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More than , people were estimated to have visited the gay-lesbian street festival. The median age of MSM was 39 years range: 16—73 years; interquartile range 29—48 years which was similar to the age distribution of cases in the hepatitis A outbreak in Berlin data not shown. The sources of information were age-dependent. Overall We investigated the use of dating apps and websites to disseminate prevention messages to MSM during an outbreak of hepatitis A in Berlin focusing on the influence of ad format and media platform used.

A total of 8, clicks received during a 3-week campaign on dating apps and websites, a decrease of case numbers and a broad knowledge among the Berlin MSM community about the outbreak suggest that the campaign had a wide reach and notable impact. Measured in clicks, the reach of our digital media campaign probably outweighed the reach of other channels such as the distribution of information material in sex-on-premises venues and traditional contact tracing by local health authorities.

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We found that both ad size and platform used influenced the number of clicks on an ad and the use of full-screen ads and the dating app Grindr were most successful in achieving clicks. Being the largest international all-male mobile dating app, Grindr has been involved in health prevention and promotion in the past and enables its users to include information on their HIV status and the last testing date in their profile.

It is conceivable that its users are more sensitised regarding health-related issues and that outbreak-related ads benefit from a general credibility concerning prevention campaigns for sexually transmitted infections. Using more versatile analytics programmes in future interventions could provide more information on conversion rates percentage of visitors who took action on the target website such as viewing a specific page, downloading a particular file, duration of stay on the website and thus help quantify the actual reach, although data protection issues need to be considered.

The marked decline in HAV cases among MSM in Berlin in mid-April following the mobile media campaign cannot be explained by the overall decline in cases in the European outbreak, in which peak and decline occurred later [ 10 ]. Fifteen per cent of MSM in the survey reported that they had been vaccinated against hepatitis A within the past 6 months as a consequence of our information campaigns digital and posters or postcards , although bias through selective participation in our survey must be considered.

MSM who had been informed by their physician general practitioner or treating physician specialised in HIV and infectious diseases treatment about the outbreak reported more frequently that they had been vaccinated against hepatitis A. This highlights the crucial role of physicians in vaccination awareness among MSM, but possibly also reflects the fact that medical advice usually directly precedes a vaccination and is therefore more readily recalled.

However, our survey was conducted 4 months after the campaign on dating apps and websites during the Gay Pride week i.

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This may have led to an underestimation of the role of dating apps in the survey. Taking delays for incubation period into account, there is an apparent temporal relationship of both HAV vaccination uptake and case decline with our campaign. However, quantifying the effect of the campaign on dating apps and websites remains difficult, as it took place in the context of a wide range of activities and interventions throughout the first half of in Berlin including information and surveys among physicians, information of patients and the broader public via newspapers and radio.

Furthermore, MSM visiting Berlin as tourists and getting vaccinated because of the campaign after their return home would not have been captured in our data on vaccination uptake.

Despite a strong decrease in the weekly hepatitis A case numbers in Berlin, the outbreak continued at a lower level throughout , which underlines that, in the context of an international outbreak, interventions cannot rely on local efforts alone. They require concerted international interventions and communication channels tailored to specific target groups. This is of even more concern given the highly interconnected sexual networks among MSM in Europe.

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According to notification data data not shown , the vast majority of the Berlin HAV outbreak cases were infected in Berlin, suggesting that the threshold needed to lower the average number of onward infections per HAV-infected person below one was not reached at the time. We therefore consider this as a useful communication tool for future large-scale international events like the gay pride festivals occurring throughout Europe.

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However, in , the year the federal German Empire was formed, Paragraph of the new Penal Code recriminalised homosexual acts. Screenshot: Happn. Online dating has never been simpler, and the number of dating app users in Berlin is growing by the day. Read more. Gay Asia Group Trips. Hepatitis A immunisation in persons not previously exposed to hepatitis A. United States.

Close collaboration with venues and organisers of large events as well as local public health offices to provide broad and up-to-date information channels for visitors was an integral part of the campaigns and the outbreak interventions. Future interventions should also consider and evaluate other potential ways of smartphone app campaigning such as sending inbox and push messages or video ads. Because a part of the purchased ad bundles were not customisable, not all combinations of ad format and media placement were used and different formats were not evenly distributed over the platforms.

The number of impressions or clicks does not correspond to the actual number of people receiving or clicking on the respective ads. Multiple displays of impressions on the same device were limited to a maximum of three for certain platforms i. Grindr and PlanetRomeo , but not for others.

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Likewise, multiple clicks caused by the same user cannot be excluded. In addition, users who did not click on the ad may still have benefited from seeing the key message and have pursued the issue in other ways. Furthermore, it remains unknown to which extend the clicks of an ad reflect preventive action by the user. However, disentangling single effects of multiple simultaneous interventions that were launched as part of an immediate outbreak response was not possible; we therefore had to use other, less well suited, surrogate parameters.

Our findings suggest that MSM dating apps and websites can be an effective tool to promote infection prevention campaigns in outbreaks, with the potential to reach also otherwise hard-to-reach MSM seeking anonymous sex. The wide reach of our digital campaign — embedded in other outbreak control activities — was indicated by a decline in cases as well as an increase in HAV vaccination uptake and knowledge about the outbreak in the MSM community.

The number of clicks and thus the overall reach of our digital campaign strongly depended on platform and format, which should be considered when launching an app-based health promotion campaign. Intervention strategies among MSM should include a variety of communication pathways and involve physicians in order to maximise impact in the outbreak setting. Conflict of interest: None declared. CR drafted the article and all authors critically revised the article and provided final approval of the version to be submitted. National Center for Biotechnology Information , U. Journal List Euro Surveill v.

Euro Surveill. Author information Article notes Copyright and License information Disclaimer. Correspondence: Claudia Ruscher ed. Received Aug 20; Accepted Mar 6. Copyright This article is copyright of the authors or their affiliated institutions, You may share and adapt the material, but must give appropriate credit to the source, provide a link to the licence, and indicate if changes were made. Abstract Background In an outbreak of hepatitis A among men who have sex with men MSM in Berlin and , patients frequently reported anonymous sex and use of dating applications to meet sexual contacts, hampering tracing and vaccination of contacts.

Aim Our objective was to evaluate dating apps and websites as a means of spreading prevention messages among MSM during the ongoing outbreak. Methods Advertisements in different formats were placed on three MSM dating apps and eight websites for anonymous dating during three weeks in March and April Conclusions Dating apps provided a means to rapidly reach and influence a substantial number of MSM in Berlin and should complement case-based contact tracing among MSM in outbreak settings.

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Keywords: outbreak, hepatitis A, MSM, online, dating apps, implementation science, sexually transmitted infections, viral infections, men who have sex with men. Introduction Hepatitis A is an acute infection of the liver, usually with a self-limiting course. Methods Our campaign consisted of three parts that took place on different and partly overlapping dates as shown in the timeline in Figure 1 : i a campaign launched on MSM dating apps and websites, ii advertising on websites of gay events and clubs and iii a poster and postcard-based campaign in clubs and sex-on-premises venues and during a gay-lesbian street festival.

Open in a separate window. Figure 1.

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Figure 2. Multivariable analysis of the campaign on dating apps and websites Results from different sources were collated into one dataset containing number of impressions, number of clicks, CTR, ad size and platform specification by day of week. Campaign in clubs and sex-on-premises venues and during a gay-lesbian street festival Overall, 13, postcards and posters, with the same design as the one used in the web campaigns, were distributed in gay clubs, darkrooms, gay saunas, pharmacies and shops between 5 May and 16 July Survey at a gay-lesbian street festival We conducted a convenience-sampled face-to-face survey among male visitors of the festival during a large annual gay-lesbian street festival on 15 and 16 July Comparison of the outbreak course in Berlin and other affected countries in Europe Routine and enhanced surveillance of HAV in Berlin was performed based on notification data, using the case definition for surveillance purposes in Germany [ 18 ].

Ethical statement The street survey was conducted within the framework of the German Infection Protection Act as part of an outbreak response and public health practice. Results Campaign on dating apps and websites From 10 March to 1 April , a total of 1,, impressions and 8, clicks on apps and websites were counted, reflecting an overall CTR of 0.

Table 1 Ad impressions, clicks and click-through-rates, by platform and ad format, hepatitis A awareness campaign on dating apps and websites, Berlin, 10 March—1 April CTR: click-through rate. Multivariable analysis In the negative binomial regression model, both the platform and the ad format were independent predictors of the number of clicks. CI: confidence interval; IRR: incidence rate ratio. Additional advertising on websites of gay events and clubs and poster and postcard campaign in clubs and sex-on-premises venues and during a gay-lesbian street festival Effects of those parts of the campaign were measured by number of page visits on the SOHSA HAV outbreak website after the campaign on dating apps and websites i.

Evaluation Course of the outbreak In Berlin, cases per month declined from an average of 18 outbreak cases during the peak months January to March to an average of six cases from April to December Figure 3. Pauli district, is Europe's largest red-light district, the famous Reeperbahn. Hamburg's gay life is concentrated in the St. Gay Hamburg. Other cities. Daddysboy : new queer-inclusive House party in Hamburg. Winter Pride : Hamburg's gay and lesbian Christmas market. Friday and Saturday evening with DJs. I envisioned him rotting away in a Soviet prison.

I was no longer the boy he talked to about New Age philosophy after yoga class — I was an emotional trigger. Oh my God, I thought, why did we have to have the Nazi talk already? For American Jews in Berlin, dating can feel like an endurance challenge, the object of which is to be comfortable and open enough to handle the most naive and arbitrary questions, ambiguous silences and disturbing admissions of familial guilt. But more than anything, dating in Berlin makes one feel like a perennial spokesJew.

Is it cultural insensitivity? An attempt to look pensive and aware of history? Who knows. Later in the week, Tobias invited me to see the band Iron and Wine perform at a warehouse in Kreuzberg, a trendy district in Berlin. I wore a polka-dot shirt and cheered wildly for the low-key folk band.