The role of peer relationships in MSM health

The thesis explores the critical role of peer relationships in the health of Men who have Sex with Men (MSM). It highlights that MSM face unique mental and sexual health challenges. The thesis underscores that peer relationships can mitigate these negative health outcomes by providing social support, reducing feelings of loneliness, providing intimacy, fostering a sense of community and providing social norms around protection against HIV. Peer communication is identified as a vital component in maintaining mental health among MSM. The thesis discusses how peer relationships offer social integration and intimacy. These relationships are not only crucial for mental well-being but also play a significant role in promoting sexual health. Peer networks facilitate the sharing of social norms about safe sex practices and HIV prevention methods, such as Pre-Exposure Prophylaxis (PrEP). First, the thesis investigates how the shift from in-person communication before the COVID-19 pandemic to remote communication during the pandemic affected social integration and loneliness. It finds that the lack of in-person contact with peers led to increased feelings of loneliness and decreased social support, highlighting the importance of in-person interactions for mental health of MSM. Second, the pandemic also intensified the need for sexual and emotional intimacy among MSM, which was harder to achieve due to social distancing measures, negatively impacting mental health. Third, the thesis explores how social norms at the individual, interpersonal, and community levels influence PrEP uptake among MSM. It finds that positive attitudes towards PrEP, supportive peer reactions, and the perception that many peers use PrEP are associated with higher intentions to use PrEP. Conversely, the belief that PrEP use is inappropriate for certain relationships and the perception of having safer sex than peers are barriers to PrEP uptake. Finally, the thesis addresses the methodological challenges of researching hidden populations like MSM. It evaluates the viability of Web-based Respondent Driven Sampling (WEB RDS) for obtaining representative samples of MSM. The findings suggest that while WEB RDS can reach diverse subpopulations, it faces significant barriers such as survey fatigue, low motivation for the topic, and digital etiquette norms that discourage sharing survey links. In conclusion, the thesis emphasizes that peer relationships are crucial for the mental and sexual health of MSM. Strong peer networks can provide social integration and intimacy, reduce loneliness, and promote healthy sexual behaviours. Understanding and leveraging these relationships can lead to more effective health interventions and better health outcomes for MSM.