AMC, Academic Medical Center; aOR, adjusted odds ratio; CI, confidence interval; CINIMA, Center for Infection and Immunology Amsterdam; DAG, directed acyclic graph; HIV, human immunodeficiency 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 in regards to accelerated shifting dating strategies as well as sero-adaptive behaviours (such as viral sorting and pre exposure prophylaxis). With each new way of dating and preventive opportunities, the rules of engagements will change. Our data are 8years old and web-based dating has developed since then. Yet these results are useful, as they demonstrate how internet-based partner acquisition can result in more information on the sex partner, and this might impact on the frequency of UAI.
Relationship online may offer other opportunities for communicating on HIV status than dating in physical environments. Local Cougars in Strathfield, NSW. Easing more on-line HIV status disclosure during partner seeking makes serosorting easier. Nevertheless, serosorting may raise the weight of other STI and will not prevent HIV disease completely. Local Cougars nearby Strathfield. Interventions to prevent HIV transmission should especially be directed at HIV-negative and oblivious MSM and stimulate timely HIV testing (i.e., after danger occasions or when experiencing symptoms of seroconversion illness) as well as routine testing when sexually active.
Because decisions on UAI appear to be partially based on sensed HIV concordance, exact knowledge of one's own and the partner's HIV status is important. In HIV negative guys and HIV status-oblivious guys, judgements on UAI will not only be based on perceived HIV status of the partner but in addition on one's own negative status. HIV serosorting is challenged by the frequency of HIV testing and also the HIV window period during which individuals can transmit HIV but cannot be diagnosed with the commonly used HIV tests. Hence serosorting cannot be regarded as an extremely effective method of averting HIV transmission 22 Besides interventions to trigger the uptake of HIV and STI testing in sexually active men, interventions to caution against UAI based on sensed HIV-negative concordant status are in order, irrespective of whether this concerns online or offline dating.
For HIV-oblivious guys the impact of dating location on UAI didn't change by adding partner characteristics, but it increased when adding lifestyle and drug use. It's hard to evaluate the actual risk for HIV for these guys: do they behave as HIV negative men who are trying to shield themselves from HIV infection, or as HIV-positive guys trying to shield their HIV-negative partner from HIV infection? A study by Horvath et al. reported that 72% of guys who were never tested for HIV, profiled themselves online as being HIV negative, which might be problematic if they're HIV-positive and participate in UAI with HIV-negative partners 12 Previously 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 correlated with UAI among HIV negative guys, a finding in agreement with some previous studies, largely among young men 21 , but in comparison with other studies 1 - 5 This may be because of the reality that most earlier studies compared sexual behavior of two groups of MSM rather than comparing two sexual behaviour patterns within one group of guys. Yet it might also reflect lay changes; possibly in the beginning of online dating a more high-risk group of guys used the Internet, and over time online dating normalized and not as high-risk MSM nowadays also utilize the Net for dating. Local cougars closest to Strathfield New South Wales Australia.
A key strength of the study was that it explored the relation between online dating and UAI among MSM who had recent sexual contact with both online and also offline casual partners. Strathfield New South Wales Local Cougars. Local Cougars Near Me Chullora New South Wales. This avoided bias due to potential differences between men only dating online and those simply dating offline, a weakness of several previous studies. Local cougars near Strathfield Australia. By recruiting participants at the largest STI outpatient clinic in the Netherlands we could include a high number of MSM, and prevent potential differences in guys sampled through Internet or face-to-face interviewing, weaknesses in some previous studies 3 , 11
Among HIV-positive men, in univariate analysis UAI was reported significantly more frequently with on-line associates than with offline associates. When correcting for associate features, the effect of online/offline dating on UAI among HIV positive MSM became somewhat smaller and became non-significant; this suggests that differences in partnership variables between online and offline partnerships are in charge of the increased UAI in online established partnerships. This may be due to a mediating effect of more info on associates, (including perceived HIV status) on UAI, or to other variables. Among HIV-negative guys no effect of online dating on UAI was observed, either in univariate or in any of the multivariate models. Among HIV-oblivious guys, online dating was connected with UAI but only essential when adding partner and venture variables 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 men this lack of assocation was clear (aOR = 0.94 95 % CI 0.59-1.48); among HIV positive men there was a non significant association between online dating and UAI (aOR = 1.62 95 % CI 0.96-2.72). Simply among men who indicated they weren't aware 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). Local cougars nearby Strathfield. UAI was significantly more likely if more sex acts had occurred in the venture (OR = 16.29 95 % CI 7.07-37.52 for >10 sex acts within the venture compared to just one sex act). Other factors significantly associated with UAI were group sex within the partnership, and sex-connected multiple drug use within venture.
In multivariate model 3 (Tables 4 and 5 ), additionally including variables concerning sexual behaviour in the partnership (sex-associated multiple drug use, sex frequency and partner kind), the independent effect of online dating location on UAI became somewhat stronger (though not essential) for the HIV-positive guys (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 effect of online dating on UAI became stronger (and critical) for HIV-unaware men (aOR = 2.55 95 % CI 1.11-5.86) (Table 5 ).
In univariate analysis, UAI was significantly more prone to happen in on-line than in offline ventures (OR = 1.36 95 % CI 1.03-1.81) (Table 4 ). The self-perceived HIV status of the participant was firmly correlated with UAI (OR = 11.70 95 % CI 7.40-18.45). The impact of dating place on UAI differed by HIV status, as can be seen best in Table 5 Table 5 shows the organization of online dating using three distinct reference classes, one for each HIV status. Among HIV positive guys, UAI was more common in online in comparison to offline partnerships (OR = 1.61 95 % CI 1.03-2.50). Among HIV negative men no association was apparent between UAI and on-line partnerships (OR = 1.07 95 % CI 0.71-1.62). Among HIV-oblivious guys, UAI was more common in online in comparison to offline ventures, though not statistically significant (OR = 1.65 95 % CI 0.79-3.44).
Characteristics of online and offline partners and ventures are shown in Table 2 The median age of the partners was 34years (IQR 28-40). Compared to offline partners, more on-line 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 online partners was more often reported as understood (61.4% vs. 49.4%; P 0.001), and in online partnerships, perceived HIV concordance was higher (49.0% vs. 39.8%; P 0.001). Participants reported that their online partners more often 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 substance use, alcohol use, and group sex were less often reported with on-line partners. Local Cougars Near Me Fairfield New South Wales.
In order to examine the potential mediating effect of more info on partners (including perceived HIV status) on UAI, we developed three multivariable models. In version 1, we adapted the association between online/offline dating place and UAI for features 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 features (age difference, ethnic concordance, lifestyle concordance, and HIV concordance). In version 3, we adjusted also for venture sexual risk behaviour (i.e., sex-associated drug use and sex frequency) and partnership type (i.e., casual or anonymous). As we assumed a differential effect of dating place for HIV positive, HIV negative and HIV status unknown MSM, an interaction between HIV status of the participant and dating location was contained in all three models by making a brand new six-class 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 only one sexual contact occurred. Statistical significance was defined as P 0.05. No adjustments for multiple comparisons were made, in order not to miss potentially significant associations. As a rather large number of statistical tests were done and reported, this strategy does lead to a higher risk of one or more false-positive associations. Evaluations were done using the statistical programme STATA, version 13 (STATA Intercooled, College Station, TX, USA).
Before the investigations we developed a directed acyclic graph (DAG) representing a causal model of UAI. In this model some variants 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 principal exposure of interest and outcome (age difference between participant and partner; ethnic concordance; concordance in life styles; HIV concordance; partnership kind; sex frequency within venture; group sex with partner; sex-related substance use in venture).
We compared characteristics of participants by self-reported HIV status (using 2-evaluations for dichotomous and categorical variables and using rank sum test for continuous variables). We compared features of participants, partners, and venture sexual behaviour by on-line or offline partnership, and calculated P values based on logistic regression with robust standard errors, accounting for related data. Continuous variables (i.e., age, number 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 analyze the association between dating place (online versus offline) and UAI. Local Cougars nearby Strathfield New South Wales. Odds ratio tests were used to gauge the value of a variable in a model.
In order to explore potential disclosure of HIV status we additionally asked the participant whether the casual sex partner understood the HIV status of the participant, with the reply alternatives: (1) no, (2) perhaps, (3) yes. Sexual behavior with each partner was dichotomised as: (1) no anal intercourse or just protected anal intercourse, and (2) unprotected anal intercourse. To discover the subculture, we asked whether the participant characterised himself or his partners as belonging to one or more of the following subcultures/lifestyles: casual, formal, substitute, drag, leather, military, sports, trendy, punk/skinhead, rubber/lycra, gothic, bear, jeans, skater, or, if not one of these characteristics were related, other. Concordant lifestyle was categorised as: (1) concordant; (2) discordant. Casual partner type was categorised by the participants into (1) known traceable and (2) anonymous partners.
HIV status of the participant was got by asking the question 'Do you know whether you are HIV infected?', with five answer choices: (1) I am certainly not HIV-contaminated; (2) I think that I'm not HIV-infected; (3) I don't know; (4) I think I may be HIV-contaminated; (5) I know for sure that I am HIV-contaminated. We categorised this into HIV negative (1,2), unknown (3), and HIV-positive (4,5) status. The questionnaire enquired about the HIV status of every sex partner with the question: 'Do you understand whether this partner is HIV-contaminated?' with similar reply choices as above. Perceived concordance in HIV status within partnerships was categorised as; (1) concordant; (2) discordant; (3) unknown. The final category represents all partnerships where the participant didn't understand 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 evaluation results after their consultation with a nurse or physician. The questionnaire 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 behavior with those partners. A thorough description of the study design and also the survey is supplied elsewhere 15 , 18 Our chief determinant of interest, dating location (e.g., the name of a pub, park, club, or the name of a website) was obtained for every partner, and categorised into online (websites), and offline (physical sites) dating places. To simplify the language of distinguishing the partners per dating location, 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 might comprehend written Dutch or English. Individuals could participate more than once, if following visits to the practice were related to a possible new STI episode. Local cougars nearest Strathfield, New South Wales. Participants were regularly 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. Local Cougars in Strathfield. Contained in this investigation were guys who reported sexual contact with at least one casual partner dated online as well one casual partner dated offline.