Condomless Sex Among Men Who Have Sex with Men: App-Facilitated Versus Non-App-Facilitated Relationships

It is unclear whether online partner-seeking via (geo)social networking and dating websites or applications ("apps") is associated with engagement in condomless anal sex (CAS) among MSM (men who have sex with men). Previous studies present mixed findings revealing either positive, or negative, or no associations between online partner-seeking and CAS among MSM, indicating a need for additional research. This cross-sectional survey of young adult MSM residing in 15 Central Kentucky counties, USA (n = 217) provided demographic, behavioral, and relationship data about male or transgender partners (n = 548), with whom respondents had recent (past 6 months) anal sex. We used multivariable generalized linear mixed effects modeling to compare engagement in CAS (i.e. used condoms only sometimes or never) between app-facilitated and non-app-facilitated relationships. Our analysis revealed most relationships involved CAS (72%), but there were no differences between app-facilitated and non-app-facilitated partnerships. Increasing age of nominated partners (especially within non-app-facilitated relationships); White, non-Hispanic race-ethnicity of respondents; daily communication with nominated partners; and respondents' lifetime history of sex with individuals living with HIV were independently associated with higher odds of CAS. Our findings showed app-facilitated relationships were no "riskier" in terms of CAS than other relationships. A large proportion of partnerships reporting CAS urges for diverse strategies designed and implemented via apps and more traditional venue outreach to promote (self-)testing, consistent condom use, and pre-exposure prophylaxis (PrEP) uptake.