Men who have sex with men account for 63 percent of new HIV infections and are the focus of a new techie approach to HIV prevention.
It has researchers and outreach groups riding the social-media wave. And up against e-mail, Craigslist, and Facebook, Grindr was not just the gnarliest (aka most awesome) but the most successful of all.
Clinical trials are essential to curing disease: it's how new treatments are proved. Early in the 32-year struggle with HIV, the gay community was adept at participating in and pushing for trials to happen.
But since HIV became a manageable disease, a new reality has taken hold. Gays aren't signing up as quickly as before, says Debora Dunbar, a nurse involved in HVTN 505 at Penn's HIV/AIDS Prevention Research Division. "There are those with the magical thinking that HIV is not what it used to be: 'I'll go to the doctor, and it'll be OK,' " Dunbar said.
And so, when it comes to enlisting participants in clinical trials, creativity is of the essence. In 2010, after trying conventional recruitment at bars and venues in the "Gayborhood," researchers began using e-mail, Craigslist, and Facebook.
Those outlets still weren't enough, so in 2012 they added Grindr. "You have to get your message out at a time when people are receptive," said Lindsey Buckingham, a University of North Carolina medical student who spent a gap year at Penn on HVTN 505. "With Grindr, the idea of sex and protection is on people's minds, so our advertisement seemed to really resonate in that space."
A GPS-based app - meaning it detects location - Grindr sorts profile pictures based on proximity and displays them on the home screen. Most users have the free version, but Grindr Xtra grants unlimited blocks, push notifications, and access to more profiles. Prices vary. A one-month iOS subscription, for example, costs $11.99.
Since its launch in 2009, Grindr has amassed 6 million users worldwide, including more than 155,000 Philadelphians. Less popular competitors include Jack'd, Scruff, and MISTER.
"There's this extreme publicness but also exclusivity. Grindr enables you to see the world, but just the gay world," Shuman said.
Recruiters for HVTN 505 cherry-picked times with peak traffic, such as Valentine's Day and Halloween. For a total of 22 days since the fall, ads worth $9,400 were blasted to all users within 30 miles of the Penn clinic.
Two types of ads appeared on Grindr: a pop-up ad that covered the entire screen when the app was first opened, and a banner ad at the bottom of the screen that rotated out after 30 seconds.
Grindr directed 18,000 visits to the trial's website. More than 300 of those people who tapped the "See More" option registered online. After screening questions over the phone, 16 Grindr users, including Shuman, ended up in Penn's study of nearly 200 people - the highest enrollment rate of all social media used.
Cara Brant, a strategist at the patient recruitment firm Clinical Trial Media, lauded the effort, even if recruitment rates could be higher. "What used to work for clinical trials may not anymore," she said. "You've got to roll with the times."
When Shuman pulls up his profile picture - a blurred oil painting of a nude man with his back turned - its demureness makes him barely recognizable. But a closer look reveals his signature high-top hair.
He had snapped a photo of the artwork at Studio Incamminati, where he works on and off as a figure model to support his career as a modern dancer.
Shuman has a perfomer's confidence - whether he's talking about religion or sexual behavior. "If you read the Torah," he said, "a man who spills his seed with another man must be stoned to death. But we belonged to a Reconstructionist synagogue that had a lesbian rabbi. Jewish practices and Jewish understanding - what connects all of it - is this room for debate and discussion. It's not about a man in the sky that tells you what to do."
Shuman doesn't consider himself at high risk for HIV, despite "playing around" a few times while in an open relationship. Two studies published last year by separate Los Angeles researchers found that Grindr users were at high risk for HIV infection. Users tend to doubt they will ever get HIV; have multiple sexual partners; rarely use preventive measures; and often take drugs or alcohol during sex.
"I personally think we hear and see and do what we want, even when it's risky," Shuman said.
In April, the National Institutes of Health discontinued HVTN 505 because preliminary data indicated the vaccine didn't prevent HIV infection or reduce viral load.
But that didn't deter participants, Buckingham said. She recalled, "The most often asked question was, 'When could I join another vaccine trial?' "
Two trials at Penn are recruiting participants for other HIV vaccines; six more trials have completed enrollment. None has used Grindr.
But the app is being employed in a trial testing the pill Truvada, which has shown promise in preventing HIV when taken daily.
Grindr also lets local men know about HIV testing through accounts set up by health facilities such as the Mazzoni Center and SafeGuards LGBT Resource Center. Eric Paulukonis, Mazzoni's director of prevention services, says the staff opens Grindr on an iPad when driving a testing van to bathhouses at night.
"We also go outside of Center City, where there aren't heavily concentrated gay populations," Paulukonis said. "With Grindr, it's helpful to have gay men know we're there."
Shuman considers Grindr a model for researchers looking to study a specific group. To describe the role he predicts for such apps, he quotes Sex and the City: "First come the gays. Then come the girls. Then comes the industry."
Contact Leila Haghighat at 215-854-4869 or firstname.lastname@example.org.