Re-Examining Gay, Bisexual, and Other Men Who Have Sex with Men's Sexual Risk in the Treatment, Information and Internet Era

Background and Purpose:Gay, bisexual, and other men who have sex with men (GBM) are persistently and disproportionately affected by HIV. New HIV treatments have reduced morbidity, mortality, and risk of onward transmission for HIV-positive GBM, and provided new prevention options for HIV-negative GBM (e.g. undetectable viral load, pre-exposure prophylaxis). Alongside these medical and epidemiologic developments, the Internet has become GBM’s primary source for health information and sex-seeking. A community-academic partnership was formed to establish a community-based participatory research study of GBM across Ontario (Canada’s most populous province) to evaluate the current state of sexual health, online practices, and service delivery. More specifically, we sought to determine what behavioral, information-seeking, and service use factors were associated with a modern definition of HIV risk among GBM in Ontario, Canada.

Methods: From December 2013 to January 2014, GBM aged 16 or older were purposively recruited from a wide range of websites, mobile-apps, and community-based organizations catering to or serving GBM across Ontario to complete a 15-minute anonymous online questionnaire regarding the following practices: sexual, online health information seeking, and HIV/STI testing. Participants were asked detailed information about the last anal sex event they had with another man. A modernized sexual HIV risk outcome was defined, taking into account an HIV-positive partner’s viral load, as any condomless anal sex with an unknown status partner or serodiscordant partner where the HIV-positive partner had an unknown or known detectable viral load. Factors associated with event-level sexual HIV risk were assessed using manual backward stepwise logistic regression (p<0.05 considered significant). Adjusted odds ratios (AOR) and 95% confidence intervals (CI) for the final multivariable model are shown.

Results:Of 1830 GBM, 1467 reported any anal sex in the past six months (80.7%). A majority of the sample identified as gay (72.6%), White (80.3%), and had an average age of 37.8 years (SD=13.2). A minority of GBM self-reported being HIV-positive (8.1%), having temporary/undocumented immigration status (4.5%), or being trans (1.4%). At last anal sex event, 11.9% reported sexual HIV risk using our study’s modernized definition. Having met your partner online was not associated with sexual HIV risk (p=0.063) nor was having experienced online outreach services (p=0.242). However, seeking information online about STI symptoms (AOR=1.57[95%CI:1.09-2.25]) and about HIV/STI testing (AOR=1.87[95%CI:1.32-2.67]) were associated with greater odds of sexual HIV risk, while seeking information online about HIV/STI prevention (AOR=0.51 [95% CI:0.33-0.80]) and actually having tested for STIs in the past year (AOR=0.42 [95% CI:0.30-0.60]) were associated with lower odds of sexual HIV risk. Event-level partner substance use was associated with greater sexual HIV risk (AOR=2.09 [95% CI:1.41-3.10]) as was self-identifying as South Asian versus White (AOR=3.62 [95% CI:1.60-8.19]). 

Conclusions and Implications: Sexual HIV risk was relatively uncommon amongst this community sample of GBM. HIV risk was positively associated with reactive information seeking (symptoms, testing) while negatively associated with proactive service use (testing) and information seeking on prevention. Social workers can use these findings to develop, focus and delivery culturally relevant practice and interventions.