CATIE News

• In a U.S. study, hookup app users reported more condomless sex than non-users
• However, participants who used apps were more likely to start PrEP when offered
• Researchers concluded that apps may be a useful platform for promoting sexual health

Advances in smartphones and their applications (apps) over the past decade have revolutionized the way that people—particularly gay, bisexual and other men who have sex with men (MSM)—find sex partners.

As part of a study of screening for HIV and sexually transmitted infections (STIs), scientists at the University of California at San Diego (UCSD) also reviewed the use of the popular hookup Grindr by some of the participants, the vast majority of whom were MSM. In this 1,256-person study, those people who tested negative for HIV and who were not already taking HIV pre-exposure prophylaxis (PrEP) were offered it.

In an article in press in the journal Clinical Infectious Diseases, the scientists report that Grindr users disclosed having more male partners, having more engagement in condomless sex and testing positive for STIs at higher rates than non-Grindr users. However, Grindr users were significantly more likely to initiate PrEP. As a result, Grindr users had fewer diagnoses of HIV infection.

The scientists suggested that “Grindr may provide a useful platform to promote HIV and STI testing and increase PrEP uptake.”

Study details

Scientists at UCSD enrolled adult MSM and transgender women for this study. Participants completed surveys regarding HIV risk behaviour. They were then offered HIV screening using HIV antibody tests. People who tested negative for these antibodies had their blood screened using assays that checked for HIV’s genetic material.

STI screening was done for chlamydia and gonorrhea using urine samples and swabs from the rectum and throat. Screening for syphilis was done using standard blood tests.

Participants who tested positive for HIV or STIs were offered immediate initiation of PrEP (a pill containing fixed doses of two anti-HIV drugs: tenofovir DF + FTC, sold as Truvada), taken once daily, at no cost.

The average profile of participants upon entry to the study was as follows:

• age – 32 years
• gender – 99% male; the remaining participants identified as transgender women or non-binary people
• major ethno-racial groups – white – 42%; Hispanic – 36%; Asian – 11%; black – 6%
• proportion reporting condomless anal sex – 50%

Scientists divided 1,256 participants into the following two groups:

• Grindr users – 580 participants
• Grindr non-users – 676 participants

Results – STIs and HIV

According to the scientists:

• Grindr users (9%) were more likely to be diagnosed with chlamydia and gonorrhea than non-users (5%).
• Overall, Grindr users were less likely to test positive for HIV (2%) than non-users (4%).
• There were no differences in rates of positive tests for syphilis (2%) based on use/non-use of Grindr.
• During the initial study visit, “the majority of Grindr users (81%) were not on PrEP, despite having significantly higher sexual risk behaviour compared to non-users.” However, after undergoing HIV testing and receiving a negative test result, “Grindr users were nearly twice as likely as non-users to initiate PrEP (25% vs. 14%).” 
• A sub-group of 340 Grindr users permitted the scientists to assess their usage of this app when visiting the study clinic. This allowed an objective assessment of time spent on the app by participants. The scientists found that time spent on the app in the past week was greater among PrEP users than among people who were not using PrEP.

A possible platform for enhancing sexual health

The scientists made the following statements:

“Given the higher risk behaviour and greater acceptance of PrEP among Grindr users, PrEP promotional messages and linkage to care on the Grindr platform could enhance PrEP uptake, as well as increase testing for HIV and STIs. The surge of dating apps and their association with high risk sex offers unique opportunities for broad delivery of prevention messages. Grindr may provide a real opportunity to reach those at risk and substantially increase PrEP awareness and uptake.”

The scientists noted that “Grindr commercially offers banner ads, which can convey an HIV prevention message … targeted toward specific regions that [is also] tailored to specific PrEP providers.” However, the scientists also stated that “a more personalized delivery of prevention messages, [for example] via advertisement on profile pictures of selected opinion leaders, may be more effective than banner ads for delivering prevention messages to Grindr users.”

Bear in mind

The UCSD scientists are beginning to grapple with an important idea: Some people in the 21^st century who are at risk for HIV and other STIs use apps to find sexual partners. Interventions associated with those apps can be used help to educate people about ways to enhance their sexual health, to encourage testing for HIV and STIs, and, in the scientists’ words, “to engage them to start PrEP.”

The scientists noted that future studies could investigate the use of other apps, as well as the use of on-demand rather than daily PrEP, “and incorporate objective measures of PrEP use to help establish if [engagement with] Grindr also translates into higher adherence.”

The current study was limited to one app—Grindr. However, there are other apps that the scientists mentioned, such as Hornet and Scruff, that could also be investigated for use as possible sexual health platforms. 

Resources

Researchers use social media to increase HIV testing among men – CATIE News

Pre-exposure prophylaxis (PrEP) resources and tools: An online collection for service providers – CATIE

PrEP resources for clients – CATIE

Is PrEP Right for Me? – CATIE

Sexual Health and Safer Sex – CATIE

Canadian guidelines on sexually transmitted infections – Public Health Agency of Canada

Pre-exposure prophylaxis (PrEP) for HIV prevention in Canada – Darrell Tan, MD

—Sean R. Hosein

REFERENCE:

Hoenigl M, Little MD, Grelotti D, et al. Grindr users take more risks, but are more open to HIV pre-exposure prophylaxis: Could this dating app provide a platform for HIV prevention outreach? Clinical Infectious Diseases. 2019; in press.