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Grindr: Promoting Sexual Health in MSM

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Jon Kim

on 13 June 2015

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Transcript of Grindr: Promoting Sexual Health in MSM

STIs among Men who have Sex with Men (MSM)
Smartphone apps that MSM use to meet sexual partners "have become a vital window of opportunity for health-related organisations to help MSM protect their sexual health" (Kirby & Thornber-Dunwell, 2014).

- STI testing centers
- obtain PEP
- links for drug counseling and support
- safer sex behavior negotiation communication
"Phone apps could help promote sexual health in MSM." The Lancet, 2014.
Innovation-Decision process
Los Angeles: Out of 195 MSM, 76% report sexual encounters from Grindr (Rice et al, 2012).

Studies found HIV-positive men online are at a higher risk of practicing unprotected anal intercourse (UAI):

1) Compared to HIV-negative MSM, HIV-positive MSM were at 4.1 times higher risk of engaging in UAI when they met partners online (Rosser et al, 2009).

2) Compared to partners met offline, HIV-positive MSM were 2.6 times more likely to engage in UAI when they met partners initially online (Bolding, 2005).

Self-reporting of negative HIV test dates may be inaccurate if they do not take account for the "window period" (~12 weeks).
GSNA users as an important risk group
Promoting Sexual Health in MSM within
Gay Social Networking Applications (GSNA)

Jonathan Kim
What are GSNA users' perceptions on the implementation of sexual health advisors directly in the applications?
1) passive profiles?
2) unsolicited contacts?


How do the GSNA users feel that the implementation of sexual health promotion campaigns might affect or not affect their:
1) safer sex practices?
2) HIV/STI testing behavior?
3) sexual health knowledge?
Research Questions
Theoretical Framework: Diffusion of Innovation
Diffusion of innovations:
a theory that seeks to explain how, why, and at what rate new ideas and technology spread through cultures. Diffusion is the process by which an innovation is communicated through certain channels over time among the participants in a social system.

Gay social networking apps (GSNA) works as the innovation in the disbursement of health information and resources.

Resources will be disseminated by health advisors entirely on the apps through real-time messages, with each advisors at a different location on the app.

Felt Need
: whether or not the individual would actively seek awareness of the innovation
Relative Advantage
: ease of use of a new product
Compatibility
: how the innovation fits into its community
Complexity
: difficulty for the individual to use a new product
Trialability
: how a new product can be tested
Observability
: how the individuals can see the new product being used by others
One-on-one interviews, semi-structured
- HIV/STI testing history and frequency
- risky sex behaviors and safer sex practices
- how they currently obtain sexual health knowledge
- reasons for using GSNAs
- perceived pros and cons to HIV/STI testing
- perceptions about HIV/STI testing frequency and behavior (among MSM and among those who use GSNAs)

Incentive
$50 for one 60-minute interview
Study Design: Qualitative Method
Limited demographics information online, one news source indicates that "almost 2/3 of Grindr's users are under 30 years old."
- Personal data: 58% of users under 30 (n=267)
- Toco Hills, Emory, Decatur
- Among 15-24 year olds is where most reported gonorrhea (34%) and chlamydia (39%) infections occur (CDC, 2014).

Pew Research Center on Mobile Phone Usage:
- 64% of American adults have a smartphone compared to last year's 58%.
- 91% of young adults 18-29 report usage of some form of social networking over the course of the 1-week duration of the survey (Smith, 2015).
Grindr Demographics / Trends in Mobile Phone Usage
Sampling
Felt Need
"Do you think there is a need for HIV/STI prevention programs for men who have sex with men? Why or why not?"

Relative Advantage
"How do you currently obtain sexual health knowledge?"
"What could be good about having a sexual health advisor that you can talk with on the social networking app of your choosing?"
"How could having a sexual health advisor who can tell you resources about where and when to get tested or treated benefit you?"

Compatibility
"How do you see the program integrating into your lifestyle?"
"Would you prefer for the health advisors to directly solicit you? Why or why not?"
Focus Group - sample questions for constructs
- Data collection is simultaneous with analysis

- Recording device for interviews (audio only)

- Transcribe recording

- Thematic analysis using MAXQDA

- initially code 5 transcripts, 2 coders for each transcript
- review codes and develop codebook & coding tree
- if a new theme emerges, modify interview guide

- Recording is destroyed after the results have been analyzed and published
Analysis Plan
MSM are at a heightened risk for obtaining HIV and other sexually transmitted infections (STIs).

New HIV incidences in the U.S. have stabilized since the mid-1990's, with ~50,000 annual infections (Hall et al, 2008).

Between 2008 and 2010, decreases in new HIV infections were observed in women, but increases were observed in the youth (CDC, 2012).
- of new infections among young MSM (13-24), YBMSM (young black MSM) account for more than half.

Among 18-24 year old MSM in 21 U.S. urban cities with HIV, 69% were unaware of their seropositivity (CDC, 2010).

Across ~20,000 tests in testing sites across the U.S., gonorrhea prevalence in MSM was 14.5% and chlamydia, 11.3%.
Population of interest
- "Sexually active MSM users of GSNAs in Metro Atlanta"

Inclusion criteria
- currently identifies as male
- age at least 18 years old
- had anal sex with a man in lifetime
- had any sex with man in past 3 months
- able to complete the interview in English
- willing to give at least two other forms of contact information
- willing to be recontacted for follow-ups, if eligible

Exclusion criteria
- plans to move away from the Atlanta area in the next few months
- current participation in any HIV prevention intervention or study
Study Population & Eligibility
Methodology

1) Researcher travels to pre-selected landmarks in Metro Atlanta
2) Open app and sort users by nearest distance, select every 3rd user (randomization)
3) Repeat for each GSNA

Sample 10 individuals initially from each of the three major GSNA's (Grindr, Jack'd, Scruff), for 30 total samples.

Sampling may be repeated as necessary!
Complexity
"How does not having to download or learn how to use another app affect your likelihood of using this resource?"
"What factors make it harder for you to use the resource?"

Triability
"How might someone try to use the resource not for its intended behavior?"

Observability
(on the last slide)
Focus Group - sample questions for constructs
1) Is Diffusion of Innovation the right framework for this design?

2) How to include Observability?

3) Is there a better study design in place of qualitative interviews?
(ex. focus groups, in-app surveys)

4) Is the inclusion criteria too narrow?

5) Is there a better recruitment tactic rather than directly from applications?

6) Is the sample size of 30 too low divided amongst 3 applications?

7) How could I evolve this into an experimental research study? What effects could I look at?
Questions
CDC. (2010). Prevalence and Awareness of HIV Infection Among Men Who Have Sex With Men --- 21 Cities, United States, 2008. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5937a2.htm

CDC. (2012). New HIV Infections in the United States. http://www.cdc.gov/nchhstp/newsroom/docs/2012/HIV-Infections-2007-2010.pdf

CDC. (2014). Reported STDs in the United States. http://www.cdc.gov/nchhstp/newsroom/docs/STD-Trends-508.pdf

Hall HI et al. Estimation of HIV incidence in the United States. JAMA 2008; 300 (5): 520-29.

Kirby T, Thornber-Dunwell M. (2014). Phone app could help promote sexual health in MSM. The Lancet 2014 Oct;384

Rice E, Holloway I, Winetrobe H, et al. Sex risk among young men who have sex with men who use Grindr, a smartphone geosocial networking application. J AIDS Clin Res. 2012;(Suppl 4):005.

Rosser BR, Oakes JM, Horvath KJ, et al. HIV sexual risk behavior by men who use the Internet to seek sex with men: results of the Men’s INTernet Sex Study-II (MINTS-II) AIDS Behav. 2009;13:488–98.

Smith, A. (2015) Mobile Access 2015. http://www.pewinternet.org/2015/04/01/us-smartphone-use-in-2015/

References
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