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

Objective: Gay and bisexual men who have sex with men (GBMSM) bear a disproportionate burden of sexually transmitted infections (STIs). Most STIs are asymptomatic and people infected wont know to seek care unless they are told about their exposure. Contact tracing, is the process of identifying and contacting sex partners of people with STIs for testing and treatment. Contact tracing is sometimes particularly challenging amongst GBMSM because of the kinds of sexual relationships which GBMSM enjoy. These include one-off partners who are particularly important for transmission dynamics as they contribute disproportionately to onwards transmission. The effectiveness of contact tracing interventions within sexual health are patterned by sexual-partner type. Contact tracing and management for one-off partners is an on-going public health challenge. Low motivation amongst index patients, high resource burden on health care professionals and problems with contactability are key barriers to contact tracing. Using insights from complex adaptive systems thinking and behavioural science, we sought to develop an intervention which addressed both the upstream and down-stream determinants of contact tracing and change the system in which many inter-dependent contact tracing behaviours are embedded. Setting UK community-recruited GBMSM, stakeholders, sexual hcp, dating app providers Method Using the MRC complex intervention framework and insights from the INDEX study, a three-phase intervention development process was adopted to specify intervention content. Phase one consisted of an inter-professional and community-member stakeholder event (n=45) where small mixed groups engaged in exploratory systems-mapping and the identification of hot spots for future intervention. Phase two used a series of focus groups with GBMSM (n=28) and interviews with representatives from key dating app providers (DAPs) (n=3) to further develop intervention ideas using the theoretical domains framework, the behaviour change wheel and the behaviour change technique taxonomy. In Phase 3 we again worked with key stakeholders expert health care professionals (HCPs) (n=5) and key workers from community-based organisations (CBOs) (n=6) to hone the intervention ideas and develop programme theory using the APEASE criteria. Results The co-produced intervention levers change simultaneously across the system within which contact tracing is embedded. Multiple change-agents (i.e., GBMSM, CBOs, HCPs) work together, sharing an overall vision to improve sexual health through contact tracing. Each make relatively modest changes that over time, synergistically combine to produce a range of multiple positively-reinforcing feedback loops to engender sustainable change around contact tracing. Agreed intervention elements included: a co-ordinated, co-produced mass and social media intervention to tip cultural norms and beliefs of GBMSM towards enabling more contact tracing and to challenge enduring STI- and sex-related stigmas; complementary CBO-co-ordinated, peer-led work to also focus on reducing STI stigma and enabling more contact tracing between one-off partners; priming GBMSM at the point of STI diagnosis to prepare for contact tracing interactions and reduce HCP and sexual health-service burden; changes to SHS environments and HCP-led interactions to systematically endorse contact tracing; changing national audits and monitoring systems to directly address one-off partner targets; delivering bespoke training to HCPs and CBO staff on one-off partners and the social and cultural context of GBMSM; DAPs active involvement in mass and social media promoting appropriate contact tracing messaging. Conclusion Our combination of multiple data sources, theoretical perspectives and diverse stakeholders have enabled us to develop an expansive, complex intervention that is firmly based in the priorities of those it will affect, and which has a solid theoretical foundation. Future work will assess if and how it will be possible to evaluate it. The resulting intervention is profoundly different than other ways of enhancing contact tracing, as it simultaneously addresses multiple, multi-levelled, upstream and social determinants of contact tracing.

Download Full-text

Using Social Media to Increase HIV Testing Among Gay and Bisexual Men, Other Men Who Have Sex With Men, and Transgender Persons: Outcomes From a Randomized Community Trial: Table 1.

Clinical Infectious Diseases ◽

10.1093/cid/ciw127 ◽

2016 ◽

Vol 62 (11) ◽

pp. 1450-1453 ◽

Cited By ~ 49

Author(s):

Scott D. Rhodes ◽

Thomas P. McCoy ◽

Amanda E. Tanner ◽

Jason Stowers ◽

Laura H. Bachmann ◽

...

Keyword(s):

Social Media ◽

Hiv Testing ◽

Gay And Bisexual Men ◽

Bisexual Men ◽

Transgender Persons ◽

And Bisexual ◽

Sex With Men ◽

Community Trial

Download Full-text

Pilot Trial of a Sexual Health Counseling Intervention for HIV-Positive Gay and Bisexual Men Who Report Anal Sex without Condoms

10.32920/14640234.v1 ◽

2021 ◽

Author(s):

Trevor A. Hart ◽

Natalie Stratton ◽

Todd A. Coleman ◽

Holly A. Wilson ◽

Scott H. Simpson ◽

...

Keyword(s):

Sexual Transmission ◽

Psychosocial Outcomes ◽

Gay And Bisexual Men ◽

Sexual Compulsivity ◽

Hiv Positive ◽

Bisexual Men ◽

Anal Sex ◽

Counseling Intervention ◽

And Bisexual ◽

Sex With Men

Background Even in the presence of promising biomedical treatment as prevention, HIV incidence among men who have sex with men has not always decreased. Counseling interventions, therefore, continue to play an important role in reducing HIV sexual transmission behaviors among gay and bisexual men and other men who have sex with men. The present study evaluated effects of a small-group counseling intervention on psychosocial outcomes and HIV sexual risk behavior. Method HIV-positive (HIV+) peer counselors administered seven 2-hour counseling sessions to groups of 5 to 8 HIV+ gay and bisexual men. The intervention employed information provision, motivational interviewing, and behavioral skills building to reduce sexual transmission risk behaviors. Results There was a significant reduction in condomless anal sex (CAS) with HIV-negative and unknown HIV-status partners, from 50.0% at baseline to 28.9% of the sample at 3-month follow-up. Findings were robust even when controlling for whether the participant had an undetectable viral load at baseline. Significant reductions were also found in the two secondary psychosocial outcomes, loneliness and sexual compulsivity. Conclusions The findings provide preliminary evidence that this intervention may offer an efficient way of concurrently reducing CAS and mental health problems, such as sexual compulsivity and loneliness, for HIV+ gay and bisexual men. Trial Registration ClinicalTrials.gov NCT02546271

Download Full-text

Helping a Buddy Out

10.18574/nyu/9781479801091.003.0006 ◽

2021 ◽

pp. 141-157

Author(s):

Tony Silva

Keyword(s):

Sexual Identity ◽

Small Town ◽

Gay And Bisexual Men ◽

Sexual Practices ◽

Hooking Up ◽

Bisexual Men ◽

Male Sex ◽

And Bisexual ◽

Sex With Men ◽

Three Components

The men interviewed interpreted sex with men as compatible with heterosexuality and masculinity. What the author calls “bud-sex” is the way rural and small-town, white, straight men interpret or engage in sex in ways that reinforce their heterosexuality and masculinity. While the sex these men have with other men involves acts similar to those between gay and bisexual men, the meanings they attach to these acts differ greatly. Bud-sex has three components. First is hooking up with other masculine, white, and straight or bisexual men. Second is having secretive, nonromantic sex. And third is interpreting male-male sex as largely unthreatening to masculinity, heterosexuality, or marriage. Bud-sex, with its unique understandings of gender and sexual identity, reflects and reinforces the men’s embeddedness in straight culture. Sexual identity and masculinity depend on what sex acts mean, rather than on mere mechanics. Consequently, interpretations of sexual practices, not sexual practices in and of themselves, are crucially important. For the straight men interviewed, their interpretations both reflected and reinforced their embeddedness in straight culture. Bud-sex allows straight men to enjoy male-male sex without threatening either their heterosexuality or their masculinity.

Download Full-text

General practitioner awareness of sexual orientation among a community and internet sample of gay and bisexual men in New Zealand

Journal of Primary Health Care ◽

10.1071/hc15204 ◽

2015 ◽

Vol 7 (3) ◽

pp. 204 ◽

Cited By ~ 6

Author(s):

Adrian Ludlam ◽

Peter Saxton ◽

Nigel Dickson ◽

Anthony Hughes

Keyword(s):

General Practice ◽

Sexual Orientation ◽

Gay And Bisexual Men ◽

Anal Intercourse ◽

Bisexual Men ◽

Transmitted Infection ◽

Missed Opportunities ◽

Hiv Test ◽

And Bisexual ◽

Sex With Men

INTRODUCTION: General practitioners (GPs) can improve HIV and sexually transmitted infection (STI) screening, vaccination and wellbeing among gay, bisexual and other men who have sex with men (GBM) if they are aware of a patient?s sexual orientation. AIM: To estimate GP awareness of their GBM patients' sexual orientation and examine whether HIV and STI screening was associated with this. METHODS: We analysed anonymous, self-completed data from 3168 GBM who participated in the community-based Gay Auckland Periodic Sex Survey (GAPSS) and internet-based Gay men's Online Sex Survey (GOSS) in 2014. Participants were asked if their usual GP was aware of their sexual orientation or that they had sex with men. RESULTS: Half (50.5%) believed their usual GP was aware of their sexual orientation/behaviour, 17.0% were unsure, and 32.6% believed he/she was unaware. In multivariate analysis, GP awareness was significantly lower if the respondent was younger, Asian or an 'Other' ethnicity, bisexual-identified, had never had anal intercourse or had first done so very recently or later in life, and had fewer recent male sexual partners. GBM whose GP was aware of their sexual orientation were more likely to have ever had an HIV test (91.5% vs 57.9%; p<0.001), specific STI tests (91.7% vs 68.9%; p<0.001), and were twice as likely to have had an STI diagnosed. DISCUSSION: Lack of sexual orientation disclosure is resulting in missed opportunities to reduce health inequalities for GBM. More proactive, inclusive and safe environments surrounding the care of sexual orientation minorities are needed in general practice to encourage disclosure. KEYWORDS: Culturally competent care; general practice; HIV; HPV; sexual health; sexual orientation

Download Full-text

1281. Awareness of U=U Among Gay and Bisexual Men Who Have Sex with Men

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1144 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S461-S461

Author(s):

Meredith E Clement ◽

Rick Zimmerman ◽

Josh Grimm ◽

Joseph Schwartz

Keyword(s):

Hiv Transmission ◽

Gay And Bisexual Men ◽

Bisexual Men ◽

Hiv Status ◽

Anal Sex ◽

And Bisexual ◽

Sex With Men ◽

Living With Hiv ◽

Hiv Negative ◽

Strong Agreement

Abstract Background The “Undetectable = Untransmittable” (“U=U”) campaign is gaining traction, but prior studies from 2012–2017 have shown that the proportion of gay and bisexual men who have sex with men (GBMSM) who are aware of or have perceived accuracy of U=U is low. We report findings from a survey administered to GBMSM in 2018 to understand whether the landscape is changing with respect to U=U message dissemination. Methods GBMSM were recruited on gay dating apps to complete a 96 question survey. Survey data were collected in April-August of 2018. Collected data elements included demographic information, HIV status, ART and PrEP use, and beliefs and opinions regarding HIV transmission. Results 969 GBMSM completed the survey; of whom, 678 had analyzable data (241 had never had anal sex with a man and 54 were missing ≥1 of the variables used in the analysis). Average age was 43 years, 65% were white, 15% black, 15% white, and 15% were HIV-infected (of whom 92% were on anti-retrovirals). Of the 85% who were HIV-uninfected, 39% were on PrEP. In response to the statement that a person with an undetectable viral load cannot transmit HIV to an HIV-uninfected person, 24% strongly agreed. Among HIV-negative GBMSM, 33% of those on PrEP agreed and 12% of those not on PrEP agreed. Among those living with HIV, 42% agreed. A multivariable logistic regression was run to explain correlates of strong agreement with U=U, using the following variables: age, education, being Black, being Hispanic, relationship status, number of lifetime male sexual partners, condom use with most recent anal sex, HIV status, PrEP use, and attitudes about living with HIV. Variables associated with strong agreement with U=U were living with HIV (AOR = 1.63, P < 0.001), taking PrEP (AOR = 2.85, P < 0.001), most recent encounter’s condom use (AOR = 2.22, P = 0.003), and having positive attitudes about living with HIV (AOR= 1.93, P < 0.001). Table 1 shows percentages for each of these variables (bivariate relationships) strongly agreeing with U=U. Conclusion Now that U=U has been scientifically proven, the challenge is public awareness. U=U awareness seems to be improving among GBMSM, with HIV-negative GBMSM making the greatest strides. Education around U=U and PrEP efficacy may help reduce guilt around HIV transmission and alleviate HIV stigma. Disclosures All authors: No reported disclosures.

Download Full-text

Sharing solutions for a reasoned and evidence-based response: chemsex/party and play among gay and bisexual men

Sexual Health ◽

10.1071/sh18023 ◽

2018 ◽

Vol 15 (2) ◽

pp. 99 ◽

Cited By ~ 2

Author(s):

Adam Bourne ◽

Jason Ong ◽

Mark Pakianathan

Keyword(s):

Sexual Health ◽

Gay And Bisexual Men ◽

Evidence Based ◽

Bisexual Men ◽

Special Issue ◽

Quality Health Care ◽

Healthcare Practice ◽

Quality Health ◽

And Bisexual ◽

Sex With Men

This Special Issue of Sexual Health examines research and healthcare practice relating to sexualised drug use among gay, bisexual and other men who have sex with men (GBMSM), colloquially known as ‘chemsex’ or ‘party and play’ (PnP). It draws together evidence relating to the epidemiology, sociology and psychology of chemsex, as well as the policy, community and clinical interventions that are required to ensure men have access to high-quality health care that meets their needs and reduces harm. Findings and discussions within the Issue emphasise the need to sensitively, non-judgementally and meaningfully engage with gay men about their engagement in chemsex in order to help improve their sexual health and wider wellbeing.

Download Full-text

Predictors of Facebook User Engagement With Health-Related Content for Gay, Bisexual, and Other Men Who Have Sex With Men: Content Analysis (Preprint)

10.2196/preprints.8145 ◽

2017 ◽

Author(s):

Kiffer George Card ◽

Nathan Lachowsky ◽

Blake W Hawkins ◽

Jody Jollimore ◽

Fahmy Baharuddin ◽

...

Keyword(s):

Negative Binomial ◽

Negative Binomial Regression ◽

Application Programming Interface ◽

Well Being ◽

Gay And Bisexual Men ◽

User Engagement ◽

Bisexual Men ◽

And Bisexual ◽

Sex With Men ◽

Health Content

BACKGROUND Social media is used by community-based organizations (CBOs) to promote the well-being of gay and bisexual men (GBM). However, few studies have quantified which factors facilitate the diffusion of health content tailored for sexual minorities. OBJECTIVE The aim of this study was to identify post characteristics that can be leveraged to optimize the health promotion efforts of CBOs on Facebook. METHODS The Facebook application programming interface was used to collect 5 years’ of posts shared across 10 Facebook pages administered by Vancouver-based CBOs promoting GBM health. Network analysis assessed basic indicators of network structure. Content analyses were conducted using informatics-based approaches. Hierarchical negative binomial regression of post engagement data was used to identify meaningful covariates of engagement. RESULTS In total, 14,071 posts were shared and 21,537 users engaged with these posts. Most users (n=13,315) engaged only once. There was moderate correlation between the number of posts and the number of CBOs users engaged with (r=.53, P<.001). Higher user engagement was positively associated with positive sentiment, sharing multimedia, and posting about pre-exposure prophylaxis, stigma, and mental health. Engagement was negatively associated with asking questions, posting about dating, and sharing posts during or after work (versus before). CONCLUSIONS Results highlight the existence of a core group of Facebook users who facilitate diffusion. Factors associated with greater user engagement present CBOs with a number of strategies for improving the diffusion of health content.

Download Full-text

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

10.2196/preprints.9321 ◽

2017 ◽

Author(s):

Stefan Baral ◽

Rachael M Turner ◽

Carrie E Lyons ◽

Sean Howell ◽

Brian Honermann ◽

...

Keyword(s):

Social Media ◽

Hiv Prevention ◽

Population Size ◽

The United States ◽

Size Estimation ◽

Same Sex ◽

Care Needs ◽

Population Size Estimates ◽

Sex With Men ◽

Size Estimates

BACKGROUND 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, Côte 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.

Download Full-text