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 guys 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). Casual encounters near Booragoon, Western Australia. Just among guys who indicated they weren't conscious of their HIV status (a little group in this study), UAI was more common with online than offline associates.
The number of sex partners in the preceding 6months of the index was likewise associated 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). Booragoon casual encounters. 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 venture 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 variants concerning sexual behavior in the venture (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 result of online dating on UAI became stronger (and essential) for HIV-unaware men (aOR = 2.55 95 % CI 1.11-5.86) (Table 5 ).
In univariate analysis, UAI was significantly more inclined to happen in online 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 location on UAI differed by HIV status, as can be seen best in Table 5 Table 5 shows the association of online dating using three different reference classes, one for each HIV status. Among HIV positive men, UAI was more common in online compared to offline ventures (OR = 1.61 95 % CI 1.03-2.50). Among HIV negative men no association was apparent between UAI and online 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 on-line and offline partners and ventures 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 ventures, 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 frequently reported multiple sexual contacts with online partners (50.9% vs. 41.3%; P 0.001). Sex-associated material use, alcohol use, and group sex were less often reported with online partners.
To be able 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 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 adapted also for partnership sexual risk behaviour (i.e., sex-associated drug use and sex frequency) and partnership sort (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 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 organizations. As a rather big number of statistical evaluations were done and reported, this strategy does lead to a higher risk of one or more false positive organizations. Analyses were done utilizing 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 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 presumed to be on the causal pathway between the principal exposure of interest and result (age difference between participant and partner; ethnic concordance; concordance in life styles; HIV concordance; venture type; sex frequency within partnership; group sex with partner; sex-related 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 characteristics of participants, partners, and venture sexual conduct by on-line or offline partnership, and computed 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 location (online versus offline) and UAI. Likelihood ratio tests were used to evaluate the significance of a variable in a model.
In order to explore potential disclosure of HIV status we also 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 only 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 subsequent subcultures/lifestyles: casual, formal, alternative, drag, leather, military, sports, fashionable, punk/skinhead, rubber/lycra, gothic, bear, jeans, skater, or, if none of these features were related, other. Concordant lifestyle was categorised as: (1) concordant; (2) discordant. Casual partner sort 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 definitely not HIV-infected; (2) I think that I am not HIV-contaminated; (3) I don't understand; (4) I think I may be HIV-infected; (5) I know for sure that I 'm HIV-contaminated. We categorised this into HIV-negative (1,2), unknown (3), and HIV positive (4,5) status. Casual encounters nearby Booragoon, WA. The questionnaire enquired about the HIV status of each sex partner with the question: 'Do you understand whether this partner is HIV-contaminated?' with similar response alternatives as above. Perceived concordance in HIV status within partnerships was categorised as; (1) concordant; (2) discordant; (3) unknown. The final group 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 survey throughout their trip to the STI outpatient clinic while waiting for preliminary test 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 behaviour with those partners. A detailed description of the study design as well as the survey 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 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 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 possible new STI episode. 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. 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.
With increased acquaintance in sexual partnerships, for example by concordant ethnicity, age, lifestyle, HIV status, and increasing sex frequency, the odds for UAI increase as well 14 - 16 We compared the incidence of UAI in online got casual partnerships to that in offline acquired casual partnerships among MSM who reported both online and offline casual partners in the preceding six months. We hypothesised that MSM who date sex partners both online and offline, report more UAI with the casual partners they date on the internet, and that this effect is partly clarified through better understanding of partner characteristics, including HIV status.
Booragoon, WA casual encounters. A meta-evaluation in 2006 found limited evidence that acquiring a sex partner online raises the danger of unprotected anal intercourse (UAI) 3 Many previous studies compared men with internet partners to men with offline partners. However, guys favoring online dating might differ in various unmeasured regards from men favoring offline dating, causing incomparable behavioural profiles. A more recent meta-analysis contained several studies examining MSM with both online and also offline acquired sex partners and found evidence for an association between UAI and internet partners, which might imply a mediating effect of more information on partners, (including perceived HIV status) on UAI 13
Men who have sex with men (MSM) frequently use the Internet to find sex partners. Several research have shown that MSM are more prone to engage in unprotected anal intercourse with sex partners they meet through the Internet (on-line) than with partners they meet at social sites (offline) 1 - 3 This suggests that guys who get partners online may be at a higher risk for sexually transmitted infections (STI) and HIV 4 - 6 Although higher rates of UAI are reported with online partners, the danger of HIV transmission also depends on accurate knowledge of one's own and the sex partners' HIV status 7 - 10
Five hundred seventy-seven guys (351 HIV negative, 153 HIV-positive, and 73 HIV-oblivious) reported UAI in 26% of 878 on-line, and 23% of 903 offline casual partnerships. The crude OR of online dating for UAI was 1.36 (95 % CI 1.03-1.81). HIV positive men were more likely to report UAI than HIV negative men (49% vs. 28% of ventures). Adjusted for demographic characteristics, online dating had no major effect on UAI among HIV-negative and HIV status-oblivious men, but HIV-positive men were more likely to have UAI with online partners (aOR = 1.65 95 % CI 1.05-2.57). After correction for partner and partnership characteristics the effect of online/offline dating on UAI among HIV positive MSM was reduced and no longer significant. Casual encounters nearby Booragoon Western Australia, Australia.
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