Geosocial networking (GSN) smartphone applications (apps) are becoming the main venue for sexual encounters among Brazilian men who have sex with men (MSM). As HIV infection risk has been increasing among MSM, the Brazilian government recently adopted pre-exposure prophylaxis (PrEP) which will be provided by the National Health System. Accordingly, an understanding of the profile of MSM who use apps for sexual encounters is needed to design combined prevention interventions tailored for this group.
Two cross-sectional online surveys using the same questionnaire were conducted in July 2016 and July 2017. Inclusion criteria were ≥ 18 years of age, cisgender, HIV uninfected and residence in any of the ten selected Brazilian capitals Chi-square tests were used to compare characteristics of MSM recruited in the two studies.
A total of 2800 and 2497 MSM completed the survey in 2016 and 2017, respectively. Median age was 30 years (IQR25-36) in both years, but more MSM aged ≤24 years were included in 2017 (26.1% vs. 29.0; p=0.036). Compared to 2016, participants with the following characteristics were more represented in the 2017 survey: non-white (36.5 vs. 42.5; p<.001), bisexual (9.2% vs. 12.9%; p<.001), less educated (<12 years: 41.4% vs. 49.5%; p<.001) and lower monthly income (≤3 Brazilian Minimum Wage – USD 250: 34.1 vs. 45.4; p<.001). Scores on ‘The HIV Incidence Risk for MSM’ scale (≥10 points: 66.5% vs. 68.2%, p=0.19) and STI diagnosis (12.4% vs. 14.0%; p=0.08) were similar. Perceived likelihood of getting HIV was higher in 2017 (21.1% vs. 25.3%, p=0.001), although more MSM reported never testing for HIV (14.3% vs. 20.3%, p<.001) and receiving money for sex (3.3% vs. 5.5%; p<.001). Having a male steady partner (18.0% vs. 19.3%; p=0.22), binge drinking (71.7% vs. 73.6%; p=0.13) and stimulants use (22.5% vs. 20.6%; p=0.08) were similar. Awareness of PrEP and nPEP was lower in 2017, while willingness to use oral daily PrEP and non-occupational post-exposure prophylaxis (nPEP) was higher. Willingness to use PrEP injection and HIV self-testing (HIVST) was higher in 2016 (Table 1).
Our results suggest that the use of GNS apps seems to have spread across younger and less educated MSM in 2017, which may explain the lower PrEP awareness in this year. As this population stratum is at the highest risk of HIV acquisition in Brazil, mobile health tools are a promising means to reach these individuals in order to increase awareness and demand of new prevention strategies.