Relationship typologies with online sexual partners and condomless anal intercourse among men who have sex with men: Evidence from latent class analysis and multilevel regression

Background Online platforms have become important contexts through which men who have sex with men (MSM) meet sexual partners, yet little is known about how relationship patterns with online partners cluster and how these patterns shape condomless anal intercourse (CAI). Objectives To identify distinct relationship typologies between MSM and their online sexual partners and examine how the typologies are associated with CAI, considering participants’ attitude towards condom use as a moderator. Methods A telephone-based, cross-sectional survey was conducted among MSM in Hong Kong between November 2023 and August 2024. Participants provided information on their demographics and condom attitudes, the relational features of their online sexual partnerships, and condom use. Results A total of 405 participants reported on 1,067 online sexual partners in the past year. Latent class analysis identified three relationship typologies among MSM and their online sexual partners: Sexual Desire-Oriented (62.5%), Relationally Driven (20.8%), and Sexually Adventurous (16.6%). Multilevel regressions showed that, compared with Sexual Desire-Oriented partnerships, Relationally Driven (odds ratio [OR]=3.11; 95% CI: 1.69–5.70) and Sexually Adventurous (OR=2.47; 95% CI: 1.31–4.65) partnerships were associated with higher odds of CAI, after adjusting for covariates. Negative attitudes towards condom use were also associated with a greater likelihood of CAI, and this association was significantly stronger in the Relationally Driven group (OR=1.13; 95% CI: 1.01–1.26). Conclusions Findings highlight the relationship heterogeneity between MSM and their online sexual partners. Tailored interventions that consider different relational contexts are needed to reduce CAI and improve HIV prevention.