Predictors of HIV risk among MSM and transgender women who report online male sexual partners: findings from a cross-sectional two-city study in India

BACKGROUND: In India, the increasing use of smartphones among MSM and transgender women (TGW) increases access to sexual partners through virtual spaces. Limited information is available on HIV risk behaviors of MSM and TGW who use virtual spaces to meet sexual partners. We aimed to examine sociodemographics and related characteristics of MSM and TGW who report online sexual partners, and to identify predictors of condomless anal sex (CAS).
METHODS: Between November 2020 and January 2021, we conducted interviewer-administered surveys with 500 MSM and 500 TGW (as part of an ongoing cohort study called 'S3') recruited through community-based organizations in Chennai and Mumbai in India. Data were collected on the use of social media and dating apps, sociodemographics, condom use, and mental health (e.g., depression, anxiety, problematic alcohol use). Multivariable logistic regression analyses were conducted to identify factors that predict CAS among those with online sexual partners.
RESULTS: Most MSM (59.2%) and TGW (50.4%) reported meeting male sexual partners online through generic platforms (e.g., Facebook, WhatsApp, Instagram), and/or gay apps (e.g., Grindr, Blued). CAS was not significantly different between those who had online sexual partners vs. those who did not (MSM: 31.1% vs. 40.4%; TGW: 29.9% vs. 34.5%). Those who had completed college (MSM: aOR=1.95, p<.001; TGW: aOR=2.20, p<.01) and those in sex work (MSM: aOR=2.13, p<.001; TGW: aOR=2.50, p<.01) had higher odds of having online sexual partners. In adjusted multivariable models, having online sexual partners was not a significant predictor of CAS. Among MSM with online sexual partners, internalized homonegativity and resilient coping were significant predictors of CAS; and among TGW with online sexual partners, internalized transprejudice and depression were significant predictors of CAS.
CONCLUSIONS: Condomless anal sex is highly prevalent among MSM and TGW who reported online sexual partners. Interventions, which can be delivered online or offline, that address internalized stigma (internalized homonegativity or transprejudice) and depression, and steps to improve resilience could decrease HIV risk among those with online sexual partners. Given the mixing of offline and online sexual networks, online interventions need to be implemented to promote safer sex and mental health, complementing physical outreach.

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