Background Mobile phone apps are now the most popular method that Australian gay men use to find sex partners. Partner-seeking mobile phone apps use location functions to identify like-minded men and display their proximity. This study examines whether meeting partners via mobile apps is associated with a greater risk of HIV and sexually transmitted infections (STIs) than with other ways of meeting partners.
Methods Data were analysed from the Gay Community Periodic Surveys, community-based, cross-sectional surveys conducted in Australian state capital cities between 2010 and 2014. χ2 tests and multinomial logistic regression were used to analyse differences in risk profiles of men who used different methods to meet partners.
Results Data were analysed from 36 428 men who participated in the Gay Community Periodic Surveys between 2010 and 2014. In 2014, 4116 men reported meeting sex partners with the use of mobile apps, increasing from 23.9% in 2011 to 42.5% in 2014. Men who used a combination of online and offline methods reported a greater number of sex partners and were more likely to report a recent STI than men who used online methods only or offline methods only.
Conclusions There has been a steep increase in the use of mobile phone apps by gay men in Australia to meet male partners. However, men who use a combination of mobile phone apps, internet websites and offline places to meet partners appear to be at increased risk of STIs or HIV compared with men who use a narrower range of online and offline methods.
- GAY MEN
- SEXUAL BEHAVIOUR
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The internet has been widely used by gay and bisexual men to find sex partners for almost 20 years.1 ,2 In Australia and other locations, the uptake of internet sex-seeking by gay and bisexual men has been paralleled by a decline in the use of other ways to meet partners, such as gay bars and sex venues.2–7 More recently the introduction of mobile phones with internet capabilities (smartphones) and global positioning system (GPS) functions has allowed the development of new applications (‘apps’) on mobile devices that can identify potential partners by proximity and location. Mobile apps were first introduced in 2008.8 The mobile app Grindr was released in 2009 and was the first to allow gay men to find potential sex partners nearby by using GPS functions. Many competitor applications have since been launched. The recent uptake in use of mobile phone apps appears to have resulted in a decline in the use of the internet and other methods (like going to venues) to meet partners in Australia.5 ,9 ,10 Mobile phone apps have become the most common way for gay and bisexual men to meet male sex partners in Australia, reported by >40% of men in some states.5 ,9–11 It is unclear whether the uptake in use of mobile phone apps will affect sexual practices or risks for HIV and other sexually transmitted infections (STIs) among gay and bisexual men. This is important to understand as HIV epidemics among gay and bisexual men appear to be resurging in many developed countries, including Australia.12 ,13
Because mobile apps are a relatively recent development, there has been relatively little published on their use by gay and bisexual men and the associations with HIV and STI risks. One of the few relevant publications compared STI rates among gay and bisexual men in Los Angeles, finding that those who used mobile apps, either alone or in combination with other methods, to meet male partners had higher rates of gonorrhoea and chlamydia (but similar rates of HIV and syphilis) compared with those who did not.14 Previous research on internet sex-seeking suggests that the effect of mobile sex-seeking by gay and bisexual men on HIV and STI risks may be variable. The rapid increase in popularity of internet sex-seeking during the 1990s led many researchers to hypothesise that this uptake may have contributed to an increase in HIV and STI-related risk-taking by gay and bisexual men.2 ,15 In particular, it was hypothesised that the apparent efficiency of meeting partners through the internet, the relative anonymity of online partner-seeking and the ability to advertise for partners with whom one could have sex without condoms could lead to an increase in HIV and STI-related risks. Some studies did find an association between internet sex-seeking and higher rates of risk behaviours such as condomless anal intercourse and a greater number of sex partners.15–17 However, other studies found no difference in risk-taking with partners met online or offline, particularly when the HIV status of partners was considered.2 ,18 ,19 Some studies found lower levels of risk-taking with partners met through the internet.20 These mixed findings suggest that technological developments in partner-seeking do not necessarily have straightforward effects on HIV and STI risks among gay and bisexual men.
Given the rapid uptake of mobile apps as a way to find partners by Australian gay and bisexual men, we decided to assess whether men who met sex partners using mobile phone apps reported higher rates of HIV and STI-related risk practices (such as number of partners, anal sex without condoms, HIV/STI testing and recent STI diagnoses).
The analyses compare men who use mobile phone apps in combination with internet websites and offline methods to meet male partners with (i) those who use mobile apps and the internet but no offline methods to meet partners and (ii) those who exclusively use offline methods to meet partners.
The Gay Community Periodic Surveys (GCPS) are cross-sectional surveys conducted annually or biennially in the largest cities of most Australian states and territories. The study protocol was approved by the University of New South Wales Human Research Ethics Committee (IRB00001145, project HC13366). GCPS procedures have been described in detail elsewhere.3 Participants are recruited by trained staff at festival events, gay bars, gyms, sex-on-premises venues and sexual health clinics. Participants complete an anonymous self-complete questionnaire which includes questions on relationships, sexual behaviour, HIV and STI testing, drug use and demographics. The questionnaire contains approximately 60–70 items.3 The response rate is typically 60%–70%. Participants recruited in Sydney, Melbourne, Brisbane, Adelaide and Perth from 2010 to 2014 were included in this analysis.
Men were asked where they had met sex partners in the previous 6 months and a list of options were presented (see table 1). Mobile app use was added in 2011. Response categories of ‘never’, ‘occasionally’ and ‘often’ were dichotomised into ‘never’ versus ‘sometimes’ for each place and method. Men who found partners at any listed place were first classified into seven groups depending on the places/methods used to meet their male sex partners in the past 6 months (see online supplementary appendix 1). The men were then classified into three groups based on methods used and number of different partners. Men were classified as ‘offline only’ if they had met partners but not used mobile apps or the internet, ‘online only’ if they only used mobile apps and/or the internet to meet partners or ‘online and offline’ if they used any combination of mobile app, internet and offline methods to meet partners. The number of places that men used was also calculated.
A range of demographic and behavioural variables were included as independent variables, including age, ethnicity, employment status and education level. Sex practices in the previous 6 months were included, specifically anal intercourse with casual and regular male partners and the number of different male partners. Regular partners are defined as ‘boyfriend/lover’ in the questionnaire; casual partners are not defined.
Data were analysed using SPSS V22. Statistical significance was set at p<0.05. χ2 tests for linear trends were used to assess changes over time in the proportions of men that found male sex partners through each of the listed places/methods. All survey participants were included in this analysis.
For the assessment of factors associated with different ways of meeting male partners, only data from the 2014 survey year was used. Bivariate associations between the type of method used to meet sex partners (offline only, online only, online and offline) and demographic and behavioural variables were analysed using χ2 tests for categorical variables and analysis of variance for age.
Variables that were found to be associated with a method of meeting partners in bivariate analyses (p<0.05) were entered into a multinomial regression procedure to identify statistically independent differences between the groups. The reference group for the multinomial regression was men who used both online and offline methods to meet male partners. Adjusted ORs and 95% CIs for the ORs were calculated.
Between 2010 and 2014, 36 428 men completed surveys in Sydney, Melbourne, Brisbane, Adelaide and Perth. Around two-thirds of all participants (n=23 515, 64.6%) reported finding at least one male sex partner using the places and methods listed in table 1. Except for mobile phone apps and sex workers, there were significant declines in the proportions of men that met sex partners at all other places and methods listed between 2010 and 2014. Mobile phone apps was the only method that showed an increase in use during the reporting period.
Only a small minority of men exclusively used online methods to meet partners, although this increased over time (from 5.9% in 2011 to 11.0% in 2014). A slightly larger proportion of men used offline methods only, although this has fallen over time (from 27.3% in 2011 to 15.0% in 2014). The proportion that used both online and offline methods increased significantly to 39.1% in 2014 while the proportion of men (around a third) who indicated that they had not used any of the listed places or methods to meet male partners remained stable. Over half of the men who had not recently met partners were recruited at gay community events (56.9%) and most (90.0%) reported none or one partner. About two-thirds (63.2%) of these men were in monogamous relationships.
In 2014, 6321 men participated. Two-thirds of these men (n=4116, 65.1%) indicated they had met male sex partners through one or more of the listed methods in the 6 months prior to survey and were included in the analysis of characteristics associated with different ways of looking for partners (table 2). A minority (17%) reported finding partners using online methods only, and 23% reported using offline methods only. The majority (60.0%) met partners using both online and offline methods. Men who used only offline methods to meet men were significantly older, reported fewer male sex partners and were less likely to report anal sex without condoms with casual partners than men who used both online and offline methods. They also reported lower rates of HIV and STI testing and STI diagnoses. Men in the online only group were a similar age to men in the online and offline group, although they reported fewer sex partners and were less likely to report anal sex without condoms with casual partners. Men in the combined online and offline group were the most likely to report illicit drug use, anal sex without condoms with casual partners, recent testing for HIV or STI and a diagnosis of an STI other than HIV in the previous 12 months.
Variables that were significantly associated with different ways of meeting sexual partners at a bivariate level (table 2) were entered into a multinomial regression model (table 3). The variables associated with the mode that men used to meet sex partners were age, employment, number of different sex partners, recent HIV testing, recent STI testing, recent STI diagnosis, condomless anal intercourse with casual partners (CAIC), illicit drug use and city of recruitment.
Compared with the men in the online and offline group, men in the offline only group were significantly older, while men in the online only group were a similar age. There was no significant difference in employment for men in the online only group, compared with the online and offline group. However, men in the offline only group were less likely to report being employed. The multinomial regression showed that men in the online only and offline only groups were less likely to report a higher number of male sex partners compared with the online and offline group.
Compared with the men in the online and offline group, men in the online only group were similarly likely to report an HIV test in the previous 12 months. However, men in the offline only group were about half as likely to report having an HIV test in the previous 12 months. Men in the online only group were less likely to report recent STI testing than men in the online and offline group, and along with the men in the offline group were less likely to report a recent STI diagnosis. Engaging in CAIC was less likely to be reported by men in the offline only group compared with men who used a combination of online and offline methods. Men in the online group were similarly likely to the men in the online and offline group to report CAIC.
There were differences between the cities where men were recruited and the mode of meeting sex partners. When comparing men in the online only group with the online and offline group, there was no difference in the proportions recruited in Sydney compared with the proportions recruited in the other cities. However, there were smaller proportions of men recruited in Melbourne, Brisbane, Adelaide and Perth who reported only finding sex partners offline compared with men in Sydney (indicating a higher proportion of men in Sydney who meet partners using only offline methods, like venues).
Given the rapid uptake of mobile phone apps to meet partners by Australian gay and bisexual men, we investigated whether the use of mobile apps to meet sex partners would be associated with an elevated risk of HIV and other STIs. Our results suggest that Australian gay and bisexual men who use mobile phone apps to meet sex partners are not necessarily more likely to report high risk behaviours than other men. Men who used mobile apps or the internet but no offline methods of meeting partners reported fewer risk behaviours than men who used a mixture of online and offline methods. Risk for HIV and other STIs was elevated among men who used the broadest range of methods to meet partners (both online and offline). Men who used a broader range of methods to meet partners also reported the highest number of male sex partners overall. These results are similar to a recent study that found that men who used mobile apps either alone or in combination with the internet and offline places to meet sex partners were at an increased risk for STIs.14 However, our results also show that men who solely rely on online methods, the majority of whom use mobile apps either exclusively or in combination with internet sites, did not show an increased risk for STIs compared with men who use both online and offline methods.
While the proportion of Australian gay and bisexual men who meet sex partners through the internet has declined slightly since 2011, the proportion using mobile apps to meet sex partners has almost doubled during the same period, from 24% to 43%. This demonstrates a shift from desktop and laptop devices to more portable computing devices such as tablets and smartphones.
Our multivariate analysis showed some differences between men that used a range of online and offline methods to meet partners, compared with men who only used online or offline methods. Compared with men who used both online and offline methods, men who used only online methods were a similar age but were less likely to report a recent STI test or diagnosis or illicit drug use. Men who used only offline methods to meet sex partners were older, less likely to be employed, less likely to have a recent HIV test, less likely to have a recent STI diagnosis and reported fewer partners compared with men who used mobile, internet and offline methods. These patterns suggest that men who rely on a narrower range of methods to meet partners (ie, online only or offline only) report fewer risks for HIV and other STIs. This pattern is also consistent with studies of internet sex-seeking that have not found an increased risk of HIV or STIs.18 ,20 ,21
There are a number of limitations of this study. First, our cross-sectional data do not allow analysis of the practices of individual men over time. Second, we may have underestimated the proportion of participants who use only mobile apps to meet partners because some mobile app users may have also selected the internet as a place where they meet sex partners (because they perceive that mobile apps are internet-based). Similarly, someone could be using a mobile app within another venue (like a gay bar), go on to meet someone there and select both mobile app and bar as the places where a sex partner was met. Last, our cross-sectional, aggregated survey data do not include information about the sex practices engaged in with particular partners through specific methods. So for men who use a combination of online and offline methods we are unable to determine whether sexual practices and risk behaviour are different with partners met via specific methods. One of the strengths of our analysis is the broad sample drawn from five cities and a wide range of venues and events. This sampling method allows the results to be generalised to other cities in Australia and possibly to other countries with similar gay community structures. Our research has repeatedly shown that these community-based samples of gay and bisexual men are at the highest risk of HIV in Australia.3
Our results demonstrate the growing popularity of mobile phone applications among Australian gay and bisexual men to meet sex partners. At the very least, this suggests that HIV prevention and health promotion should use mobile phones as a medium through which to engage gay and bisexual men (and Australian organisations increasingly do so in their educational activities and campaigns). However, mobile app use does not in itself appear to lead to increased risk-taking or risk of infection. In fact, men who use mobile apps to meet partners, either exclusively or in combination with internet sites, appear to be slightly less at risk than other men, indicating that there is no need for a panicked response to the growing popularity of mobile sex-seeking apps. Instead, our results indicate that men with a broader range of partner-seeking practices (incorporating mobile phones, the internet, bars and sex venues) have the most sex partners and report higher rates of risk practices such as condomless sex with casual partners. This suggests that HIV prevention and health promotion efforts should continue to engage with men whose practices place them at increased risk of HIV and other STIs, rather than focusing on one mode of meeting partners. Mobile phones are one way to reach gay and bisexual men at increased risk, but they are not the only way (and nor should they be an exclusive focus of any educational or engagement strategy).
The proportion of gay men finding sex partners through mobile phone apps has almost doubled from 24% to 43% between 2011 and 2014.
Men who used only online or only offline methods to meet sex partners reported fewer partners and were less likely to report a recent sexually transmitted infection (STI).
Risk for HIV and other STIs appears to be elevated among men who use a broader range of methods to find partners.
The authors thank all the participants in the Gay Community Periodic Surveys and the state and territory AIDS Councils that undertook the recruitment.
Handling editor Jackie A Cassell
Contributors MH, PH, GP, IZ, JdW and LM contributed to the design of the Gay Community Periodic Surveys, including questionnaire construction, data collection, analysis and reporting. MH and PH had the idea for the analysis presented here and took primary responsibility for writing and revising the paper. PH undertook the statistical analysis, with inputs from MH, LM and JdW, and drafted the methods and results sections. All authors commented on drafts of the paper and agreed with the final version.
Funding The Centre for Social Research in Health and The Kirby Institute receive funding from the Australian Government Department of Health and Ageing. The Gay Community Periodic Surveys are funded by the health departments from each participating state and territory.
Competing interests None declared.
Ethics approval UNSW Human Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.