Health interventions in online cruising environments more acceptable when they take a 'passive' approach

A survey of men who have sex with men in Scotland has found that sexual health promotion is acceptable in online cruising environments such as Gaydar and Grindr, but that a significant minority of men object to health workers initiating contact with them while using these websites and apps.

The researchers from Glasgow Caledonian University make several recommendations for online health promotion with gay and other men who have sex with men. Their online survey was conducted with 1326 men who were recruited through a social networking website (Facebook), sexual networking websites (Gaydar, Recon, Squirt) and sexual networking apps (Grindr, Gaydar).

Given the recruitment methods, it’s unsurprising that very large numbers of respondents used sexual networking websites (86.8%) and sexual networking apps (56.4%). Around four in ten respondents used one of these websites (38.0%) or apps (42.8%) on a daily basis.

Fewer respondents used BBRT and other sites focused on barebacking (14.7%), with only 4.6% using them every day. Unsurprisingly, unprotected anal intercourse was widely reported by men using these sites. But while it is often thought that they are mostly used by HIV-positive men who want to serosort, this survey found that a significant number of users of those sites believed themselves to be HIV-negative.

As expected, the websites and apps were primarily used for sexual reasons, but they also served a social purpose for some men, especially those living away from the big cities. The main reasons to use them were to meet men for sex, for dating and to swap erotic photos or messages, but around a third of men used sexual networking websites to make new friends or to be connected to the gay community.

‘Killing time’ was also a reason that a third of men used these websites and apps.

The researchers were interested in what kinds of health promotion interventions would be acceptable in these environments. Of note, less than 5% of website users and 2% of app users said they used these services to access sexual health information.

Few respondents objected to health workers taking a ‘passive’ approach. On sexual networking websites such as Gaydar, Recon or Squirt, 85.7% said it was acceptable for workers to have a profile or identity and to wait to be approached by users. Slightly fewer (74.5%) supported this approach on smartphone apps such as Grindr.

There was less support for a more ‘active’ approach, in which health workers approach participants and solicit engagement. On websites this was supported by 54.6% of respondents; on apps it was acceptable to 40.5%.

The researchers note that while the sexual nature of these online environments – and the higher rates of unprotected sex reported by frequent users – would seem to make them appropriate locations for sexual health interventions, proactive interventions may be met with resistance from some users. They say this resonates with research in public sex environments, which has found that specific social and sexual areas are delineated – sexual health promotion is only acceptable in the ‘social’ areas.

Utilising existing social spaces on websites or apps – or creating new ones – for health interventions may be culturally more appropriate than outreach within main areas, they argue. However, it remains to be seen whether such an approach would be effective in reaching large numbers of men, especially those with higher-risk behaviours.

The authors also point to the importance of finding acceptable ways to interact with men on the specialist barebacking websites, who are likely to be at higher risk of sexually transmitted infections (STIs) or of being involved in HIV transmission. Furthermore, their qualitative research found that some HIV-positive men reporting these sites being important locations of community support (mentioned more often in interviews than websites established by health agencies.) While this role could possibly be harnessed, health organisations may be uncomfortable doing so. “Orthodox public health systems may have trouble engaging with the transgressive sites favoured by some gay men with HIV,” the authors comment.

Men responding to the survey supported sexual health promotion in various online media – around half said they would be likely to use an app allowing a 1-2-1 chat with a sexual health adviser (52.7%) or a service which would send a text message when it’s time to go for a sexual health check-up (49.4%). The latter was most acceptable to men who would benefit the most – those who reported unprotected sex with multiple partners and those who did not report annual HIV and STI testing.

But the researchers urge local health bodies – such as those who commissioned the research – to collaborate with and promote existing sexual health websites, rather than to create new local services.

They also suggest that sexual health promoters should consider how the negotiation of safer sex occurs in digital settings, where more direct negotiation is possible than in face-to-face encounters and intentions can be signalled by profile options. Health promotion could provide guidance to men who have sex with men on minimising the risks of online cruising – addressing issues such as managing information and disclosure; dealing with truth, ambiguity and omissions within online relationships; and the transfer of relationships from the digital to the physical world.