Examining the social, sexual, and technological behaviour of gay, bisexual, and other men who have sex with men

Online sex seeking (OSS) has previously been associated with condomless anal sex (CAS) among gay, bisexual, and other men who have sex with men (GBM). Previous studies suggest that this association may be due in part to the uptake of OSS among GBM who are more likely to engage in CAS. This thesis examines the interpersonal factors that might underlie this association. Data for this thesis was collected through the Momentum Health Study, a longitudinal cohort of GBM living in Metro Vancouver and recruited using Respondent-Driven Sampling. Latent class analysis, hierarchical regression, and structural equation models examined (i) patterns of online and offline community connectedness, (ii) covariates of event-level CAS within the context of online-initiated partnerships, and (iii) confounding effects of collectivism on the OSS-CAS relationship. Latent modeling of patterns of community connectedness identified three classes: Class 1, “Socialites,” (38.8%) were highly connected both online and offline. Class 2, “Traditionalists,” (25.7%) were moderately connected with little app/website-use. Class 3, “Techies,” (35.4%) had high online connectedness and relatively low in-person connectedness. In multivariable modelling, Socialites had higher collectivism than Traditionalists, who had higher collectivism than Techies. Patterns of community connectedness were also related to HIV-testing, perceptions of HIV stigma, serodisclosure, and condom use. Supporting these findings, hierarchical event-level logistic regression showed that collectivism, altruism, and social embeddedness were protective factors against CAS – particularly for HIV-negative men. Structural equation modelling revealed that collectivism, altruism, and sensation seeking accounted for approximately 40% of the association between OSS and CAS. In conclusion, these analyses suggest that collectivism, and related sociocultural constructs, promotes greater adherence to established HIV-prevention practices (such as condom use) while individualism may be more amenable to novel risk-reduction strategies which may or may not include condoms. While further research is needed to understand the plasticity of these interpersonal factors, these results suggest that programs facilitating collectivism might have the potential to establish broad sexual health norms. Furthermore, sex-positive risk reduction is likely an important component of HIV prevention for GBM who are less attuned to traditional social influences – many of whom predominantly use the Internet to connect with other GBM.