Exchange Sex and Condom Use Among Gay, Bisexual, and Other Men Who Have Sex with Men Who Use Social and Sexual Networking Technologies

The practice of sex work or exchange sex (having sex in exchange for money, drugs, shelter, or other things) and the risks for HIV and sexually transmissible infections (STIs) associated with it differ based on the venues where partners meet (e.g., streets, agencies, or the Internet). Although there is evidence that gay, bisexual, and other men who have sex with men (MSM) use social media and dating/hookup applications and websites to find exchange sex, little is known about this phenomenon. We used online survey data collected among MSM in New York City recruited through social/sexual networking technologies to learn more about the practice of exchange sex in this population. Overall, 28.8% of participants had ever exchanged (sold) sex, including 8.4% who had done so in the prior three months. Almost half (46.4%) of those who had ever exchanged sex had met their first client through a social/sexual networking app/website (that was not a website dedicated to sex work), and the majority (88%) of those who had exchanged sex in the prior three months had done so with a client met through these technologies. In multivariable analyses, those who had exchanged sex in the prior three months reported at least twice the number of condomless anal sex partners in that period (compared to those who never exchanged sex) after controlling for covariates (incidence-rate ratio [IRR] = 2.08, 95% confidence interval [CI] 1.52–2.84). Social/sexual networking technologies are important venues for finding exchange sex among MSM, a practice that may present high risk for HIV and/or STI transmission.

Identification of an HIV-1 and Neurosyphilis Cluster in Vermont

Background Rates of syphilis in the U.S. have more than doubled over the last several decades, largely among men who have sex with men (MSM). Our study characterizes a cluster of neurosyphilis cases among HIV-1-infected individuals in Vermont in 2017-2018. Methods Vermont Department of Health disease intervention specialists conduct interviews with all newly diagnosed HIV-1 cases and pursued sexual networking analyses. Phylogenetic and network analyses of available Vermont HIV-1 polymerase (pol) sequences identified clusters of infection. Fishers-exact and independent t-tests were used to compare HIV-1-infected individuals within or outside an identified cluster. Results Between January 1, 2017 and December 31, 2018, 38 Vermont residents were newly diagnosed with HIV-1 infection. The mean age was 35.5 years, 79% were male and 82% were white. Risk factors for HIV-1 acquisition included MSM status (79%) and methamphetamine use (21%). Eighteen cases (49%) had HIV-1 viral loads (VLs) >100,000 copies/mL and 47% had CD4 cell counts <200/mm 3. Eleven of the 38 (29%) cases had positive syphilis serology, including four (36%) with neurosyphilis. Sexual networking analysis revealed a ten-person cluster with higher VLs at diagnosis (90% with VLs > 100,000 copies/mL vs. 33%, p=0.015). Phylogenetic analysis of pol sequences showed a cluster of 14 cases with sequences that shared 98-100% HIV-1 nucleotide identity. Conclusions This investigation of newly infected HIV-1 cases in Vermont led to identification of a cluster that appeared more likely to have advanced HIV-1 disease and neurosyphilis. Identification of a cluster was strongly supported by both phylogenetic and network analyses of HIV-1 pol sequences.

Maximizing Response Rates to Ads for Free At-Home HIV Testing on a Men-for-Men Geosocial Sexual Networking App: Lessons Learned and Implications for Researchers and Providers

Internet-based recruitment can be effective in reaching large numbers of geographically diverse individuals. Geosocial sexual networking apps on smartphones have emerged as the modal way in which men who have sex with men (MSM) meet sex partners, and as venues for sexual health research. We report on the performance of three types of ads—text-only, text with male figure (no face), and text with male figure (with face)—used on a geosocial sexual networking app to advertise free at-home HIV testing and to enroll in an online study. We ran five 2-week-long ads on a popular MSM geosocial app between fall 2017 and spring 2018 (~2.19 million impressions). Ads were evaluated in terms of the click-through rate (CTR = advertisement clicks/advertisement impressions), conversion rates (CR = number of enrolled participants/ad-generated clicks), cost per enrolled participant, and demographic composition of survey respondents. We enrolled n = 4,023 individuals, n = 2,430 of whom completed HIV testing—$6.21 spent on advertising per participant enrolled and $10.29 spent for everyone who completed HIV testing. Cost per enrolled participant was associated with the content of the ad used—ads featuring male figures (with or without a face shown) were more cost efficient than ads featuring text alone. These ads also outperformed text-only ads across a range of metrics, including responsiveness among younger MSM as well as MSM of color. Advertising materials that combine text with images may have greater appeal among priority populations.

Stigma and Mobile App Use Among Young Black Men Who Have Sex With Men

Young black men who have sex with men (YBMSM) are disproportionately affected by HIV. Intersectional stigmas are associated with increased HIV vulnerability, and worse outcomes for YBMSM with HIV. YBMSM find sex partners through sexual networking apps, but stigma on apps has been poorly studied. We conducted cross-sectional analysis of 324 YBMSM seeking sex partners through apps to assess stigma experiences in eight dimensions compared to non-users (N = 150). We conducted detailed stratified analyses to identify granular stigma data. App users had higher median scores than non-users in perceived HIV discrimination, perceived HIV stigma, experienced sexual minority stigma, racial discrimination, and perceived homophobia. We demonstrate higher levels of intersectional stigmas among app users than non-users, but did not find an overall increase in stigma with increasing app use. Considering the prominent role of apps in YBMSM sexual networking, interventions that reduce stigma on apps are needed.