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Assessment of U=U understanding, PrEP awareness, HIV risk behaviours and factors associated with low HIV knowledge among users of Hornet, an online dating application for LGBTQ, in Thailand
  1. Tanat Chinbunchorn1,2,
  2. Natapong Thaneerat1,3,
  3. Sean Howell4,
  4. Teaka Sowaprux5,
  5. Panyaphon Phiphatkunarnon5,
  6. Sita Lujintanon1,
  7. Quanhathai Kaewpoowat6,
  8. Praphan Phanuphak1,
  9. Nittaya Phanuphak1,
  10. Reshmie A Ramautarsing1
  1. 1 Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand
  2. 2 Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  3. 3 Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
  4. 4 Hornet, San Francisco, California, USA
  5. 5 Love Foundation, Bangkok, Thailand
  6. 6 Faculty of Medicine and Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
  1. Correspondence to Dr Tanat Chinbunchorn, Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, 02115; tanat_chinbunchorn{at}


Background Over 50% of HIV infections in Thailand annually occur among men who have sex with men (MSM) and transgender women who use online applications to meet their sexual partners. We conducted a cross-sectional study assessing undetectable=untransmittable (U=U) understanding, pre-exposure prophylaxis (PrEP) awareness, sexual behaviours and factors associated with HIV knowledge among users of Hornet in Thailand.

Methods From November 2019 to January 2020, a survey was conducted using convenience sampling on Hornet in Thailand. HIV literacy was assessed via 22 questions, and multivariable linear regression was performed.

Results 960 responses were assessed; median age was 34 years, the majority were MSM (80.4%), Thai (83.8%), had at least bachelor’s degree (74.9%). Regarding the risk profiles, 39.1% reported inconsistent condom use, 15.0% used amphetamine-type stimulants, 56.9% had not taken PrEP in the last six months and 20.5% never had an HIV test. Only 22.8% thought that U=U was completely accurate. Lower HIV knowledge was associated with being from Africa (β −8.13, 95% CI −14.39 to –1.87), age of 25 years or younger (β −2.6, 95% CI −4.37 to –0.82), education less than bachelor’s degree (β −2.58, 95% CI −3.98 to –1.19), having more than one sexual partners (β −2.41, 95% CI −4.13 to –0.69), paying three or more people to have intercourse (β −2.5, 95% CI −4.26 to –0.74), not knowing one’s HIV status (β −3.56, 95% CI −5.45 to –1.68) and not answering about previous PrEP use (β −4.11, 95% CI −7.86 to –0.36). Higher HIV knowledge was associated with being from Europe (β 2.54, 95% CI 0.46 to 4.61), the Americas (β 3.37, 95% CI 0.44 to 6.30) and previous PrEP use (β 2.37, 95% CI 0.94 to 3.81).

Conclusion Among Hornet users in Thailand, the U=U message was unclear, and PrEP use was suboptimal. Large HIV knowledge gaps and high-risk behaviours were concerning. Educational campaigns in online spaces are needed to promote awareness and HIV prevention strategies.

  • epidemiology
  • HIV
  • pre-exposure prophylaxis
  • sexual behavior

Data availability statement

Data are available on reasonable request. Data are available upon request.

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Data availability statement

Data are available on reasonable request. Data are available upon request.

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  • Handling editor Jason J Ong

  • Contributors TC, SH, TS, PP, QK and NP were involved in setting up the study and revising the questionnaires. TC and NT drafted the manuscript, and all authors commented on the subsequent versions. All authors approved the final manuscript. TC is the guarantor of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.