Blue Ribbon Boys Factors associated with PrEP use, ART use, and undetectable viral load among gay app users across six regions of the world Glenn-Milo Santos, PhD, MPH* Assistant Professor, University of California San Francisco Senior Research Scientist, San Francisco Department of Public Health Co-Authors George Ayala*1, Sonya Arreola1, Alex Garner2, Keletso Makofane3, Sean Howell2 (* authors contributed equally to the work ) 1. MPact Global Action for Gay Men's Health and Rights 2. Hornet 3. Harvard School of Public Health

Background HIV prevalence and incidence consistently higher among gay men and other men who have sex with men (MSM) when compared with other groups, worldwide. Same-sex behaviours remain criminalized across many countries Homophobic criminalization and stigma can limit the uptake of HIV services Gay social networking apps highly popular among MSM, offering opportunities for connection and data collection in these hostile country contexts These apps present new areas for collaboration between community-led organizations and tech for advocacy and linkages to resources

Methods In 2016, the MPact Global Action for Gay Men's Health and Rights (Mpact; formerly Global Forum on MSM & HIV [MSMGF]) partnered with the gay social networking app Hornet, to support an educational initiative called Blue Ribbon Boys. Blue Ribbon Boys initiative prompts Hornet users to answer a short series of yes-no questions about their sexual health: Pre-exposure prophylaxis (PrEP) Antiretroviral Treatment (ART) Undetectable viral load (UVL) Other HIV info Evaluated factors associated with PrEP, ART, self- reported UVL Separate multivariable generalized estimating equation (GEE) models, controlling for participant demographic characteristics and clustering by country

Participant Characteristics (N=12,126)

Sexual Health Questionnaire Responses All HIV-Negative HIV-Positive Unknown Status

Multivariable Analyses: PrEP Use Characteristics AOR 95% CI Age – (per 10 year increase) 1.00 0.93 - 1.07 Relationship Status - Single (reference)   Not single (relationship/companion) 1.13 1.36 Not reported 1.03 1.15 Sexual Position/Role Preference - Versatile (reference) Bottom 1.18 0.94 1.49 Top 0.83 0.68 1.02 1.09 0.91 1.30 Language - English (reference) Spanish 0.52 0.33 0.82* Portuguese 1.44 Thai 0.27 0.40* Other 1.12 0.79 1.59 Yes, in the past year had an STI test and/or treatment 2.19 3.21* Yes, taking steps to protect yourself from HIV 1.41 1.76*

Multivariable Analyses: Antiretroviral Therapy Use Characteristics AOR 95% CI Age – (per 10 year increase) 1.28 1.12 - 1.46* Relationship Status - Single (reference)   Not single (relationship/companion) 1.13 0.58 2.19 Not reported 0.78 1.63 Sexual Position/Role Preference - Versatile (reference) Bottom 0.55 2.94 Top 0.56 0.21 1.48 Not Reported 0.71 0.47 1.07 Language - English (reference) Spanish 1.44 0.48 4.33 Portuguese 2.21 1.60 3.06* Thai 1.77 1.32 2.39* Other 1.03 0.60 1.76 Yes, in the past year had an STI test and/or treatment 4.54 2.65 7.78* Yes, aware undetectable it's virtually impossible to transmit HIV 1.53 2.26*

Multivariable Analyses: Undetectable Viral Load Characteristics AOR 95% CI Age – (per 10 year increase) 1.29 1.11 - 1.51* Relationship Status - Single (reference)   Not single (relationship/companion) 1.18 0.64 2.19 Not reported 0.87 1.17 Sexual Position/Role Preference - Versatile (reference) Bottom 1.27 0.63 2.56 Top 0.60 0.35 1.04 0.68 0.45 1.02 Language - English (reference) Spanish 2.11 0.92 4.85 Portuguese 2.60 1.88 3.61* Thai 2.94 2.05 4.22* Other 1.09 0.66 1.80 Yes, in the past year had an STI test and/or treatment 4.84 2.74 8.55* Yes, aware undetectable it's virtually impossible to transmit HIV 1.98 1.37 2.85*

Conclusions PrEP use was low, few MSM asked providers about PrEP, and PrEP use associated with language, suggesting regional disparities Younger MSM has significantly lower likelihood of using ART and having UVL Those who are not aware that undetectable viral load = untransmittable less likely to be on ART and less likely to have UVL Findings point to gaps in HIV prevention, treatment and care that can undermine HIV prevention, and treatment as prevention, particularly among younger gay men Association between HIV transmissibility from having undetectable viral load should be incorporated into treatment and prevention messaging tailored to various age groups Community led efforts and partnerships with gay social networking apps can be effectively used for rapid data collection and sexual health promotion with MSM

THANK YOU! Acknowledgements Blue Ribbon Boys MPact (MSMGF) staff and consultant time was funded by the Ministry of Foreign Affairs in the Netherlands, through the Bridging the Gaps Programme and U.S. PEPFAR/ USAID/LINKAGES The authors acknowledge the in-kind contribution made by Hornet, which designed the app interface and accompanying information website, and collected data We acknowledge former MPact (MSMGF) Senior Communications Officer, Jack Mackenroth, who co- created and led the Blue-Ribbon Boys Initiative