In this large study among MSM attending the STI clinic in Amsterdam, we found no signs that online dating was independently associated with 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 nonsignificant association between online dating and UAI (aOR = 1.62 95 % CI 0.96-2.72). Female Escorts in Marrickville New South Wales. Just among men who suggested they were not aware of their HIV status (a small 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 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). Marrickville female escorts. 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 venture compared to only one sex act). Other variables 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 behavior in the partnership (sex-associated multiple drug use, sex frequency and partner type), the independent effect of online dating place on UAI became somewhat stronger (though not critical) for the HIV positive guys (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 more powerful (and critical) for HIV-oblivious men (aOR = 2.55 95 % CI 1.11-5.86) (Table 5 ).
In univariate analysis, UAI was significantly more likely 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 associated 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 ventures (OR = 1.61 95 % CI 1.03-2.50). Among HIV-negative guys no association was apparent between UAI and on-line ventures (OR = 1.07 95 % CI 0.71-1.62). Among HIV-unaware 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).
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 on-line partners was more frequently 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 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 internet 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.
To be able to examine the potential mediating effect of more info on partners (including perceived HIV status) on UAI, we developed three multivariable models. In version 1, we adapted the organization between online/offline dating place 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 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 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 location was included 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-unaware men. We performed a sensitivity analysis restricted 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 fairly large number of statistical tests were done and reported, this approach does lead to a higher risk of one or more false-positive organizations. Evaluations were done utilizing the statistical programme STATA, version 13 (STATA Intercooled, College Station, TX, USA).
Before the analyses 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; 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 results (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-associated material 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 venture sexual behavior by on-line or offline partnership, and computed P values predicated on logistic regression with robust standard errors, accounting for linked 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 place (online versus offline) and UAI. Likelihood ratio tests were used to assess the importance of a variable in a model.
As a way to explore potential disclosure of HIV status we additionally asked the participant whether the casual sex partner understood the HIV status of the participant, with the response alternatives: (1) no, (2) perhaps, (3) yes. Sexual behaviour with each partner was dichotomised as: (1) no anal intercourse or only protected anal intercourse, and (2) unprotected anal intercourse. To ascertain 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, alternate, drag, leather, military, sports, trendy, 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 sort 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 understand whether you are HIV infected?', with five answer options: (1) I 'm certainly not HIV-infected; (2) I think that I am not HIV-infected; (3) I don't know; (4) I think 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. Female Escorts near Marrickville, NSW. The survey enquired about the HIV status of every sex partner with all 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 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 questionnaire during their visit to the STI outpatient clinic while waiting for preliminary evaluation results after their consultation with 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 behaviour with those partners. A thorough description of the study design as well as the questionnaire is provided elsewhere 15 , 18 Our chief determinant of interest, dating location (e.g., the name of a pub, park, club, or the name of a web site) was obtained for every partner, and categorised into on-line (websites), and offline (physical sites) dating places. To simplify the language of recognizing the partners per dating location, we refer to them as on-line 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 understand written Dutch or English. Individuals could participate more than once, if subsequent visits to the clinic were related to a potential 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 approved by the medical ethics committee of the Academic Medical Center of Amsterdam (MEC 07/181), and written informed consent was obtained from each participant. Included in this analysis 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 raising sex frequency, the chances for UAI increase as well 14 - 16 We compared the occurrence of UAI in online got casual partnerships to that in offline got casual partnerships among MSM who reported both on-line 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 knowledge of partner characteristics, including HIV status.
Marrickville, NSW Female Escorts. A meta-evaluation in 2006 found limited evidence that acquiring a sex partner online raises the risk of unprotected anal intercourse (UAI) 3 Many previous studies compared guys with internet partners to men with offline partners. Yet, men preferring online dating might differ in several unmeasured regards from guys preferring offline dating, causing incomparable behavioural profiles. A more recent meta-analysis included several studies analyzing MSM with both online and offline acquired sex partners and found evidence for an association between UAI and online partners, which might suggest a mediating effect of more info on partners, (including perceived HIV status) on UAI 13
Men who have sex with men (MSM) often use the Net to discover sex partners. Several research have revealed that MSM are more inclined to participate in unprotected anal intercourse with sex partners they meet through the Internet (online) than with partners they meet at social places (offline) 1 - 3 This implies that men who acquire 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 threat of HIV transmission also depends on exact knowledge of one's own and the sex partners' HIV status 7 - 10
Five hundred seventy-seven men (351 HIV-negative, 153 HIV-positive, and 73 HIV-oblivious) reported UAI in 26% of 878 online, 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). Fixed for demographic characteristics, online dating had no important effect on UAI among HIV-negative and HIV status-unaware men, but HIV positive men were more likely to have UAI with online associates (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 important. Female escorts near Marrickville New South Wales, Australia.
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