBMSM are to informing the development and monitoring of HIV prevention, treatment, and care programs and coverage. However, pervasive stigma and criminalization of same-sex practices and relationships provide a challenging environment for population enumeration, and these factors have been associated with implausibly low or absent size estimates of GBMSM, thereby limiting knowledge about the dynamics of HIV transmission and the implementation of programs addressing GBMSM. Objective: This study leverages estimates of the number of members of a social app geared towards gay men (Hornet) and members of Facebook using self-reported relationship interests in men, men and women, and those with at least one reported same-sex interest. Results were categorized by country of residence to validate official size estimates of GBMSM in 13 countries across five continents. Methods: Data were collected through the Hornet Gay Social Network and by using an a priori determined framework to estimate the numbers of Facebook members with interests associated with GBMSM in South Africa, Ghana, Nigeria, Senegal, C�te d'Ivoire, Mauritania, The Gambia, Lebanon, Thailand, Malaysia, Brazil, Ukraine, and the United States. These estimates were compared with the most recent Joint United Nations Programme on HIV/AIDS (UNAIDS) and national estimates across 143 countries. Results: The estimates that leveraged social media apps for the number of GBMSM across countries are consistently far higher than official UNAIDS estimates. Using Facebook, it is also feasible to assess the numbers of GBMSM aged 13-17 years, which demonstrate similar proportions to those of older men. There is greater consistency in Facebook estimates of GBMSM compared to UNAIDS-reported estimates across countries. Conclusions: The ability to use social media for epidemiologic and HIV prevention, treatment, and care needs continues to improve. Here, a method leveraging different categories of same-sex interests on Facebook, combined with a specific gay-oriented app (Hornet), demonstrated significantly higher estimates than those officially reported. While there are biases in this approach, these data reinforce the need for multiple methods to be used to count the number of GBMSM (especially in more stigmatizing settings) to better inform mathematical models and the scale of HIV program coverage. Moreover, these estimates can inform programs for those aged 13-17 years; a group for which HIV incidence is the highest and HIV prevention program coverage, including the availability of pre-exposure prophylaxis (PrEP), is lowest. Taken together, these results highlight the potential for social media to provide comparable estimates of the number of GBMSM across a large range of countries, including some with no reported estimates.