Compared to those who aren't on Grindr, cisgender gay and bisexual men on the app were definitely taking more sexual risks that made them more likely to contract HIV and sexually transmitted infections (STIs) -- but they were also more likely to use pre-exposure prophylaxis (PrEP) or be open to using PrEP, according to new research. Men on Grindr did in fact tend to have higher rates of chlamydia and gonorrhea than men who weren't on Grindr, but those on the hook-up app also had fewer new HIV diagnoses. The study findings were released at the IDWeek 2019 conference on Oct. 4 in Washington, D.C.
"Grindr could be a great platform to promote PrEP, as well as testing for HIV and STIs, given the higher-risk behavior and greater acceptance of the prevention medication," said Martin Hoenigl, M.D., lead author of the study and assistant professor at the University of California at San Diego. "Additionally, HIV and STI testing programs could assess Grindr use to prioritize who should be tested and who would be good candidates for PrEP."
The researchers surveyed 1,256 men who have sex with men. The men filled out questionnaires; researchers found that 1,087 men (86.5%) were not currently using PrEP, and 580 (46%) men had used Grindr in the past seven days. Researchers also found that the men who used Grindr had engaged in higher-risk sex acts, including a higher number of male partners and more instances of condomless sex in the past year.
When it came to actual STI or HIV risk, researchers found men on Grindr were more likely to test positive for chlamydia or gonorrhea (8.6% vs. 4.7% of non-users). Grindr users were more likely to take PrEP (18.7%) compared to men who didn't use Grindr (8.7%). Researchers said the higher PrEP use among Grindr users resulted in fewer HIV diagnoses among Grindr users (9) than men not on the app (26). Also Grindr men not currently using PrEP were almost twice as likely as men not on Grindr to agree to begin PrEP, even though more than 81% of men on Grindr were not using PrEP.
"There are a number of possible explanations for this, including that PrEP was simply not offered, or they didn't feel that they were at high risk," said Hoenigl. "Clearly, Grindr provides a real opportunity for infectious diseases specialists and other health care providers to reach those at risk and help them understand the benefits of PrEP."
The debates about whether or not hook-up apps like Grindr are helping fuel HIV and other STIs among gay and bisexual men won't likely end soon. The apps also carry a certain kind of stigma -- gay men often judge one's promiscuity or character by whether or not you're using the apps. PrEP, despite how effective it is, is similar. In some circles, use of PrEP is still frowned upon by some gay men, and jokes are often made about men on PrEP having other STIs like chlamydia or gonorrhea. But some advocates think that Grindr may be helping to set the tone for more open dialog about PrEP and sexual health.
"From this data, it seems that people on Grindr are exposed to more sex-positive and HIV status–neutral information, more than the general public," said Ace Robinson, director of strategic partnerships at NMAC. "And using PrEP to avert HIV acquisition is more normalized for folks on Grindr. These apps are reducing stigma about people simply taking control of their sex lives."
Of the various dating and hook-up apps that are used by gay and bisexual men, Grindr was an early adopter of a field where people can select "HIV negative, On PrEP" or "HIV positive, Undetectable," which may have helped educate other users on what these terms and prevention strategies mean. Similarly, Grindr also shares ads that educate users on issues of sexual health.
But accessing PrEP is partly about it being normalized in one's sexual networks. It's also about being able to access the drug, and that usually begins with a conversation with a provider.
Just last month, the Centers for Disease Control and Prevention released results of a study showing that disparities among gay and bisexual men regarding PrEP use persist. In their survey of 4,056 gay and bisexual men in 23 U.S. urban areas, 95% of white men were aware of PrEP, compared to 87% of Hispanic and 86% of black men. And although these numbers were pretty good for overall awareness of PrEP, when asked if they'd discussed PrEP with their providers in the past year, 58% of white men had talked about PrEP with a provider compared to 44% of Hispanic and 43% of black men. While the overall rates of PrEP use were relatively low for all groups, it was higher among all men who had discussed it with their doctor (though black men were less likely than whites to be insured or to have a sustained relationship with a provider).
"I personally have been utilizing PrEP for almost six years," said Robinson. "The intermittent, or 2-1-1, regimen works best for me. I'm lucky that I've been educated and empowered about PrEP. I want that for everyone. In the world of PrEP and U=U [undetectable equals untransmittable], we can all love without fear. "