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MSM Grindr Users Take More Sex Risks But Seem More Open to PrEP
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IDWeek, October 2-6, 2019, Washington, DC
Mark Mascolini
Men who have sex with men (MSM) who used the Grindr app to find sex partners took more sexual risks than MSM who did not use the dating tool, according to results of a 1256-man study in San Diego [1]. But Grindr users proved more open to preexposure prophylaxis (PrEP) of HIV infection, a finding suggesting Grindr can be provide an HIV testing and PrEP-promoting platform.
University of California, San Diego (UCSD) researchers who conducted this study noted that more than 60% of MSM in the United States now use internet or smartphone tools to track down sex partners. Grindr, a geosocial networking app, ranks as the most-used dating app among US MSM. The UCSD team conducted this study to assess Grindr activity in MSM participating in a local HIV and sexually transmitted infection (STI) screening program and to determine whether Grindr use correlates with HIV risk and prevention behavior, with a focus on PrEP use.
Study participants were MSM who received community-based HIV and STI screening between September 2018 and June 2019. Men who test positive for HIV or an STI in the screening program get offered immediate free treatment, while men who test negative for HIV and do not use PrEP but have substantial HIV risk can opt to receive immediate free PrEP. Because iPhones record time spent on Grindr in the past 7 days (on-screen activity), researchers asked study participants with iPhones to record on-screen activity.
The investigators used a validated HIV risk tool, the San Diego Early Test (SDET) Score [2], to determine each participant's risk of becoming infected with HIV. For this study, researchers slightly adjusted that score to reflect a 3-month risk-reporting period. The UCSD team compared demographics, PrEP use, substance use, risk behaviors, and other variables in Grindr users versus nonusers. They deployed univariate and multivariate logistic regression to identify predictors of starting PrEP after HIV/STI testing.
Among 1256 consecutive MSM and transgender females, 580 (46%) opened Grindr in the past 7 days. Grindr users had a slightly but significantly younger average age than nonusers (35 versus 38, P < 0.001). But users and nonusers did not differ by race/ethnicity or whether they were MSM or transgender.
Compared with nonusers, recent Grindr users included a higher proportion of PrEP users in the past 14 days (18% versus 9%, P < 0.001) and had a significantly higher median adjusted SDET (HIV-risk) score (2 versus 0, P < 0.001), a higher number of male sex partners in the past 3 months (4 versus 2, P < 0.001), a higher positive test rate for chlamydia or gonorrhea (8.6% versus 4.7%, P = 0.005), but a lower positive HIV test rate (1.8% versus 3.8%, P = 0.014).
Among 1087 participants not on PrEP, 472 (43.4%) reported recent Grindr use. These Grindr users had significantly higher sexual risk behavior by adjusted SDET score than nonusers (median 2 versus 0, P < 0.001) and more recent male sex partners (median 4 versus 2, P < 0.001).
Among PrEP-eligible participants, a significantly higher proportion of Grindr users than nonusers started PrEP (100 of 406 or 24.6% versus 72 of 514 or 14.0%, P < 0.001). Multivariate analysis isolated three factors that independently predicted PrEP uptake: recent Grindr use (adjusted odds ratio [aOR] 1.611, P = 0.009), adjusted SDET score (1.196 per point, P < 0.001), and chlamydia or gonorrhea diagnosis (aOR 1.996, P = 0.028). The same analysis determined that older men had lower odds of starting PrEP (aOR 0.964 per year, P < 0.001).
Of 580 MSM who recently used Grindr, 376 (64.8%) had an iPhone and 340 had their iPhone with them when tested for HIV and STIs. Median on-screen time proved significantly longer in participants who reported PrEP use in the last 14 days than in those who did not (244 versus 142 minutes, P = 0.017).
The UCSD team concluded that Grindr users take more sexual risks but are also more likely to use PrEP (which may contribute to their lower HIV rate in this study). And after HIV and STI testing, Grindr users proved more likely to start PrEP. But the researchers stressed that most Grindr users, 81%, were not using PrEP. "Given greater acceptance of PrEP among MSM who used Grindr," the researchers suggested, "Grindr may provide a useful platform to promote HIV and STI testing [and] increase PrEP uptake."
References
1. Hoenigl M, Little SJ, Stockman JK, et al. Grindr™ on screen activity on iPhones correlates with HIV risk and substance use in men who have sex with men, San Diego. IDWeek, October 2-6, 2019, Washington, DC. Abstract 1961.
2. Hoenigl M, Weibel N, Mehta SR, et al. Development and validation of the San Diego Early Test Score to predict acute and early HIV infection risk in men who have sex with men. Clin Infect Dis. 2015;61:468-475. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4542926/
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