Although there are several limitations to our approach, there is a clear signal towards higher estimates of GBMSM when digital approaches are utilized. While several studies have focused on the role dating apps and websites play in risk-taking behaviors among GBMSM [ 25 ], only recently has there been interest in leveraging apps to serve the HIV prevention, treatment, and care needs among GBMSM. Our data suggest that same-sex dating apps and social media networks are promising data sources for designing population estimates and programmatic targets for GBMSM.
The usage of the Internet is becoming increasingly normalized throughout the world, and this trend will only continue.
Empirical and market-research data, generally derived from higher income settings, demonstrate that GBMSM are high utilizers of the Internet, often using the Internet to find partners, given limited venues and significant social stigma [ 26 - 30 ]. This trend towards online spaces has largely been attributed to stigma that same-sex behaviors face and the confidentiality that is afforded in online spaces [ 32 - 34 ], which enable users to more accurately report their attraction or in some instances, trace their behavior and eliminate biases in self-reported data. Although these studies were predominantly completed in higher income settings, similar results have been observed among GBMSM in Southern Africa and Nigeria [ 35 , 36 ].
Given the significant usage of the Internet, online spaces likely represent an important approach for collecting same-sex attraction and behavioral data, especially in more stigmatizing settings. However, most men have their first sexual encounters with other men before the age of 18, and HIV incidence has been shown to be high among young GBMSM across settings [ 38 , 39 ]. Moreover, men under the age of 18 are generally not included in surveys or HIV prevention, treatment, and care programs, given the challenges in achieving consent [ 40 ].
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Given that younger GBMSM are more likely to leverage virtual spaces, as evidenced by these data, the use of digital data for size estimation represents a strategy to inform the numbers and HIV prevention, treatment, and care needs of young GBMSM [ 41 ]. While the legal challenges of consent remain, especially in settings where same-sex practices are criminalized, there is a clear need to scale up evidence-based and human rights-affirming HIV prevention strategies for younger GBMSM, including condoms, lubricants, and preexposure prophylaxis PrEP.
There are several limitations in the methods and results presented here. Moreover, the extent of specificity is likely subject to specific cultural contexts, thereby leading to overestimating the numbers of GBMSM with this metric. The metric used for Hornet was unique users with only one account allowed per device. While it is feasible to create multiple accounts on Facebook with unique email addresses, this likely represents a very low proportion of users.
Although Internet usage is increasing rapidly, there is less access in many lower- and middle-income countries, which may underestimate the numbers of GBMSM. However, Internet access around the world continues to increase, especially due to the rapid increase in affordable smartphones, suggesting that the utility of social media-based estimates of population size will increase over time. Moreover, some of the respondents captured online in low- and middle-income countries may be expatriates rather than GBMSM from that country.
The contribution of expatriates to these estimates is considered to be low, given the limited number of expatriates, and only people who noted the country as their country of residence were included. Additional research studying appropriate search strategies according to each social media platform, including large platforms not studied in these analyses, are required.
Building collaborations with social media platforms may also facilitate improved estimates of population size along with insights into appropriate strategies to deliver interventions that leverage these platforms. Taken together, these data clearly suggest a significant discrepancy between size estimates of GBMSM reported by normative agencies and estimates from digital sources. Over four decades of the HIV pandemic, GBMSM have been well known to bear a disproportionate burden of HIV due to the biology of the virus, which is compounded by criminalization, intersectional stigma, discrimination, and violence.
Deriving estimates of the numbers of people at risk of acquiring and living with HIV is complex, and other studies have highlighted these challenges for other populations. Developing common methods of counting GBMSM, especially the use of central data collection with consistent approaches, provides an additional data source that is directly comparable across settings.
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Although these additional approaches have biases, they are complementary to the biases of existing methods. The approach presented here that leverages social media is imperfect, but is relatively low cost to implement and provides comparable estimates across a large range of countries, including some with no extant estimates.
Triangulating multiple data sources including social media may facilitate optimal estimations of the numbers of GBMSM for program planning, evaluation, and estimates of HIV epidemic dynamics. These methods also allow for the estimation of numbers of GBMSM in settings where stigma and risks of violence are too great to even report in this paper [ 44 ]. The practice of pointing to no data in this instance nonexistent GBMSM size estimates to justify not funding or grossly underresourcing programs for GBMSM has long been identified by advocates, and should be challenged.
Not doing so runs the risk of having evidence-based and human rights-affirming programs that address specific needs of GBMSM disappear. Ultimately, we cannot overstate the importance of understanding the characteristics and numbers of those most affected by HIV to truly achieve an AIDS-free generation.
The funders had no role in study design, data collection and analyses, decision to publish, or preparation of the manuscript. Distribution of Facebook identified same-sex interests by country — expanded Table 2. Conflicts of Interest: All other authors declare no conflicts of interest.
National Center for Biotechnology Information , U. Published online Feb 8. Reviewed by Teymur Noori and Elizabeth Fearon.
Author information Article notes Copyright and License information Disclaimer. Corresponding author.
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Corresponding Author: Stefan Baral ude. This is an open-access article distributed under the terms of the Creative Commons Attribution License https: The complete bibliographic information, a link to the original publication on http: This article has been cited by other articles in PMC. Objective This study leverages estimates of the number of members of a social app geared towards gay men Hornet and members of Facebook using self-reported relationship interests in men, men and women, and those with at least one reported same-sex interest.
Conclusions The ability to use social media for epidemiologic and HIV prevention, treatment, and care needs continues to improve. Introduction Consensual sex between adult men remains stigmatized in much of the world. Methods The overarching goal of this study was to assess the utility of using data on users of mobile phone apps and social media communities to obtain estimates of GBMSM population sizes.
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Open in a separate window. Table 2 Distribution of Facebook-identified same-sex interests by country. Limitations There are several limitations in the methods and results presented here. Conclusions Over four decades of the HIV pandemic, GBMSM have been well known to bear a disproportionate burden of HIV due to the biology of the virus, which is compounded by criminalization, intersectional stigma, discrimination, and violence. Click here to view. Multimedia Appendix 6 Distribution of Facebook identified same-sex interests by country — expanded Table 2.
fensterstudio.ru/components/vywurog/majeq-programa-espia.php Multimedia Appendix 7 Age distribution of male Facebook users by country proportion of males. Footnotes Conflicts of Interest: References 1. Carroll A, Mendos LR. May, . State-sponsored homophobia Estimating the size of key populations: AIDS Behav. Baral S, Phaswana-Mafuya N. Sahara J. Global health burden and needs of transgender populations: The Lancet.
Khan S, Khan OA. The trouble with MSM. Am J Public Health. Young R, Meyer IH. The prevalence of sexual behavior stigma affecting gay men and other men who have sex with men across Sub-Saharan Africa and in the United States. Estimating the population size of men who have sex with men in the United States to obtain HIV and syphilis rates.
Estimating the population sizes of men who have sex with men in US states and counties using data from the American Community Survey. Office for National Statistics. Experimental official statistics on sexual identity in the UK in by region, sex, age, marital status, ethnicity and National Statistics socio-economic classification.
ONS; Oct 04, Statistical bulletin: The Other Foundation. Human Sciences Research Council. Sutherland C.
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