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Thesis Defence

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Examining the Social, Sexual, and Technological Behaviour of Gay Bisexual, and Other Men Who Have Sex with Men

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Thesis Defence

  1. 1. EXAMINING THE SOCIAL, SEXUAL, AND TECHNOLOGICAL BEHAVIOUR OF GAY, BISEXUAL, AND OTHER MEN WHO HAVE SEX WITH MEN Doctoral Thesis
  2. 2. 0.50 1.00 2.00 Recruited Online 14 Studies | Yang et al., 20141.35 (1.13-1.62) Sought Sex Online 15 Studies | Liau et al., 20061.68 (1.18-2.40) Online-Initiated Events 11 Studies | Lewnard et al., 20141.24 (1.01-1.52) Meta-analytic odds for CAS, by internet use indicator
  3. 3. Proportion of Respondents “Seeking Sex Online” 2.1% per year R² = 0.339 0 10 20 30 40 50 60 70 80 90 100 2000 2002 2004 2006 2008 2010 2012 2014
  4. 4. “ “The use of traditional venues – such as gay bars, beats and sex-on-premises venues – by gay men to meet sex partners has also declined while the use of Internet appears to have replaced traditional venues for that purpose. Internet increasingly assumes the role of a virtual venue, but the nature of the interaction that occurs is not exactly the same as that which occurs in traditional physical sites. That is there may be differences in the way men think about HIV and risk and negotiate sexual encounters in the physical and virtual environments.” - Zablotska et al., 2011
  5. 5. App-User Density by Population Density West End Strathcona & Mt. Pleasant 0 5000 10000 15000 20000 25000 30000 0 20 40 60 80 100 120 140 160 180 AverageDisseminationAreaPopulationDensity 1-mile Sampling Area App User Density r2 = 0.34
  6. 6. 39% 29% 1 2 3 4 5 6 7 8 Proportion(%) Visit Number Proportion of men who attended gay “group meetings” in the past six months. p < 0.001
  7. 7. 80% 66% 1 2 3 4 5 6 7 8 Proportion(%) Visit Number Proportion of men who patroned gay bars in the past six months. p < 0.001
  8. 8. 83% 54% 1 2 3 4 5 6 7 8 Proportion(%) Visit Number Proportion of men who read gay news papers in the past six months. p < 0.001
  9. 9. 78% 70% 1 2 3 4 5 6 7 8 Proportion(%) Visit Number Proportion of men who believes community involvement is important/somewhat important. p < 0.001
  10. 10. 25% 30% 1 2 3 4 5 6 7 8 Proportion(%) Visit Number Proportion of men who spent more than 50% of their social time with other GBM in the past six months. p = 0.060
  11. 11. 22% 27% 1 2 3 4 5 6 7 8 Proportion(%) Visit Number Proportion of men who went to the most recent pride parade in the past twelve months. p = 0.371
  12. 12. 49% 51% 1 2 3 4 5 6 7 8 Proportion(%) Visit Number Figure 2g. Proportion of men who lives in downtown / the west end. p < 0.013
  13. 13. “The Internet – rather than gay venues – has become one of the most common ways for men to meet each other” - Holt, 2011 SEEK SEX ONLINE GO TO BARS 73.7% 67.7%
  14. 14. 76% 62% 1 2 3 4 5 6 7 8 Proportion(%) Visit Number Proportion of men who sought sex online in the past six months. p < 0.001
  15. 15. Table 1. Relationship between online sex seeking and community attachment Any vs. none > Monthly vs. Monthly/none More than monthly vs. < monthly Attend Gay Group Meetings 1.32 (0.84-2.07) 1.29 (0.89-1.87) 1.32 (0.84-2.07) Patron Gay Bars/Clubs 1.33 (0.95-1.87) 1.22 (0.91-1.65) 1.41 (1.01-1.97) Read Gay News Media 0.85 (0.63-1.14) 0.85 (0.63-1.14) 1.72 (1.18-2.49) Go to Pride Celebration 0.99 (0.73-1.34) - - No. of Forms of Participation 1.11 (0.96-1.29) - - Table 2. Select adjusted results for factors associated with online sex seeking aOR (95% CI) Social time spent with gay men <25% or less 1.00 26-75% 1.99 (1.33-2.97) >76% or more 1.17 (0.66-2.08) aOR (95% CI) Collectivism 1.08 (1.01-1.16) No. of Facebook Friends. 1.07 (1.01-1.13)
  16. 16. “Men prone to engage in risky sex may be more likely than men who practice safer sex to use the Internet to meet sex partners (self-selection hypothesis). That is, high-risk men may be more prone to gravitate to the Internet as a main or as an additional venue to meet partners.” - Liau et al.,2006 Association between OSS and CAS ?
  17. 17. … “Our whole social environment seems to us to be filled with forces which really exist only in our minds.” ― Émile Durkheim “All knowledge of cultural reality, as may be seen, is always knowledge from particular points of view.” – Max Weber
  18. 18. The claim behind cultural cognition is that culture is prior to facts in societal disputes over risk.” - Kahan, Slovic, Braman, Gastil, 2005 “
  19. 19. BehaviorSocial environment Background Factors Culture Individual-level Factors
  20. 20. 1. To describe patterns of online and offline connectedness among GBM. 2. To identify factors associated with condomless anal sex within the context of sexual encounters between GBM who first met online. 3. To characterize the pathways by which various social factors and cognitive risk perceptions shape GBM’s behaviour in online and offline environments.
  21. 21. • gender-identified as a man, regardless of sex at birth, 774 participants recruited; 119 (15.4%) were seeds COLOUR: white = HIV-negative; black = HIV-positive; grey = unknown SHAPE: circle = 16-24 years; square = 25-39 years, triangle = 40+ years • received an RDS voucher for participation in the study, or were selected as an initial “seed”, and • reported having had sex with a man in the past 6 months, • were able to complete a questionnaire in English • were 16 years or older at time of enrollment,
  22. 22. SurveyDesignAnalysisInterpretation C γ1 γ2 γ3 γ4 γ5 K1 K2 K3 γ6 γ7 γ8 γ9 Indicators Latent Variable Classes AIM 1: To describe patterns of online and offline connectedness among GBM. • Used websites to seek sex, P6M • Used apps to seek sex, P6M • Had Facebook, Currently • Attended gay bars, P6M • Attended gay pride parade, P12M • Read gay news/ media, P6M • Attended gay group meetings, P6M • Played on gay sports team, P6M • Spent >50% social time with GBM
  23. 23. AIM 1: To describe patterns of online and offline connectedness among GBM. • Age (per year older) • Collectivism • Annual Income (≥30,000 vs. <$30,000) • Current Relationship • Monogamous/Married • (Partially) Open • No Regular Partner • Stigma Scale • HIV Tested, Ever • Ask Partners their HIV Status • CAS with serodiscordant/unknown partner, P6M • # Male Sex Partners, P6M • Recruitment Time (odds per month) β1 β4 β2 Β… 𝑌C Covariates Latent Class Assignment
  24. 24. Generalized Estimating Equation Stratified by HIV-Status Subject (ith) Visit (jth) Event (kth) i1 j1 j2 j3 i1 i2 i3 i4 i5 i1 i2 i3 i4 i5 i1 i2 i3 i4 i5 AIM 2: To identify factors associated with event-level CAS during encounters between online-met partners. What sexual activities did you do with the partner named above the most recent time you had sex?  He fucked me in the ass and he used a condom.  He fucked me in the ass and he did use a condom.  I fucked him in the ass and I used a condom.  I fucked him in the ass and I did use a condom  He gave me a blowjob  I gave him a blowjob  Rimming  Fisting  Sex Toys  Masturbation
  25. 25. AIM 2: To identify factors associated with event-level CAS during encounters between online-met partners. • Age • Sexual Identity • Gay • Bisexual • Other • Race/Ethnicity • Other • White • Highest Formal Education • < High school • > High school • Annual Income • Employment Status Demographics • Collectivism • PC 1: Embeddedness • PC 2: Involvement • No. of MSM Known • No. of MSM Known Well • Communal Sexual Altruism • Social Support • Loneliness Scale • Online Sex Seeking, P6M • # Male Anal Sex Partners, P6M • HADS-Anxiety • HADS-Depression • Negative Self-Esteem • Treatment Optimism • Sensation Seeking • Cognitive Escape Psychosocial • No. of Events with Partner, P6M • Months Since First Event with Partner • Location of Recent Sex with Partner • HIV Status of Partner • Comparative Age to Partner • Event Level Substance Use • Alcohol • Marijuana • Poppers • Erectile Dysfunction Drugs • Crystal Meth • GHB • Ecstasy/MDMA Event Level
  26. 26. Social Time Gay Sports Team Gay Bars/Clubs Gay-Newspapers 𝑃𝐶1 Pride Parade PrincipalComponentAnalysis 𝑃𝐶2 Gay-Specific Groups AIM 2: To identify factors associated with event-level CAS during encounters between online-met partners.
  27. 27. AIM 2: To identify factors associated with event-level CAS during encounters between online-met partners. Generalized Estimating Equation - Stratified by HIV-Status 𝐶𝐴𝑆 𝑣𝑠. 𝑁𝑜𝑛𝑒 Psychosocial Demographics Event-Specific Explanatory Factors Outcome Factor Events with “Online-met” Partners How or where did you guys first meet?  Internet or Smart phone app  Telephone chat line  Bathhouse  Club or bar  Coffee shop or restaurant  Social gathering or through friends  Sex party  Other
  28. 28. AIM 3: To examine if salient psychosocial constructs confound the associated between OSS and CAS.
  29. 29. 67.3% 51.5 67.1 Annual Income < $30,000: 72.9% Gay-identified: 79.9% HIV-negative: 78.6% White: 68.8% || Indigenous: 9.5% Age < 24: 21.9% || Age ≥ 40: 34.9% Single: 61.6% 34 (26–47) Median (Q1-Q3) Proportion of social time spent with other GBM 55.9% 11.8% 32.3% 0 1 2 3 4 No. of Gay Venues Visited
  30. 30. 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 Attend Gay Bars/Clubs Read Gay News/Media Attended Pride Parade >50% Social Time with GBM Attend Gay Groups Used Apps to Seek Sex Used Websites to Seek Sex Has Facebook ItemResponseProbabilities Socialites Traditionalists Techies AIM 1: To describe patterns of online and offline connectedness among GBM.
  31. 31. 0 50 100 150 200 250 300 Feb. 2012 - Jul. 2012 Aug. 2012 - Jan. 2013 Feb. 2013 - Jul. 2013 Aug. 2013 - Jan. 2014 Feb. 2014 - Jul. 2014 Aug. 2014 - Jan. 2014 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% TotalNumberRecruited (Line) ProportionofRecruitsinEachGroup (Bar) Techies Traditionalists Socialites Total AIM 1: To describe patterns of online and offline connectedness among GBM.
  32. 32. Traditionalists vs. Socialites Techies vs. Socialites Techies vs. Traditionalists aOR (95%CI) aOR (95%CI) aOR (95%CI) Age (per year older) 1.06 (1.04-1.07) 1.01 (1.00-1.03) 0.96 (0.94-0.98) Annual Income (≥30,000 vs. <$30,000) 0.43 (0.28-0.66) 0.59 (0.41-0.86) 1.38 (0.89-2.15) Current Relationship Monogamous/Married Ref Ref Ref (Partially) Open 0.67 (0.37-1.22) 1.12 (0.60-2.07) 1.67 (0.88-3.19) No Regular Partner 0.54 (0.32-0.91) 1.45 (0.85-2.47) 2.70 (1.54-4.74) Collectivism, per 1-point increase 0.82 (0.75-0.89) 0.75 (0.69-0.81) 0.92 (0.84-0.99) Stigma Scale 0.93 (0.87-0.99) 1.00 (0.94-1.06) 1.07 (1.00-1.15) HIV Tested, Ever 0.37 (0.17-0.84) 1.23 (0.52-2.91) 3.30 (1.43-7.63) Ask Partners their HIV Status 0.57 (0.38-0.85) 1.03 (0.71-1.48) 1.80 (1.20-2.70) CAS with serodiscordant/unknown partner, P6M 0.74 (0.48-1.14) 1.32 (0.91-1.92) 1.79 (1.16-2.70) # Male Sex Partners, P6M 0.99 (0.98-1.00) 1.00 (1.00-1.00) 1.01 (1.00-1.02) Recruitment Time (odds per month) 0.98 (0.96, 1.01) 1.03 (1.00, 1.05) 1.05 (1.02, 1.08) AIM 1: To describe patterns of online and offline connectedness among GBM.
  33. 33. AIM 1: To describe patterns of online and offline connectedness among GBM. Socialites Traditionalists Techies 0 to 5 6 to 7 8 9 to 12
  34. 34. AIM 2: To identify factors associated with event-level CAS during encounters between online-met partners. 0.50 1.00 2.00 0.62 (0.51-0.75) Communal Altruism No. of MSM known Well1.03 (1.00-1.05) Collectivism0.93 (0.89-0.98) Social Embeddedness (PC1)0.87 (0.79-0.96) HIV-Negative/Unknown Men 0.60 (0.47-0.77) Communal Altruism HIV-Positive Men
  35. 35. AIM 2: To identify factors associated with event-level CAS during encounters between online-met partners. 0.50 1.00 2.00 0.62 (0.51-0.75) Communal Altruism No. of MSM known Well1.03 (1.00-1.05) Collectivism0.93 (0.89-0.98) Social Embeddedness (PC1)0.87 (0.79-0.96) HIV-Negative/Unknown Men 0.60 (0.47-0.77) Communal Altruism HIV-Positive Men
  36. 36. AIM 2: To identify factors associated with event-level CAS during encounters between online-met partners. “Where altruism is generally used in a broad sense to mean concern for others’ welfare—in contrast to pure self-interest or egoism. Prevention altruism is being defined here to include the values, motivations, and practices of caretaking in one’s sexual behavior which arise out of a concern for others. In its most narrow sense, this means taking care that one’s sexual partners do not become infected by disease. More broadly, it may include concern for the effects which being infected could have on others from one’s family or friends to a larger group, such as the gay community. Whether a man uses condoms to protect his evening’s trick or out of devotion to his long-term lover; whether he wants to spare his mother the pain of his illness and death or express a commitment not to place more members of the gay community in danger—he is moved by values of prevention altruism, a concern for others’ well-being which directly affects his sexual behavior.” – Nimmons, “In this together.” 1998
  37. 37. AIM 2: To identify factors associated with event-level CAS during encounters between online-met partners. “Sensation seekers are nonconformists and risk takers. They are somewhat asocial in the sense that they are ruled by their own needs rather than social conventions or the needs and attitudes of others. They are attracted toward a life-style that maximizes the opportunity for independence…” – Zuckerman, “Beyond the Optimal Level of Arousal”, 1979 “
  38. 38. AIM 3: To examine if salient psychosocial constructs confound the associated between OSS and CAS.
  39. 39. AIM 3: To examine if salient psychosocial constructs confound the associated between OSS and CAS.
  40. 40. . 1. RDS bias towards a socially active sample. 2. Incompatibility of analytic approaches with RDS 3. Shifting equilibrium during recruitment 4. Novel use and measure of “collectivism” 5. Dichotomous prevalence vs. frequency 6. Events between online-met partners 7. Abbreviated scales in path analysis
  41. 41. • For each 1-point increase in collectivism, the odds of belonging to the traditionalist class dropped by 18% and the odds of belonging to the techie class dropped by 25% (vs. belonging to the socialite class). • The uptake of apps and websites among GBM with lower altruism and collectivism and among those with higher sensation seeking explained a substantial proportion (≈40%) of the association between OSS and CAS. • For HIV-positive men, each 1-point increase in altruism was associated with a 40% decrease in the odds for CAS; and for HIV-negative men each 1-point increase in collectivism, 1-point increase in altruism, and 1-point increase in social embeddedness were associated with a respective 7%, 38% and 13% reduction in the odds for CAS.
  42. 42. “ “If we were invited to make a coalition between group-grid theory and psychometrics, it would be like going to heaven.” – Mary Douglas

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