Rates of HIV infection continue to rise for men who have sex with men (MSM), and may be partially due to lack of testing among groups at risk for HIV. Mobile applications have demonstrated promise to identify at-risk MSM, though more research is needed to address testing patterns among this population. We conducted an online survey of 1,351 MSM in the New York City (NYC) area recruited from Grindr and analyzed predictors of lifetime and past-year testing using Pearson’s chi-squared statistic, Fisher’s exact tests, and logistic regression. A majority (90 %) of men had been tested within their lifetimes, and most (71 %) had been tested within the prior year. Among those who had never been tested (n = 135), one-third had engaged in unprotected anal intercourse (UAI) in the prior 3 months and nearly one-third identified themselves as HIV-negative rather than unknown. Older age, reporting an HIV-negative (versus unknown) status, and recent UAI were independently associated with lifetime testing. Greater proportions of men who had recently engaged in UAI reported testing within the past year compared with those who had not engaged in UAI. Overall, rates of testing among MSM in this sample exceeded those of the general population, including the general population in NYC. A greater proportion of this sample had never tested compared to a population-based sample of NYC MSM, though a higher percentage had also tested in the past year. This study demonstrated that 1 in 10 NYC men using Grindr and 1 in 5 who were 18–24 years of age had never received an HIV test in their lives. Using the existing infrastructure and popularity of mobile technology such as Grindr to identify and link men to information regarding HIV testing may be a useful strategy for prevention.
Background: Several studies have demonstrated no linked HIV transmissions in serodifferent sexual encounters where the partner with HIV has an undetectable viral load. As a result, awareness and dissemination of treatment as prevention, and movements such as “Undetectable = Untransmittable” (U = U), has grown. Setting: We conducted an online cross-sectional survey from November 2017 through September 2018 to gather data from a total of 111,747 sexual minority men (SMM) in the United States. Methods: Participants provided sociodemographic data and answered questions regarding biomedical status, HIV and STI prevention behaviors, drug use, condomless anal sex, and perceived accuracy of the U = U message. We conducted analyses to understand factors associated with perceived accuracy of U = U stratified by HIV status. Results: Overall, 53.2% of the sample perceived U = U as accurate, with the highest rates among HIV-positive SMM (83.9%), followed by HIV-negative (53.8%) and status-unknown (39.0%) SMM. Multivariable models showed accuracy beliefs were, on average, 1–2% higher for each consecutive month of recruitment. Consistent with previous work, there was greater heterogeneity among HIV-negative and unknown men, with several factors differentiating perceived accuracy, compared with SMM with HIV. Perceived transmission risk levels with undetectable partners were skewed well above accurate levels, and greater perceived transmission risk was associated with lower perceived accuracy of U = U. Conclusions: Public confidence in treatment as prevention and U = U is growing, but clear, unequivocal messaging about the effectiveness of U = U is critical. Owing to misunderstandings of risk, language that focuses on protective benefits rather than transmission risks may reach more people and allow for better comparisons with PrEP and condoms.
We adapted time-space sampling to enroll men who have sex with men (MSM) off Craigslist.org for face-to-face interviews. Men responding to our ads (n=322) were instructed to either complete an online pre-screening survey (to determine preliminary eligibility) or call our office directly. Of those taking further initiative to enroll, 29% (n=41) called directly and 71% (n=101) opted to first complete the online survey. Participants scheduled via online pre-screening were more likely to present for their face-to-face assessment than men deemed eligible directly via phone screening (72.3% vs. 47.1%). Online pre-screening was a useful tool to offer potential participants when recruiting on Craigslist and improved study enrollment.
This study assessed the perceived importance of five health issues for gay and bisexual men (N=660) using time-space sampling in gay bars/clubs and bathhouses in New York City: “HIV & STDs,” “Drugs & Alcohol,” “Body Image,” “Mental Health,” and “Smoking.” This study compared ratings based on demographic differences, recent substance use, recent sexual risk behavior, and whether or not participants owned a smart device (e.g., “smart” phone, iPad, iPod touch). Contrary to research indicating that gay and bisexual men may be experiencing HIV prevention fatigue, this study identified that HIV and STIs were perceived as most important. Drugs and alcohol and mental health were also rated high, suggesting that providers may be well served to include mental health and drugs and alcohol as part of their comprehensive approach to HIV prevention. A majority of participants (72%) owned a smart device. Smart device owners rated health issues similarly to those who did not, suggesting that such devices may be a useful platform to reach gay and bisexual men for health education and prevention.
Background Men who have sex with men (MSM) currently account for more than two-thirds of new HIV diagnoses in the United States and, among young MSM (YMSM) aged 20 to 29 years, as many as 79% to 84% of new infections occur between primary partners. Contributing to HIV risk, YMSM use drugs at comparatively high rates. To date, no interventions have been developed that specifically address the unique needs of partnered YMSM or incorporate a focus on relationship factors in addressing personal motivation for change. Objective The study’s primary aim is to evaluate the efficacy of the PARTNER intervention and evaluate potential moderators or mediators of intervention effects. The study’s secondary aims were to gather ideographic data to inform a future effectiveness implementation study and develop a novel biomarker for pre-exposure prophylaxis (PrEP) adherence by analyzing PrEP drug levels in fingernails. Methods PARTNER is a 4-session motivational interviewing–based intervention that integrates video-based communication training to address drug use and HIV prevention among partnered YMSM. This study utilizes a randomized controlled trial design to compare the PARTNER intervention with an attention-matched psychoeducation control arm that provides information about HIV-risk reduction, PrEP, and substance use. Participants are randomized in a 1-to-1 ratio stratified on age disparity between partners, racial composition of the couple, and relationship length. Follow-up assessments are conducted at 3-, 6-, 9-, and 12-months postbaseline. The study recruits and enrolls 240 partnered YMSM aged between 18 to 29 years at a research center in New York City. Participants will be HIV-negative and report recent (past 30-day) drug use and condomless anal sex with casual partners; a nonmonogamous primary partner (regardless of HIV status); or a serodiscordant primary partner (regardless of sexual agreement). Primary outcomes (drug use and HIV sexual transmission risk behavior) are assessed via a Timeline Follow-back interview. Biological markers of outcomes are collected for drug use (fingernail assay), sexual HIV transmission risk (rectal and urethral gonorrhea and chlamydia testing), and PrEP adherence (dried blood spots and fingernails for a novel PrEP drug level assay). Results The study opened for enrollment in February 2018. Anticipated completion of enrollment is October 2021. Primary outcome analyses will begin after final follow-up completion. Conclusions Existing research on partnered YMSM within the framework of Couples Interdependence Theory (CIT) has suggested that relationship factors (eg, dyadic functioning and sexual agreements) are meaningfully related to drug use and HIV transmission risk. Results pertaining to the efficacy of the proposed intervention and the identification of putative moderators and mediators will substantially inform the tailoring of interventions for YMSM in r...
The use of digital technologies to conduct large-scale research with limited interaction (i.e., no in-person contact) and objective endpoints (i.e., biological testing) have significant potential for the field of epidemiology, but limited research to date has been published on the successes and challenges of such approaches. We analyzed data from a cohort study of sexual minority men across the United States (US). collected using digital strategies during a 10-month period from 2017 to 2018. Overall, 113,874 individuals were screened, of whom 26,000 were invited to the study, 10,691 joined the study, and 7,957 completed all enrollment steps, including return of a human immunodeficiency virus (HIV)-negative sample. We examined group differences in completion of the steps towards enrollment to inform future research and found significant differences by several factors, including age and race. This study adds to prior work to provide further proof-of-concept for this limited interaction, technology-mediated methodology, highlighting some of its strengths and challenges, including rapid access to more diverse populations but also potential for bias due to differential enrollment. This method has strong promise and future implementation research is needed to better understand the roles of burden, privacy, access, and compensation, to enhance representativeness and generalizability of the data generated.
Given the ongoing HIV epidemic, it is essential to identify gay and bisexual men who are interested in starting PrEP as well as active PrEP users. We report on online survey data gathered over a 17-month period in 2014–2015 from gay and bisexual men identified via six sources of recruitment (n = 2903): Facebook, a hookup website, two geosocial-sexual networking apps (herein “App 1 – Pop up ads” and “App 2 – Banner ads”), and two types of listservs (one focused on general gay nightlife, and one focused on gay sex parties). Willingness to take PrEP were as follows: sex party listservs (71.3%), both Apps (69.8%), Facebook (67.6%), hookup website (65.2%), and nightlife listservs (50.5%). Experience having taken PrEP was as follows: sex party listservs (23.4%), App 2 – Banner ads (22.5%), nightlife listservs (17.1) Facebook (14.2%), App 1 – Pop-up ads (12.4%), and hookup website (2.1%). In multivariable modeling, willingness to go on PrEP was independently associated with being younger, single, a person of color, and having been tested for HIV in the last 12 months. Source of recruitment was largely unassociated with willingness to start PrEP. Number of recent male partners, number of recent condomless anal sex (CAS) events, and when data were collected (i.e., time in months) were not significantly associated with willingness to start PrEP. In multivariable models, experience having taken PrEP was positively associated with sexual identity as gay, number of recent male sex partners, number of recent CAS acts, being tested for HIV in the last 12 months, and time (in months). Experience taking PrEP varied greatly by recruitment source, suggesting both researchers and providers might be well served to utilize digital mediums to effectively identify these individuals; however, should do so with caution as not all digital options may prove fruitful.
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