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 when it comes to rapid altering dating methods as well as sero-adaptive behaviours (such as viral sorting and pre exposure prophylaxis). With every new way of dating and preventative opportunities, the rules of battles will change. Our data are 8years old and internet-based dating has developed since then. However these results are useful, as they show how net-based partner acquisition can lead to more information on the sex partner, and this might impact on the frequency of UAI.
Relationship online may offer other chances for communicating on HIV status than dating in physical environments. Adult Hookups nearby Stafford Queensland. Adult Hookups Near Me Bundaberg Queensland. Easing more online HIV status disclosure during partner seeking makes serosorting easier. Nonetheless, serosorting may raise the load of other STI and WOn't prevent HIV infection completely. Interventions to prevent HIV transmission should especially be directed at HIV negative and unaware MSM and arouse timely HIV testing (i.e., after risk events or when experiencing symptoms of seroconversion illness) as well as routine testing when sexually active.
Because decisions on UAI appear to be partially based on sensed HIV concordance, precise knowledge of one's own and the partner's HIV status is important. In HIV negative men and HIV status-oblivious men, 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 and the HIV window phase during which people can transmit HIV but cannot be diagnosed with the commonly used HIV tests. Hence serosorting can't 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 men the effect of dating location on UAI did not change by adding partner characteristics, but it increased when adding lifestyle and drug use. It's difficult to evaluate the real risk for HIV for these men: do they behave as HIV-negative men that 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 debatable 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 sensed HIV negative MSM were analyzed HIV positive. The study population included the MSM reported in this study 15
Online dating wasn't 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 because of 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 men. However it could also represent lay 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 less high-risk MSM now also use the Web for dating.
An integral strength of the study was that it investigated the relationship between online dating and UAI among MSM who had recent sexual contact with both online and offline casual partners. This avoided prejudice caused by potential differences between guys only dating online and those simply dating offline, a weakness of numerous previous studies. By recruiting participants at the greatest STI outpatient clinic in the Netherlands we could include a lot of MSM, and avoid potential differences in guys tried 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 frequently with online partners than with offline associates. When correcting for associate characteristics, 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 factors between online and offline partnerships are responsible for the increased UAI in online established ventures. This might be due to a mediating effect of more info on associates, (including perceived HIV status) on UAI, or to other factors. Among HIV-negative men no effect of online dating on UAI was observed, either in univariate or in the multivariate models. Adult Hookups closest to Stafford Queensland. Among HIV-unaware guys, online dating was connected with UAI but only essential when adding associate and venture variables to the model.
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. Adult Hookups near Stafford, Queensland. 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 non significant association between online dating and UAI (aOR = 1.62 95 % CI 0.96-2.72). Only among guys who suggested they were not aware of their HIV status (a small group in this study), UAI was more common with online than offline partners.
The number 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). 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 venture compared to just one sex act). Other factors significantly associated with UAI were group sex within the venture, and sex-related multiple drug use within venture.
In multivariate model 3 (Tables 4 and 5 ), additionally including variables concerning sexual behavior in the partnership (sex-related multiple drug use, sex frequency and partner type), the separate effect of online dating location on UAI became somewhat more powerful (though not essential) 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 essential) for HIV-oblivious guys (aOR = 2.55 95 % CI 1.11-5.86) (Table 5 ).
In univariate analysis, UAI was significantly more prone 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 firmly associated 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 distinct reference groups, 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 partnerships (OR = 1.07 95 % CI 0.71-1.62). Among HIV-unaware men, UAI was more common in online in comparison to offline partnerships, though not statistically significant (OR = 1.65 95 % CI 0.79-3.44).
Characteristics of online and offline partners and ventures are shown 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 frequently reported as known (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 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 on-line partners.
In order to analyze the potential 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 venture features (age difference, ethnic concordance, lifestyle concordance, and HIV concordance). In model 3, we adjusted additionally for venture sexual risk behavior (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 location 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 significant organizations. As a fairly big number of statistical evaluations were done and reported, this approach does lead to a higher risk of one or more false-positive organizations. Evaluations 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. Stafford Adult Hookups. of male sex partners in preceding 6months), and some were presumed to be on the causal pathway between the primary exposure of interest and result (age difference between participant and partner; ethnic concordance; concordance in life styles; HIV concordance; venture sort; sex frequency within partnership; 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). Adult Hookups Near Me Maroochydore Queensland. We compared features of participants, partners, and venture sexual behavior by online or offline venture, and computed P values predicated on logistic regression with robust standard errors, accounting for related 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 analyze the association between dating place (online versus offline) and UAI. Odds ratio tests were used to evaluate the importance of a variable in a model.
To be able to explore possible disclosure of HIV status we also asked the participant whether the casual sex partner knew the HIV status of the participant, together with the response options: (1) no, (2) perhaps, (3) yes. Sexual behavior with each partner was dichotomised as: (1) no anal intercourse or only shielded 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 characteristics were applicable, 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 know whether you're HIV infected?', with five response options: (1) I am definitely not HIV-infected; (2) I think that I'm not HIV-infected; (3) I do not know; (4) I think I may be HIV-infected; (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 every sex partner with all the question: 'Do you understand whether this partner is HIV-contaminated?' with similar response alternatives as previously. Perceived concordance in HIV status within partnerships was categorised as; (1) concordant; (2) discordant; (3) unknown. Adult hookups near Stafford QLD. The last 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.