title: Characteristics of men who have sex with men in southern Africa who seek sex online: a cross-sectional study.
abstract: BACKGROUND
  Use of the Internet for finding sexual partners is increasing, particularly among men who have sex with men (MSM). In particular, MSM who seek sex online are an important group to target for human immunodeficiency virus (HIV)/sexually transmitted infection (STI) interventions because they tend to have elevated levels of sexual risk behavior and because the Internet itself may serve as a promising intervention delivery mechanism. However, few studies have examined the correlates of online sexual partner seeking among MSM in sub-Saharan Africa.
  
  
  OBJECTIVE
  These analyses aim to describe the prevalence of using the Internet to find new male sexual partners among MSM in two southern African countries. In addition, these analyses examine the sociodemographic characteristics, experiences of discrimination and stigma, mental health and substance use characteristics, and HIV-related knowledge, attitudes, and behaviors among MSM associated with meeting sex partners online.
  
  
  METHODS
  MSM were enrolled into a cross-sectional study across two sites in Lesotho (N=530), and one in Swaziland (N=322) using respondent-driven sampling. Participants completed a survey and HIV testing. Data were analyzed using bivariate and multivariable logistic regression models to determine which factors were associated with using the Internet to meet sex partners among MSM.
  
  
  RESULTS
  The prevalence of online sex-seeking was high, with 39.4% (209/530) of MSM in Lesotho and 43.8% (141/322) of MSM in Swaziland reporting meeting a new male sexual partner online. In the multivariable analysis, younger age (adjusted odds ratio [aOR] 0.37, 95% confidence interval [CI] 0.27-0.50 per 5 years in Lesotho; aOR 0.68, 95% CI 0.49-0.93 in Swaziland), having more than a high school education (aOR 18.2, 95% CI 7.09-46.62 in Lesotho; aOR 4.23, 95% CI 2.07-8.63 in Swaziland), feeling scared to walk around in public places (aOR 1.89, 95% CI 1.00-3.56 in Lesotho; aOR 2.06, 95% CI 1.23-3.46 in Swaziland), and higher numbers of male anal sex partners within the past 12 months (aOR 1.27, 95% CI 1.01-1.59 per 5 partners in Lesotho; aOR 2.98, 95% CI 1.51-5.89 in Swaziland) were significantly associated with meeting sex partners online in both countries. Additional country-specific associations included increasing knowledge about HIV transmission, feeling afraid to seek health care services, thinking that family members gossiped, and having a prevalent HIV infection among MSM in Lesotho.
  
  
  CONCLUSIONS
  Overall, a high proportion of MSM in Lesotho and Swaziland reported meeting male sex partners online, as in other parts of the world. The information in this study can be used to tailor interventions or to suggest modes of delivery of HIV prevention messaging to these MSM, who represent a young and highly stigmatized group. These data suggest that further research assessing the feasibility and acceptability of online interventions will be increasingly critical to addressing the HIV epidemic among MSM across sub-Saharan Africa.
authors.affiliation: Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States. sstahlm1@jhu.edu.
authors.forename: Shauna
authors.identifier: http://orcid.org/0000-0003-2861-7734
authors.initials: S
authors.lastname: Stahlman
authors.forename: Ashley
authors.identifier: http://orcid.org/0000-0001-5759-7125
authors.initials: A
authors.lastname: Grosso
authors.forename: Sosthenes
authors.identifier: http://orcid.org/0000-0002-6050-605X
authors.initials: S
authors.lastname: Ketende
authors.forename: Tampose
authors.identifier: http://orcid.org/0000-0002-6854-6339
authors.initials: T
authors.lastname: Mothopeng
authors.forename: Noah
authors.identifier: http://orcid.org/0000-0001-6522-7167
authors.initials: N
authors.lastname: Taruberekera
authors.forename: John
authors.identifier: http://orcid.org/0000-0001-6079-5042
authors.initials: J
authors.lastname: Nkonyana
authors.forename: Xolile
authors.identifier: http://orcid.org/0000-0002-2160-9670
authors.initials: X
authors.lastname: Mabuza
authors.forename: Bhekie
authors.identifier: http://orcid.org/0000-0002-0848-3495
authors.initials: B
authors.lastname: Sithole
authors.forename: Zandile
authors.identifier: http://orcid.org/0000-0001-6479-3773
authors.initials: Z
authors.lastname: Mnisi
authors.forename: Stefan
authors.identifier: http://orcid.org/0000-0002-5482-2419
authors.initials: S
authors.lastname: Baral
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D013541:Eswatini; D015658:HIV Infections / Q000517:prevention & control; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D020407:Internet; D007927:Lesotho; D016015:Logistic Models; D008297:Male; D012309:Risk-Taking; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D057545:Social Stigma; D019966:Substance-Related Disorders / Q000453:epidemiology; D055815:Young Adult
keywords: HIV; Internet; male homosexuality; sexual behavior; social stigma; southern Africa