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 changing dating approaches and sero-adaptive behaviours (like viral sorting and pre exposure prophylaxis). With every new way of dating and preventative chances, the rules of battles will change. Our data are 8years old and web-based dating has developed since then. Nevertheless these results are useful, as they demonstrate how web-based partner acquisition can result in more info on the sex partner, and this might affect on the frequency of UAI.
Relationship online may offer other chances for communication on HIV status than dating in physical surroundings. Women escorts closest to Epping, New South Wales. Women Escorts Near Me Lindfield New South Wales. Facilitating more on-line HIV status disclosure during partner seeking makes serosorting easier. However, serosorting may raise the burden of other STI and WOn't prevent HIV disease completely. Interventions to prevent HIV transmission should particularly be directed at HIV-negative and oblivious MSM and excite timely HIV testing (i.e., after risk events or when experiencing symptoms of seroconversion illness) as well as regular testing when sexually active.
Because conclusions on UAI appear to be partly based on sensed HIV concordance, exact knowledge of one's own and the partner's HIV status is essential. In HIV negative guys and HIV status-unaware guys, decisions on UAI WOn't 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 phase during which individuals can transmit HIV but cannot be diagnosed with the commonly used HIV tests. Consequently serosorting cannot be regarded as an extremely powerful way of averting 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-unaware men the impact of dating location on UAI did not change by adding partner characteristics, but it increased when adding lifestyle and drug use. It is difficult to evaluate the real risk for HIV for these men: do they behave as HIV negative men who want to protect themselves from HIV infection, or as HIV positive men 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 unaware and perceived HIV-negative MSM were tested 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 can also reflect lay 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 now also make use of the Net for dating.
A key strength of this 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. This avoided prejudice caused by potential differences between men just dating online and those just dating offline, a weakness of numerous previous studies. By recruiting participants at the biggest STI outpatient clinic in the Netherlands we could include a high number of MSM, and avoid potential differences in men tried 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 online associates than with offline partners. When adjusting 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 liable for the increased UAI in online established partnerships. This might be because of a mediating effect of more information on partners, (including perceived HIV status) on UAI, or to other factors. Among HIV-negative men no effect of online dating on UAI was discovered, either in univariate or in some of the multivariate models. Women escorts in Epping, New South Wales. Among HIV-oblivious men, online dating was connected with UAI but only important when adding partner and venture variables to the model.
In this large study among MSM attending the STI clinic in Amsterdam, we found no evidence that online dating was independently associated with a higher risk of UAI than offline dating. Women Escorts nearby Epping, 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 nonsignificant association between online dating and UAI (aOR = 1.62 95 % CI 0.96-2.72). Just among men who indicated they were not aware of their HIV status (a little 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 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). 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 partnership compared to only one sex act). Other factors significantly associated with UAI were group sex within the venture, and sex-connected multiple drug use within venture.
In multivariate model 3 (Tables 4 and 5 ), additionally including variants concerning sexual behaviour in the venture (sex-associated multiple drug use, sex frequency and partner type), the independent effect of online dating place on UAI became somewhat more powerful (though not critical) 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 effect of online dating on UAI became stronger (and essential) for HIV-oblivious men (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 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 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 in comparison to offline ventures (OR = 1.61 95 % CI 1.03-2.50). Among HIV negative guys no association was evident between UAI and internet ventures (OR = 1.07 95 % CI 0.71-1.62). Among HIV-unaware men, UAI was more common in online compared to offline partnerships, though not statistically significant (OR = 1.65 95 % CI 0.79-3.44).
Features of on-line 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 online partners was more often 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 frequently 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 online partners (50.9% vs. 41.3%; P 0.001). Sex-associated material use, alcohol use, and group sex were less often reported with internet partners.
In order to analyze the possible mediating effect of more info on partners (including perceived HIV status) on UAI, we developed three variant models. In model 1, we adjusted the association 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 venture features (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 venture 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 place 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 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 associations. As a rather big number of statistical tests were done and reported, this approach does lead to an elevated risk of one or more false-positive organizations. Analyses were done utilizing the statistical programme STATA, version 13 (STATA Intercooled, College Station, TX, USA).
Prior to 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; on-line partner acquisition), others were considered as confounders (participants' age, participants' ethnicity, and no. Epping Women Escorts. of male sex partners in preceding 6months), and some were presumed to be on the causal pathway between the main exposure of interest and result (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 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). Women Escorts Near Me Carlingford New South Wales. We compared features of participants, partners, and venture sexual conduct 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. Likelihood ratio tests were used to measure the value of a variable in a model.
As a way to investigate possible disclosure of HIV status we also asked the participant whether the casual sex partner understood the HIV status of the participant, together with the reply alternatives: (1) no, (2) maybe, (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 determine the subculture, we asked whether the participant characterised himself or his partners as belonging to one or more of the subsequent subcultures/lifestyles: casual, formal, substitute, drag, leather, military, sports, fashionable, punk/skinhead, rubber/lycra, gothic, bear, jeans, skater, or, if not one of these features were appropriate, other. Concordant lifestyle was categorised as: (1) concordant; (2) discordant. Accidental 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 understand whether you are HIV infected?', with five answer options: (1) I 'm certainly not HIV-infected; (2) I think that I'm not HIV-contaminated; (3) I don't know; (4) I think I may be HIV-contaminated; (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. The survey enquired about the HIV status of each sex partner with the question: 'Do you know 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. Women Escorts closest to Epping NSW. The last class represents all partnerships where the participant didn't 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.