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In the last decade there has been a sharp increase in the spread of smartphones, with a parallel increase in the use of geosocial networking (GSN) applications (apps) in men who have sex with men (MSM). One of the most popular uses of GSN apps among MSM is for finding nearby sexual or romantic partners. GSN apps such as Grindr, Hornet, Jack’d and Scruff have become quite popular and there are now tens of millions of MSM who use such apps globally.1 In a meta-analysis of MSM GSN users, app users versus non-app users were found to be younger, more likely to engage in risky sexual behaviours and have a higher prevalence of prior STIs, but lower prevalence of HIV.1 It has become of great interest to see whether GSN apps can also be used as platforms to promote increased sexual health awareness and testing for HIV and STIs.
There have been several types of interventions that have used apps to promote HIV and STI awareness and testing. One approach has been to use stand-alone HIV/STI apps that have been created to provide services such as information about HIV/STIs, testing information and condom promotion. However, these apps were infrequently downloaded and not highly rated, limiting their effectiveness.2 An alternative approach is to use existing popular GSN apps to promote HIV and STI testing. Some groups have used advertising/pop-up messaging within GSN apps for this purpose. This method has been used within Grindr to recruit MSM in Los Angeles, California for rectal microbicide development research,3 increase syphilis testing in Darwin, Australia,4 and increase HIV self-testing among minority MSM in Los Angeles, California.5 A more proactive approach has also been taken in which health educators create user profiles within GSN apps to allow for ‘chatting’ with app users to promote HIV/STI testing or provide linkage to testing or other prevention services. Grindr has been used in an intervention targeting suburban MSM in San Mateo County, California, in which health educators, using profiles with stock image avatars of young men, would provide information for HIV and STI testing to app users who initiated chats. The intervention was acceptable and increased the MSM reached for counselling and education by 14-fold. Although 816 MSM made contact with health educators through Grindr, only 14 people actually presented for testing.6 Another multiplatform intervention (A4A Radar, Grindr, Jack’d, Scruff) in North Carolina used a similar model in which health educators created profiles with photos of themselves dressed in business casual attire. All interactions were initiated by the target population. While the overall acceptability of this intervention was good, there were no data on HIV/STI follow-up testing or effectiveness.7
In this study by Alarcón Gutiérrez and colleagues,8 a multiplatform intervention was implemented in Barcelona in which investigators located at two ASPB sites (Barcelona’s Public Health Agency) initiated chats with nearby adult MSM users of the GSN apps Grindr, PlanetRomeo and Wapo who were using the app at the time of contact or within the prior 7 days. App users were offered referrals to free HIV, syphilis, hepatitis C testing as well as hepatitis A and B vaccination at the two ASPB sites. The response rate was 38.4% to the 2656 individual messages that were sent during the 4-month intervention, and of those 1020 who responded, 83.0% found the contact acceptable. A smaller group of 108 people expressed interest in receiving referrals of whom 79 (73%) people showed up to receive testing or vaccination.
While many other studies have performed interviews and surveys suggesting high potential acceptability of GSN app-based interventions, this study provided evidence on real-life acceptability and effectiveness of a GSN app intervention, with clear enumeration of the drop-off at each step between outreach, contact, referral and testing or vaccination. That information is difficult to track and often missing from other studies. The authors also provide characteristics of those who responded to messages, as well as attended HIV/STI services, which offers revealing insight into the actual uptake of the intervention. Interestingly, of those who followed through with testing/vaccination, almost half had a country of origin other than Spain, which may reflect the increased need of that group for prevention services. Many also had characteristics of high-risk individuals; almost half had not had an HIV test in the last year and about a quarter had a previous STI diagnosis. More targeted outreach to those who did not follow-up with testing is needed, either through optimisation of this intervention, or through other means. Other strengths of this study include the large number of messages sent and the multiplatform nature of the intervention, enabling a broad reach. The study also had a larger proportion of referred people who followed up with testing compared with other similar interventions,6 though the overall number was still small.
What truly sets this intervention apart from others was the proactive method that was used to contact individuals. Instead of the pop-up ad or the passive approach of waiting for users to initiate chats, study staff initiated chats with those who were in close proximity to the testing sites and who recently used the apps. This approach likely contributed to higher uptake since the intervention was temporally and geographically targeted. That many users found this acceptable is an important contribution to the field.
While this intervention was shown to be feasible, acceptable and effective, the impact of the intervention was limited by the timing and narrow scope of the services offered. Because of the clinic-based nature of the referrals, the reach was limited to those who were within close proximity to the ASPB clinics and who were using the GSN apps during business hours. Regarding the scope of services, gonorrhoea and chlamydia testing was not offered, and only 22 individuals received syphilis testing because of supply issues. In the era of HIV pre-exposure prophylaxis (PrEP), this could have been an opportune time to engage high-risk individuals in HIV prevention services including PrEP and/or condom promotion. More comprehensive sexual health services are needed to optimise the health of MSM.
As GSN apps have become ubiquitous, it will be increasingly important to understand the effect they have on sexual networks and sexual practices. This study shows that existing GSN apps can be harnessed to deliver prevention and testing messages to users. While this study provides important insights, some of which may be generalisable, there may be specific cultural, logistic, geographic or sociobehavioural factors that need to be tailored to different contexts or populations. Nevertheless, this study provides important information for the Barcelona context, as most other similar studies have been performed in the USA, Australia and China.1
Furthermore, GSN apps and technologies are rapidly changing and require close following in order to adapt the interventions to remain relevant and effective to the target populations. For example, Grindr has recently created a feature that enables users to receive HIV testing reminders at certain intervals and contains a link to websites that enable users to find nearby testing sites.9 There is also a community messaging programme that works with groups worldwide to deploy messaging on advocacy, health and safety information, including HIV testing, based on geolocation technology.10 As technology evolves it will be important to ensure that interventions preserve the privacy of users and that app policies are not violated.
Finally, the impact of GSN app interventions for HIV and STI testing will be greater if testing promotion can be integrated with services that are not linked to brick and mortar clinics which have limited hours and locations. Examples of novel interventions include the use of vending machines to offer HIV tests,11 home specimen collection for STI testing12 and using GSN app pop-up messages to refer users to a website to order home-delivered HIV self-test kits.5 Ultimately, GSN apps are just one method of reaching MSM who may be at high risk for HIV and STIs, but multiple methods, including other social media platforms13 and traditional outreach, are needed to curb the HIV and STI epidemics among MSM.
Handling editor Jackie A Cassell
Contributors JYC and JDK collaborated to develop a detailed outline. JYC wrote the first draft. JDK revised and expanded the manuscript. Both authors revised, reviewed and approved the final version.
Funding This study was funded by the National Institute of Allergy and Infectious Diseases (10.13039/100000060) and grant number: UCLA Center for AIDS Research (CFAR) NIH/NIAID AI028697.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.
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