Currently submitted to: Journal of Medical Internet Research
Date Submitted: Nov 26, 2019
Open Peer Review Period: Nov 26, 2019 - Jan 21, 2020
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Using Geosocial Networking Apps and HIV Risk Behavior among Men Who Have Sex with Men: Case-Crossover Analysis of Respondents to an Online Survey Delivered via Blued in China
HIV disproportionately affects the estimated 21 million men who have sex with men (MSM) who live in China. The HIV epidemic is largely driven by unprotected anal sex (sex not protected by condoms or HIV pre-expsoure prophylaxis). The possible association between unprotected anal sex and the use of a geospatial networking apps has been a subject of scientific debate.
This study assesses 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 compared to men not using the online dating medium.
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 1,311 MSM not taking pre-exposure prophylaxis (PrEP) who reported both unprotected and protected anal sex in the past 6 months. Multivariable conditional logistic regression was used to quantify the association of where the partnership was initiated (offline or online) and unprotected anal sex, controlling for other interval-level covariates. Four sensitivity analyses were conducted to assess other potential sources of bias.
We identified 1311 matched instances where a person reported both an unprotected anal sex act and a protected anal sex acts in the last 6 months. Of the most recent unprotected anal sex acts, 22% (n=292), were initiated offline. Of the most recent protected anal sex acts, 16% (n=214), were initiated offline. In multivariable analyses, initiating a partnership offline was positively associated with unprotected anal sex (OR 2.66, 95% CI 1.84 – 3.85, p<.001), compared to initiating a partnership online. These results were robust to each of the different sensitivity analyses we conducted.
Among Blued users in these four Chinese cities, men were less likely to have unprotected anal sex in partnerships that they initiated online compared to partnerships 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 to 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, and that these platforms should be viewed as a useful venue to identify individuals at risk for HIV transmission to allow for targeted service provision.
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