Addressing the Persistent Health Challenges of GBMSM

Globally, gay, bisexual, and other men who have sex with men (GBMSM) are disproportionately affected by HIV and other sexually transmitted infections (STIs). This group's significant ongoing sexual health needs are especially pronounced in regions like Hong Kong, where our study was recently conducted. Despite the decline in HIV cases from a peak of 725 in 2015 to 397 in 2023, GBMSM continue to represent the majority of these new diagnoses. Furthermore, a global systematic review from 2000 to 2020 shows a disturbingly high pooled prevalence of syphilis at 7.5%. These figures highlight a critical and persistent gap in meeting the sexual health needs of GBMSM, despite global efforts to address these issues.

Limited Coverage of HIV Pre-Exposure Prophylaxis (PrEP) in Hong Kong

HIV Pre-Exposure Prophylaxis (PrEP) involves the use of antiretroviral medications by HIV-negative individuals to prevent infection and is highly effective in reducing HIV transmission among high-risk populations. Endorsed by health authorities like the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), PrEP remains a primary prevention strategy. However, access to PrEP in Hong Kong is severely limited; it is not included in government HIV prevention strategies and is unavailable through the public healthcare system. Individuals must purchase PrEP at private clinics or from overseas, which is prohibitively expensive. This limited access creates several significant issues:

1. Accessibility: High-risk individuals often cannot obtain PrEP, leaving them vulnerable to infection.
2. Health Equity: The high cost creates a disparity where only the financially well-off can afford PrEP.
3. Clinical Follow-Up: Those sourcing PrEP from overseas face challenges in maintaining consistent clinical follow-up and regular testing for HIV and other STIs.

This situation underscores the urgent need to rethink and expand HIV prevention strategies in Hong Kong to include PrEP, ensuring equitable and effective protection for all individuals at risk.

Motivation Behind Our Study

Before the widespread availability of HIV PrEP in public health systems, behavioral interventions promoting consistent condom use and regular HIV testing remain vital. This prompted our research team to develop an eHealth intervention targeted at improving sexual health among GBMSM. Our study focused on GBMSM using smartphone dating apps—a platform that, while facilitating connections, also poses sexual health risks such as inconsistent condom use and higher STI rates.

Development and Evaluation of Our Sexual Health Intervention

We began with a qualitative study involving 31 GBMSM to understand their experiences with dating apps and their sexual encounters. The insights gained were invaluable in developing a culturally sensitive and tailored sexual health intervention. We opted for a website delivery method to ensure convenience and privacy and included gamification elements to engage participants. Our randomized controlled trial (RCT) assessed the intervention’s effectiveness on behavioral outcomes, such as consistent condom use and regular testing for HIV and other STIs, along with psychological outcomes like self-efficacy and attitudes toward condom use

Key Findings

The intervention significantly reduced instances of condomless anal sex by enhancing self-efficacy and attitudes toward condom use, with effects sustained over both three and six months. However, it did not affect other behaviors such as chemsex, group sex, or the frequency of HIV and other STI testing.

Looking Ahead

Building on this success, there is substantial potential for further initiatives. Collaborating with non-governmental organizations (NGOs) and community partners to translate research into practice is essential for scaling up impact. Additionally, future interventions should adopt a holistic approach to meet the comprehensive health needs of GBMSM, including mental health components and more tailored sexual health education based on individual risk profiles. Furthermore, we should explore interactive interventions such as chat-bot assistants to dynamically engage users. By addressing these areas, we can better serve and protect this vulnerable population, ensuring they receive the comprehensive care and support they deserve. 

The study was led by Associate Professor Edmond Choi  at the University of Hong Kong. Please visit his lab's website to learn more.