Gay apps reveal moderate HIV testing rates among gay men in Tokyo
Despite moderate HIV testing rates among men who have sex with men using apps in Tokyo, more needs to be done to reach those not attached to the gay community.
Gay geo-social networking apps (gay mobile apps) provide vital insight into HIV testing behaviours among men who have sex with men (also known as MSM) in Tokyo, Japan, including those not previously reached because they were not part of the wider gay community.
In Japan, sex between men makes up 78% of all new HIV cases in men. However, suspected underreporting in this group means that actual figures may be much higher. In addition, it is thought that around two-thirds of men who have sex with men are not attached to the gay community, meaning they are hidden from HIV communications and information collection that traditionally takes place in gay venues.
Country-wide, Japan is falling behind many other high-income countries in taking hold of its HIV epidemic. While in many high-income countries AIDS diagnoses are becoming increasingly rare, still in Japan almost 30% of all new diagnoses in 2016 were diagnosed as AIDS, and it’s thought that the true figure could be much higher, as most smaller health facilities still do not report a difference between HIV and AIDS. Furthermore, the volume of HIV tests in Japan has reduced by 35% from 2008 to 2016, while HIV prevention resources are being increasingly used for treatment.
Gay mobile apps provide an excellent opportunity to reach out to men who have sex with men and, importantly, those ‘hidden’ or not part of a community. This study looked at 1,657 gay mobile app users, to understand testing rates and testing intentions as well as identify sub-populations of gay men for future targeting.
The men were recruited by sending a direct message with links to the survey using popular gay mobile apps including jack’d, Hornet, Grindr and 9Monster. But men were more commonly recruited through an advertisement placed on 9Monster – Japan’s most popular gay mobile app. Socio-demographic data collected included age, gender, sexual orientation, marital status, birthplace, current residence, length of residence in Greater Tokyo, self-rated health, education, occupation, work hours. Intercourse partner sex was also collected from the respondents.
Other data collected included respondents’ motivations for using the app (e.g. to find sex, to find friends, to find a relationship, to avoid being identified as gay), and gay community participation (e.g. attending a gay bar, bathhouse or event, attending a gay group activity, and identity as a gay community member). HIV behaviours were also collected, including frequency of condom use, having ever tested for HIV, testing in the last six months, and future intention to test.
The survey found that 29.7% of the men report testing for HIV in the last six months – the recommended testing schedule for sexually active gay men – and 72.8% of the men report ever testing for HIV.
These testing rates are moderate for the region but considering the high levels of availability of free HIV testing, counselling, antiretroviral therapy and relatively low stigma towards HIV testing – much more needs to be done to get the hardest-to-reach testing, and regularly.
HIV testing was associated with being older, educated, visiting a gay venue, knowledge about HIV, and having anal intercourse. Low levels of HIV testing were associated with being young, less educated, living outside of central Tokyo, and having male and female partners.
Of the men who report condomless intercourse, around a third (31.5% with a regular male partner, 30.7% with a casual male partner) had not tested in the last six months, and 23.6% of those who had sex with a female partner hadn’t tested in this time.
Among men who had never tested before, over half (54.8%) had engaged in condomless sex with casual male partners, and 42.4% had condomless sex with female partners. Alarmingly, one-fifth (20%) of those never tested had no intention of testing for HIV in the future. Young men who have sex with men aged 18–25 years had the lowest lifetime HIV testing (50%) and the lowest rate of HIV testing in the past six months (24.7%).
The authors commented that “increasing HIV testing rates for non-gay community MSM, specifically bisexual and young MSM may help stop HIV bridging into the Japanese heterosexual population, which has been previously identified as possible but low risk.”
They also call on Japan to provide more options for the non-gay community to test for HIV and prevent infections, such as self-test kits and pre-exposure prophylaxis (PrEP), both of which have not yet been approved in Japan. Using vending machines which are already popular in Japan and have been proven as efficacious in China can be a good distribution method of testing kits if these were to eventually be approved.
“Utilization of popular gay mobile apps to promote nearby HIV testing facilities may be an effective prevention policy to target non-community attached MSM, particularly at-risk youth .”