Kiffer G. Card

Including Online-Recruited Seeds: A Respondent-Driven Sample of Men Who Have Sex With Men

Background Technology has changed the way men who have sex with men (MSM) seek sex and socialize, which may impact the implementation of respondent-driven sampling (RDS) among this population. Initial participants (also known as seeds) are a critical consideration in RDS because they begin the recruitment chains. However, little information is available on how the online-recruited seeds may effect RDS implementation. Objective The objectives of this study were to compare (1) online-recruited versus offline-recruited seeds and (2) subsequent recruitment chains of online-recruited versus offline-recruited seeds. Methods Between 2012 and 2014, we recruited MSM using RDS in Vancouver, Canada. RDS weights were used with logistic regression to address each objective. Results A total of 119 seeds were used, 85 of whom were online-recruited seeds, to recruit an additional 600 MSM. Compared with offline-recruited seeds, online-recruited seeds were less likely to be HIV-positive (OR 0.34, 95% CI 0.13-0.88), to have attended a gay community group (AOR 0.33, 95% CI 0.12-0.90), and to feel gay community involvement was “very important” (AOR 0.16, 95% CI 0.03-0.93). Online-recruited seeds were more likely to ask a sexual partner’s HIV status always versus <50% of the time (AOR 5.21, 95% CI 1.17-23.23), to have watched the Pride parade (AOR 6.30, 95% CI 1.69-23.45), and to have sought sex online (AOR 4.29, 95% CI 1.53-12-12.05). Further, compared with recruitment chains started by offline-recruited seeds, recruits from chains started by online-recruited seeds (283/600, 47.2%) were less likely to be HIV-positive (AOR 0.25, 95% CI 0.16-0.40), to report “versatile” versus “bottom” sexual position preference (AOR 0.56, 95% CI 0.35-0.88), and to be in a relationship lasting >1 year (AOR 1.65, 95% CI 1.06-2.56). Recruits of online seeds were more likely to be out as gay for longer (eg, 11-21 vs 1-4 years, AOR 2.22, 95% CI 1.27-3.88) and have fewer Facebook friends (eg, 201-500 vs >500, AOR 1.69, 95% CI 1.02-2.80). Conclusions Online-recruited seeds were more prevalent, recruited fewer participants, but were different from those recruited offline. This may therefore help create a more diverse overall sample. Our work has shown the value of geosocial networking apps for aiding RDS recruitment efforts, especially when faced with slow participation uptake by other means. Understanding the degree to which networks interact will be an important next step in confirming the efficacy of online RDS recruitment strategies.

An Event-Level Analysis of the Interpersonal Factors Associated With Condomless Anal Sex Among Gay, Bisexual, and Other Men Who Have Sex With Men (MSM) With Online-Met Partners

The interpersonal determinants of condomless anal sex (CAS) within online-initiated sexual relationships remain poorly understood. Therefore, respondent-driven sampling was used to recruit a prospective cohort of sexually active gay, bisexual, and other men who have sex with men (MSM), aged ≥ 16 years in Vancouver, Canada. Follow-up occurred every 6 months, up to seven visits; at each visit participants reported their last sexual encounter with their five most recent partners. Stratified by self-reported HIV status, individual-level, interpersonal, and situational covariates of event-level CAS with partners met online were modeled using generalized estimating equations (GEE). CAS was reported during 32.4% (n = 1,015/3,133) of HIV-negative/unknown mens events, and 62.1% (n = 576/928) of HIV-positive mens events. Social (i.e., collective identity, altruism, network size social embeddedness) and situational (i.e., number of encounters, location, comparative age, seroconcordance, substance use) factors were identified as important correlates of CAS. Implications include the need for HIV prevention addressing social contexts associated with CAS.

Exploring the role of sex-seeking apps and websites in the social and sexual lives of gay, bisexual and other men who have sex with men: a cross-sectional study.

Background The objective of this study was to explore the relationship between online sex-seeking, community/social attachment and sexual behaviour. METHODS Respondent-driven sampling was used to recruit 774 sexually active gay and bisexual men in Vancouver, Canada, aged ≥16 years. Multivariable logistic regression compared men who had used online sex-seeking apps/websites in the past 6 months (n=586) with those who did not (n=188). RESULTS Multivariable results showed that online sex seekers were more likely to be younger [adjusted odds ratio (aOR)=0.95, 95% CI: (0.93-0.96)], college educated [aOR=1.60, 95% CI: (1.07, 2.40)], have more Facebook friends [aOR=1.07, 95% CI: (1.01, 1.13)], spend more social time with other gay men [aOR=1.99, 95% CI: (1.33-2.97)], and were less likely to identify emotionally with the gay community [aOR=0.93, 95% CI: (0.86-1.00)]. Further, they had displayed high sensation-seeking behaviour [aOR=1.08, 95% CI: (1.03-1.13)], were more likely to engage in serodiscordant/unknown condomless anal sex [aOR=2.34, 95% CI: (1.50-3.66)], use strategic positioning [aOR=1.72, 95% CI: (1.08-2.74)], ask their partners HIV-status prior to sex [aOR=2.06, 95% CI: (1.27-3.37)], and have ever been tested for HIV [aOR=4.11, 95% CI: (2.04-8.29)]. CONCLUSION These findings highlight the online and offline social behaviour exhibited by gay and bisexual men, pressing the need for pro-social interventions to promote safe-sex norms online. We conclude that both Internet and community-based prevention will help reach app/web users.

Seroadaptive Strategies of Vancouver Gay and Bisexual Men in a Treatment as Prevention Environment

ABSTRACT British Columbia’s treatment as prevention policy has provided free access to highly active antiretroviral therapy (HAART) to all HIV-positive provincial residents since 1996. One outcome is an increase in HIV-positive gay and bisexual men (GBM) with suppressed viral loads. Previous cross-sectional analyses indicated that some Vancouver GBM now recognize condomless anal sex with men on HAART who report a suppressed viral load as a seroadaptive strategy. To test the hypothesis that this new strategy, termed viral load sorting (VLS), is recognized and used among by GBM in the Momentum Health Study, we analyzed longitudinal data for HIV-negative/unknown (n = 556) and HIV-positive (n = 218) serostatus participants. Analyses indicated that both groups reported VLS, and that serostatus and Treatment Optimism Scale scores were significant determinants in frequency and use. Results exemplify the medicalization of sex and Rogers’ Diffusion Of Preventative Innovations Model, and they have important implications for HIV research and GBM sexual decision-making.

A latent class analysis of substance use and culture among gay, bisexual and other men who have sex with men

Abstract Assessments of gay and bisexual men’s substance use often obscures salient sociocultural and identity-related experiences related to how they use drugs. Latent class analysis was used to examine how patterns of substance use represent the social, economic and identity-related experiences of this population. Participants were sexually active gay and bisexual men (including other men who have sex with men), aged ≥ 16 years, living in Metro Vancouver (n = 774). LCA indicators included all substances used in the past six months self-reported by more than 30 men. Model selection was made with consideration to model parsimony, interpretability and optimisation of statistical criteria. Multinomial regression identified factors associated with class membership. A six-class solution was identified representing: ‘assorted drug use’ (4.5%); ‘club drug use’ (9.5%); ‘street drug use’ (12.1%); ‘sex drug use’ (11.4%); ‘conventional drug use’ (i.e. tobacco, alcohol, marijuana; 25.9%); and ‘limited drug use’ (36.7%). Factors associated with class membership included age, sexual orientation, annual income, occupation, income from drug sales, housing stability, group sex event participation, gay bars/clubs attendance, sensation seeking and escape motivation. These results highlight the need for programmes and policies that seek to lessen social disparities and account for social distinctions among this population.

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

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.

Associations between sexual partner number and HIV risk behaviors: implications for HIV prevention efforts in a Treatment as Prevention (TasP) environment

ABSTRACT Previous research indicates that gay and bisexual men (GBM) have significantly more sexual partners than same-aged heterosexual men and women. As a result, some HIV intervention programs have focused on partner reduction. However, new research findings question the relevance of sexual partner number as a sexual risk measure for GBM given Treatment as Prevention (TasP) programs and new seroadaptive strategies which have led to lower GBM community viral load and new HIV prevention behaviors. To assess if sexual partner number continues to remain an important measure of sexual risk for GBM living in a city that actively promotes TasP as provincial policy, we analysed cross-sectional data from 719 GBM recruited through respondent-driven sampling in Vancouver, Canada. Multivariable negative binomial regression analysis showed that partner number was significantly associated with previously identified HIV risk factors including condomless anal intercourse with serodiscordant and/or unknown serostatus partners, using sex toys, attending group sex events, receiving money for sex, and sex drug use. These results indicate that sexual partner number remains an important proximate HIV risk measure. However, more nuanced measures of HIV treatment status and greater understanding of the possible causes of increased partner number among GBM are needed.

Erratum to: Factors Associated with Mood Disorder Diagnosis Among a Population Based Cohort of Men and Women Living With and Without HIV in British Columbia Between 1998 and 2012

Using data from the Comparison of Outcomes and Service Utilization Trends (COAST) study we examined factors associated with mood disorder diagnosis (MDD) among people living with HIV (PLHIV) and HIV-negative individuals in British Columbia, Canada. MDD cases were identified between 1998 and 2012 using International Classification of Disease 9 and 10 codes. A total of 491,796 individuals were included and 1552 (23.7%) and 60,097 (12.4%) cases of MDD were identified among the HIV-positive and HIV-negative populations, respectively. Results showed HIV status was associated with greater odds of MDD among men and lower odds among women. Among PLHIV, MDD was significantly associated with: identifying as gay, bisexual or other men who have sex with men compared to heterosexuals; higher viral load; history of injection drug use; and concurrent anxiety, dysthymia, and substance use disorders. Findings highlight the need for comprehensive and holistic HIV and mental health care.

Repeated Measures Analysis of Alcohol Patterns Among Gay and Bisexual Men in the Momentum Health Study

ABSTRACT Background: This study analyzed repeated study visits (n = 2,624) of 693 gay and bisexual men (GBM) in the Momentum Health Study from July, 2012 to June, 2015. Based on recent cross-sectional analyses, we hypothesized that over the study period: (1) hazardous drinking levels would remain high, (2) GBM classified as Hazardous Drinkers will be consistently associated with high risk sex, and (3) GBM classified as Always Hazardous Drinkers differ significantly from Sometimes Hazardous Drinkers. Methods: AUDIT classified participants as Non-Hazardous Drinkers or Hazardous Drinkers, the Cochran–Mantel–Haenszel Test assessed hazardous drinking trends, and Generalized Estimating Equations (GEE) analysis identified Hazardous Drinking covariates. Logistic regression analysis of participants with at least two study visits (575) compared those who were Sometimes Hazardous Drinkers (n = 171) with Always Hazardous Drinkers (n = 129). Results: At baseline 40% of participants were Hazardous Drinkers, but there was a significant decline in hazardous drinking by visit and Hazardous Drinkers were not significantly associated with high risk sex. Always Hazardous Drinkers had significantly more high risk sex and gay bar attendance, but less often sought Internet sex partners compared to Sometimes Hazardous Drinkers. Conclusions: Analyses did not support the first two hypotheses, but distinguishing between Always and Sometimes Hazardous drinkers identified a young GBM subgroup associated with significantly higher levels of high risk sex and social support measures. These results suggest interventions programs based on Social Norms Theory, which predicts peer norms among youth are important factors in regulating drinking patterns, may be effective for these men.

Using Geosocial Networking Apps to Understand the Spatial Distribution of Gay and Bisexual Men: Pilot Study

Background While services tailored for gay, bisexual, and other men who have sex with men (gbMSM) may provide support for this vulnerable population, planning access to these services can be difficult due to the unknown spatial distribution of gbMSM outside of gay-centered neighborhoods. This is particularly true since the emergence of geosocial networking apps, which have become a widely used venue for meeting sexual partners. Objective The goal of our research was to estimate the spatial density of app users across Metro Vancouver and identify the independent and adjusted neighborhood-level factors that predict app user density. Methods This pilot study used a popular geosocial networking app to estimate the spatial density of app users across rural and urban Metro Vancouver. Multiple Poisson regression models were then constructed to model the relationship between app user density and areal population-weighted neighbourhood-level factors from the 2016 Canadian Census and National Household Survey. Results A total of 2021 app user profiles were counted within 1 mile of 263 sampling locations. In a multivariate model controlling for time of day, app user density was associated with several dissemination area–level characteristics, including population density (per 100; incidence rate ratio [IRR] 1.03, 95% CI 1.02-1.04), average household size (IRR 0.26, 95% CI 0.11-0.62), average age of males (IRR 0.93, 95% CI 0.88-0.98), median income of males (IRR 0.96, 95% CI 0.92-0.99), proportion of males who were not married (IRR 1.08, 95% CI 1.02-1.13), proportion of males with a postsecondary education (IRR 1.06, 95% CI 1.03-1.10), proportion of males who are immigrants (IRR 1.04, 95% CI 1.004-1.07), and proportion of males living below the low-income cutoff level (IRR 0.93, 95% CI 0.89-0.98). Conclusions This pilot study demonstrates how the combination of geosocial networking apps and administrative datasets might help care providers, planners, and community leaders target online and offline interventions for gbMSM who use apps.