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 stay up-to-date in regards to fast changing dating strategies as well as sero-adaptive behaviours (such as viral sorting and pre exposure prophylaxis). With each new way of dating and preventive chances, the rules of battles will vary. Our data are 8years old and net-based dating has developed since then. Nevertheless these results are useful, as they demonstrate how internet-based partner acquisition can result in more info on the sex partner, and this may affect on the frequency of UAI.
Dating online may offer other chances for communication on HIV status than dating in physical environments. Local single women near Doonside, NSW. Easing 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 disease completely. Local single women closest to Doonside. Interventions to prevent HIV transmission should especially be directed at HIV negative and unaware MSM and stimulate timely HIV testing (i.e., after hazard 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, precise knowledge of one's own and the partner's HIV status is essential. In HIV-negative men and HIV status-unaware guys, 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 people can transmit HIV but cannot be diagnosed with the commonly used HIV tests. Hence serosorting cannot be regarded as a very powerful way of averting HIV transmission 22 Besides interventions to stimulate the uptake of HIV and STI testing in sexually active men, interventions to caution 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 improved when adding lifestyle and drug use. It's hard to evaluate the real risk for HIV for these guys: do they act as HIV negative men who are trying to protect themselves from HIV infection, or as HIV positive men attempting to protect 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 debatable if they are HIV positive and engage in UAI with HIV negative partners 12 Previously Matser et al. reported that 1.7% of the unaware and perceived HIV negative MSM were tested HIV positive. The study population included the MSM reported in this study 15
Online dating wasn't associated 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 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 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 also utilize the Internet for dating. Local Single Women nearest Doonside New South Wales, Australia.
A vital strength of the study was that it explored the connection between online dating and UAI among MSM who had recent sexual contact with both online and also offline casual partners. Doonside, New South Wales Local Single Women. Local Single Women Near Me Dulwich Hill New South Wales. This averted bias due to potential differences between men just dating online and those only dating offline, a weakness of numerous previous studies. Local Single Women nearby Doonside Australia. By recruiting participants at the biggest STI outpatient clinic in the Netherlands we could comprise a large number of MSM, and prevent potential differences in men sampled through Internet or face to face interviewing, weaknesses in certain previous studies 3 , 11
Among HIV-positive men, in univariate analysis UAI was reported significantly more often with online 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 nonsignificant; this suggests that differences in partnership factors between online and also offline partnerships are in charge of the increased UAI in online established ventures. This could be because of a mediating effect of more information on associates, (including perceived HIV status) on UAI, or to other variables. Among HIV negative guys no effect of online dating on UAI was detected, either in univariate or in the multivariate models. Among HIV-oblivious guys, online dating was associated with UAI but only critical when adding associate and venture variables to the model.
In this large study among MSM attending the STI clinic in Amsterdam, we found no evidence 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 nonsignificant association between online dating and UAI (aOR = 1.62 95 % CI 0.96-2.72). Only among men who indicated they were not informed of their HIV status (a little 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 also 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 single women in Doonside. UAI was significantly more likely if more sex acts had happened in the partnership (OR = 16.29 95 % CI 7.07-37.52 for >10 sex acts within the venture compared to only one sex act). Other factors significantly associated with UAI were group sex within the partnership, and sex-related multiple drug use within venture.
In multivariate model 3 (Tables 4 and 5 ), additionally including variants concerning sexual behaviour in the venture (sex-related multiple drug use, sex frequency and partner kind), the separate effect of online dating place on UAI became somewhat stronger (though not significant) for the HIV positive men (aOR = 1.62 95 % CI; 0.96-2.72), but remained similar for HIV-negative guys (aOR = 0.94 95 % CI 0.59-1.48). The result 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 likely to occur 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 result of dating place 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 classes, one for each HIV status. Among HIV-positive men, 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 apparent between UAI and on-line ventures (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).
Features of on-line and offline partners and partnerships are revealed 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 on-line partners was more frequently reported as understood (61.4% vs. 49.4%; P 0.001), and in on-line partnerships, perceived HIV concordance was higher (49.0% vs. 39.8%; P 0.001). Participants reported that their on-line 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-associated material use, alcohol use, and group sex were less frequently reported with on-line partners. Local Single Women Near Me St Albans New South Wales.
To be able 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 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 characteristics (age difference, ethnic concordance, lifestyle concordance, and HIV concordance). In model 3, we adapted additionally for partnership sexual risk behavior (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 location for HIV-positive, HIV negative and HIV status unknown MSM, an interaction between HIV status of the participant and dating place was contained 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 individually for HIV negative, HIV positive, and HIV-oblivious guys. We performed a sensitivity analysis confined 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 organizations. As a rather large number of statistical tests were done and reported, this approach does lead to an elevated danger of one or more false-positive organizations. Investigations 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 assumed 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 venture; group sex with partner; sex-related 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 behaviour by on-line or offline venture, and computed P values predicated 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 examine the association between dating place (online versus offline) and UAI. Local single women nearest Doonside New South Wales. Likelihood ratio tests were used to gauge the value of a variable in a model.
As a way 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 options: (1) no, (2) possibly, (3) yes. Sexual behavior with each partner was dichotomised as: (1) no anal intercourse or only 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 at least one of the following subcultures/lifestyles: casual, formal, alternative, drag, leather, military, sports, fashionable, punk/skinhead, rubber/lycra, gothic, bear, jeans, skater, or, if none of these characteristics 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 got by asking the question 'Do you understand whether you're HIV infected?', with five response choices: (1) I 'm certainly not HIV-infected; (2) I believe that I'm not HIV-contaminated; (3) I don't understand; (4) I believe I may be HIV-contaminated; (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 each sex partner with all the question: 'Do you understand whether this partner is HIV-infected?' with similar response options as previously. Perceived concordance in HIV status within ventures was categorised as; (1) concordant; (2) discordant; (3) unknown. The final category represents all partnerships where the participant did not 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 during their visit to the STI outpatient clinic while waiting for preliminary test results after their consultation using 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 data on sexual conduct with those partners. A comprehensive description of the study design and also the questionnaire is supplied 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 online (websites), and offline (physical sites) dating locations. To simplify the language of distinguishing 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 understand written Dutch or English. Individuals could participate more than once, if subsequent visits to the practice were related to a possible new STI episode. Local single women near me Doonside, New South Wales. 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 Single Women closest to Doonside. 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.