Baral Stefan, Turner Rachael M, Lyons Carrie E, Howell Sean, Honermann Brian, Garner Alex, Hess Robert, Diouf Daouda, Ayala George, Sullivan Patrick S, Millett Greg
Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States.
Hornet Gay Social Network, San Francisco, CA, United States.
JMIR Public Health Surveill. 2018 Feb 8;4(1):e15. doi: 10.2196/publichealth.9321.
Gay, bisexual, and other cisgender men who have sex with men (GBMSM) are disproportionately affected by the HIV pandemic. Traditionally, GBMSM have been deemed less relevant in HIV epidemics in low- and middle-income settings where HIV epidemics are more generalized. This is due (in part) to how important population size estimates regarding the number of individuals who identify as GBMSM are to informing the development and monitoring of HIV prevention, treatment, and care programs and coverage. However, pervasive stigma and criminalization of same-sex practices and relationships provide a challenging environment for population enumeration, and these factors have been associated with implausibly low or absent size estimates of GBMSM, thereby limiting knowledge about the dynamics of HIV transmission and the implementation of programs addressing GBMSM.
This study leverages estimates of the number of members of a social app geared towards gay men (Hornet) and members of Facebook using self-reported relationship interests in men, men and women, and those with at least one reported same-sex interest. Results were categorized by country of residence to validate official size estimates of GBMSM in 13 countries across five continents.
Data were collected through the Hornet Gay Social Network and by using an a priori determined framework to estimate the numbers of Facebook members with interests associated with GBMSM in South Africa, Ghana, Nigeria, Senegal, Côte d'Ivoire, Mauritania, The Gambia, Lebanon, Thailand, Malaysia, Brazil, Ukraine, and the United States. These estimates were compared with the most recent Joint United Nations Programme on HIV/AIDS (UNAIDS) and national estimates across 143 countries.
The estimates that leveraged social media apps for the number of GBMSM across countries are consistently far higher than official UNAIDS estimates. Using Facebook, it is also feasible to assess the numbers of GBMSM aged 13-17 years, which demonstrate similar proportions to those of older men. There is greater consistency in Facebook estimates of GBMSM compared to UNAIDS-reported estimates across countries.
The ability to use social media for epidemiologic and HIV prevention, treatment, and care needs continues to improve. Here, a method leveraging different categories of same-sex interests on Facebook, combined with a specific gay-oriented app (Hornet), demonstrated significantly higher estimates than those officially reported. While there are biases in this approach, these data reinforce the need for multiple methods to be used to count the number of GBMSM (especially in more stigmatizing settings) to better inform mathematical models and the scale of HIV program coverage. Moreover, these estimates can inform programs for those aged 13-17 years; a group for which HIV incidence is the highest and HIV prevention program coverage, including the availability of pre-exposure prophylaxis (PrEP), is lowest. Taken together, these results highlight the potential for social media to provide comparable estimates of the number of GBMSM across a large range of countries, including some with no reported estimates.
男同性恋、双性恋和其他与男性发生性关系的顺性别男性（GBMSM）受艾滋病毒大流行的影响尤为严重。传统上，在艾滋病毒疫情更为普遍的低收入和中等收入环境中，GBMSM在艾滋病毒疫情中的相关性被认为较低。这（部分）归因于确定为GBMSM的个体数量估计对于为艾滋病毒预防、治疗和护理计划及覆盖范围的制定和监测提供信息的重要性。然而，对同性行为和关系的普遍污名化以及将其定罪为犯罪行为，为人口普查提供了具有挑战性的环境，这些因素与GBMSM数量估计低得难以置信或根本没有估计值有关，从而限制了对艾滋病毒传播动态的了解以及针对GBMSM的计划的实施。
本研究利用一款面向男同性恋者的社交应用程序（Hornet）的会员数量估计值，以及Facebook上使用自我报告的对男性、男性和女性以及至少有一项报告的同性兴趣的会员数量估计值。结果按居住国进行分类，以验证五大洲13个国家GBMSM的官方规模估计值。
通过Hornet同性恋社交网络收集数据，并使用先验确定的框架来估计南非、加纳、尼日利亚、塞内加尔、科特迪瓦、毛里塔尼亚、冈比亚、黎巴嫩、泰国、马来西亚、巴西、乌克兰和美国有与GBMSM相关兴趣的Facebook会员数量。将这些估计值与联合国艾滋病规划署（UNAIDS）的最新估计值以及143个国家的国家估计值进行比较。
利用社交媒体应用程序对各国GBMSM数量的估计值一直远高于UNAIDS的官方估计值。利用Facebook，评估13至17岁GBMSM的数量也是可行的，其比例与年龄较大的男性相似。与UNAIDS报告的各国估计值相比，Facebook对GBMSM的估计值具有更高的一致性。
利用社交媒体进行流行病学及艾滋病毒预防、治疗和护理需求评估的能力不断提高。在此，一种利用Facebook上不同类别的同性兴趣，并结合一款特定的面向同性恋者的应用程序（Hornet）的方法，显示出的估计值明显高于官方报告的估计值。虽然这种方法存在偏差，但这些数据强化了需要使用多种方法来统计GBMSM数量（尤其是在污名化程度更高的环境中），以便更好地为数学模型和艾滋病毒项目覆盖范围提供信息。此外，这些估计值可为针对13至17岁人群的项目提供信息；这一年龄组的艾滋病毒发病率最高，而包括暴露前预防（PrEP）可用性在内的艾滋病毒预防项目覆盖范围最低。综上所述，这些结果凸显了社交媒体在为大量国家（包括一些没有报告估计值的国家）提供可比的GBMSM数量估计值方面的潜力。
