JMIR Publications

ABSTRACT

Background:

The spread of healthy behaviors through social networks may be accelerated by influential individuals. Previous studies have used lay health influencers to prevent sexually transmitted infections (STIs) among internet-using men who have sex with men (MSM). However, there is a lack of understanding of the characteristics of this key subset of MSM.

Objective:

The purpose of this study was to examine socio-demographic characteristics, HIV/syphilis testing, and sexual behaviors of online MSM sexual health influencers (SHIs) in China, defined as individuals with relatively stronger influence on spreading HIV/STI information online.

Methods:

An online survey of MSM was conducted in August 2017, as a final follow-up of a randomized controlled trial promoting HIV testing in eight Chinese cities. Men were recruited through a gay social networking mobile phone application and were included if they were born biologically male, aged 16 years and above, ever had sex with another man, and HIV negative or with unknown HIV status. Information regarding socio-demographic characteristics, sexual behaviors and HIV/syphilis testing was obtained. We also assessed men’s online sexual health influence using a standardized 6-item opinion leadership scale focused on HIV/STI information. Influencers were defined as those whose mean score ranked within the top 13% (a higher score means greater influence). We used multivariable linear/logistic regression models to measure association between being an influencer and HIV/syphilis testing and other related outcomes, controlling for intervention trial effects, age, education, income and marital status.

Results:

Overall, 1031 men completed the survey. Most men were younger than 30 years old (819, 79.5%), and had at least college education (667, 64.7%). Influencers were more likely to get tested for HIV (55.3% vs 37.5%, p<0.001) and syphilis (26.5% vs 15.2%, p=0.001) in the last three months compared to non-influencers. There were no significant differences in condomless sex with male partners (19.7% vs 22.6%, p=0.46), mean number of male sex partners (1.32 vs 1.11, p=0.16) in the last three months, and mainly meeting male sex partners online in the last 12 months (73.5% vs 74.4%, p=0.82) between influencers and non-influencers. Regression analyses showed that influencers had higher odds of HIV testing (adjusted odds ratio [AOR]=2.16, 95% CI 1.48, 3.17) and syphilis testing (AOR=1.99, 95% CI 1.28, 3.10) in the last three months.

Conclusions:

We identified online sexual health influencers who might be more likely to help promote healthy HIV testing behaviors through MSM populations. Leveraging existing influencers may help improve HIV/syphilis testing among their networks.