Op-ed: Hooking Up and HIV/AIDS When You're Zero Feet Away

HIV infection rates across the country's general population have been fairly stable for the last few years. But one group showed a significant increase in HIV infections: men who have sex with men, or MSM, aged 13-29. Though this generation of young gay men has been raised in a more HIV-aware world, all of the outreach and awareness work still does not explain why the rates won't stop ticking up.

Coincidentally, recent advances in technology have paved a new way for gay and bisexual men to find sexual partners. In 2009 many developers launched location-based mobile apps geared toward gay and bisexual men, allowing users to scan for nearby men, chat with them, and meet, often for sexual encounters. For example, Grindr counts more than 3.5 million users in 192 nations, just three years after its launch. Other popular apps include Scruff, Manhunt, and Growlr, in addition to traditional social networks like Facebook and Twitter.

Several studies link unprotected sex with the use of mobile apps and the Internet, alcohol, drugs, and sexually charged venues for hooking up with potential sexual partners. But we set out to understand how young men who use these apps perceive HIV, their knowledge on the facts of the virus, and how they view their own risk of getting the virus. Our pool of participants included 686 gay and bisexual males over the age of 18 (the average age was about 36) who use location-based mobile apps to meet sexual partners.

The survey found that reasons behind risk-taking behaviors during intercourse go well beyond lack of knowledge and HIV status. Most people could identify the fluids that can transmit HIV, like blood. And while 91% of participants say they know how to protect themselves from HIV, nearly 70% of the study participants said they're afraid of getting the virus or getting reinfected. The vast majority of respondents considers barebacking, or unprotected anal sex, to be dangerous. Yet 46.4% of respondents have engaged in bareback sex, versus 53.6% who reportedly never engage in unprotected anal intercourse.

Among those who practice sex without condoms, 84% said it was because condoms decrease the sensation of sex. Three quarters say it's because of impulsive sexual behavior, and 57% say it's because they were under the influence of drugs. Half said it was because they already knew the HIV status of their partner.

Interestingly, half of respondents concurred with the statement "AIDS is now a common and manageable disease." When it comes to asking sexual partners their HIV status, 49% of respondents feel very comfortable and 29% said they are comfortable having sex with HIV-positive partners.

About half of the participants knew of pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP), and some respondents voluntarily disclosed having accessed PEP services and some shared being part of PreP studies.

Eighteen percent of those who opted to disclose their HIV status said that they were HIV-positive, 72% said they were negative, and the remaining people said they were unsure of their status.

As found in other studies, people may know the facts about things like unsafe sex, smoking cigarettes, or drinking and driving, but that doesn't necessarily inform how they act. Respondents identified the way condoms feel, impulsive behaviors, and the use of drugs as the principal causes for engaging in bareback sex. This places control externally, in tools that interrupt the sexual experience's fluidity or interfere with making healthy choices.

All things considered, many gay and bisexual men are undeniably knowledgeable about HIV and AIDS but still participate in risk-taking activities. Our participants were certainly clear: Men do not like condoms, and men are led by powerful and deep cognitive factors. Right now HIV prevention is based on providing HIV education, distributing condoms, encouraging safer sex, and teaching people behavioral strategies to facilitate decision-making. There is a clear discrepancy between the reasons why men engage in unprotected anal intercourse and the way prevention initiatives attempt to address risk behaviors.

Generations of HIV/AIDS workers have been distributing condoms to men who clearly do not like how condoms feel. Researchers have created cognitive tools to approach men who report being driven by impulsive needs, which, by definition, cannot be rationally controlled. One researcher suggested that prevention programs should be multifaceted and address psychological, emotional, and behavioral aspects of barebacking. The survey reached similar conclusions for gay and bisexual men on mobile apps. The hurdle isn't necessarily a lack of knowledge. The hurdle is facing complicated variables that come into play during sexual encounters, which appear to be primarily emotional experiences rather then mechanical behaviors.

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RENATO BARUCCO is the head of the Transgender Family Program at the Community Healthcare Network in New York City. He manages general medical care and HIV care for special populations and creates behavioral interventions to promote healthy behaviors.

LUIS FREDDY MOLANO, MD, is the vice president for HIV programs for the Community Healthcare Network. He has been published in the American Journal of Preventive Medicine and WPATH, a transgender health forum. He is also the cochair for both the Bronx and Brooklyn Knows Testing Campaigns.