JMIR Publications

ABSTRACT

Background:

Substance use and HIV epidemics have disproportionately affected sexual and gender minoritized (SGM) communities, with heightened risks among men who have sex with men (MSM) and transgender women of color due to intersecting challenges like poverty, mental health issues, and discrimination. Despite overall declines in substance use and sexual risk behaviors in the general population, these issues persist within SGM communities, exacerbated by stigma and systemic barriers to care. Digital health interventions have emerged as promising tools to address these disparities, offering accessible and stigma-reducing alternatives to traditional care, particularly effective among younger individuals and in underserved areas.

Objective:

This study seeks to examine the social correlates of substance use and sexual risk perception among an online sample of help-seeking men who have sex with men (MSM) and transgender women in San Francisco, California.

Methods:

We recruited 409 help-seeking men who have sex with men and transgender women using social media advertisements on Facebook, Instagram, and Grindr in 2022-2024. Participants provided informed consent and completed a baseline assessment.

Results:

Utilization of testing resources for HIV and Hepatitis was high among participants (98.04% and 88.02%, respectively). Knowledge of HIV or other STI health services was also high (92.91%). Fewer participants (64.79%) were knowledgeable about substance use-related services. While many participants reported that using substances posed high risk of harm, some perceived engaging in condomless sex, using prescription opioid drugs without a prescription, and using substances during sex as low risk (29.83%, 10.27%, and 14.91%, respectively). Participants that identify as Latine have 4.68 times the odds of perceiving sharing needles as low risk compared to white counterparts (CI = 1.06-32.40). Participants who reported experiencing unstable housing were more likely to report perceiving sharing needles (aOR = 8.30, CI = 2.68-28.20) and non-prescription opioid use (aOR = 3.02, CI = 1.48-5.97) as low risk. Participants who reported an income below the federal poverty level were more likely to report perceiving sharing needles (aOR = 8.30, CI = 2.68-28.20), prescription opioid use (aOR = 3.02, CI = 1.48-5.97), and substance use during sex (aOR = 2.28, CI = 1.20-4.20) as low risk. Participants who have not been tested for Hepatitis in the past have 2.63 times the odds of perceiving prescription opioid use as low risk compared to counterparts who have been tested for Hepatitis before (CI = 1.15-5.60).

Conclusions:

This study underscores the importance of social determinants in shaping low risk perception of harm associated with substance use behaviors among online help-seeking SGM people in the San Francisco. These systemic inequities structure participants’ perceptions, access, and utilization of preventive and public health services. Our findings identify critical opportunities for outreach and preventative efforts needed to serve vulnerable populations.