The Experience of Using Dating Applications for Sexual Hook-Ups: A Qualitative Exploration among HIV-Negative Men Who Have Sex With Men in Hong Kong

ABSTRACT

Men who have sex with men (MSM) use dating applications (apps) to explore various romantic and sexual relationships. This qualitative study aimed to describe HIV-negative MSM’s experiences with app usage, the sexual activities arranged accordingly and their experiences in using dating apps to arrange sexual encounters. Thirty-one MSM who were sexually active and who used dating apps were recruited. Individual semi-structured interviews were conducted. Qualitative data were thematically analyzed to outline significant phenomena and perceptions. The factors associated with matching on apps included sex roles, human immunodeficiency virus serostatus and availability of a venue for meetup. Facilitated by these apps, diverse types of sexual encounters were arranged. Condoms were typically used for safer intercourse, except by people who were younger and inexperienced or when drugs were consumed before or during sex (chemsex). Extensive interest in non-penetrative sexual behaviors was expressed by our sample. Searching for post-exposure prophylaxis methods and/or sexual health screenings was common after exposure to risk of infections. Sexually abusive encounters were followed by changes in sex-searching habits and lowered trust in relationship formation. The results of this study are important for the development of appropriate interventions to promote safer sexual practices among HIV-negative MSM dating app users.

Introduction

The methods by which men who have sex with men (MSM) find partners have evolved over the past decades. A transition in the trends of partner exploration among MSM has also been observed (Chow et al., 2019). Aside from the traditional ways of meeting people in bars and cruising venues and posting messages on online forums, members of the community now look for dates and sexual encounters actively using the different dating applications (apps) on their smartphones (Chow et al., 2016). Venue-based characteristics (such as alcohol in bars, dark spaces in saunas and anonymous online settings) have been suggested to affect how MSM negotiate sex and human immunodeficiency virus (HIV)-associated risk behavior (Grov et al., 2013). For example, a study on MSM found that the odds of unprotected anal intercourse increased significantly for men who reported finding sex partners through the Internet (Horvath et al., 2006). Rosser et al. (2009) also found that men reported almost twice the number of unprotected anal intercourse partners met online than offline. These studies indicate that sexual behaviors are different between men who meet partners online and those who meet partners offline.

The affordance theory by Gibson (1979) has been applied to understand the unique features of dating apps. In brief, the term “affordance” refers to what the environment offers, provides or furnishes (Gibson, 1979). According to this theory, dating apps offer at least three types of affordance: (1) Mobility – dating apps run on smartphones, so they can be used anywhere at any time; (2) Proximity – using GPS, dating apps connect users in the immediate vicinity; and (3) Immediacy – dating apps promise quick or instant sexual encounters (Chan, 2017b; Licoppe et al., 2016). In summary, dating apps offer unique benefits that other modalities, such as physical venues or traditional dating websites, cannot match. Through an app, individuals can gain access to a large pool of prospective partners in their immediate vicinity at any time.

Moreover, because of the stigmatization and discrimination against sexual minorities in society, dating apps provide a private and safe platform for MSM to meet partners without overexposing their identities (Miller, 2015). At the same time, sexual minorities constitute a small group relative to the heterosexual population, making it more difficult to initiate encounters or relationships in daily life (Hillier et al., 2012). In this context, dating apps serve as convenient platforms that involve less risks of wider exposure or embarrassment (Miller, 2015)

Besides expanding one’s social circles, the immediacy of dating apps also allows almost instant encounters for sex (Chan, 2017a, 2017b). The number of young people employing dating apps to search for sexual activities is notable in Hong Kong (Choi et al., 2016). However, many harmful consequences have been associated with sexual behaviors organized through dating apps across populations, such as increased risk of acquiring sexually transmitted infections (STIs), including HIV (Lehmiller & Ioerger, 2014; Xu et al., 2018), as well as of sexual assaults and violence (Choi et al., 2018).

The use of dating apps has also been posited to encourage engagement in risky sexual behaviors (i.e. behaviors that are likely to introduce HIV/STI transmission) (Choi, Wong, Fong et al., 2017; Zou & Fan, 2017). For example, a study found that dating apps were associated with having multiple sex partners, condomless anal sex and group sex among MSM in Hong Kong (Yeo & Ng, 2016). In addition, it was reported that dating app use was associated with alcohol and recreational drug use (Choi, Wong, Lo et al., 2017; Sorelle, 2016). Colloquially known as chemsex, consuming illicit drugs, such as methamphetamine (ice), ecstasy and popper, for recreational use before or during sexual activities is also a growing trend among dating app users (Boonchutima & Kongchan, 2017; Nimbi et al., 2020). A recent systematic review found a higher prevalence of chemsex behaviors among a sample recruited from dating apps compared with samples recruited from health clinics (Maxwell et al., 2019). From a sociological perspective, such practices denote the involvement of autonomous risk-taking, thereby intensifying emotions and sexual sensation-seeking (Hickson, 2018).

Notably, the levels of interest in taking pre-exposure prophylaxis (PrEP) vary substantially among MSM populations. For example, a study in London reported that compared with older MSM, MSM who were younger were more likely to consider future PrEP use (Aghaizu et al., 2013). Having multiple sex partners or being at a higher risk of HIV/STI acquisition was also suggested as contributory attributes to finding PrEP favorable (Bil et al., 2015; Van Dijk et al., 2020). The context of dating apps in allowing prompt sexual encounters among MSM with different profiles and the rise of PrEP as a biomedical HIV prevention option compound the already complicated struggle against the use of substances during sex among MSM (Kwan & Lee, 2019; Maxwell et al., 2019). As a result, this population is at greater odds of testing positive for STIs, such as chlamydia and gonorrhea (Beymer et al., 2014). According to local data in Hong Kong, sexual activity among MSM was the commonest mode of HIV transmission and accounted for more than half (58.6%) of all new HIV infection cases in 2019 (Centre for Health Protection (HKSAR), 2020). The ratios of infection between heterosexual men and homosexual or bisexual men are 0.2:1 for HIV and 0.4:1 for AIDS, suggesting a greater burden of HIV among MSM.

The use of dating apps is an increasingly prevalent social phenomenon, yet little work has been done to explore how MSM use dating apps to arrange sexual encounters in Hong Kong. The present study aimed to describe HIV-negative MSM’s experiences with app usage, the sexual activities arranged accordingly and their experiences in using dating apps to arrange sexual encounters.

Method

Participant Recruitment

The present research constituted a qualitative study wherein individual interviews were conducted to address the research questions. The study participants were recruited through different local non-governmental organizations (NGOs) geared toward MSM populations and on social media platforms. The enrolled participants were also asked to invite potentially interested friends, especially those whom they met via dating apps, to join the study to expand the sampling pool. The criteria for inclusion in the study were as follows: 1) MSM; 2) cis-male; 3) aged 18 years or older; 4) currently using dating apps; 5) self-reported HIV-negative; and 6) sexually active (self-reported having any sexual contact in the last 12 months). Individuals who were unable to read and understand Chinese were excluded.

Data Collection

The ideal sample size in qualitative studies has not been standardized, but previous research has suggested that 12 interviews are sufficient for data saturation and code generation in research on sexual behaviors (Guest et al., 2006). In view of this, the research team decided to recruit at least 30 participants to obtain a good variety of responses and experiences. The individual interviews were conducted by the first author. Convenience sampling was adopted in recruiting participants who fulfilled the inclusion criteria. Random sampling via dating apps was difficult, so the present study involved individuals who were easily accessible to the researchers (Given, 2008).

After reviewing the literature and consulting experienced frontline workers who were experts in providing STI testing, consultation and community education to MSM in Hong Kong, four questions were generated: 1) What criteria were used in screening and selecting matches on apps? 2) What types of sexual behaviors were arranged via the dating apps and where did the individuals meet in person? 3) Were safety measures adopted during sex and, if so, what kind of measures were used? 4) What happened to the individuals after the sexual encounters? A semi-structured interview guide consisting of open-ended questions was then developed to elicit answers that were relevant to the research questions from the participants. Questions such as “What components on a person’s dating app profile would attract or discourage you from matching with him?”, “How would you feel about seeing a person disclosing his HIV status on the app?”, “How fast would you propose or accept an invitation to sex in real life?”, “Do you know what chemsex is and have you tried it with your dating app matches?” and “How’s the relationship after the sexual encounters? Will you maintain a close contact with them?” were asked during the interviews. The details of the questions were refined as the interviews progressed to obtain more relevant answers from the participants.

All interviews were conducted by a single research team member to ensure consistency in question interpretations and to minimize discrepancies in interview content. The interviewer was a cis-female who had not met any of the participants prior to the interview. The sessions were conducted in private rooms at the university, at NGOs providing MSM support services in Hong Kong or at an event space, with each session lasting from one to one-and-a-half hour.

Data Analysis

Following the guide set by Braun and Clarke (2006) in conducting thematic analysis, the data were first transcribed verbatim by two individual transcribers who were not part of the investigation team. To increase accuracy, the transcribers were briefed on the slang and terms used by the MSM community. The accuracy of the transcripts was checked by two members of the research team who were not involved in the transcribing process. Content that was inconsistent or untranscribable were checked against the recording and the field notes by the interviewer. Verified data were entered into NVivo (version 12 Pro, QSR) to foster data familiarization. Initial codes labeling the significant features of the data were cyclically developed and refined (Boyatzis, 1998). The codes were deduced from the research questions surrounding the participants’ experiences in using dating apps to arrange sexual encounters through a top-down approach. Representative codes that were relevant were condensed into themes capturing the experiences of the population. After reviewing the relationships between codes and themes, several main themes and sub-themes were constructed. The internal homogeneity and external heterogeneity of the themes were also considered (Patton, 1990). They were reviewed and finalized to present valid accounts of the responses to the research questions representing the entire data sample. The codes and the themes were checked by the two members of the investigation team.

Ethics Statement

The study was reviewed and approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (HKU/HA HKW IRB) (Reference No. UW 18–129). Written consent was obtained from each participant prior to the interview.

Results

Overall, 31 participants aged between 18 and 39 years (M = 27.32) provided consent and completed the study. Most of them had a bachelor’s degree or above (N = 21). Although all of them had experienced using more than one app, Grindr, Jack’d and Hornet were the top three apps used by the participants. The majority (N = 23) had used dating apps for more than one year and had met a varied number of people through the apps. Only one participant had had sexual contact with a female partner over the past 12 months, whereas the remaining 30 individuals engaged in sex with male partners only during the specified period. Other sexual behaviors and the demographics of the participants are presented in detail in Table 1. Their dating app usage and sexual encounters arranged through apps are presented below.

Table 1. Participant characteristics and types of dating apps used (N = 31)

	N (%)		N (%)
Age		Dating Apps used^a
Mean (SD)	27.32 (5.64)	Grindr	30 (96.8)
18–19	2 (6.5)	Jack’d	27 (87.1)
20–24	9 (29.0)	Hornet	18 (58.1)
25–29	10 (32.3)	Tinder	15 (48.4)
30–34	6 (19.4)	Coffee Meets Bagel	5 (16.1)
35–39	4 (12.9)	Scruff	4 (12.9)
Education level		Blued	2 (6.45)
Secondary school	4 (12.9)	Skout	2 (6.45)
Post-secondary	6 (19.4)	Apps/sites use experience
Undergraduate or above	21 (67.7)	< 1 month	3 (9.7)
The last HIV test result & date		1– 3 months	0 (0.00)
Negative	29 (93.5)	3– 6 months	2 (6.5)
Within the last month	7 (24.1)	6 months – 1 year	3 (9.7)
The past 3 months	8 (27.6)	> 1 year	23 (74.2)
The past 6 months	9 (31.0)	No. of people encountered via Apps
The past year	4 (13.8)	1– 10	11 (35.5)
> 1 year	1 (3.4)	11– 20	2 (6.45)
Never tested	2 (6.5)	21– 30	3 (9.68)
Type of sex engaged over the past 12 months^a		31– 50	0 (0.00)
With male partners:		51– 100	3 (9.68)
Hand-job	27 (87.1)	>100	4 (12.9)
Blow-job	27 (87.1)	Do not remember	8 (25.8)
Anal sex	28 (90.3)	Last sex with men
With female partners:		Over the past week	10 (32.3)
Vaginal sex	1 (3.2)	Over the past month	14 (45.2)
		Over the past 3 months	4 (12.9)
		Over the past year	3 (9.7)

^a Participants were allowed to select more than one option.

Theme 1: Picking Mr. Right – Screening and Selecting a Partner

The participants suggested multiple criteria to identify suitable matches on dating apps. Other than physical characteristics and geolocations, the three factors below were emphasized as crucial in selecting favorable partners for sexual encounters.

Sexual Roles

Although uneasy, the participants typically look for a match to their sexual roles to facilitate speedy sexual encounters. If they encounter people who prefer the same sexual position (for example, both of them prefer to preform insertive anal sex), some participants would forgo having an encounter but some would commit to non-penetrative sex (i.e. oral “blow job” or manual “hand job” sex). A threesome was also possible if the person possessed favorable physical characteristics, such as being muscular.

‘I don’t always have to do anal … Something simple, such as kissing or using hands (doing hand job), is also “fun” (sex) for me’. (Interviewee 21, 28 years old, had used dating apps for over six months)

Serostatus and Testing Results

Some dating apps allow users to disclose their HIV status on their profiles. However, this was rarely practiced or observed by our participants, as disclosing their STI status by sending pictures of recent test results before setting up a casual sexual encounter was more common. The participants’ attitudes toward HIV/STI disclosure were diverse. Dating app users expressed varied attitudes toward the listing of HIV/STI status on one’s profile, with (1) some appreciating other people’s honesty in revealing their results; (2) some not trusting the results presented; (3) some avoiding people with positive results, especially those with HIV status; and (4) some being unconcerned.

‘People can lie. So … I mean, I will appreciate if they put it in there, but I would not just buy it’. (Interviewee 10, 30 years old, had used dating apps for more than one year)

‘(If the person stated that he is HIV-positive on his profile) I would avoid approaching him for sex, but it is totally fine to be friends with him’. (Interviewee 15, 19 years old, had used dating apps for over six months)

‘I would respect this person a lot. To be honest, this kind of person is a better choice for a long-term relationship’. (Interviewee 28, 38 years old, had used dating apps for less than one month)

Venues for Sex

Although places to meet up could be easily arranged, some interviewees did not mind having sex in public or semi-public areas, such as public toilets. For some of the participants, it would be favorable if a venue could be offered by the match, especially for younger individuals.

‘I actually prefer going to hotels, but I am still studying, so unless the person can pay for the room booking, I will stick with visiting his home’. (Interviewee 20, 23 years old, had used dating apps for more than one year)

Homes and hotels were considered secure and, hence, were the most preferred, while motels were often avoided due to the perceived risk of embarrassment and uncertainty regarding their LGBT friendliness.

‘Going to motels in Hong Kong can be quite embarrassing because most of them are usually for men and women and are not LGBT friendly. I don’t want to be stared at’. (Interviewee 27, 31 years old, had used dating apps for more than one year)

Theme 2: App-Facilitated Sexual Practices – Variations and Adaptations

The participants decided on the types of sexual practices after obtaining a suitable match on dating apps. Sometimes they presented their preferences directly on their app profiles through verbal or non-verbal cues, such as emoji. The following practices were suggested to be commonly performed with app matches or were frequently initiated by people on apps.

Condomless Sex

Most of the participants were cautious about practicing safe sex. They generally considered not using a condom only when (1) either partner was taking PrEP or (2) they were in a close relationship with the person.

‘Unless I am very close with him or familiar with his status, I would not go condomless’. (Interviewee 5, 24 years old, had used dating apps for more than one year)

However, condomless sex was also reported by the participants, especially when they were younger, during their first meeting with people through online apps. The younger participants were less experienced about sex and were unaware of the consequences of condomless sex. Thus, they were often persuaded or forced by their matches to perform unsafe anal penetration.

‘I was quite young at that time and he was experienced in sex. We went to his place and I knew nothing about protection, so we did it without a condom. It was my first sex’. (Interviewee 14, 22 years old, had used dating apps for more than one year)

Chemsex

Almost all of the participants agreed on the increasing popularity of chemsex. On dating apps, it is easy to identify chemsex users through specific symbols (e.g., ice cream and snowflakes, which stand for methamphetamine/ice) on their app profile and typical pickup lines. Concerns regarding the harmful effects of chemsex, including reduced autonomy in using condoms and the possibilities of becoming addicted, were expressed by participants who were against recreational drug use. Some non-users also associated HIV/STIs with chemsex and assumed that every chemsex user was already infected. Additionally, chemsex users reported difficulties in using condoms and increased engagement in group sex.

‘Many chemsex users go bareback (condomless anal sex). It is clearly written. You should bear in mind that this person is likely infected already’. (Interviewee 3, 38 years old, had used dating apps for more than one year)

‘Chemsex is somehow equivalent to HIV’. (Interviewee 7, 26 years old, had used dating apps for more than three months)

A few chemsex users felt that they were in control and that the use of drugs was their personal choice rather than a simple addiction. They agreed with the possible side effects but argued that people should be strategic in balancing the risks.

‘I cannot say that I am not addicted, but I can stop for one month. I only do it when I want to. Previously, when I had chemsex with others, I was feeling unwell. I can also stop taking it voluntarily’. (Interviewee 19, 32 years old, used dating apps for more than one year)

‘If you control it well, use it occasionally and how should I say this? It’s like how coffee works but if you drink it every day, it is definitely harmful. Therefore, I think it is fine to use it moderately’. (Interviewee 24, 20 years old, had used dating apps for more than six months)

Group Sex

Although less commonly encountered, some participants had been invited to saunas, gay cruising areas or hotels for group sex or sex parties.

‘Both of them are 1 (Top), so they searched the apps for 0 (Bottom) to do a threesome. They have been dating for a long time.’ (Interviewee 14, 22 years old, had used dating apps for more than one year)

Several participants reported being invited by couples to threesomes. They commented that this type of threesome could be difficult to handle, as complicated emotions or dilemmas might occur if the couple failed to adjust the segregation of sex and intimate relationships properly.

‘I don’t really like having sex with couples. I do not know how to position myself in such a context’. (Interviewee 2, 30 years old, had used dating apps for more than one year)

Non-penetrative Sex

A vast majority of the interviewees preferred non-penetrative sex over anal sex, especially when condoms were not available.

‘Right before we begin sex, I would ask, “Hey do you have a condom?” If he doesn’t have one, I will then do other stuff (other than anal sex)’. (Interviewee 26, 20 years old, had used dating apps for more than one year)

Some also exercised this option when the match was less attractive than they expected.

‘Due to the discrepancies (from expected), maybe I will no longer want to do that thing (anal sex). Perhaps, simply a blow job or a hand job, not entirely willingly but just to finish the date’. (Interviewee 25, 29 years old, had used dating apps for more than one year)

Instead of rejecting the other person directly, they would at least engage in a certain degree of sexual activities. This was intended to avoid embarrassment and becoming notorious within the community.

Theme 3: Safe Sex Only? Navigating Protective Measures for Safer Encounters

The participants had varied opinions on the ways by which they could protect themselves during sex. The use of condoms was mainly practiced, while the application of PrEP was occasionally discussed by the participants.

Condom Negotiation

Although the participants unanimously agreed on the importance of using condoms during sex, some felt that it was the responsibility of the tops (the insertive partner) to carry condoms. The pattern of condom use negotiations was polarized. Multiple interviewees saw practicing sex with condoms as an unspoken rule and assumed the use of condoms; thus, they did not spend time discussing it on the apps. By contrast, some were keen to obtain consent and confirmation on condom use prior to the encounter to avoid potential risks and disappointment.

‘Not a lot of people will go condomless nowadays. If someone intends to not use one, they will be the person to ask if we are okay with it’. (Interviewee 17, 28 years old, had used dating apps for more than one year)

Pre-Exposure Prophylaxis (PrEP)

The participants had disparate levels of knowledge about PrEP. In fact, some had never heard of the term. Those familiar with PrEP had learnt it from related NGOs or friends or they themselves received a prescription for it in other countries, as prescriptions were not available at the local healthcare system. Besides the expensive price (around HKD$8,000–$10,000 per month) and limited supply in private clinics (AIDS Concern, 2020), few were aware of the side effects and the proper ways to finish the course. Some participants were skeptical when someone claimed to be on PrEP as it was difficult to verify the consumption of pills. Thus, they would still prefer sex with condoms.

‘The question is, how much do I trust this person and whether he is using PrEP correctly?’ (Interviewee 4, 30 years old, had used dating apps for more than one year)

Theme 4: The Ramifications of Unsafe Sex

Subsequent to the sexual encounters arranged through the dating apps, the participants faced different challenges and changes to their sexual health and relationship development. Some of them also altered their practices in utilizing dating apps in everyday life.

Between HIV and Other STIs

Some participants were concerned about acquiring HIV or STIs after engaging in condomless sex. Some attended clinics in the public health sector or related NGOs for HIV/STI testing or purchased self-test kits. Concerns over infections were either only about HIV or about all kinds of infections. The former group saw HIV as the worst condition that would impact their general wellbeing and sexual health, as other STIs are usually curable or treatable. The participants currently on PrEP were likely to agree to requests for condomless sex, as PrEP had provided them with baseline protection against HIV transmission. However, some participants reported getting repeatedly infected with non-HIV STIs.

‘This community seems to be less cautious about other stuff (STIs). You’re fine as long as you are not infected with syphilis and HIV because others are curable. Some even say that syphilis is curable. You can do some injections’. (Interviewee 17, 28 years old, had used dating apps for more than one year)

The after pill: Post-exposure Prophylaxis (PEP)

Many of the participants first heard of PEP while looking for urgent remediation after encounters with condomless sex. The experiences were often traumatizing due to the limited supply in Hong Kong, the extravagant cost and the stringent procedures (you must be older than 16 years) to receive the prescriptions, particularly in private health clinics. Despite being also available at the accident and emergency department in local hospitals, prescriptions were normally given only to healthcare professionals who were exposed to risks of infection during medical procedures. Additionally, individuals with PEP needs are likely to be categorized as “non-urgent”, resulting in an average waiting time of more than 5 hours.

‘I thought he was using his hand, but I realised it was his penis without a condom. It was my first few experiences with fun, and I was really frightened. He said he tested negative but I was still concerned. I found information about PEP online and realised that it had to be taken within 24 hours, which was already too late for me. This was a very traumatic experience’. (Interviewee 21, 28 years old, had used dating apps for more than six months)

Altered Sexual Behaviors

The participants who had negative experiences from dating app arrangements, such as being forced to engage in non-consensual sexual contact or being infected with STIs, reported changes in their sexual behaviors afterward. Some avoided anal sex and only felt comfortable with non-penetrative sex, which has a lower risk of infection. Multiple participants also reported ceasing their habits of seeking sex online.

‘After that incident, for two years, even if I engaged in fun, I only had oral sex, nothing more. I was afraid that my partner had (STIs) and I was worried that I would get infected’. (Interviewee 14, 22 years old, had used dating apps for more than one year)

Moving to the Next Level

Attitudes in managing relationships after sex varied among the participants. If the sexual experience was satisfactory, some extended the connections and developed friendships or became regular sex partners. However, many denied the likelihood of establishing romantic relationships with the casual sex partners they met online. Despite admitting that the use of dating apps was very common, they did not want their potential partners to know that they had used dating apps to seek sexual partners. Stigmatization was still associated with the use of apps, and histories of using them often contributed to trust issues within romantic relationships.

‘If I like that person, I will not want him to know. I don’t want him to think that I am not taking relationships seriously. Having casual sex can be labelled as not being serious in terms of developing romantic relationships’. (Interviewee 22, 26 years old, had used dating apps for more than one year)

Discussion

The present study demonstrated the selection criteria adopted to locate suitable matches via dating apps among HIV-negative MSM and how they arranged sexual encounters on such platforms. The availability and types of meeting venues influenced whether the match for sex would be possible. Different types of sexual practices, such as condomless sex, chemsex and non-penetrative sex, were reported under various circumstances among app matches. A strong motivation to use condoms during sex was observed in the study. The intention to use PrEP, as well as confidence/trust in the matched person claiming to be committed to the proper use of PrEP, was not high among the sampled population. On the other hand, the quality of encounters arranged through apps strongly influenced whether future hookups would be possible and how a person would continue with his app usage.

First, we found that the location of potential sexual encounters was a major consideration in selecting matches in apps. Similar to a previous study by Downing (2011), the privacy, anonymity and access to sex provided by commercial sexual venues, such as saunas and hotels, were ideal for the stigmatized sexual practices associated with MSM. However, the entrance costs to these venues may hinder men with lower socioeconomic status from using them (Neaigus et al., 2012; Rusow et al., 2017), as was the case for students and younger individuals in the present study. Thus, public environments have become popular. Besides the possibility of being charged with “Indecency in Public” under Hong Kong Laws, having sex in public was associated with risky sexual behaviors (Rusow et al., 2017). Sexual activities with anonymous partners were more likely to happen at venues such as toilets or parks. The lesser availability of personal information and health status, including HIV serostatus, also increases risks of HIV infection (Elwood et al., 2003). As corroborated by previous data, individuals were also less prone to communicate their preferences for safer sex (Frankis & Flowers, 2009).

Despite hearing about their acquaintances’ experiences of sexual abuse, the dangers of abuse at private apartments were not recognized by the participants in the present study. Previous studies have demonstrated that being coerced into non-consensual sexual activity is not uncommon (Fenaughty et al., 2006), with numbers significantly higher among MSM compared with heterosexual men (De Visser et al., 2003). Physical and sexual violence against men at home has also been reported (Walker et al., 2005). However, protective strategies were rarely practiced by the MSM in this study. One possible explanation is that there is a common and strong perception that men are unlikely to be sexually abused (Pournaghash-Tehrani & Feizabadi, 2007).

Younger age and being less informed about condom usage were the characteristics identified in our study as associated with individuals who were vulnerable to condomless sex and increased risks of acquiring HIV/STIs. Consistent with previous literature, the power dynamics between a novice member and a more sexually experienced partner that fosters coercion to have condomless sex was also acknowledged by the participants in the present study (Aspin et al., 2009; Gavey et al., 2009). At the same time, it is alarming to observe the low age of users on dating apps. This suggests the need to address the issue by targeting younger MSM users in risk-reduction interventions and to advance existing sex education programmes to expand the level of knowledge on sexual health and the importance of practicing safer sex in general.

In chemsex, where substances are used to reduce anxieties and increase sensations during sex (Starks et al., 2015), individuals under the influence tend to have limited perceptions of risks and focus more on pleasure (Boonchutima & Kongchan, 2017). The fact that lowered self-control reduces the likelihood of using condoms and increases the occurrence of risky sexualized behaviors was also reported in this sample. The impression that chemsex users are usually infected by HIV/STIs was also noted among our participants. In contrast to the traditional impression that drug users are heavily addicted, the regular chemsex users in our sample were confident about their usage. Our study participants referred to their use of these substances as a personal choice rather than a compulsion.

Consistent with existing data that anal sex is not the only preferred sexual activity among MSM (Rice et al., 2016), engagement in non-penetrative sex was endorsed and preferred by many of the participants in the present study. Practicing external stimulations, such as masturbation, reduced risks when condoms were not available. Misinterpretations of images of individuals’ bodies also seemed common on the dating apps (Duguay, 2017; Markowitz & Hancock, 2018). If the match appeared to be inconsistent with a profile online, switching to non-penetrative sexual activities such as oral or manual sex would resolve embarrassment and accelerate date termination, as reported by the participants in the present study.

The participants in this study had strong motivations to use condoms. Although PrEP has been recommended for MSM by the World Health Organization (WHO, 2014), not every interviewed individual recognized it as reliable. In particular, non-users and persons who conformed to the use of condom found PrEP less trustworthy. Besides divergent familiarity with its application and effectiveness, verifying whether a person is taking PrEP was difficult, especially on apps. Along with the unavailability of prescriptions locally, the generalized use of PrEP in Hong Kong is challenging. On the other hand, many of the participants described learning about PEP only subsequent to unsafe encounters. The agonizing wait for test results or a history of infections induced changes in their sexual behaviors. Some individuals avoided anal sex, as it carries a higher risk of acquiring HIV/STI. A decline in unprotected sexual behaviors upon HIV diagnosis has been reported in Hong Kong (Poon et al., 2018) and in other populations (Gorbach et al., 2011; Khosropour et al., 2016). Distress regarding HIV infection appeared to outweigh concerns over other STIs. Our participants referred to the incurability and lethality of HIV as the most significant harm despite knowing that a viral load of HIV can now be suppressed to become untransmittable with regular adherence to drugs and has been purposed as an HIV prevention strategy since 2014 (Eisinger et al., 2019; UNAIDS, 2018). Public awareness toward biomedical interventions in HIV prevention, including PrEP and PEP, should be enhanced in the future. Besides disseminating knowledge about their effectiveness and prescriptions, the use of PrEP should also be reinforced as an additional means of protection rather than a substitute or alternative to condoms among MSM (WHO, 2015).

We also found that behavioral alterations occurred among the participants who had unpleasant encounters from arrangements made via the apps. Coercive and unwanted sexual behaviors were particularly traumatizing and associated with psychological distress and increased risk for suicidality (Rusow et al., 2014). Contrary to studies that found a strong correlation between sexual abuse and engagement in risky sexual behaviors, such as having multiple sex partners and a higher frequency of anal intercourse (Guadamuz et al., 2011; Shaw et al., 2012), our sample demonstrated more caution about new sexual hookups and fewer casual sexual encounters. The users in our study feared initiating relationships and found the loss of trust difficult to restore.

The use of dating apps and the search for casual sex in the local MSM community in Hong Kong are common. Despite arranging sexual encounters, the participants in this sample reported experiences in searching and forming relationships other than purely sexual ones using dating apps. However, the stigmas associated with these practices remain largely acknowledged. Dating app users expressed being frequently criticized as promiscuous and struggled between satisfying their sexual desires and initiating romantic relationships (Blackwell et al., 2015; Fitzpatrick & Birnholtz, 2018). Dating app users are stereotypically labeled as less committed to monogamous relationships. Their identity as a current or former dating app user is often intentionally hidden from potential romantic partners. The emergence of dating apps was aimed to facilitate social connections instantly and privately, as well as to fulfil individual goals that are favorable to users (Wu & Ward, 2018). While sex seeking should not be morally criticized as deviant, the use of dating apps in romantic partnership formations should also be acknowledged. A positive outlook toward the use of dating apps and arranging consensual sexual encounters ought to be encouraged.

Limitations

This study had some limitations. First, this was a convenience sample recruited through social media and specific NGOs or through the referral of peers. We acknowledge the disadvantages of these sampling strategies, which might have biased our results. Our study sample cannot represent the entire population of MSM dating app users in Hong Kong. However, being a preliminary study addressing the experience of MSM in Hong Kong in the use of dating apps, the methodology applied allowed the collection of genuine and concise information about this issue and fosters the development of more in-depth studies in the future. Second, the participants used not only typical dating apps, but also social networking sites, in searching for sexual encounters. Excluding the experiences arranged on these emerging platforms limited the exploration of patterns and the comprehensive assessment of risks. Third, the study sample was relatively young (aged 18 to 39 years). Therefore, the study findings might not be generalizable to older MSM dating app users. Fourth, MSM who are HIV-positive were excluded. As aforementioned, this group of individuals would be more likely to be rejected by the general community due to fear of infection. They might, therefore, experience episodes regarding app usage and sexual encounter arrangements that are different from those described in this study. Further qualitative studies to understand the experience of dating app usage by HIV-positive MSM should be conducted.

Conclusion

Depending on an individual’s socio-economic status and urge to have sex, different factors are considered in selecting matches and organizing sexual hookups on dating apps. Sexual, emotional and relational behaviors can be altered subject to the quality of sexual experience. The intention to use condoms was high among our participants, except in early sexual encounters or chemsex. Aside from expanding the related educational interventions to include younger individuals, awareness of PrEP and PEP as strategies for HIV combination prevention should also be strengthened. Additionally, a preference for non-penetrative sexual behaviors was observed in this sample. This might signify a possible shift in MSM sexual activities in the current sample and should be a focus of further investigation within a larger population. Despite their widespread acceptability and use, stigmatization against dating apps remains. The MSM’s concealment of their histories of seeking sex online prior to developing romantic relationships suggests a subliminal association between promiscuity and casual sex.

This study constitutes the first attempt to sample the patterns of dating app use in sexual encounter arrangements among MSM in Hong Kong. The results obtained will enhance existing programmes on sex education and foster the development of primary HIV prevention programmes and the encouragement of safer practices in app usage and sexual activities. Investigations involving a larger proportion and variety of MSM should be conducted in the future to expand the generalizability of the findings.

Ethics

This study was reviewed and approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (HKU/HA HKW IRB) (reference number: UW 18–129).

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent was obtained from all individual participants included in the study.

Acknowledgments

We would like to thank Mr. LH Leung and Mr. KL Lee from AIDS Concern for the help with development of the semi-structured guide and participant recruitment.

Disclosure Statement

All authors declare that they had no conflict of interest.

Additional information

Funding

The study was funded by Research Grants Council (Early Career Scheme), reference number: 27607518. EPFC is supported by an Australian National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grant (GNT1172873).