Younger Canadian Gay, Bisexual and Other Men Who Have Sex with Men's Online Sexual Health

Background: Young gay, bisexual and other men who have sex with men (YMSM) are increasingly using the Internet and geosocial navigation (GSN) apps for sociosexual purposes and seeking sexual health information. Not unrelated, yet not fully understood, YMSM experience higher rates of new HIV infections in the United States and Canada. However, there is a paucity of research among Canadian YMSM that examines the ways in which they are using GSN apps for sexual health information. We sought to determine how YMSM differ from older MSM in terms of demographics, online health services and information seeking, and how these online practices may relate to YMSM’s sexual risk.

Methods: From December 2013 to January 2014, MSM aged 16 or older were recruited from websites, GSN apps, and community-based organizations across Ontario (Canada’s most populous province) to complete a 15-minute anonymous online questionnaire. We conducted a between-group analysis of differences between YMSM (aged <30) and older MSM (aged 30+), and then did a within-group analysis of YMSM to identify online factors associated with sexual risk using multivariable logistic regression with manual backward stepwise selection. Sexual risk was defined as condomless anal sex with an unknown HIV status partner or a serodiscordant partner where the HIV-positive partner has a known detectable or unknown viral load.

Results: A total of 1805/1830 participants completed the survey and reported their age, which included 617 YMSM (34.2%). YMSM differed on nearly all demographics. With regard to online practices, YMSM spent less time weekly cruising compared with older MSM (8.2 hours/week vs. 9.5 hours/week, p=0.01), but spent similar amounts of time seeking health information (1.2 hours/week for all GBM, p=0.80). When searching for online sexual health information, YMSM were significantly more likely to use an online search engine (75.9% versus 63.0%, p<0.001), marginally less likely to use community-based organizations (20.2% versus 24.2%, p=0.061), and similarly likely to use public health or government sites (25.1% versus 25.0%, p=0.96). YMSM were significantly more likely to look online for information on mental health (34.7% versus 19.4%), relationships/dating (34.5% versus 17.8%), and antiretroviral-based prevention (22.4% versus 15.4%) (all p<0.001). In terms of online health service use, there was no difference in the proportion having experienced “online outreach” (8.4% versus 8.5%, p=0.91). However, YMSM who hadn’t used online outreach were significantly less likely to know about these services than older MSM (37.7% versus 28.8%, p<0.001). Among YMSM, 13.3% reported sexual risk during their last anal intercourse event (11.1% for older MSM, p=0.2). For younger GBM, sexual risk was less likely among those who sought relationship/dating information online (AOR=0.58, 95%CI:0.37-0.89), but more likely among South Asian men (AOR=3.69, 95%CI:1.69-8.05).

Conclusions and Implications: YMSM have distinct online practices from older MSM, are less awareness of currently available online outreach services, but have a greater appetite for various sexual health information topics. Sexual health promotion must ensure it is age-relevant, and reaches those younger MSM least connected/aware and most at need.