UC Berkeley

New technologies, such as mobile phones and the Internet, have created digital environments that may alter the social and environmental factors that contribute to sexual behavior. To date, sexual health research has largely focused on participation in digital environments as risk factors for sexual behavior, with relatively little exploration of their possible contribution to protective sexual behavior. This research explores the possibility of a more fluid association of digital environments with sexual behavior, with the capacity to contribute to either risky or protective sexual behavior. We present three analyses to make connections between digital environments and sexual behavior more explicit among populations who are traditionally sexually stigmatized, hidden, and at high risk for adverse sexual health outcomes in resource-limited settings. The populations studied included female sex workers (FSWs), men who have sex with men (MSM), and adolescents.

The first analysis examined the use of mobile phones as a platform to solicit clients among FSWs, and the association between this behavior and inconsistent condom use with clients in two diverse areas in South India. The second analysis tested the extent to which sex work income moderates the relationship between mobile phone solicitation and condom use with clients among South Indian FSWs. Finally, a systematic review of sexual health studies in naturalistic situations, i.e., in the absence of technology-based sexual health interventions, among three hidden populations (e.g., FSWs, MSM, and adolescents) was conducted. Existing evidence was examined to identify patterns linking findings of risk versus protective factors that may inform the relationship between sexual behavior and the digital environment.

These findings demonstrated--for the first time in the literature on Indian FSWs-a protective association between client solicitation via mobile phone and condom use with clients as well as evidence that sex work income moderates this association. Both findings were dependent on the type of mobile phone method applied. These empirical findings and existing evidence from adolescent and MSM populations suggest utilization strategies, the way in which digital environments are employed for sexual interactions, may provide a concrete approach to help clarify differential risk/ protective effects between digital environments and sexual behavior. These findings offer new insights to help inform a next generation of technology-based sexual health interventions targeting hidden populations in resource-limited settings.