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 in regards to rapid shifting dating strategies as well as sero-adaptive behaviours (such as viral sorting and pre exposure prophylaxis). With each new way of dating and preventative chances, the rules of battles will be different. Our data are 8years old and internet-based dating has developed since then. Nevertheless these results are useful, as they show how web-based partner acquisition may lead to more information on the sex partner, and this might impact on the frequency of UAI.
Dating online may offer other chances for communicating on HIV status than dating in physical surroundings. Local cougars near Wakerley, QLD. Facilitating more online HIV status disclosure during partner seeking makes serosorting easier. However, serosorting may raise the load of other STI and WOn't prevent HIV infection entirely. Local cougars near Wakerley. Interventions to prevent HIV transmission should especially be directed at HIV-negative and oblivious MSM and spark timely HIV testing (i.e., after danger occasions or when experiencing symptoms of seroconversion illness) as well as regular testing when sexually active.
Because determinations on UAI seem to be partially based on perceived HIV concordance, exact knowledge of one's own and the partner's HIV status is important. In HIV negative men and HIV status-unaware men, conclusions on UAI WOn't 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 phase during which individuals can transmit HIV but cannot be diagnosed with the commonly used HIV tests. Consequently serosorting cannot be regarded as a very powerful method of avoiding HIV transmission 22 Besides interventions to trigger the uptake of HIV and STI testing in sexually active men, interventions to warn against UAI based on sensed HIV negative concordant status are in order, irrespective of whether this concerns online or offline dating.
For HIV-oblivious men the effect of dating location on UAI didn't change by adding partner features, but it improved 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 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 problematic if they're HIV-positive and participate in UAI with HIV negative partners 12 Formerly Matser et al. reported that 1.7% of the oblivious and sensed HIV negative MSM were tested HIV positive. The study population comprised 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 contrast with other studies 1 - 5 This may be because of the reality that most earlier studies compared sexual behaviour of two groups of MSM rather than comparing two sexual behavior patterns within one group of men. Yet it may also represent 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 additionally utilize the Net for dating. Local Cougars nearest Wakerley Queensland, Australia.
An integral strength of this study was that it investigated the connection between online dating and UAI among MSM who had recent sexual contact with both online and also offline casual partners. Wakerley Queensland Local Cougars. Local Cougars Near Me Upper Coomera Queensland. This averted prejudice caused by potential differences between men just dating online and those just dating offline, a weakness of several previous studies. Local Cougars nearby Wakerley, Australia. By recruiting participants at the greatest STI outpatient clinic in the Netherlands we could include a high number of MSM, and prevent potential differences in men tried through Internet or face to face interviewing, weaknesses in certain previous studies 3 , 11
Among HIV-positive guys, in univariate analysis UAI was reported significantly more often with online associates than with offline partners. 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 implies 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 info on partners, (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 the multivariate models. Among HIV-oblivious men, online dating was connected with UAI but just critical when adding partner and partnership variants to the model.
In this large study among MSM attending the STI clinic in Amsterdam, we found no evidence that online dating was independently associated with 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 guys who indicated they were not aware of their HIV status (a little group in this study), UAI was more common with on-line than offline partners.
The amount 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 Wakerley. UAI was significantly more likely if more sex acts had occurred in the partnership (OR = 16.29 95 % CI 7.07-37.52 for >10 sex acts within the partnership compared to only one sex act). Other factors significantly associated with UAI were group sex within the venture, and sex-related multiple drug use within partnership.
In multivariate model 3 (Tables 4 and 5 ), additionally including variables concerning sexual behaviour in the partnership (sex-related multiple drug use, sex frequency and partner kind), the separate effect of online dating place 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 essential) for HIV-unaware guys (aOR = 2.55 95 % CI 1.11-5.86) (Table 5 ).
In univariate analysis, UAI was significantly more inclined to happen 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 connected 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 different reference types, 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-unaware men, 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 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 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 frequently understood the HIV status of the participant than offline partners (38.8% vs. 27.2%; P 0.001). Participants more frequently reported multiple sexual contacts with online partners (50.9% vs. 41.3%; P 0.001). Sex-related substance use, alcohol use, and group sex were less often reported with internet partners. Local Cougars Near Me Helensvale Queensland.
In order to examine the potential mediating effect of more information on partners (including perceived HIV status) on UAI, we developed three variant models. In version 1, we adapted the association between online/offline dating location 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 partnership features (age difference, ethnic concordance, lifestyle concordance, and HIV concordance). In model 3, we adapted additionally for partnership sexual risk behavior (i.e., sex-related drug use and sex frequency) and venture 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 place was included in all three models by making a brand new six-category variable. For clarity, the effects of online/offline dating on UAI are also presented separately for HIV-negative, HIV-positive, and HIV-unaware guys. We performed a sensitivity analysis confined 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 important organizations. As a fairly big number of statistical tests were done and reported, this approach does lead to an increased risk of one or more false-positive associations. Analyses were done using the statistical programme STATA, version 13 (STATA Intercooled, College Station, TX, USA).
Prior to the evaluations 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 result (age difference between participant and partner; ethnic concordance; concordance in life styles; HIV concordance; venture sort; sex frequency within venture; group sex with partner; sex-associated substance use in venture).
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 features of participants, partners, and partnership sexual conduct by on-line or offline partnership, and computed P values based on logistic regression with robust standard errors, accounting for linked 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 near Wakerley Queensland. Likelihood ratio tests were used to evaluate the significance of a variable in a model.
As a way to explore possible disclosure of HIV status we also asked the participant whether the casual sex partner understood the HIV status of the participant, with the answer alternatives: (1) no, (2) possibly, (3) yes. Sexual behaviour with each partner was dichotomised as: (1) no anal intercourse or merely 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 subsequent subcultures/lifestyles: casual, formal, substitute, drag, leather, military, sports, trendy, punk/skinhead, rubber/lycra, gothic, bear, jeans, skater, or, if not one of these features were related, 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 got by asking the question 'Do you know whether you're HIV infected?', with five response alternatives: (1) I am definitely not HIV-infected; (2) I think that I'm not HIV-infected; (3) I do not know; (4) I believe I may be HIV-contaminated; (5) I know for sure that I am HIV-infected. 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 together with the question: 'Do you know whether this partner is HIV-contaminated?' with similar reply choices as previously. Perceived concordance in HIV status within partnerships was categorised as; (1) concordant; (2) discordant; (3) unknown. The final 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 questionnaire during their trip to the STI outpatient clinic while waiting for preliminary test results after their consultation using a nurse or physician. The survey elicited information on socio-demographics and HIV status of the participant, the three most recent partners in the preceding six months, and data on sexual conduct with those partners. A comprehensive description of the study design and also the questionnaire is supplied elsewhere 15 , 18 Our chief determinant of interest, dating place (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 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 understand written Dutch or English. Individuals could participate more than once, if following visits to the practice were related to a potential new STI episode. Local cougars in Wakerley, Queensland. Participants were routinely screened for STI/HIV according to the standard procedures of the STI outpatient clinic 15 , 17 The study was accepted 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 near me Wakerley. Contained in this analysis were men who reported sexual contact with at least one casual partner dated online as well one casual partner dated offline.