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 stay up-to-date when it comes to rapid altering dating strategies and sero-adaptive behaviours (such as viral sorting and pre exposure prophylaxis). With each new way of dating and preventative chances, the rules of engagements will vary. Our data are 8years old and internet-based dating has developed since then. Yet these results are useful, as they show how internet-based partner acquisition can result in more info on the sex partner, and this might influence on the frequency of UAI.
Dating online may offer other opportunities for communication on HIV status than dating in physical surroundings. Local Single Women closest to Richmond VIC. Facilitating more online HIV status disclosure during partner seeking makes serosorting easier. Nevertheless, serosorting may raise the burden of other STI and will not prevent HIV infection entirely. Local single women near me Richmond. Interventions to prevent HIV transmission should particularly be directed at HIV negative and unaware MSM and stimulate timely HIV testing (i.e., after danger occasions or when experiencing symptoms of seroconversion illness) as well as regular testing when sexually active.
Because decisions on UAI seem to be partly based on sensed 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, conclusions 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. So serosorting can't be regarded as a very effective method of preventing 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 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 did not change by adding partner characteristics, but it improved when adding lifestyle and drug use. It's hard to assess the real risk for HIV for these men: do they behave as HIV-negative men that are trying to shield 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 problematic if they are 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, mostly 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 behavior of two groups of MSM rather than comparing two sexual behaviour patterns within one group of guys. Yet it can also reflect secular changes; perhaps 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 Web for dating. Local single women nearby Richmond Victoria, Australia.
A key 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 offline casual partners. Richmond, Victoria local single women. Local Single Women Near Me Blackburn Victoria. This averted prejudice caused by potential differences between guys only dating online and those just dating offline, a weakness of numerous previous studies. Local Single Women closest to Richmond Australia. By recruiting participants at the largest STI outpatient clinic in the Netherlands we could comprise a lot of MSM, and avoid 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 often with on-line associates than with offline partners. When correcting for partner characteristics, 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 variables between online and offline partnerships are accountable for the increased UAI in online established partnerships. This may be due to a mediating effect of more information on partners, (including perceived HIV status) on UAI, or to other variables. Among HIV-negative men no effect of online dating on UAI was detected, either in univariate or in the multivariate models. Among HIV-unaware guys, online dating was correlated with UAI but only 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 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 guys there was a non-significant association between online dating and UAI (aOR = 1.62 95 % CI 0.96-2.72). Only among guys who suggested they weren't aware of their HIV status (a small group in this study), UAI was more common with online than offline associates.
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 Single Women near me Richmond. 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 partnership 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 ), additionally including variables concerning sexual behavior in the partnership (sex-associated multiple drug use, sex frequency and partner kind), the independent effect of online dating place on UAI became somewhat stronger (though not significant) 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 result of online dating on UAI became more powerful (and critical) for HIV-unaware guys (aOR = 2.55 95 % CI 1.11-5.86) (Table 5 ).
In univariate analysis, UAI was significantly more prone to happen in online 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 associated 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 organization 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 guys no association was evident between UAI and online ventures (OR = 1.07 95 % CI 0.71-1.62). Among HIV-unaware 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 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 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 understood (61.4% vs. 49.4%; P 0.001), and in online ventures, 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-associated substance use, alcohol use, and group sex were less frequently reported with on-line partners. Local Single Women Near Me Melbourne Victoria.
In order to examine the possible mediating effect of more information on partners (including perceived HIV status) on UAI, we developed three variant models. In version 1, we adjusted the organization 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 venture characteristics (age difference, ethnic concordance, lifestyle concordance, and HIV concordance). In model 3, we adjusted also for venture sexual risk behaviour (i.e., sex-related drug use and sex frequency) and venture kind (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 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-oblivious men. We performed a sensitivity analysis restricted 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 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; 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 results (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-associated substance use in partnership).
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 computed P values predicated on logistic regression with robust standard errors, accounting for correlated 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 location (online versus offline) and UAI. Local single women closest to Richmond Victoria. Odds ratio tests were used to measure the importance of a variable in a model.
To be able to investigate possible disclosure of HIV status we additionally asked the participant whether the casual sex partner knew the HIV status of the participant, with the reply alternatives: (1) no, (2) potentially, (3) yes. Sexual behavior with each partner was dichotomised as: (1) no anal intercourse or simply shielded 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, alternative, drag, leather, military, sports, fashionable, punk/skinhead, rubber/lycra, gothic, bear, jeans, skater, or, if none of these characteristics were applicable, other. Concordant lifestyle was categorised as: (1) concordant; (2) discordant. Accidental 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 response options: (1) I 'm certainly not HIV-contaminated; (2) I think that I am not HIV-contaminated; (3) I do not know; (4) I believe I may be HIV-infected; (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 survey enquired about the HIV status of each sex partner with the question: 'Do you know whether this partner is HIV-infected?' with similar answer options as previously. 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 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 evaluation 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 behavior with those partners. A thorough description of the study design and also the questionnaire is provided elsewhere 15 , 18 Our primary determinant of interest, dating place (e.g., the name of a pub, park, club, or the name of a web site) was obtained for every partner, and categorised into online (websites), and offline (physical sites) dating locations. To simplify the terminology of differentiating 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. People could participate more than once, if following visits to the practice were related to a possible new STI episode. Local single women near me Richmond, Victoria. 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 near me Richmond. 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.