Swipe and burn (Image: Daniel Stolle)
Swipe right and your next-but-one date could be in a clinic. Apps like Tinder and Grindr are being linked to a flare-up of sexually transmitted infections
SOME people do it in bed. Others slope off to the bathrooms at work. Look carefully and you’ll probably spot someone at it on the train. You might even be one of them.
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Whether or not you have joined the millions regularly logging on to hook-up apps such as Tinder and Grindr, it is clear that over the past few years they have become an accepted part of today’s dating scene. With touchscreen interfaces that allow users to swipe through profiles of available matches, they make finding a date as quick and easy as flicking through the pages of a magazine.
Tinder, used by men and women, generates 15 million mutual matches a day. Grindr, a similar app for men seeking men, has 6 million users, with 10,000 joining daily. And because these apps rely on GPS to recommend potential matches within a given radius, they make meeting people in the flesh easier than ever.
But for all the fun and spontaneity, a darker side is emerging. The rise of such apps has coincided with a surge in outbreaks of sexually transmitted infections (STIs) that had long been under control, and an increase in other rare diseases. Public health officials are now pointing the finger of blame at a combination of relaxed attitudes towards safe sex and the easy access to partners provided by these apps.
“What it comes down to is mobile convenience leading to more efficient STI transmission,” says epidemiologist Matthew Beymer at the . That’s not all. Research is starting to explore the idea that this technology makes you more likely to change your behaviour, causing you to leave your common sense at the bedroom door.
Syphilis was once one of the most feared STIs, but was almost confined to the history books after it became treatable with penicillin in the 1940s. By 2000, it was on the brink of elimination in both the US and the UK.
But cases of syphilis have rocketed over the past few years in many Western countries, including the US, Canada, UK, Germany, Sweden and Australia. Now the UK sees more than 3000 cases a year and the (see graph). Australia had its last September.
It’s not just syphilis. Infection rates for other STIs that had plummeted during the AIDS epidemic in the 1980s are also on the rise. In Australia, gonorrhoea cases between 2009 and 2013. Chlamydia and multidrug-resistant gonorrhoea are on the increase in numerous countries.
In their public responses to these outbreaks, health officials have repeatedly blamed hook-up apps. “You’ve suddenly invented a way of discovering where the nearest sexually available person is to the nearest metre – it’s not difficult for you to get with them,” says at the British Association for Sexual Health and HIV.
Rash behaviour
Research into the cause of the STI increase is still in the early stages, but evidence is starting to stack up in support of this idea.
An investigation of six regional outbreaks of syphilis across the UK since 2012 found that location-based networking apps in how patients had met their sexual partners, especially for men who have sex with men.
The team behind the research, led by Ian Simms at Public Health England in Colindale, UK, says that as well as making it quicker and easier to find new partners, the technology joins together isolated sexual networks in which disease would previously have been contained. This results in “hyper-efficient transmission” of infections, Simms says, so epidemics spread faster and further.
Further evidence that links app use with STIs comes from a small study of men who have sex with men. This found that those who met up through smartphone apps had significantly more past sexual partners and were more likely to have ever been diagnosed with an STI than those who didn’t use the apps ().
That finding was backed up by Beymer and his colleagues, who conducted the first major study to compare STI rates in people who use apps and those who don’t. His team had noticed that increasingly, men who came to their clinic for testing were using apps such as Grindr, ’d, Recon and Scruff (see “Fast Love“).
The team looked at disease incidence in 7000 men who came in for screening and found that those who used phone apps to meet sexual partners were 40 per cent than those who met sexual partners online. They were 25 per cent more likely to have the disease than men who had met partners socially.
What was “startling”, Beymer says, is that even when they controlled for other factors that are known to influence STI risk, such as age, ethnicity and drug use, the link to phone app use remained.
“Grinder: Over 5 mill users since 2009”
STIs are the core concern, but in the past two years Simms and others have been surprised to find that infections that weren’t traditionally thought to spread through sexual contact also now seem to be spreading this way. Two infections that had hitherto been known as travel-related stomach bugs, the gastroenteric bacterium and the rare verocytotoxin-producing , were reported in clusters of gay and bisexual men in the UK. Many cases weren’t linked to travel to countries where the disease is endemic, and later interviews with the men revealed factors such as the use of the internet and apps to meet partners.
“Essentially we are saying all these overlapping epidemics are all sides of the same dice,” Simms says. “They are sustained by very closely related sexual networks facilitated by geospatial networking apps which allow all these previously un-joined networks to be linked up.”
These studies suggest a link, but it could be that the results aren’t about the apps but the users, says at the Luskin School of Public Affairs at the University of California, Los Angeles. “We don’t yet know if there’s something inherent about these apps or the individuals choosing to use them,” he says.
Meeting up has never been easier (Image: Jesse Untracht Oakner/Plainpicture)
Anecdotally, the spontaneity involved seems to make people more relaxed. “You are more likely to throw caution to the wind,” says Kate (not her real name), who started using Tinder after a breakup. She didn’t originally sign up to Tinder for casual sex, but ended up sleeping with three of the five men she met. “Sometimes we’d been chatting for ages so you feel more advanced in your flirtation when you meet them for the first time than with someone you meet in a bar, so it’s more likely that things will happen,” she says.
But what’s the evidence? Working out why and how people behave the way they do when it comes to sex is delicate and complicated. Yet studies suggest that the way people meet their sexual partners might influence what happens when they end up in bed – translating into health consequences.
“We have done work to show that the actual process of interaction online can increase risk-taking,” says at the University of New South Wales, Australia. With colleague Philippe Adam, he conducted a who have sex with men to see if their online experiences affected their actions.
“We found out that 70 per cent of gay men who use these online chat sites or apps fantasise around unprotected sex with their partner as a way of getting aroused – without the intention to actually do that. But in fact all these fantasies modify their sexual script,” says Adam, and some men act on them regardless of their initial intentions.
Safer swiping
Much of the research has so far focused on men having sex with men, but the surge of STIs is far from confined to this community, with outbreaks also occurring in heterosexual adults. Similar research on Tinder would be interesting, says Holloway.
One of the reasons officials are confident that apps are helping to drive the problem is a result of contact tracing, one of the first things they do when trying to address an outbreak. Those who test positive in the clinic are asked for the contact details of recent sexual partners so that they can be alerted of the risk. And it’s this process, they say, which often reveals the role of hook-up apps: in the Canadian city of Winnipeg, for example, 50 per cent of people being treated for syphilis said they had met sexual partners through them.
Apps also make contact tracing harder than if people meet through social connections as there is no need for users to reveal their real name or contact details, making halting an outbreak more difficult.
But although apps have been implicated in the STI surge, they are far from the only factor. Cases of syphilis have been rising for around a decade, and this coincides with a reduction in sexual health campaigns and a change in attitudes towards HIV. As the perception of AIDS has changed from it being seen as a death sentence to a chronic condition that can be managed with drugs, a so-called “safe-sex fatigue” has ensued. The same generation that is now connecting more easily using mobile devices is also less concerned about safe sex than the generation before.
The success of preventative pre- and post-exposure pills for HIV, which protect against HIV but don’t stop other STIs, may add to the issue, officials say, as well as the popularity of “serosorting” websites. These connect people on the basis of their HIV status. Without the HIV risk, people may be less likely to practice safe sex.
With such a complex issue, Holloway cautions against vilifying networking apps. Instead, he thinks they could be harnessed as valuable prevention tools.
That’s why he and his colleagues have teamed up with , which owns internet sites and mobile apps such as Manhunt and ’d, to conduct a study into how HIV prevention advice through mobile apps might be received by at-risk groups.
Online Buddies has a research arm, OLB Research Institute in Cambridge, Massachusetts, which is focused on gathering evidence on the best way to get sexual health messages across on their platforms. It also acts as a consultancy to health agencies to help them design mobile campaigns that users are more likely to engage with. The institute is headed by David Novak, who was previously National Syphilis Elimination Coordinator at the US Centers for Disease Control but felt that he could do more by working in the industry.
The approach can work. During a deadly meningitis outbreak in New York City in 2012, Novak says they worked with local public health authorities and directed one-third of local Manhunt users to get vaccinated using an advert on the site.
Other app companies are also getting on board. In October last year, Grindr and six other app makers formed a collaboration with the and the with the aim of finding new ways to encourage testing, raise awareness and reduce stigma.
Getting the message right is crucial, however. “Once you make a change to a site of millions of users, if you don’t do it properly it can have a bad health outcome,” says Novak.
Online Buddies will turn down paid public health advertising or campaigns it feels aren’t right for their mobile platforms. For example, it recently refused a syphilis campaign that it felt stigmatised people who had the disease.
And a barrage of criticism fell on the public health department of San Mateo County in northern California recently for its . The accounts use stock photos as avatars and are operated by trained STI counsellors, says Darryl Lampkin, Community Program Supervisor at the department. Once they get chatting to users, the counsellors find the first opportune moment to reveal that they are actually healthcare providers, and use the chat to supply health information. But critics have slammed this as patronising and unethical, and have likened it to entrapment.
“Tinder has an estimated 50 million users since 2012 15 million Tinder matches per day”
“We recognise how this strategy can be perceived as being deceptive,” says Lampkin. But he says it works, with 80 per cent of men remaining online after the counsellors they are chatting to have come clean. They have also seen a rise in the number of men coming in to be tested.
Encouraging testing is crucial, but sending people their results quickly and in a shareable, electronic format can also help to increase dialogue about STIs, says Ramin Bastani, CEO of health platform , which works with public health bodies in the US to develop electronic test results. Bastani envisages a day when app users will expect to see some kind of verified sexual health tick or “badge” on people’s profiles – noting that many men in the gay community already post their HIV status on their online profiles.
Quite how this technology will evolve remains to be seen. Holloway points out that the possible re-sharing of test results raises privacy issues that have yet to be resolved.
But what is clear is that there is a real drive to change the way sexual health messages are presented. “Young people don’t want boring messages about public health,” says Adam. “They want to know about relationships. Sexual health messages need to be embedded in this.” As Basani puts it, “the healthcare of the 21st century will not look like healthcare – it will look like your iPhone, your computer. The things you use every day.”
Fast love
Tinder
Linked to Facebook, it finds potential matches in the local area. Swipe left for no, right for yes
Grindr
Location-based social network for men, it provides users with a grid of potential matches in the vicinity
Growlr
The social network for gay “bears” – heavier, hairier men. More than 4 million users
’d
Location-based gay social app. Launched in 2010, it now has 5 million users
Manhunt
Launched as an online site and also a mobile network for “guys looking for fun, dates, or friends”
Recon
Fetish hook-up site for gay men
Scruff
Dating and social networking app for men. Fifty million messages are exchanged each week
This article appeared in print under the headline “Swipe and burn”
