Receptiveness to monkeypox vaccines and public health communication strategies among gay, bisexual and other men who have sex with men in Singapore: cross-sectional quantitative and qualitative insights.

OBJECTIVES: Monkeypox (mpox) was declared as a global health emergency by the WHO, with most reported cases disproportionately involving gay, bisexual and other men who have sex with men (GBMSM). This study explored the willingness of Singaporean GBMSM to receive mpox vaccines and engage in changes to sexual behaviour, and analysed the factors influencing both decisions. METHODS: An online cross-sectional study was disseminated through community groups and Grindr from September to October 2022 among GBMSM in Singapore, where we surveyed respondents' demographics, stigma associated with mpox, perceived risks of sexually transmitted infections (STIs) and changes to sexual behaviours in response to mpox. Descriptive statistics and multivariable linear and logistics regression analyses, as well as thematic analysis of data, were also conducted. RESULTS: 237 GBMSM community members responded to the survey, with the majority being receptive to vaccine and 67.5% indicating changes to sexual behaviour in view of rising mpox infections. Predictors of vaccine receptivity among GBMSM included self-perceived mpox risk (adjusted OR (aOR)=0.44, 95% CI 0.07, 0.82) and self-perceived STI risk (aOR=0.39, 95% CI 0.03, 0.76). Predictors for changes to sexual behaviour included self-perceived mpox stigma (aOR=1.17, 95% CI 1.08, 1.27), self-perceived mpox risk (aOR=1.22, 95% CI 1.03,1.44), age (aOR=0.96, 95% CI 0.93, 1.00) and race (aOR=0.31, 95% CI 0.10, 0.93). In the thematic analysis, respondents raised concerns about vaccine effectiveness, side effects, cost and privacy. CONCLUSIONS: Our findings suggest that the rise in mpox infections have prompted changes to GBMSM's sexual practices. In general, GBMSM are willing to receive the mpox vaccine but are concerned about the physical and social consequences of uptake. These concerns should be addressed when vaccines are released.

Perceived Accuracy Around Undetectable = Untransmitable Among Sexual and Gender Minorities Using Smartphones in India.

Sexual and gender minorities (SGM) using online venues in India are usually not reached by government HIV interventions, remaining an understudied yet important population. We investigated sociodemographic characteristics, sexual behaviours along with familiarity, knowledge, and correlated factors around perceived accuracy of the Undetectable = Untransmittable (U = U) slogan. Grindr users in India completed an online, cross-sectional survey in May-June 2022. We included individuals ≥ 18 years old who reported sex with men (excluding those who were born female and or identified as cis-gender female). Associations with perceived U = U accuracy were estimated using adjusted prevalence odds ratios (aPOR) with 95% confidence intervals (95% CI). The survey was completed by 3,126 eligible participants. The median age was 28 years and most participants lived in urban areas and had graduate or postgraduate education. HIV prevalence was 3.1%. Only 14% reported familiarity with the U = U slogan and after an explanation was provided, 25% perceived it as completely accurate. This was associated with knowing their HIV status (HIV Negative aPOR 1.37 [95%CI 1.1, 1.71], HIV Positive aPOR 3.39 [95%CI 2.11, 5.46]), having heard of PrEP (aPOR1.58 [95%CI 1.29,1.92]) or have used PrEP (aPOR1.56 [95%CI 1.15, 2.12]) along with use of party drugs (aPOR1.51 [95%CI 1.0 2.10]), being in touch with NGOs (aPOR 1.61 [95%CI 1.27, 2.02], p < .001) and having attended LGBTQIA + events (aPOR1.38 [95%CI 1.1, 1.73]). SGMs in India had low familiarity and low perceived accuracy around U = U. Education about U = U and innovating new strategies to reach this hidden population could reduce stigma around HIV in India.

RESUMEN: Las minorías sexuales y de género (MSG) que utilizan sitios en línea en la India, generalmente no son alcanzadas por el gobierno a través de sus intervenciones contra el VIH aunque siguen siendo una población importante, pero poco estudiada. Se investigaron las características sociodemográficas, el comportamiento sexual y, adicionalmente, la familiaridad, el conocimiento y la percepción de exactitud sobre el eslogan Indetectable = Intransmisible (I = I). Los usuarios indios de Grindr completaron una encuesta transversal en línea entre mayo y junio del 2022. Se incluyeron a personas ≥ 18 años que informaron haber tenido relaciones sexuales con hombres (se excluyeron aquellas asignadas como mujer al nacer y que se identificaron como mujeres cisgénero). Las asociaciones con la precisión percibida de I = I se estimaron con razones de probabilidad de prevalencia ajustadas (aPR) con intervalos de confianza a 95% (IC 95%). En total, 3,126 participantes elegibles completaron la encuesta. La mediana de edad fue de 28 años, la mayoría vivían en áreas urbanas y eran graduados o posgraduados. La prevalencia del VIH fue de 3.1%. Solo 14% informó que conocía el eslogan I = I, pero incrementó a 25% después de que se proporcionó una explicación y lo percibieron como completamente exacto. Esto se asoció con conocer su estado serológico (aPR VIH negativo = 1.37 [IC 95%: 1.1, 1.71]; aPR VIH positivo = 3.39 [IC 95%: 2.11, 5.46]), tener conocimiento de la profilaxis preexposición (PrEP) (aPR = 1.58 [IC 95%: 1.29,1.92]), haber usado la PrEP (aPR = 1.56 [IC 95% 1.15, 2.12]), usado drogas con fines recreativos (aPR = 1.51 [IC 95%: 1.0, 2.10]), estar en contacto con las ONG (aPOR 1.61 [95%CI 1.27, 2.02], p < .001) y haber asistido a eventos LGBTIQA+ (aPR = 1.38 [IC 95%: 1.0, 2.10]). Las MSG en India tuvieron poco conocimiento y poca percepción de exactitud sobre el eslogan I = I. La educación sobre I = I y otras estrategias innovadoras de prevención para el VIH en esta población podría ayudar a reducir el estigma en torno a esta enfermedad en la India.

HIV Pre-Exposure Prophylaxis, Condoms, or Both? Insights on Risk Compensation Through a Discrete Choice Experiment and Latent Class Analysis Among Men Who Have Sex With Men.

OBJECTIVES: We considered how decision making around human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) among gay, bisexual, and other men who have sex with men (GBMSM) is made in the context of one's perceived risk of HIV acquisition and the availability of condoms. METHODS: We recruited 648 GBMSM aged 18 years old and residing in Singapore through Grindr. Participants were given information on PrEP and participated in a discrete choice experiment requiring them to choose between 2 baskets of PrEP attributes and compare the chosen "PrEP only" option to default options of "condoms only" or "PrEP with condoms." Generalized multinomial logit model was used to examine the scaling effect and preference heterogeneity. Latent class analysis was conducted to examine preference heterogeneity in the sample. RESULTS: Latent class analysis revealed 3 classes of GBMSM: PrEP conservatives (53.9%), moderates (31.1%), and liberals (14.9%). PrEP conservatives were more likely to report greater utility when using condoms only compared with PrEP only, as well as PrEP with condoms, compared with PrEP only, and more likely to report the lowest utility for PrEP as perceived HIV risk increased. PrEP liberals were more likely to report greatest utilities for PrEP only compared with condoms only, as well as PrEP only compared with PrEP with condoms. The utility for PrEP was not affected by perceived risk of HIV or sexually transmitted infections when risks were low. CONCLUSION: This study provides some evidence for risk compensation among a class of GBMSM who already perceived themselves to be good candidates for PrEP before the discrete choice experiment.

Extent and selectivity of sexual orientation disclosure and its association with HIV and other STI testing patterns among gay, bisexual and other men who have sex with men.

OBJECTIVES: Gay, bisexual and other men who have sex with men (GBMSM) in Singapore may fear disclosing their sexual orientation to others due to negative societal attitudes, and the law that criminalises sexual relations between men, which may, in turn, impede access to HIV/sexually transmitted infection (STI)-related health services. This study attempts to determine how selective disclosure to varying social groups, and the extent of disclosure, may serve to impact HIV/STI testing patterns among GBMSM. METHODS: In this observational study, we recruited GBMSM in Singapore through an online cross-sectional survey disseminated via the smartphone app Grindr from 14 January to 11 February 2018. Respondents provided information on their sociodemographic characteristics, disclosure of sexual orientation towards other lesbian, gay, bisexual, transgender and questioning (LGBTQ) individuals, non-LGBTQ family members, non-LGBTQ friends and non-LGBTQ colleagues, along with their HIV/STI testing patterns. Extent of disclosure was defined as the number of social groups that a participant had disclosed his sexual orientation to. Statistical analyses were conducted through descriptive statistics, multivariable binary, ordinal, and multinomial logistic regression models. RESULTS: We recruited 1339 respondents, of which 1098 who had provided their response to questions on HIV/STI testing were included in the analytic sample. Multivariable analyses indicated that disclosure towards non-LGBTQ family members (adjusted OR [aOR] 1.85, 95% CI 1.12 to 3.07) and other LGBTQ individuals (aOR 1.63, 95% CI 1.12 to 2.37) were positively associated with recent HIV testing, whereas disclosure towards non-LGBTQ colleagues (aOR 1.56, 95% CI 1.09 to 2.22) was positively associated with regular HIV testing. Extent of disclosure exhibited a positive, dose-response relationship with all testing outcomes. CONCLUSIONS: Results indicate how the fear of being identified as an LGBTQ individual may deter GBMSM from getting tested for HIV and other STIs. Health services should bridge the gaps to accessing healthcare among individuals who fear being stigmatised for attending sexual health-specific clinics or being identified as GBMSM.

Cost and anonymity as factors for the effective implementation of pre-exposure prophylaxis: an observational study among gay, bisexual and other men who have sex with men in Singapore.

Background HIV pre-exposure prophylaxis (PrEP) is currently offered by several public and private clinics at unsubsidised prices in Singapore, but to date, no information is available on the effect of these services. This study sought to assess the knowledge and uptake of, and willingness to use PrEP among gay, bisexual and other men who have sex with men (GBMSM) in Singapore. METHODS: Recruitment was conducted through Grindr®, a geosocial networking application for GBMSM. Results were quantitatively analysed through descriptive statistics and multivariate Poisson regression models, while open-ended responses were qualitatively coded and categorised. RESULTS: Of the 1339 participants who responded, 1098 participants who indicated their knowledge and use of PrEP were included in the analytic sample. Overall, 15.0% (n=154) had taken PrEP, 66.2% (n=678) had heard of but not taken PrEP, while 18.8% (n=193) had never heard of PrEP. Of those who had ever taken PrEP, 59.6% (n=90) had obtained PrEP from overseas or other unofficial sources. Of those who had heard of but never taken PrEP, 73.3% (n=486) reported that they would consider taking PrEP. Those who had taken PrEP were older and had higher educational attainment. CONCLUSIONS: The gap between the willingness to use PrEP and its uptake may be attributed to the cost of PrEP and issues of anonymity at healthcare settings in Singapore. National financing schemes are needed to expand access to PrEP if it is to make a meaningful effect to the Singapore HIV/AIDS response.