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'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 remain up to date in regards to accelerated altering dating strategies and sero-adaptive behaviours (like viral sorting and pre exposure prophylaxis). With each new way of dating and preventative chances, the rules of battles will vary. Our data are 8years old and web-based dating has developed since then. Yet these results are useful, as they demonstrate how net-based partner acquisition can lead to more information on the sex partner, and this might influence on the frequency of UAI.
Dating online may offer other chances for communicating on HIV status than dating in physical environments. Free hook ups closest to Wentworthville, New South Wales. Free Hook Ups Near Me Concord New South Wales. Easing more on-line HIV status disclosure during partner seeking makes serosorting simpler. Nonetheless, serosorting may raise the weight of other STI and will not prevent HIV disease completely. Interventions to prevent HIV transmission should notably be directed at HIV negative and oblivious MSM and stimulate timely HIV testing (i.e., after risk occasions or when experiencing symptoms of seroconversion illness) as well as routine testing when sexually active.
Because conclusions on UAI appear to be partly based on perceived HIV concordance, exact knowledge of one's own and the partner's HIV status is essential. In HIV-negative guys and HIV status-oblivious men, determinations on UAI will not 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 as well as the HIV window period during which individuals can transmit HIV but cannot be diagnosed with the commonly used HIV tests. Consequently serosorting cannot be regarded as a very successful method of preventing HIV transmission 22 Besides interventions to stimulate 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 guys the impact of dating place on UAI didn't change by adding partner characteristics, but it improved when adding lifestyle and drug use. It's difficult to evaluate the actual risk for HIV for these men: do they behave as HIV-negative guys who want to shield themselves from HIV infection, or as HIV positive men trying 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 engage in UAI with HIV negative partners 12 Previously Matser et al. reported that 1.7% of the unaware and sensed HIV negative MSM were tested HIV-positive. The study population comprised 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, mainly among young men 21 , but in contrast with other studies 1 - 5 This may be due to the reality that most earlier studies compared sexual behavior of two groups of MSM rather than comparing two sexual behavior patterns within one group of men. Nevertheless it might also reflect secular 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 additionally utilize the Internet for dating.
A vital strength of the study was that it investigated the connection between online dating and UAI among MSM who had recent sexual contact with both online and offline casual partners. This averted bias brought on by potential differences between men just dating online and those just dating offline, a weakness of several previous studies. By recruiting participants at the biggest STI outpatient clinic in the Netherlands we could contain a large number of MSM, and avoid potential differences in men 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 features, 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 variables between online and offline partnerships are in charge of the increased UAI in online established partnerships. This might be due to a mediating effect of more info on associates, (including perceived HIV status) on UAI, or to other variables. Among HIV-negative men no effect of online dating on UAI was found, either in univariate or in any of the multivariate models. Free Hook Ups nearest Wentworthville, New South Wales. Among HIV-oblivious guys, online dating was associated with UAI but just important when adding partner and venture variants 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 risk of UAI than offline dating. Free Hook Ups near Wentworthville New South Wales. For HIV negative men this dearth 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). Simply among guys who suggested they were not conscious 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 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 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 variables significantly associated with UAI were group sex within the partnership, and sex-connected multiple drug use within venture.
In multivariate model 3 (Tables 4 and 5 ), additionally including variables concerning sexual behaviour in the partnership (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 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 stronger (and essential) for HIV-oblivious guys (aOR = 2.55 95 % CI 1.11-5.86) (Table 5 ).
In univariate analysis, UAI was significantly more likely 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 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 distinct reference groups, one for each HIV status. Among HIV-positive men, UAI was more common in online in comparison to offline partnerships (OR = 1.61 95 % CI 1.03-2.50). Among HIV-negative guys no association was apparent between UAI and online ventures (OR = 1.07 95 % CI 0.71-1.62). Among HIV-oblivious 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 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 often reported as understood (61.4% vs. 49.4%; P 0.001), and in online partnerships, perceived HIV concordance was higher (49.0% vs. 39.8%; P 0.001). Participants reported that their online partners more frequently understood 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 material use, alcohol use, and group sex were less frequently reported with on-line partners.
To be able 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 adapted 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 adapted also 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 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 separately for HIV-negative, HIV positive, and HIV-unaware 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 miss potentially important organizations. As a fairly big number of statistical tests were done and reported, this strategy does lead to a heightened risk of one or more false-positive associations. Investigations were done using the statistical programme STATA, version 13 (STATA Intercooled, College Station, TX, USA).
Before the evaluations 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. Wentworthville free hook ups. of male sex partners in preceding 6months), and some were assumed 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 type; sex frequency within venture; 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). Free Hook Ups Near Me Casula New South Wales. We compared features of participants, partners, and partnership sexual behaviour by on-line or offline partnership, and calculated P values predicated on logistic regression with robust standard errors, accounting for correlated 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. Likelihood ratio tests were used to assess the value of a variable in a model.
To be able to explore possible disclosure of HIV status we additionally asked the participant whether the casual sex partner understood the HIV status of the participant, with the answer alternatives: (1) no, (2) perhaps, (3) yes. Sexual behaviour with each partner was dichotomised as: (1) no anal intercourse or simply shielded 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, substitute, drag, leather, military, sports, fashionable, punk/skinhead, rubber/lycra, gothic, bear, jeans, skater, or, if none of these characteristics were related, 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 are HIV infected?', with five answer alternatives: (1) I 'm definitely 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 '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 know whether this partner is HIV-infected?' with similar response choices as above. Perceived concordance in HIV status within ventures was categorised as; (1) concordant; (2) discordant; (3) unknown. Free hook ups nearby Wentworthville NSW. The last class 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.