Published on in Vol 7 , No 3 (2021) :March

Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/21812, first published .
The Annual American Men’s Internet Survey of Behaviors of Men Who Have Sex With Men in the United States: Key Indicators Report 2018

The Annual American Men’s Internet Survey of Behaviors of Men Who Have Sex With Men in the United States: Key Indicators Report 2018

The Annual American Men’s Internet Survey of Behaviors of Men Who Have Sex With Men in the United States: Key Indicators Report 2018

Rapid Surveillance Report

Rollins School of Public Health, Emory University, Atlanta, GA, United States

Corresponding Author:

Sarah Wiatrek, MPH

Rollins School of Public Health

Emory University

1518 Clifton Rd

Atlanta, GA

United States

Phone: 1 470 603 5783

Email: swiatre@emory.edu


The American Men’s Internet Survey (AMIS) is an annual web-based behavioral survey conducted in the United States of men who have sex with men (MSM). This rapid surveillance report describes the sixth cycle of data collection (September-December 2018; AMIS 2018). The key indicators were the same as those previously reported for past AMIS cycles. The AMIS methodology has not substantively changed since AMIS 2017. MSM were recruited from a variety of websites using banner advertisements and email blasts. In addition, participants from AMIS 2017 who agreed to be recontacted for future research were emailed a link to AMIS 2018. Men were eligible to participate if they were aged ≥15 years, resided in the United States, provided a valid US ZIP code, and reported ever having sex with a man or identified as gay or bisexual. The analysis was limited to those who reported having oral or anal sex with a male partner in the past 12 months. We examined demographic and recruitment characteristics using multivariable regression modeling (P<.05) stratified by the participants’ self-reported HIV status. The AMIS 2018 round of data collection resulted in 10,129 completed surveys from MSM representing every US state, Puerto Rico, and Guam. Most participants were non-Hispanic White, aged between 15 and 24 years, living in urban areas in the southern United States, and recruited from general social networking websites. The plurality (4230/10,129, 41.76%) of participants was in the youngest age group, 15-24 years, followed by the 40 years and older age group (3088/10,129, 30.49%). The self-reported HIV prevalence was 6.08% (616/10,129). Compared with HIV-negative or unknown status participants, HIV-positive participants were more likely to have had anal sex without a condom with a male partner in the past 12 months (adjusted odds ratio [aOR] 2.02, 95% CI 1.63-2.50) and more likely to have had anal sex without a condom with a serodiscordant or an unknown status partner (aOR 3.90, 95% CI 3.27-4.66). The reported use of marijuana in the past 12 months was higher among HIV-positive participants than among HIV-negative or unknown status participants (aOR 1.39, 95% CI 1.15-1.68). The reported use of methamphetamines and other illicit substances in the past 12 months was higher among HIV-positive participants than among HIV-negative or unknown status participants (aOR 3.42, 95% CI 2.41-4.87 and aOR 1.90, 95% CI 1.56-2.32, respectively). Most HIV-negative or unknown status participants (6838/9513, 71.88%) reported ever taking an HIV test previously, and 52.51% (4995/9513) of the participants reported undergoing HIV testing in the past 12 months. HIV-positive participants were more likely to report testing and diagnosis of sexually transmitted infections than HIV-negative or unknown status participants (aOR 3.50, 95% CI 2.89-4.24 and aOR 2.61, 95% CI 2.10-3.25, respectively).

JMIR Public Health Surveill 2021;7(3):e21812

doi:10.2196/21812

Keywords



The American Men’s Internet Survey (AMIS) is an annual web-based behavioral survey conducted in the United States of men who have sex with men (MSM). AMIS was developed to produce timely data from large-scale monitoring of behavior trends among MSM recruited on the web. It was designed to complement the Centers for Disease Control and Prevention’s National HIV Behavioral Surveillance (NHBS) system, which collects data on MSM in major US cities every 3 years through venue-based recruitment [1]. An increasing number of MSM are meeting sexual partners through the internet and may have different patterns of sexual risk and HIV testing behaviors compared with MSM recruited through physical venues. AMIS is able to generate annual snapshots of behaviors in a large sample of internet-using MSM with broad geographic diversity as a supplement to venue-based studies, such as the NHBS system. We were also able to collect, update, and share state-level data with public health authorities to inform issues of local relevance by using AMIS.

The methods and past AMIS cycle data (AMIS 2013, AMIS 2014, AMIS 2015, AMIS 2016, and AMIS 2017) have been previously published [2-6].

This supplemental report has updated the existing information with the data collected in AMIS 2018. The methods in AMIS 2018 have not changed from the previously published methods, unless otherwise noted. An in-depth analysis, discussion, and limitations of multiyear trends for indicators reported herein have been published and include data for the first 4 cycles of AMIS (AMIS 2013 to AMIS 2016) [7].


Recruitment and Enrollment

Similar to the previous year’s recruitment process, AMIS participants were recruited through convenience sampling from a variety of websites using banner advertisements or email blasts to members of the website (hereafter referred to generically as ads). For AMIS 2018, data were collected from September 2018 to December 2018. The survey was not incentivized. Men who clicked on the ads were taken directly to the survey website hosted on a secure server administered by SurveyGizmo. Recruitment was also done by emailing participants from the previous cycle of AMIS (AMIS 2017) who consented to be recontacted for future studies. To be eligible for the survey, participants had to be aged ≥15 years, be cisgender male, reside in the United States, and report that they either had oral or anal sex with a male partner at least once in the past or identify as gay or bisexual (hereafter referred to as MSM). Persons who were aged <15 years or refused to provide their age were not asked any other screening questions. MSM who met the eligibility criteria and consented to participate in the study started the web-based survey immediately. The full questionnaire for AMIS 2018 is presented in Multimedia Appendix 1.

Several data cleaning steps were performed on the raw data set of eligible responses to obtain the final analysis data set, in the same manner as in previous AMIS cycles [2-6]. Briefly, these steps were as follows: deduplication; limiting to surveys deemed successful, that is, observations with no missing values for the first question of at least two consecutive sections; limiting to participants who reported having oral or anal sex with a male partner in the past 12 months; and ZIP code validation. These steps are further described in detail.

First, to deduplicate survey responses, demographic data for near-complete (>70%) survey responses with nonunique internet protocol addresses were compared, and responses that showed a 100% match for age, race, ethnicity, ever having sex with a woman, and email address were considered to be duplicate responses. Only the observation with the highest survey completion was retained. The data set was, then, limited to those surveys that were deemed successful. Finally, the data set was restricted to include participants who reported having oral or anal sex in the past 12 months and who provided a valid US ZIP code. ZIP codes were validated in the same manner as done in AMIS 2017 [6]. Valid US ZIP codes were those that could be matched to the ZIP code of county crosswalk files created by the US Department of Housing and Urban Development [8]. Any ZIP codes that could not be matched to this list were then hand validated by checking against the ZIP code locator tool on the US Postal Service website [9]. ZIP codes that could not be found were classified as invalid.

Human Subjects Protections

The study was conducted in compliance with federal regulations governing the protection of human subjects and was reviewed and approved by our institution’s human subjects research review board. No incentive was provided to the participants. Data sets for analyses were stored on secure data servers with access only granted to study staff. The study data are protected under a federal certificate of confidentiality that prevents legal action to force data release.

Measures and Analyses

For the AMIS 2018 analyses, participants were categorized as either AMIS 2017 participants who took the survey again or new participants from the website or app based on the target audience and purpose: gay social networking (n=2), gay general interest (n=1), general social networking (n=4), and geospatial social networking (n=2). Recruitment outcomes and demographic characteristics for the AMIS 2018 participants are presented in the first two tables, and thereafter, they are recategorized to how they were originally recruited in AMIS 2017. We did not provide the names of the websites or apps to preserve operator and client privacy, particularly when a category has only one operator. Participants whose data were eligible, unduplicated, and successful and who provided consent; reported having male-male sex in the past 12 months; and provided a valid US ZIP code were included in analyses of participant characteristics and behavior.

To facilitate comparisons, the key indicators and analytic approach used in AMIS were designed to mirror those used by the NHBS system [10]. Population density was defined in the same manner as defined in AMIS 2017 and was based on the National Center for Health Statistics Rural-Urban classification scheme for counties [11]. The self-reported HIV status was categorized as HIV-positive, HIV-negative, or unknown, consistent with surveillance reports produced by the NHBS system [10]. In total, 3 substance use behaviors in the past 12 months were assessed: use of nonprescribed marijuana, use of methamphetamines, and use of any illicit drug other than marijuana or methamphetamines. All other indicators assessed remained unchanged from AMIS 2017 [6].

The analysis methods for AMIS 2018 did not substantively differ from those previously published but are repeated in this report for clarity. Overall, chi-square tests were used to identify whether participant characteristics differed significantly among recruitment sources. Multivariable logistic regression modeling was used to determine significant differences in behaviors based on the self-reported HIV status while controlling for race or ethnicity, age group, NHBS city residency, and type of recruitment website. The metropolitan statistical areas included in the NHBS system in 2018 were as follows: Atlanta, Georgia; Boston, Massachusetts; Chicago, Illinois; Dallas, Texas; Denver, Colorado; Detroit, Michigan; Houston, Texas; Los Angeles, California; Memphis, Tennessee; Miami, Florida; Nassau-Suffolk, New York; New Orleans, Louisiana, New York City, New York; Newark, New Jersey; Philadelphia, Philadelphia; Portland, Oregon; San Diego, California; San Francisco, California; San Juan, Puerto Rico; Seattle, Washington; Virginia Beach-Norfolk, Virginia; and Washington, District of Columbia. HIV testing behaviors were only examined among those who did not report that they were living with HIV, and these data were presented in participant characteristics. The multivariable logistic regression results were presented as adjusted odds ratios (aORs) with 95% CI and Wald chi-square P values to denote an independently significant difference in the behavior for each subgroup compared with a reference group. Statistical significance was set at P=.05.


Recruitment Outcomes

AMIS 2018 was conducted from September 2018 to December 2018 and resulted in 91,142 persons screened for eligibility (Table 1). Of the 3713 participants who completed the AMIS 2017 survey and were emailed links to the AMIS 2018 survey, 39.94% (1483/3713) completed the screening. Almost half (42,011/91,142, 46.09%) of the participants who completed the screening process were eligible to participate. The most common reason for ineligibility was not ever having male-male sex or not identifying as gay or bisexual. Almost all (40,847/42,011, 97.23%) of the participants who were eligible consented to participate in the survey. A total of 6595 (6595/40,847, 16.15%) surveys were likely from duplicate participants. Among unduplicated surveys, 35.75% (12,246/34,252) were considered successful. Most successful surveys were from men who reported having sex with another male in the past 12 months (10,232 /12,246, 83.55%). Almost all of these surveys (10,129/10,232, 98.99%) provided a valid US ZIP code. Overall, the completion rate was 11.1%, with an analytical sample consisting of 10,129 surveys from 91,142 screened participants. The median survey completion time, including eligibility screening, was 20.7 minutes (IQR=16.5-27.4).

Table 1. Recruitment outcomes for the American Men’s Internet Survey, United States, 2018.
Recruitment outcomesTotalGay social networking (n=2)aGeneral gay interest (n=1)aGeneral social networking (n=4)aGeospatial social networking (n=2)aAMISb 2017 participants
Screenedc, N91,142128819780,76874061483
Ineligibled, n (%)49,131 (53.91)279 (21.66)140 (71.07)46,689 (57.81)1857 (25.07)166 (11.19)

Not >15 years of agee22,659 (46.12)115 (41.22)13 (9.29)21,507 (46.06)951 (51.21)73 (43.98)

Not malee38,832 (79.04)226 (81)48 (34.29)36,830 (78.88)1590 (85.62)138 (83.13)

Not MSMe,f48,398 (98.51)257 (92.11)53 (37.86)46,233 (99.02)1697 (91.38)158 (95.18)

Nonresidente36,714 (74.73)220 (78.85)131 (93.57)34,637 (74.19)1597 (86)129 (77.71)
Eligiblec, n (%)42,011 (46.09)1009 (78.34)57 (28.93)34,079 (42.19)5549 (74.93)1317 (88.81)
Consentedg, n (%)40,847 (97.23)964 (95.54)55 (96.49)33,087 (97.09)5429 (97.84)1312 (99.62)
Unduplicatedh, n (%)34,252 (83.85)859 (89.11)51 (92.73)27,527 (83.20)4639 (85.45)1176 (89.63)
Successi, n (%)12,246 (35.75)489 (56.93)39 (76.47)8150 (29.61)2537 (54.69)1031 (87.67)
MSM in the past 12 monthsj, n (%)10,232 (83.55)434 (88.75)32 (82.05)6424 (78.82)2395 (94.40)947 (91.85)
Valid ZIP codek, n (%)10,129 (98.99)430 (99.08)32 (100)6351 (98.86)2375 (99.16)941 (99.37)

aRefers to the number of websites or apps in this category.

bAMIS: American Men’s Internet Survey.

cProportion of participants who started the screening questionnaire.

dProportion of total participants screened. Participants who did not complete the screening questionnaire were considered ineligible.

eProportion of ineligible participants, including those who did not respond to the question.

fMSM: men who have sex with men or identify as gay or bisexual.

gProportion of eligible participants.

hProportion of participants who consented. Deduplication removes participants who were marked as duplicates using the internet protocol address and demographic data matching.

iProportion of unduplicated participants. Success removes participants who do not pass the test for completeness.

jProportion of successes.

kProportion of men who had sex with men in the past 12 months. Valid US ZIP codes were those that could be matched to the ZIP code for county crosswalk files created by the US Department of Housing and Urban Development. Any ZIP codes that could not be matched to this list were then hand validated by checking against the ZIP code locator tool on the US Postal Service website. ZIP codes that could not be found were classified as invalid.

Participant Characteristics

In total, 69.22% (7011/10,129) of the participants included in this report were non-Hispanic White and 41.76% (4230/10,129) were aged 15-24 years; the most common region of residence was the south, followed by the west (Table 2). Participants were recruited from all US states, and there were at least 100 participants each from 29 states and the District of Columbia (Figure 1). About one-third (3338/10,129, 32.95%) of participants resided in an NHBS city, and about the same proportion (3680/10,129, 36.33%) lived in an urban county. Overall, 6.08% (616/10,129) of participants were living with HIV, 66.39% (6725/10,129) were HIV negative, and 27.52% (2788/10,129) had an unknown HIV status. All participant characteristics differed significantly based on the recruitment source, except NHBS city resident (Table 2).

Table 2. Characteristics of men who have sex with men in the American Men’s Internet Survey by recruitment type, United States, 2018.
Participant characteristicsTotalGay social networking (n=2)aGeneral gay interest (n=1)aGeneral social networking (n=3)aGeospatial social networking (n=2)aAMISb 2016 participantsP valuec
Race or ethnicity, n (%)<.001

Black, non-Hispanic553 (5.46)36 (8.4)<5 (—)d337 (5.3)127 (5.3)52 (5.5)

Hispanic1630 (16.09)32 (7.4)<5 (—)1220 (19.21)269 (11.33)106 (11.26)

White, non-Hispanic7011 (69.22)333 (77.4)24 (75)4128 (65)1801 (75.83)725 (77.05)

Other or multiple races749 (7.39)16 (3.7)<5 (—)546 (8.6)133 (5.6)51 (5.4)
Age (years), n (%)<.001

15-244230 (41.76)18 (4.19)5 (15.63)3919 (61.71)153 (6.44)135 (14.35)

25-291308 (12.91)19 (4.42)<5 (—)968 (15.24)197 (8.29)123 (13.07)

30-391503 (14.84)63 (14.65)5 (15.63)774 (12.19)484 (20.38)177 (18.81)

≥403088 (30.49)330 (76.74)21 (65.63)690 (10.86)1541 (64.88)506 (53.77)
Region, n (%).02

Northeast1632 (16.11)89 (20.70)7 (21.88)1007 (15.86)351 (14.78)178 (18.92)

Midwest2198 (21.70)93 (21.63)<5 (—)1397 (22)509 (21.43)195 (20.72)

South3865 (38.16)163 (37.91)11 (34.38)2441 (38.43)906 (38.15)344 (36.56)

West2426 (23.95)85 (19.77)10 (31.25)1502 (23.65)606 (25.52)223 (23.70)

US-dependent areas8 (0.08)<5 (—)<5 (—)<5 (—)<5 (—)<5 (—)
NHBSe city resident, n (%).12

Yes3338 (32.95)133 (30.93)15 (46.88)2022 (31.84)782 (32.93)386 (41.02)

No6791 (67.05)297 (69.07)17 (53.13)4329 (68.16)1593 (67.07)555 (58.98)
Population densityf, n (%)<.001

Urban3680 (36.33)129 (30)17 (53.13)2187 (34.44)906 (38.15)441 (46.87)

Suburban2110 (20.83)112 (26.05)5 (15.63)1351 (21.27)477 (20.08)165 (17.53)

Small or medium metropolitan3317 (32.75)138 (32.09)6 (18.75)2181 (34.34)715 (30.11)277 (29.44)

Rural1013 (10)51 (11.86)<5 (—)627 (9.87)274 (11.54)57 (6.06)
Self-reported HIV status, n (%)<.001

Positive616 (6.08)42 (9.8)<5 (—)205 (3.2)255 (10.74)110 (11.7)

Negative6725 (66.39)300 (69.77)25 (78.13)3758 (59.17)1868 (78.65)774 (82.25)

Unknown2788 (27.52)88 (20.47)<5 (—)2388 (37.6)252 (10.61)57 (6.06)
Total, n (%)10,129 (100)430 (4.26)32 (0.32)6351 (62.70)2375 (23.45)941 (9.29)N/Ag

aRefers to the number of websites or apps in this category.

bAMIS: American Men’s Internet Survey.

cA chi-square test for the difference in characteristics between recruitment types.

dPercentage is not reported due to an insufficient n.

eNHBS: National HIV Behavioral Surveillance.

fThe National Center for Health Statistics urban or rural category could not be assigned to 10 participants living in US territories.

gN/A: not applicable.

Figure 1. The number of men who have sex with men who participated in the American Men’s Internet Survey (AMIS) by state, 2018.
View this figure

Sexual Behaviors

Approximately two-thirds (6926/10,129, 68.37%) of participants reported having anal sex without a condom with another male in the past 12 months, and about one-fifth (2390/10,129, 23.59%) of participants reported doing so with a partner of a discordant or an unknown HIV status (Table 3). Compared with HIV-negative or unknown status participants, those who were living with HIV were significantly more likely to report anal intercourse without a condom (aOR 2.02, 95% CI 1.63-2.50), including with male partners who were of a discordant or an unknown status (aOR 3.90, 95% CI 3.27-4.66). Stratified by the serostatus group, anal intercourse without a condom differed significantly for only HIV-negative or unknown status participants by race or ethnicity, age group, and recruitment website. Anal intercourse without a condom with partners of a discordant or an unknown HIV status differed significantly by race or ethnicity, residence in an NHBS city, and recruitment type for HIV-negative or unknown status participants only.

Table 3. Sexual behaviors with male partners of men who have sex with men in the American Men’s Internet Survey, United States, 2018.
Participant characteristics by HIV statusParticipants (N)Sexual behaviors with male partners in the past 12 months


Anal intercourse without a condomAnal intercourse without a condom with a partner of a discordant or an unknown HIV status


n (%)P valuean (%)P valuea
HIV positive616499 (81)<.001b338 (54.87)<.001b

Race or ethnicity


Black, non-Hispanic9769 (71.13).3139 (40.20).09


Hispanic7358 (79.45).9241 (56.16). 35


White, non-Hispanic406341 (83.99)Refc240 (59.11)Refc


Other or multiple races2921 (72.41).4013 (44.83).42

Age (years)


15-244337 (86.05).7624 (55.81).86


25-294037 (92.50).1224 (60).29


30-3910486 (82.69).3660 (57.69)>.99


≥40429339 (79.02)Refc230 (53.61)Refc

NHBSd city resident


Yes255203 (79.61).89137 (53.73).89


No361296 (81.99)Refc201 (55.68)Refc

Recruitment type


Gay social networking5945 (76.27)>.9933 (55.93).83


General gay interest75 (71.43).524 (57.14).95


General social networking260205 (78.85)Refc128 (49.23)Refc


Geospatial social networking290244 (84.14).10173 (59.66).43
HIV negative or unknown status95136427 (67.56)Refb,c2052 (21.57)Refb,c

Race or ethnicity


Black, non-Hispanic456294 (64.47).32130 (28.51).008


Hispanic15571049 (67.37).05367 (23.57).79


White, non-Hispanic66054526 (68.52)Refc1357 (20.55)Refc


Other or multiple races720449 (62.36).03166 (23.05).78

Age (years)


15-2441872626 (62.72)<.001799 (19.08).08


25-291268965 (76.10)<.001292 (23.03).08


30-3913991072 (76.63)<.001308 (22.02).37


≥4026591764 (66.34)Refc653 (24.56)Refc

NHBS city resident


Yes30832103 (68.21).41732 (23.74).002


No64304324 (67.25)Refc1320 (20.53)Refc

Recruitment type


Gay social networking503280 (55.66)<.001108 (21.47).73


General gay interest4225 (59.52).576 (14.29).23


General social networking65874385 (66.57)Refc1266 (19.22)Refc


Geospatial social networking23661725 (72.91)<.001668 (28.23)<.001

aWald chi-square P values from the multivariate logistic regression model comparing behavior (yes vs no) between groups with specific characteristics and a reference group.

bWald chi-square P values from the multivariate logistic regression model comparing behavior (yes vs no) among HIV-positive participants and HIV-negative or unknown serostatus participants. Model controlled for race or ethnicity, age, NHBS system city residency, and recruitment type.

cRef: The reference group being compared to within the multivariate logistic regression models.

dNHBS: National HIV Behavioral Surveillance.

Substance Use Behaviors

In total, 31.93% (3235/10,129) of participants reported using marijuana, 2.31% (234/10,129) reported using methamphetamines, and 20.43% (2069/10,129) reported using other illicit substances in the past 12 months (Table 4). Compared with participants with HIV negative or unknown status, HIV-positive participants were significantly more likely to report the use of marijuana (aOR 1.39, 95% CI 1.15-1.68), methamphetamines (aOR 3.42, 95% CI 2.41-4.87), and other illicit substances (aOR 1.90, 95% CI 1.56-2.32) in the past 12 months. Among HIV-positive participants, the use of marijuana varied significantly by age, and the use of other illicit substances varied significantly by race or ethnicity. In addition, the use of marijuana, methamphetamines, and other illicit substances differed significantly by age and race or ethnicity among HIV-negative or unknown status participants. In this group, the use of marijuana and other illicit substances differed significantly by residence in an NHBS city, and the use of marijuana differed significantly by the recruitment website.

Table 4. Substance use behaviors of men who have sex with men in the American Men’s Internet Survey, United States, 2018.
Participant characteristics by HIV statusParticipants (N)Used marijuanaUsed methamphetaminesUsed other substances


n (%)P valuean (%)P valuean (%)P valuea
HIV positive616189 (30.68).001b50 (8.12)<.001b169 (27.44)<.001b

Race or ethnicity


Black, non-Hispanic9718 (18.56).12<5 (—)c.218 (8.24)<.001


Hispanic7322 (30.14).915 (6.85).8521 (28.77).15


White, non-Hispanic406137 (33.74)Refd37 (9.11)Refd130 (32.02)Refd


Other or multiple races298 (27.58).81<5 (—).957 (24.14).77

Age (years)


15-244322 (51.16).002<5 (—).8112 (27.91).82


25-294014 (35).88<5 (—).2413 (32.50).62


30-3910442 (40.38).9611 (10.58).1936 (34.62).20


≥40429111 (25.87)Refd34 (7.93)Refd108 (25.17)Refd

NHBSe city resident


Yes25581 (31.76).2224 (9.41).1970 (27.45).46


No361108 (29.92)Refd26 (7.20)Refd99 (27.42)Refd

Recruitment type


Gay social networking5915 (25.42).63<5 (—).9716 (27.12).84


General gay interest7<5 (—).42<5 (—).96<5 (—).37


General social networking26073 (28.08)Refd22 (8.97)Refd61 (23.46)Refd


Geospatial social networking290100 (34.48).0626 (8.9).9689 (30.69).93
HIV negative or unknown status95133046 (32.02)Refb,d184 (1.93)Refb,d1900 (19.97)Refb,d

Race or ethnicity


Black, non-Hispanic456122 (26.75).0026 (1.32).1860 (13.16)<.001


Hispanic1557544 (34.94).8642 (2.70).002337 (21.64).10


White, non-Hispanic66052071 (31.36)Refd117 (1.77)Refd1301 (19.70)Refd


Other or multiple races720269 (37.36).0213 (1.81).81173 (24.03)<.001

Age (years)


15-2441871611 (38.48)<.00147 (1.12).009861 (20.56).18


25-291268427 (33.68).0122 (1.74).70310 (24.45)<.001


30-391399468 (33.45).0341 (2.93).01328 (23.45).005


≥402659540 (20.31)Refd74 (2.78)Refd401 (15.08)Refd

NHBS city resident


Yes30831100 (35.68)<.00157 (1.85).35731 (23.71)<.001


No64301946 (30.26)Refd127 (1.98)Refd1169 (18.18)Refd

Recruitment type


Gay social networking50399 (19.68).00221 (4.17).1080 (15.90).33


General gay interest4219 (45.23).003<5 (—).9311 (26.19).18


General social networking65872294 (34.83)Refd84 (1.28)Refd1343 (20.39)Refd


Geospatial social networking2366632 (26.71).1578 (3.30).65464 (19.61).75

aWald chi-square P values from the multivariate logistic regression model comparing behavior (yes vs no) between groups with specific characteristics and a reference group.

bWald chi-square P values from the multivariate logistic regression model comparing behavior (yes vs no) among HIV-positive participants and HIV-negative or unknown serostatus participants. Model controlled for race or ethnicity, age, National HIV Behavioral Surveillance system city residency, and recruitment type.

cPercentage is not reported due to an insufficient n.

dRef: The reference group being compared to within the multivariate logistic regression models.

eNHBS: National HIV Behavioral Surveillance.

HIV Testing Behaviors

HIV testing behaviors were examined among participants who were not HIV positive (Table 5). Most participants (6836/9513, 71.85%) were previously tested for HIV infection, and 52.51% (4995/9513) of the participants were tested in the past 12 months. HIV testing behavior, both ever tested and tested in the past 12 months, differed significantly by age, residence in an NHBS city, and type of recruitment website.

Table 5. HIV testing behaviors of HIV-negative or unknown status men who have sex with men in the American Men’s Internet Survey, United States, 2018.
Participant characteristicsParticipants (N)HIV testing behaviors


Ever tested for HIVTested for HIV in the past 12 months


n (%)P valuean (%)P valuea
Race or ethnicity

Black, non-Hispanic456339 (74.34).46256 (56.14).50

Hispanic15571028 (66.02).87799 (51.32).66

White, non-Hispanic66054871 (73.75)Refb3480 (52.69)Refb

Other or multiple races720489 (67.92).93377 (52.36).73
Age (years)

15-2441872115 (55.01)<.0011692 (40.41)<.001

25-2912681057 (83.36).11752 (59.31).001

30-3913991268 (90.64)<.001901 (64.40)<.001

≥4026592398 (90.18)Refb1650 (62.05)Refb
NHBSc city resident

Yes30832339 (75.87)<.0011797 (58.29)<.001

No64304499 (69.97)Refb3198 (49.74)Refb
Recruitment type

Gay social networking503414 (82.31)<.001261 (51.88).03

General gay interest4238 (90.47).2219 (45.24).07

General social networking65874243 (64.41)Refb3063 (46.50)Refb

Geospatial social networking23662128 (89.94).081640 (69.32)<.001
Total95136838 (71.88)4995 (52.51)

aWald chi-square P values from the multivariate logistic regression model comparing behavior (yes vs no) between groups with specific characteristics and a reference (Ref) group.

bRef: The reference group being compared to within the multivariate logistic regression models.

cNHBS: National HIV Behavioral Surveillance.

Sexually Transmitted Infection Testing and Diagnosis

In total, 42.59% (4314/10,129) of participants reported sexually transmitted infection (STI) testing in the past 12 months, and 10.08% (1022/10,129) of participants reported a diagnosis of STI in the past 12 months. Compared with HIV-negative or unknown status participants, HIV-positive participants were significantly more likely to report STI testing (aOR 3.50, 95% CI 2.89-4.24) and STI diagnosis (aOR 2.61, 95% CI 2.10-3.25) in the past 12 months (Table 6). The most common STI diagnosis among HIV-positive participants was syphilis (78/616, 12.7%), followed by gonorrhea (64/616, 10.4%) and chlamydia (62/616, 10.1%). Gonorrhea was the most common STI diagnosis among HIV-negative or unknown status participants (542/9513, 5.69%), followed by chlamydia (520/9513, 5.47%) and syphilis (282/9513, 2.96%). STI testing and diagnosed with any STI significantly differed by age, residence in an NHBS city, and recruitment website among HIV-negative or unknown status participants. Among HIV-positive participants, STI testing only significantly differed by residence in an NHBS city.

Table 6. Sexually transmitted infection testing and diagnosis of men who have sex with men in the American Men’s Internet Survey, United States, 2018.
Participant characteristics by HIV statusParticipants (N)STIa history in the past 12 months


Tested for any STIDiagnosed with any STI


n (%)P valuebn (%)P valueb
HIV positive616448 (72.7)<.001c135 (21.9)<.001c

Race or ethnicity


Black, non-Hispanic9773 (75).4624 (25).68


Hispanic7356 (77).8923 (32).19


White, non-Hispanic406290 (71.4)Refd80 (19.7)Refd


Other or multiple races2921 (72).536 (21).47

Age (years)


15-244337 (86).0913 (30).28


25-294030 (75).7211 (28).92


30-3910488 (84.6).2833 (31.7).19


≥40429293 (68.3)Refd78 (18.2)Refd

NHBSe city resident


Yes255202 (79.2).00462 (24.3).32


No361246 (68.1)Refd73 (20.2)Refd

Recruitment type


Gay social networking5941 (70).9310 (17).54


General gay interest75 (71).99<5 (—).48


General social networking260184 (70.8)Refd56 (21.5)Refd


Geospatial social networking290218 (75.2).2867 (23.1).84
HIV negative or unknown status95133866 (40.64)Refc,d887 (9.32) Refc,d

Race or ethnicity


Black, non-Hispanic456192 (42.1).9049 (10.8).77


Hispanic1557642 (41.23).41169 (10.85).25


White, non-Hispanic66052669 (40.41)Refd587 (8.89)Refd


Other or multiple races720293 (40.7)>.9968 (9.4).61

Age (years)


15-2441871419 (33.89)<.001330 (7.88).09


25-291268631 (49.76)<.001161 (12.70)<.001


30-391399676 (48.32)<.001153 (10.94).44


≥4026591140 (42.87)Refd243 (9.14)Refd

NHBSe city resident


Yes30831425 (46.22)<.001389 (12.62)<.001


No64302441 (37.96)Refd498 (7.74)Refd

Recruitment type


Gay social networking503183 (36.4).7241 (8.2).96


General gay interest4212 (29).06<5 (—)f.62


General social networking65872476 (37.59)Refd545 (8.27)Refd


Geospatial social networking23661188 (50.21)<.001296 (12.51).02

aSTI: sexually transmitted infection (includes chlamydia, gonorrhea, and syphilis).

bWald chi-square P values from the multivariate logistic regression model comparing behavior (yes vs no) between groups with specific characteristics and a reference (Ref) group.

cWald chi-square P values from the multivariate logistic regression model comparing behavior (yes vs no) among HIV-positive participants and HIV-negative or unknown serostatus participants. Model controlled for race or ethnicity, age, NHBS system city residency, and recruitment type.

dRef: The reference group being compared to within the multivariate logistic regression models.

eNHBS: National HIV Behavioral Surveillance.

fPercentage is not reported due to an insufficient n.


The sixth round of data collection for AMIS was successfully implemented and resulted in over 10,000 surveys from a diverse sample of internet-using MSM residing in all US states. A majority of eligible and enrolled participants were recruited from general social networking, were White, non-Hispanic, aged between 15 and 24 years, and reported being HIV negative. There were notable differences in key behavioral indicators by self-reported HIV status. Compared with HIV-negative or unknown status participants, HIV-positive participants were more likely to have had anal sex without a condom with a male partner in the past year and more likely to have had anal sex without a condom with a serodiscordant or an unknown status partner. The reported use of marijuana, methamphetamines, and other illicit substances in the past year was higher among HIV-positive participants than among HIV-negative or unknown status participants. HIV-positive participants were also more likely to report testing and diagnosis of STIs than HIV-negative or unknown status participants. When stratified by HIV status, some significant differences in these behavioral indicators by demographics and recruitment websites were also observed.

Acknowledgments

The study was funded by a grant from the National Institutes of Health (P30AI050409)—the Emory Center for AIDS Research.

Conflicts of Interest

TS and PS are members of the Editorial Board of JMIR Public Health and Surveillance. However, they had no involvement in the editorial decision for this manuscript. The manuscript was reviewed and handled by an independent editor.

Multimedia Appendix 1

American Men’s Internet Survey 2018 questionnaire.

DOCX File , 406 KB

  1. Finlayson T, Le B, Smith A, Bowles K, Cribbin M, Miles I, et al. HIV risk, prevention, and testing behaviors among men who have sex with men--National HIV Behavioral Surveillance System, 21 U.S. cities, United States, 2008. MMWR Surveillence Summaries 2011;60(14):1-34 [FREE Full text] [Medline]
  2. Sanchez TH, Sineath RC, Kahle EM, Tregear SJ, Sullivan PS. The annual American men's internet survey of behaviors of men who have sex with men in the United States: protocol and key indicators report 2013. JMIR Public Health Surveill 2015;1(1):e3 [FREE Full text] [CrossRef] [Medline]
  3. Sanchez T, Zlotorzynska M, Sineath C, Kahle E, Sullivan P. The annual American men's internet survey of behaviors of men who have sex with men in the United States: 2014 key indicators report. JMIR Public Health Surveill 2016 May 25;2(1):e23 [FREE Full text] [CrossRef] [Medline]
  4. Zlotorzynska M, Sullivan P, Sanchez T. The annual American men's internet survey of behaviors of men who have sex with men in the United States: 2015 key indicators report.. JMIR Public Health Surveill 2017 Mar 25;3(1):e13 [FREE Full text] [CrossRef] [Medline]
  5. Zlotorzynska M, Sullivan P, Sanchez T. The annual American men's internet survey of behaviors of men who have sex with men in the United States: 2016 key indicators report. JMIR Public Health Surveill 2019 Feb 20;5(1):e11313 [FREE Full text] [CrossRef] [Medline]
  6. Zlotorzynska M, Cantu C, Rai R, Sullivan P, Sanchez T. The annual American men's internet survey of behaviors of men who have sex with men in the United States: 2017 key indicators report. JMIR Public Health Surveill 2020 Apr 13;6(2):e16847 [FREE Full text] [CrossRef] [Medline]
  7. Sanchez TH, Zlotorzynska M, Sineath RC, Kahle E, Tregear S, Sullivan PS. National trends in sexual behavior, substance use and HIV testing among United States men who have sex with men recruited online, 2013 through 2017. AIDS Behav 2018 Aug;22(8):2413-2425. [CrossRef] [Medline]
  8. HUD USPS ZIP code crosswalk files.   URL: https://www.huduser.gov/portal/datasets/usps_crosswalk.html [accessed 2017-02-15]
  9. USPS ZIP code lookup.   URL: https://tools.usps.com/go/ZipLookupAction_input [accessed 2017-02-15]
  10. Centers for Disease ControlPrevention. Hiv infection risk, prevention, and testing behaviors among men who have sex with men. National HIV Behavioral Surveillance, 20 U.S. Cities. 2014.   URL: https:/​/www.​cdc.gov/​hiv/​pdf/​library/​reports/​surveillance/​cdc-hiv-surveillance-special-report-number-15.​pdf [accessed 2021-02-16]
  11. Ingram DD, Franco SJ. 2013 NCHS Urban-rural classification scheme for counties. Vital Health Stat 2 2014 Apr(166):1-73 [FREE Full text] [Medline]


AMIS: American Men’s Internet Survey
aOR: adjusted odds ratio
MSM: men who have sex with men
NHBS: National HIV Behavioral Surveillance System
STI: sexually transmitted infection


Edited by G Eysenbach; submitted 26.06.20; peer-reviewed by S Badawy, D Rao; comments to author 08.08.20; revised version received 11.10.20; accepted 17.01.21; published 04.03.21

Copyright

©Sarah Wiatrek, Maria Zlotorzynska, Ramona Rai, Patrick Sullivan, Travis Sanchez. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 04.03.2021.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Public Health and Surveillance, is properly cited. The complete bibliographic information, a link to the original publication on http://publichealth.jmir.org, as well as this copyright and license information must be included.