AMC, Academic Medical Center; aOR, adjusted odds ratio; CI, confidence interval; CINIMA, Center for Infection and Immunology Amsterdam; DAG, directed acyclic graph; HIV, human immuno-deficiency virus; i.e., id est, it's, for example; IQR, interquartile range; MEC, Medical Ethics Committee; MSM, men who have sex with men; OR, odds ratio; RIVM, National Institute of Public Health and the Environment, Centre for Infectious Disease Control; STI, sexually transmitted infection; UAI, unprotected anal intercourse; UMCU, University Medical Center Utrecht
New research should remain up-to-date as it pertains to accelerated shifting dating approaches as well as sero-adaptive behaviours (like viral sorting and pre exposure prophylaxis). With every new way of dating and preventive chances, the rules of engagements will vary. Our data are 8years old and web-based dating has developed since then. Yet these results are useful, as they demonstrate how net-based partner acquisition can result in more information on the sex partner, and this might affect on the frequency of UAI.
Relationship online may offer other chances for communication on HIV status than dating in physical surroundings. Free fuck book nearest Kensington SA. Easing more on-line HIV status disclosure during partner seeking makes serosorting easier. However, serosorting may raise the load of other STI and WOn't prevent HIV infection completely. Free fuck book in Kensington. Interventions to prevent HIV transmission should especially be directed at HIV-negative and unaware MSM and stimulate timely HIV testing (i.e., after risk occasions or when experiencing symptoms of seroconversion illness) as well as regular testing when sexually active.
Because decisions on UAI seem to be partially based on perceived HIV concordance, precise knowledge of one's own and the partner's HIV status is important. In HIV negative guys and HIV status-unaware guys, judgements on UAI will not only be based on perceived HIV status of the partner but also on one's own negative status. HIV serosorting is challenged by the frequency of HIV testing and the HIV window phase during which people can transmit HIV but cannot be diagnosed with the commonly used HIV tests. Thus serosorting cannot be regarded as an extremely effective way of preventing HIV transmission 22 Besides interventions to stimulate the uptake of HIV and STI testing in sexually active men, interventions to warn against UAI based on perceived HIV-negative concordant status are in order, irrespective of whether this concerns online or offline dating.
For HIV-unaware guys the effect of dating location on UAI didn't change by adding partner characteristics, but it increased when adding lifestyle and drug use. It is difficult to assess the actual risk for HIV for these men: do they behave as HIV-negative guys who are trying to shield themselves from HIV infection, or as HIV positive men trying to guard their HIV-negative partner from HIV infection? A study by Horvath et al. reported that 72% of men who were never tested for HIV, profiled themselves online as being HIV negative, which might be debatable if they are HIV positive and participate in UAI with HIV negative partners 12 Formerly Matser et al. reported that 1.7% of the unaware and sensed HIV-negative MSM were analyzed HIV-positive. The study population included the MSM reported in this study 15
Online dating wasn't associated with UAI among HIV negative men, a finding in agreement with some previous studies, mainly among young men 21 , but in contrast with other studies 1 - 5 This may be because of the fact that most earlier studies compared sexual behaviour of two groups of MSM rather than comparing two sexual behavior patterns within one group of men. Nevertheless it might also represent secular changes; perhaps in the beginning of online dating a more high-risk group of men used the Internet, and over time online dating normalized and less high-risk MSM now additionally utilize the Internet for dating. Free fuck book nearby Kensington South Australia, Australia.
A key strength of this study was that it explored the relation between online dating and UAI among MSM who had recent sexual contact with both online and offline casual partners. Kensington, South Australia free fuck book. Free Fuck Book Near Me Windsor South Australia. This avoided prejudice caused by potential differences between guys only dating online and those simply dating offline, a weakness of several previous studies. Free fuck book nearby Kensington Australia. By recruiting participants at the greatest STI outpatient clinic in the Netherlands we could comprise a great number of MSM, and prevent potential differences in men sampled through Internet or face to face interviewing, weaknesses in some previous studies 3 , 11
Among HIV positive guys, in univariate analysis UAI was reported significantly more often with on-line partners than with offline associates. When adjusting for associate features, the effect of online/offline dating on UAI among HIV positive MSM became somewhat smaller and became non-significant; this indicates that differences in partnership factors between online and also offline partnerships are liable for the increased UAI in online established ventures. This may be because of a mediating effect of more information on partners, (including perceived HIV status) on UAI, or to other variables. Among HIV negative guys no effect of online dating on UAI was found, either in univariate or in the multivariate models. Among HIV-oblivious men, online dating was associated with UAI but only significant when adding associate and venture variants to the model.
In this large study among MSM attending the STI clinic in Amsterdam, we found no signs that online dating was independently related to a higher danger of UAI than offline dating. For HIV negative guys this lack of assocation was clear (aOR = 0.94 95 % CI 0.59-1.48); among HIV positive guys there was a nonsignificant association between online dating and UAI (aOR = 1.62 95 % CI 0.96-2.72). Only among men who suggested they weren't conscious of their HIV status (a small group in this study), UAI was more common with on-line than offline associates.
The number of sex partners in the preceding 6months of the index was likewise correlated with UAI (OR = 6.79 95 % CI 2.86-16.13 for those with 50 or more recent sex partners compared to those with fewer than 5 recent sex partners). Free Fuck Book near Kensington. UAI was significantly more likely if more sex acts had happened in the venture (OR = 16.29 95 % CI 7.07-37.52 for >10 sex acts within the venture compared to only one sex act). Other variables significantly associated with UAI were group sex within the partnership, and sex-connected multiple drug use within partnership.
In multivariate model 3 (Tables 4 and 5 ), also including variants concerning sexual behavior in the partnership (sex-associated multiple drug use, sex frequency and partner type), the separate effect of online dating location on UAI became somewhat more powerful (though not critical) for the HIV positive men (aOR = 1.62 95 % CI; 0.96-2.72), but remained similar for HIV negative men (aOR = 0.94 95 % CI 0.59-1.48). The result of online dating on UAI became more powerful (and important) for HIV-oblivious guys (aOR = 2.55 95 % CI 1.11-5.86) (Table 5 ).
In univariate analysis, UAI was significantly more likely to occur in on-line than in offline partnerships (OR = 1.36 95 % CI 1.03-1.81) (Table 4 ). The self-perceived HIV status of the participant was strongly correlated with UAI (OR = 11.70 95 % CI 7.40-18.45). The result of dating location on UAI differed by HIV status, as can be seen best in Table 5 Table 5 shows the association of online dating using three distinct reference types, one for each HIV status. Among HIV-positive guys, UAI was more common in online when compared with offline ventures (OR = 1.61 95 % CI 1.03-2.50). Among HIV-negative men no association was evident between UAI and online ventures (OR = 1.07 95 % CI 0.71-1.62). Among HIV-oblivious guys, UAI was more common in online when compared with offline partnerships, though not statistically significant (OR = 1.65 95 % CI 0.79-3.44).
Features of on-line and offline partners and ventures are revealed in Table 2 The median age of the partners was 34years (IQR 28-40). Compared to offline partners, more online partners were Dutch (61.3% vs. 54.0%; P 0.001) and were defined as a known partner (77.7% vs. 54.4%; P 0.001). The HIV status of on-line partners was more often reported as known (61.4% vs. 49.4%; P 0.001), and in on-line ventures, perceived HIV concordance was higher (49.0% vs. 39.8%; P 0.001). Participants reported that their online partners more frequently understood the HIV status of the participant than offline partners (38.8% vs. 27.2%; P 0.001). Participants more often reported multiple sexual contacts with internet partners (50.9% vs. 41.3%; P 0.001). Sex-related material use, alcohol use, and group sex were less often reported with internet partners. Free Fuck Book Near Me Hawthorn South Australia.
In order to analyze the possible mediating effect of more info on partners (including perceived HIV status) on UAI, we developed three variant models. In model 1, we adapted the organization between online/offline dating place and UAI for characteristics of the participant: age, ethnicity, number of sex partners in the preceding 6months, and self-perceived HIV status. In model 2 we added the venture characteristics (age difference, ethnic concordance, lifestyle concordance, and HIV concordance). In version 3, we adjusted also for partnership sexual risk behaviour (i.e., sex-associated drug use and sex frequency) and partnership sort (i.e., casual or anonymous). As we assumed a differential effect of dating location for HIV-positive, HIV-negative and HIV status unknown MSM, an interaction between HIV status of the participant and dating place was included in all three models by making a fresh six-category variable. For clarity, the effects of online/offline dating on UAI are also presented individually for HIV-negative, HIV positive, and HIV-oblivious guys. We performed a sensitivity analysis limited to partnerships in which just one sexual contact occurred. Statistical significance was defined as P 0.05. No adjustments for multiple comparisons were made, in order not to lose potentially important associations. As a fairly big number of statistical evaluations were done and reported, this approach does lead to a higher danger of one or more false-positive associations. Analyses were done utilizing the statistical programme STATA, version 13 (STATA Intercooled, College Station, TX, USA).
Prior to the investigations we developed a directed acyclic graph (DAG) representing a causal model of UAI. In this model some variables were putative causes (self-reported HIV status; on-line partner acquisition), others were considered as confounders (participants' age, participants' ethnicity, and no. of male sex partners in preceding 6months), and some were presumed to be on the causal pathway between the primary exposure of interest and results (age difference between participant and partner; ethnic concordance; concordance in life styles; HIV concordance; partnership type; sex frequency within venture; group sex with partner; sex-related material use in partnership).
We compared characteristics of participants by self-reported HIV status (using 2-tests for dichotomous and categorical variables and using rank sum test for continuous variables). We compared characteristics of participants, partners, and venture sexual behavior by online or offline venture, and calculated P values predicated on logistic regression with robust standard errors, accounting for related data. Continuous variables (i.e., age, amount of sex partners) are reported as medians with an interquartile range (IQR), and were categorised for inclusion in multivariate models. Random effects logistic regression models were used to examine the association between dating place (online versus offline) and UAI. Free Fuck Book nearby Kensington, South Australia. Odds ratio tests were used to measure the value of a variable in a model.
In order to explore potential disclosure of HIV status we also asked the participant whether the casual sex partner knew the HIV status of the participant, with the response alternatives: (1) no, (2) possibly, (3) yes. Sexual conduct with each partner was dichotomised as: (1) no anal intercourse or simply protected anal intercourse, and (2) unprotected anal intercourse. To determine the subculture, we asked whether the participant characterised himself or his partners as belonging to one or more of the subsequent subcultures/lifestyles: casual, formal, substitute, drag, leather, military, sports, fashionable, punk/skinhead, rubber/lycra, gothic, bear, jeans, skater, or, if not one of these features were applicable, other. Concordant lifestyle was categorised as: (1) concordant; (2) discordant. Chance partner kind was categorised by the participants into (1) known traceable and (2) anonymous partners.
HIV status of the participant was obtained by asking the question 'Do you know whether you're HIV infected?', with five answer alternatives: (1) I am certainly not HIV-infected; (2) I think that I am not HIV-infected; (3) I do not understand; (4) I think I may be HIV-infected; (5) I know for sure that I 'm HIV-infected. We categorised this into HIV negative (1,2), unknown (3), and HIV positive (4,5) status. The survey enquired about the HIV status of every sex partner together with the question: 'Do you know whether this partner is HIV-contaminated?' with similar reply alternatives as above. Perceived concordance in HIV status within ventures was categorised as; (1) concordant; (2) discordant; (3) unknown. The last class represents all partnerships where the participant did not know his own status, or the status of his partner, or both. In this study the HIV status of the participant is self-reported and self-perceived. The HIV status of the sexual partner is as perceived by the participant.
Participants completed a standardised anonymous survey throughout their trip to the STI outpatient clinic while waiting for preliminary test results after their consultation with a nurse or doctor. The survey elicited information on socio-demographics and HIV status of the participant, the three most recent partners in the preceding six months, and information on sexual conduct with those partners. A thorough description of the study design and the survey is provided elsewhere 15 , 18 Our main determinant of interest, dating location (e.g., the name of a pub, park, club, or the name of a site) was obtained for every partner, and categorised into on-line (websites), and offline (physical sites) dating locations. To simplify the terminology of recognizing the partners per dating place, we refer to them as online or offline partners.
We used data from a cross-sectional study focusing on spread of STI via sexual networks 15 Between July 2008 and August 2009 MSM were recruited from the STI outpatient clinic of the Public Health Service of Amsterdam, the Netherlands. Men were eligible for participation if they reported sexual contact with men during the six months preceding the STI consultation, they were at least 18years old, and may comprehend written Dutch or English. People could participate more than once, if following visits to the practice were related to a potential new STI episode. Free fuck book nearest Kensington, South Australia. Participants were routinely screened for STI/HIV according to the standard procedures of the STI outpatient clinic 15 , 17 The study was approved by the medical ethics committee of the Academic Medical Center of Amsterdam (MEC 07/181), and written informed consent was obtained from each participant. Free Fuck Book nearby Kensington. Included in this investigation were guys who reported sexual contact with at least one casual partner dated online as well one casual partner dated offline.