China: Use of gay apps and associated HIV/syphilis risk

Wei, Lan, et al. "Use of gay app and the associated HIV/syphilis risk among non-commercial men who have sex with men in Shenzhen, China: a serial cross-sectional study." Sexually transmitted infections (2019): sextrans-2018.


Objectives Geosocial networking application specific to men who have sex with men (MSM) (gay app) has revolutionised the social networking of MSM globally, much concern was raised over its linkage to HIV/syphilis risk. This study sought to examine the association between use of gay app and sexual behaviours and HIV/syphilis risk among Chinese MSM.

Methods Eligible MSM were recruited through combined offline methods from 2015 to 2017 in Shenzhen, China, with data collected including demographics, sexual behaviours, app use, recreational drug use and HIV testing. All participants are required to sign a written informed consent and take a confidential HIV and syphilis testing.

Results The prevalence of app use among non-commercial MSM (NcMSM) has rapidly increased from 12.5% in 2015 to 52.6% in 2017. The primary four apps used were Blued (97.2%), Aloha (18.4%), Jack’d (14.1) and Zank (14.1%). After controlling for confounders, HIV prevalence was still significantly lower among app users than non-app users (adjusted odds ratios [AOR]: 0.77, 95% CI 0.61 to 0.97), yet the lower prevalence of syphilis was not significant (AOR: 0.97, 95% CI 0.76 to 1.23). App-using NcMSM were more likely to be younger, unmarried, self-identified as homosexuality and having higher education level and income than non-app-using NcMSM. App-using NcMSM had higher rate of consistent condom use and HIV testing, higher level of knowledge on HIV/AIDS prevention and condom use; however, they were more likely to have multiple sexual partners, practice receptive role in anal sex and use recreational drug.

Conclusions App-using NcMSM are more likely to have sexual risk behaviours as well as risk-reduction behaviours such as consistent condom use and HIV testing. Scaled-up and innovative venue-based HIV interventions are warranted for these high-risk MSM frequent social venues with less condom use and fewer HIV tests. Meanwhile, gay app should alternatively serve as an intervention and education platform for the MSM hard-to-reach via venue-based approaches.


Previous findings on the association between app use and HIV/syphilis risk were controversial, with some suggested that use of gay apps was correlated with more sexual risk behaviours and increased the HIV/STI infections, while some others reported no significant difference or lower HIV prevalence. Our study found app-using NcMSM had lower HIV prevalence than their counterparts, yet the difference was not significant for syphilis after controlling for confounders, which is consistent with a recent systematic review. The lower HIV prevalence among app-using NcMSM could be explained by the following reasons. First, as app-using MSM are more likely to engage in certain risky sexual behaviours, they may be more aware of their HIV-acquisition risk and take more risk-reduction behaviours such as condom use and HIV testing. Studies found that use of gay app was to some extent linked to MSM community building and strengthened social support and thus may produce a positive environment for MSM and encourage risk-reduction behaviours. The higher rate of lifetime HIV testing among app-using MSM in this study may be partially attributed to the local sexual health outreach and HIV testing promotion delivered or linked through such apps. For example, the Blued app includes an ‘AIDS’ ribbon which provides monthly banners on HIV testing and suggests the nearest appropriate medical and testing facilities. As the app-using MSM had higher HIV-testing rate, they may have higher chance to know their HIV serostatus. It is known that the majority (90%) of HIV-1 infected MSM in Shenzhen were migrants, and those migrant MSM may be more likely to return to their hometowns once they know their positive serostatus or be less likely to be recruited into this survey, which to some extent helps to explain the lower HIV prevalence of gay-app users.

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