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 is, 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 rapid shifting dating strategies and sero-adaptive behaviours (like viral sorting and pre exposure prophylaxis). With each new way of dating and preventive chances, the rules of battles will change. Our data are 8years old and net-based dating has developed since then. Nevertheless these results are useful, as they demonstrate how net-based partner acquisition can lead to more info 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. Local Prostitutes in Mount Gravatt QLD. Easing more online HIV status disclosure during partner seeking makes serosorting simpler. Yet, serosorting may raise the weight of other STI and WOn't prevent HIV disease entirely. Local Prostitutes closest to Mount Gravatt. Interventions to prevent HIV transmission should notably be directed at HIV-negative and oblivious MSM and stimulate timely HIV testing (i.e., after risk events or when experiencing symptoms of seroconversion illness) as well as routine testing when sexually active.
Because determinations on UAI seem to be partially based on perceived HIV concordance, precise knowledge of one's own and the partner's HIV status is essential. In HIV-negative men and HIV status-oblivious guys, judgements on UAI WOn't 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 as well as the HIV window period during which people can transmit HIV but cannot be diagnosed with the commonly used HIV tests. Therefore serosorting cannot be regarded as an extremely 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 guys the effect of dating place on UAI didn't change by adding partner features, but it improved when adding lifestyle and drug use. It is hard to assess the real risk for HIV for these men: do they behave as HIV-negative men who are attempting to shield themselves from HIV infection, or as HIV-positive guys attempting to safeguard 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 Formerly Matser et al. reported that 1.7% of the oblivious and perceived HIV-negative MSM were analyzed HIV positive. The study population comprised the MSM reported in this study 15
Online dating was not associated with UAI among HIV-negative men, a finding in agreement with some previous studies, largely among young men 21 , but in contrast with other studies 1 - 5 This may be due to the fact that most earlier studies compared sexual behaviour of two groups of MSM rather than comparing two sexual behaviour patterns within one group of men. Nevertheless it could also reflect 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 not as high-risk MSM today also use the Web for dating. Local prostitutes closest to Mount Gravatt Queensland Australia.
A key strength of this study was that it investigated the relation between online dating and UAI among MSM who had recent sexual contact with both online and offline casual partners. Mount Gravatt Queensland Local Prostitutes. Local Prostitutes Near Me Brisbane Queensland. This prevented bias brought on by potential differences between men just dating online and those simply dating offline, a weakness of several previous studies. Local Prostitutes closest to Mount Gravatt, Australia. By recruiting participants at the biggest STI outpatient clinic in the Netherlands we could include a large number of MSM, and avoid potential differences in guys tried 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 frequently with on-line partners than with offline associates. When correcting for partner 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 variables between online and also offline partnerships are accountable for the increased UAI in online established partnerships. This may be because of a mediating effect of more information on associates, (including perceived HIV status) on UAI, or to other factors. Among HIV negative men no effect of online dating on UAI was found, either in univariate or in the multivariate models. Among HIV-oblivious men, online dating was connected with UAI but just important when adding associate and venture 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 men this dearth of assocation was clear (aOR = 0.94 95 % CI 0.59-1.48); among HIV positive men there was a nonsignificant association between online dating and UAI (aOR = 1.62 95 % CI 0.96-2.72). Only among guys who suggested they weren't informed of their HIV status (a little group in this study), UAI was more common with on-line than offline associates.
The amount of sex partners in the preceding 6months of the index was likewise connected 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 Prostitutes in Mount Gravatt. 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 partnership compared to just one sex act). Other variables significantly associated with UAI were group sex within the partnership, and sex-related multiple drug use within partnership.
In multivariate model 3 (Tables 4 and 5 ), also including variants concerning sexual behaviour in the partnership (sex-related multiple drug use, sex frequency and partner kind), the separate effect of online dating location on UAI became somewhat more powerful (though not essential) 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 effect 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 inclined 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 strongly correlated with UAI (OR = 11.70 95 % CI 7.40-18.45). The effect 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 categories, one for each HIV status. Among HIV-positive guys, UAI was more common in online when compared with offline partnerships (OR = 1.61 95 % CI 1.03-2.50). Among HIV negative men no association was apparent between UAI and internet partnerships (OR = 1.07 95 % CI 0.71-1.62). Among HIV-oblivious guys, UAI was more common in online compared to offline ventures, though not statistically significant (OR = 1.65 95 % CI 0.79-3.44).
Characteristics of online and offline partners and partnerships 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 known (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 on-line partners more frequently knew 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 online partners (50.9% vs. 41.3%; P 0.001). Sex-associated substance use, alcohol use, and group sex were less frequently reported with internet partners. Local Prostitutes Near Me Richmond Queensland.
To be able to examine the possible mediating effect of more information on partners (including perceived HIV status) on UAI, we developed three multivariable models. In version 1, we adjusted the association between online/offline dating location 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 partnership features (age difference, ethnic concordance, lifestyle concordance, and HIV concordance). In version 3, we adjusted also for venture sexual risk behaviour (i.e., sex-related drug use and sex frequency) and venture 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-unaware 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 lose potentially important organizations. As a rather large number of statistical evaluations were done and reported, this strategy does lead to a heightened risk 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 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; online partner acquisition), others were considered as confounders (participants' age, participants' ethnicity, and no. of male sex partners in preceding 6months), and some were supposed 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; venture kind; sex frequency within partnership; 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 partnership sexual behaviour by online or offline partnership, and calculated P values predicated on logistic regression with robust standard errors, accounting for correlated 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 location (online versus offline) and UAI. Local Prostitutes nearest Mount Gravatt Queensland. Likelihood ratio tests were used to evaluate the value of a variable in a model.
To be able to investigate possible disclosure of HIV status we also asked the participant whether the casual sex partner understood the HIV status of the participant, together with the reply choices: (1) no, (2) perhaps, (3) yes. Sexual behavior with each partner was dichotomised as: (1) no anal intercourse or merely 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 at least one of the following subcultures/lifestyles: casual, formal, substitute, drag, leather, military, sports, trendy, punk/skinhead, rubber/lycra, gothic, bear, jeans, skater, or, if none of these features were appropriate, 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 obtained by asking the question 'Do you know whether you are HIV infected?', with five answer choices: (1) I 'm certainly not HIV-contaminated; (2) I think that I'm not HIV-contaminated; (3) I don't know; (4) I think 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 each sex partner together with the question: 'Do you know whether this partner is HIV-infected?' with similar reply alternatives as previously. Perceived concordance in HIV status within partnerships was categorised as; (1) concordant; (2) discordant; (3) unknown. The last group represents all partnerships where the participant didn't 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 visit to the STI outpatient clinic while waiting for preliminary evaluation 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 detailed description of the study design and the questionnaire is provided elsewhere 15 , 18 Our primary 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 could comprehend written Dutch or English. People could participate more than once, if following visits to the clinic were related to a potential new STI episode. Local Prostitutes near me Mount Gravatt Queensland. Participants were regularly 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 prostitutes near me Mount Gravatt. Contained in this investigation were men who reported sexual contact with at least one casual partner dated online as well one casual partner dated offline.