Sexual and Psychosocial Risk Burdens Associated With Online Sex Seeking Among Young Men Who Have Sex With Men: Cross-Sectional Study

Abstract

Background: The heightened HIV vulnerability associated with men who have sex with men (MSM) who find sex online in Western and East Asian countries may pose similar concerns for MSM in Southeast Asia. However, this line of research is underexamined among Southeast Asian MSM, especially in Southeast Asian cities with a high HIV prevalence among young MSM, such as Ho Chi Minh City, Vietnam. Objective: This study aimed to characterize the sexual behavioral and psychosocial correlates of online sex seeking in a sample of largely gay-identified young MSM in Ho Chi Minh City, Vietnam, and examine the relationships among social support, outness, and last instance of condomless anal sex while not on preexposure prophylaxis (PrEP) for HIV or antiretroviral therapy (ART). The analysis included specific attention paid to the use of different types of online sex platforms, which may contribute to the understanding of online sex seeking. Methods: Patterns of online sex seeking in a cross-sectional sample of young MSM (N=1005) were identified using latent class analysis. Multinomial logistic regressions and Poisson regressions with robust variance were used to estimate the associations between patterns of online sex seeking and other participant characteristics. Results: We found four latent classes of MSM with distinct profiles of online platform use for sex seeking: (1) negligible app users, (2) gay app users, (3) poly app users, and (4) low-cost app users. Patterns of online sex seeking moderated the protective effects of social support and outness on last instance of condomless anal sex while not on PrEP or ART. When stratified by level of social support and outness, only gay app users were associated with a protective effect on last instance of condomless anal sex while not on PrEP or ART when social support and outness were high, respectively. Low-cost app users were marginally associated with a higher prevalence of condomless anal sex while not on PrEP or ART when the level of outness was low. Conclusions: Young Vietnamese MSM who find sex partners online have distinct patterns of app use, with contrasting sexual and psychosocial health burdens that indicate that online sex seeking is a socially patterned behavior. HIV prevention programs and tailored digital interventions should consider the different exposures to social influences associated with patterns of social networking app use as they could moderate the effectiveness of the delivered programs and interventions for reducing HIV vulnerability in young MSM.