Introduction

Men who have sex with men (MSM) belong to a population which classically presents additional vulnerability to sexually transmitted infections (STIs), due to factors such as homophobia, discrimination, difficulty accessing health services and sexual behavior. ¹ Coupled with these vulnerabilities, the use of geosocial dating apps to find partners has boosted vulnerability behaviors. ^{2 , 3}

Even though the literature presents several studies about this issue worldwide, most are conducted in the United States and other developed countries, with a lack of studies in Latin America that would allow to establish a profile of app users. ^{2 , 4} In general, previous studies have shown that the use of these apps to find sexual partners can result in new patterns of behaviors and relationships that place MSM at risk of STIs. ^{4 - 7}

In general, there are two types of apps: those aimed at the general population and those directed only at specific populations, such as lesbians, gays, bisexuals, transvestites, transsexuals, and transgenders (LGBTQ+). Among the latter, the most popular in Brazil and the world are Grindr®, SCRUFF® and Hornet®. The first of its kind, Grindr® alone has 2.4 million active users every day in almost 200 countries. ²

Even though the market for these apps is one of the greatest in the technology field, little is known about Brazil’s participation, with most information limited to assumptions made by high-circulation nonscientific newspapers. ⁸ Identifying the profile of users is the first step to assessing vulnerability behaviors and provide an idea of the social, demographic and use characteristics that can influence the consumption of apps and, consequently, associated vulnerabilities. ⁹

Based on the above, the goal of the present study was to be the first to conduct a nationwide survey to establish the profile of geosocial dating app users in Brazil in terms social, demographic and consumption variables of apps and estimate the prevalence of STIs and factors associated with condom use.

Methods

This was a descriptive and cohort cross-sectional study with 2250 individuals who participated in the epidemiological survey “Behaviors, Practices and Vulnerabilities of men who have sex with men who use geosocial dating apps in Brazil” ( Comportamentos, Práticas e Vulnerabilidades de homens que fazem sexo com homens usuários de aplicativos para encontros baseado em geolocalização no Brasil )” The study was coordinated by researches of the Ribeirão Preto College of Nursing at the University of São Paulo, in partnership with the Federal University of Piauí and the Federal Fluminense University.

To reach the intended sample size, the study was disseminated on Facebook®. A fixed post was created associated with the survey’s official page (https://www.facebook.com/taafimdeque/), presenting information about the study and an invitation to participate. This post was boosted weekly, between November 2016 and January 2017, reaching all regions of Brazil, until the planned sample size was reached.

The post contained a hyperlink that provided access to the survey questionnaire, which was subdivided into four sections in order to obtain social, demographic and health information on the participants: (1) Personal characteristics; (2) Sociocultural characteristics; (3) Health issues; and (4) Sexual practices. The researchers used the free tool Google forms to create a form projected so that all questions had to be answered. The questionnaire would only be considered for analysis if all the conditions had been met, and, therefore, incomplete surveys were not saved by the system. To answer the questionnaire, participants provided their email address, preventing duplicated entries.

The inclusion criteria were: identifying as a cisgender man; being 18 years of age or older; and having used apps for sexual encounters at least once in the last 30 days. Users who were in the country at the time of the study but were not Brazilian residents were excluded, as the objective of the survey was to assess Brazilian users.

The information was grouped according to sociodemographic data, data about the consumption of apps, and the prevalence of STIs among participants, which were recorded in a Microsoft Excel database, used for the description and bivariate analysis of the data. Categorical variables were analyzed using the chi-squared test or Fisher’s exact test to assess statistical significance, set at p≤0.05 with a confidence interval of 95%.

The survey was approved by the Research Ethics Committee of the Federal University of Piauí (Resolution no.: 1.523.003). The participants read the free and informed consent form and then signed it, thereby indicating their agreement with the proposed objectives and willingness to participate in the study. This consent was applied and obtained online.

Results

On average, the participants were 25.74 years old (SD=7.76), had completed university (57.8%), were single (75.2%), did not practice any religion (63.9%), lived with their parents (55.5%), identified themselves as homosexual (75.7%) and adopt a “versatile” sexual position (40.8%). Most participants lived in the southeast region of Brazil (50.3%) ( Table 1 ).

Table 2 presents data about the consumption of dating apps by MSM. Of these, 64.1% had met their partners on the apps, especially through Tinder® (57.3%) and Grindr® (53.3%). The mean number of total partners in the 30 days prior to the study was 2.8, and the participants had met 1.91 of them on the apps. The participants used the apps primarily for sex (69.7%), mostly every day (36.2), at night (76.7%) and during week days (55.9%). Furthermore, most users reported having used the apps for over a year (55.5%). These findings show that the apps are not used sporadically, but are a recurring part of these men’s daily lives ( Table 2 ).

Regarding the prevalence of STIs, 11.1% had presented with an infection in the last year, including syphilis (3.1%) and herpes (1.5%). The study also showed a significant prevalence of HIV (7.1%) and a considerable number of individuals who were unaware of their HIV status (28.3%) ( Table 3 ). Considering the high percentage of condomless sex in the 30 days prior to the survey (7.3%), an important risk factor for STIs, the researchers investigated which of the social, demographic and app consumption variables could be statistically associated with the consistent use of the male condom. The following associated factor were considered: meeting partner through app (p=0.003), using Grindr ® (p=0.002), Scruff ® (p=0.027) or Hornet ® (p<0.001), using apps for friendship (p<0.001), sex (p<0.001) or relationship (p<0.001), frequency of app use (p<0.001), and using apps at night (p=0.003).

Discussion

In Brazil, adherence to geosocial dating apps is high among MSM, especially the younger population (>25 years). This result corroborates the findings of a recent review ² and of most studies of this kind in the world. ^{7 , 10 - 13}

Mobile app use by MSM is a practical and efficient way to establish sexual partnerships quicker than conventional methods. Establishing partnerships through apps allows MSM to select partners according to their preferences and change their profile, which provides users with a different experience for expressing sexuality, ¹⁴ especially younger individuals, ¹⁵ one reason that explains the growing popularity of these apps.

Dating apps facilitate mutual identification, communication, and encounters for casual sex among MSM. They allow users to create profiles with pictures and brief descriptions of themselves, locate other users close to them using geolocation, and exchange messages with possible sexual and romantic partners easily, discretely, conveniently and free of cost. ^{14 - 16}

The frequency of app use, according to the data in this study, shows that the use of these apps is, in fact, so significant to MSM that it has become part of the LBGTQ+ community. They enable interactions among members in the same region, creating and strengthening social networks that blend the virtual and real world.

Among the apps aimed exclusively at homoaffective partnerships, Grindr® stood out in terms of frequency of use in this and other similar studies. ^{17 , 18} This app is more popular among this population, ^{2 , 17 , 18} connecting users discretely, conveniently and free of charge. The success of this app among mobile applications is due to the possibility of building communities, experiences of entertainment and favoring greater socialization, as the app lowers entry barriers of MSM and reduces risk of encountering homophobia. ¹⁹ One reason for its greater popularity is that it has been around longer in the market and caused an impact on the LGBTQ+ community, thus defining a model for similar apps and its use by MSM.

Hornet®, another popular app, has over 25 million users worldwide, according to company data, ¹⁹ and Brazil is one of its main consumer markets. ⁹ Its popularity is associated with its innovative marketing strategies, the use of other social networks, and the pioneer approach of including sexual health information in its settings, which explains its association with condom use in our findings. ²⁰

Conclusion

Dating apps in Brazil are mainly used by youths who identify as homosexual, have high education levels and are single. These youths use the apps intensely, especially as a way to meet new sexual partners. The particularities of this consumption are associated with condom use, especially purpose, frequency, and time of day of app use. The experiences provided by the search for partners on apps lead to patterns of behaviors and relationships, exposing MSM to situations of vulnerability in terms of STIs, which present elevated prevalence, especially HIV and syphilis.