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

Examining the social, sexual, and technological behaviour of gay, bisexual, and other men who have sex with men

Online sex seeking (OSS) has previously been associated with condomless anal sex (CAS) among gay, bisexual, and other men who have sex with men (GBM). Previous studies suggest that this association may be due in part to the uptake of OSS among GBM who are more likely to engage in CAS. This thesis examines the interpersonal factors that might underlie this association. Data for this thesis was collected through the Momentum Health Study, a longitudinal cohort of GBM living in Metro Vancouver and recruited using Respondent-Driven Sampling. Latent class analysis, hierarchical regression, and structural equation models examined (i) patterns of online and offline community connectedness, (ii) covariates of event-level CAS within the context of online-initiated partnerships, and (iii) confounding effects of collectivism on the OSS-CAS relationship. Latent modeling of patterns of community connectedness identified three classes: Class 1, “Socialites,” (38.8%) were highly connected both online and offline. Class 2, “Traditionalists,” (25.7%) were moderately connected with little app/website-use. Class 3, “Techies,” (35.4%) had high online connectedness and relatively low in-person connectedness. In multivariable modelling, Socialites had higher collectivism than Traditionalists, who had higher collectivism than Techies. Patterns of community connectedness were also related to HIV-testing, perceptions of HIV stigma, serodisclosure, and condom use. Supporting these findings, hierarchical event-level logistic regression showed that collectivism, altruism, and social embeddedness were protective factors against CAS – particularly for HIV-negative men. Structural equation modelling revealed that collectivism, altruism, and sensation seeking accounted for approximately 40% of the association between OSS and CAS. In conclusion, these analyses suggest that collectivism, and related sociocultural constructs, promotes greater adherence to established HIV-prevention practices (such as condom use) while individualism may be more amenable to novel risk-reduction strategies which may or may not include condoms. While further research is needed to understand the plasticity of these interpersonal factors, these results suggest that programs facilitating collectivism might have the potential to establish broad sexual health norms. Furthermore, sex-positive risk reduction is likely an important component of HIV prevention for GBM who are less attuned to traditional social influences – many of whom predominantly use the Internet to connect with other GBM

What public health interventions do people in Canada prefer to fund? A discrete choice experiment

Objective To assess public support of tailored and targeted public health interventions for marginalized communities. Methods We conducted a discrete choice experiment using a web-based survey advertised to Facebook and Instagram users living in Canada, aged > 16. Participants were asked to choose between funding two hypothetical public health programs. Each program was described by its purpose; expected increase in life expectancy; and target audience. Demographically weighted generalized linear mixed-effects models were constructed to identify program factors associated with program selection. Results Participants completed up to 8 discrete choice comparison exercises each resulting in 23,889 exercises were completed by 3054 participants. Selected programs were less likely to focus on prevention (vs. treatment). For each 1-year increase in the marginal years of life gained, there was a 15% increase in the odds of a program being selected. Interventions tailored to marginalized communities or targeting stigmatized health conditions were less likely to be selected compared to interventions targeted to the general population or targeting chronic health conditions. Noteworthy exceptions included an increased preference for interventions aligning with the perceived needs or cultural expectations for marginalized communities. Conclusions Stigmatizing perceptions of health conditions and key populations likely influence public health programming preferences of Canadians. Public health implications Informational campaigns highlighting disparities experienced by marginalized populations may improve support for targeted and tailored interventions.Other UBCNon UBCReviewedFacultyResearcherOthe

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

A cross sectional examination of HIV, aging, and chronic health conditions among gay and bisexual men

Purpose: The purpose of this study was to evaluate the association between HIV status and the presence of chronic health conditions among gay and bisexual men (gbMSM) recognizing that many studies fail to account for behavioral factors – such as smoking and alcohol consumption – or focus on the general population without attention to the unique circumstances of gbMSM. Methods: Sexually-active gbMSM, aged >16 years, were recruited using respondent-driven sampling between February/2012 and February/2015. HIV serology confirmed HIV-status. Chronic health conditions were classified into one of six broader categories (i.e., cardiovascular, cancer, gastrointestinal, respiratory, mental health, other). Logistic regression models tested whether HIV-status was associated with any of the six categories. All models used an interaction term between HIV status and age and adjusted for race/ethnicity, annual income, body mass index, daily smoking, and ‘risky drinking.’ Results: Overall, 223 HIV-positive gbMSM and 551 HIV-negative gbMSM reported histories of cardiovascular disease (16.1%), cancer (5.1%), gastrointestinal illness (7.2%), respiratory problems (16.1%), mental health conditions (49.2%), and ‘other’ co-/morbidities (13.1%). Compared with older HIV-negative gbMSM, those with HIV were more likely to report cardiovascular (aOR=1.15, 95%CI:1.07, 1.24) and respiratory (aOR=1.08, 95%CI:1.02, 1.14) disease. There were no differences by HIV status for other co-/morbidities. Conclusion: Findings support the need for increased resources focused on aging, HIV, and cardiovascular and respiratory health among gbMSM aging with HIV

Generational differences in sexual behaviour and partnering among gay, bisexual, and other men who have sex with men

Given that different generations of gay, bisexual, and other men who have sex with men (gbMSM) have been influenced by substantially different life course events and cultural contexts, we explored differences in sexual behaviour between millennials, Gen-Xers, and baby boomers. Sexually active gbMSM from Metro Vancouver, ≥ 16 years, were recruited using respondent-driven sampling between 2012–2015 and completed computer- assisted self-interviews every 6 months, up to 2017. To explore differences between generations (millennials born ≥ 1987, Gen-Xers born 1962–1986, baby boomers born < 1962) we used multivariable logistic regression models using baseline, RDS-weighted data. We also examined 6-month trends, stratified by generation, in partner number, prevalence of high-risk sex, and relationship status using hierarchical mixed-effects models. Among 774 gbMSM (190 millennials, 469 Gen-Xers, 115 baby boomers), median age of first anal sex with a male partner decreased from 20 (aQ1,aQ3:17,25) among baby boomers to 18 (aQ1,aQ3: 16,20) among millen- nials (x2 (DF = 2, N = 764) = 12.920, p = 0.002). After controlling for relevant demographics, differences were observed for some sexual behaviours (i.e., anal sex positioning, giving oral sex, sex toys, masturbation, sexual app/website use, transactional sex) but not others (i.e., receiving oral sex, rimming, fisting, watersports, group sex). At baseline, millennials reported less high-risk sex than other generations but all trended toward less high- risk sex, fewer partners, and regular partnering over the course of the study. While there was notable similarity across generations, millennial gbMSM reported earlier age at first anal intercourse and less high-risk sex. However, all generations trended towards less high-risk sex, fewer partners, and regular partnering over time

Seroadaptive strategies of Vancouver gay and bisexual men in a treatment as prevention environment

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