“Do you want to get naked or do you want a cup of tea?” Smartphone geosocial networking apps and the health of lesbian, gay and bisexual users in the UK and USA

Background: Globally lesbian, gay and bisexual (LGB) persons experience physical and mental health inequalities, with men who have sex with men (MSM) at particular risk of sexual ill-health. Introduced in 2009, smartphone geosocial networking applications (GSN apps, e.g. Grindr, Tinder) have become a common way for LGB people to meet sexual and romantic partners. Early evidence suggested GSN apps were associated with negative sexual health outcomes and discrimination for MSM in the USA, China and Australia. Little research has investigated their use in the UK or by women who have sex with women (WSW). Aim: To explore GSN app use by LGB people in UK and USA; including patterns of app use, perceived impacts on health, factors influencing behaviour, risk management by users, and differences between countries or genders. Methodology: A two stage, cross-cultural mixed methods approach with GSN app users in Merseyside (MS; UK) and Connecticut (CT; USA). Stage One: An exploratory, cross-sectional online survey investigated patterns of GSN app use in those looking for same-gender partners (n=207; 64% MS, 36% CT; 41% women, 52% men, 7% non-binary/other/no gender). Stage 2: 33 semi-structured interviews (CT: n=8 women, 8 men, 1 non-binary. MS: n=7 women, 8 men, 1 non-binary) used photo-elicitation (mock-up GSN app profiles) to investigate perceived health impacts, influences on app use and risk management on apps. Thematic analysis of interviews was followed by triangulation in relation to the research objectives. Findings: Men in CT used GSN apps in very similar ways to men in MS, and women in CT were very similar to women in MS. However, men were more sex-focused than women (e.g. looking for casual sex and reporting higher numbers of sexual partners) and experienced more discrimination, harassment and body shaming. Although traditionally associated with “hook-ups”, for all genders sex was only one factor; friendship, romance, community, entertainment and mental health benefits were also important. However, participants reported fear of violence and deception, and negative impacts on their mental health. Users sought to balance risks and benefits of using GSN apps; for most the positives outweighed the negatives. Within the socio-ecological model of health, influences on behaviour varied from the individual to community level, affected by social norms and the functionality of different apps. Participants of all genders used strategies to reduce risk and protect their health on GSN apps. MSM reported widespread sexual health harm reduction strategies, whereas WSW had little concern for sexual health. Bisexual women were particularly cautious of male app users. Conclusions: Findings were very similar in CT and MS suggesting the North American evidence may be applicable in the UK. Health organisations should expand app-based health promotion and outreach that builds on users’ existing harm reduction strategies. Although GSN app companies need to do more to tackle discrimination on apps, apps show a promising opportunity for health improvement and reducing health inequalities