AMC, Academic Medical Center; aOR, adjusted odds ratio; CI, confidence interval; CINIMA, Center for Infection and Immunology Amsterdam; DAG, directed acyclic graph; HIV, human immunodeficiency 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 stay up to date in regards to accelerated shifting dating procedures as well as sero-adaptive behaviours (like viral sorting and pre exposure prophylaxis). With each new way of dating and preventative chances, the rules of engagements will be different. Our data are 8years old and web-based dating has developed since then. Yet these results are useful, as they reveal how internet-based partner acquisition may lead to more info on the sex partner, and this might influence on the frequency of UAI.
Relationship online may offer other opportunities for communicating on HIV status than dating in physical environments. Women Escorts nearest Booragoon, Western Australia. Women Escorts Near Me Bicton Western Australia. Easing more online HIV status disclosure during partner seeking makes serosorting simpler. Nonetheless, serosorting may raise the load of other STI and WOn't prevent HIV infection entirely. Interventions to prevent HIV transmission should notably be directed at HIV-negative and unaware MSM and spark timely HIV testing (i.e., after risk events or when experiencing symptoms of seroconversion illness) as well as regular testing when sexually active.
Because determinations on UAI seem to be partially based on sensed HIV concordance, accurate knowledge of one's own and the partner's HIV status is important. In HIV negative men and HIV status-oblivious guys, determinations on UAI will not 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 period during which individuals can transmit HIV but cannot be diagnosed with the commonly used HIV tests. Thus serosorting can't be regarded as an extremely powerful way of preventing HIV transmission 22 Besides interventions to trigger the uptake of HIV and STI testing in sexually active men, interventions to caution 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 effect of dating place on UAI did not change by adding partner characteristics, but it improved when adding lifestyle and drug use. It's difficult to assess the real risk for HIV for these guys: do they behave as HIV-negative men who are trying to shield themselves from HIV infection, or as HIV-positive guys trying to guard their HIV-negative partner from HIV infection? A study by Horvath et al. reported that 72% of men who were never tested for HIV, profiled themselves online as being HIV-negative, which might be problematic if they are HIV positive and participate in UAI with HIV-negative partners 12 Previously Matser et al. reported that 1.7% of the unaware and sensed HIV-negative MSM were examined HIV-positive. The study population comprised the MSM reported in this study 15
Online dating was not connected with UAI among HIV-negative men, a finding in agreement with some previous studies, mostly among young men 21 , but in comparison 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 behaviour patterns within one group of guys. However it could also reflect secular changes; maybe in the beginning of online dating a more high risk group of men used the Internet, and over time online dating normalized and less high-risk MSM now also make use of the Internet for dating.
An integral strength of this study was that it investigated the relationship between online dating and UAI among MSM who had recent sexual contact with both online and also offline casual partners. This avoided prejudice caused by potential differences between men only dating online and those only dating offline, a weakness of several previous studies. By recruiting participants at the biggest STI outpatient clinic in the Netherlands we could comprise a lot of MSM, and avoid potential differences in men tried through Internet or face to face interviewing, weaknesses in certain previous studies 3 , 11
Among HIV positive guys, in univariate analysis UAI was reported significantly more frequently 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 implies that differences in partnership factors between online and offline partnerships are accountable for the increased UAI in online established partnerships. This could be due to a mediating effect of more info on associates, (including perceived HIV status) on UAI, or to other factors. Among HIV negative guys no effect of online dating on UAI was found, either in univariate or in the multivariate models. Women Escorts in Booragoon, Western Australia. Among HIV-oblivious men, online dating was connected with UAI but only critical when adding partner and venture variants to the model.
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. Women Escorts nearest Booragoon Western Australia. 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). Just among guys who indicated they weren't informed of their HIV status (a little group in this study), UAI was more common with online than offline associates.
The amount of sex partners in the preceding 6months of the index was also 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 partnership (OR = 16.29 95 % CI 7.07-37.52 for >10 sex acts within the venture compared to just one sex act). Other variables significantly associated with UAI were group sex within the partnership, and sex-related multiple drug use within venture.
In multivariate model 3 (Tables 4 and 5 ), also including variants concerning sexual behavior in the partnership (sex-related multiple drug use, sex frequency and partner kind), the independent effect of online dating place on UAI became somewhat more powerful (though not significant) 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 effect of online dating on UAI became more powerful (and significant) for HIV-unaware men (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 strongly associated 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 different reference groups, one for each HIV status. Among HIV positive guys, UAI was more common in online compared to offline ventures (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 guys, UAI was more common in online compared to offline ventures, though not statistically significant (OR = 1.65 95 % CI 0.79-3.44).
Features of online 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 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 often reported as understood (61.4% vs. 49.4%; P 0.001), and in on-line partnerships, perceived HIV concordance was higher (49.0% vs. 39.8%; P 0.001). Participants reported that their on-line 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 on-line partners.
In order to examine the possible mediating effect of more info on partners (including perceived HIV status) on UAI, we developed three multivariable models. In version 1, we adjusted the organization 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 partnership features (age difference, ethnic concordance, lifestyle concordance, and HIV concordance). In version 3, we adapted also for partnership sexual risk behavior (i.e., sex-related 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 place was included in all three models by making a brand 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 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 miss potentially significant associations. 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. Analyses were done utilizing the statistical programme STATA, version 13 (STATA Intercooled, College Station, TX, USA).
Prior to the evaluations 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; on-line partner acquisition), others were considered as confounders (participants' age, participants' ethnicity, and no. Booragoon women escorts. of male sex partners in preceding 6months), and some were presumed to be on the causal pathway between the primary exposure of interest and outcome (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-evaluations for dichotomous and categorical variables and using rank sum test for continuous variables). Women Escorts Near Me Northbridge Western Australia. We compared characteristics of participants, partners, and venture sexual conduct by online or offline partnership, 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 examine the association between dating place (online versus offline) and UAI. Odds 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, with the reply options: (1) no, (2) potentially, (3) yes. Sexual conduct 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 following subcultures/lifestyles: casual, formal, substitute, drag, leather, military, sports, trendy, 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. 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 answer alternatives: (1) I 'm certainly not HIV-infected; (2) I believe that I am not HIV-contaminated; (3) I do not understand; (4) I think I may be HIV-contaminated; (5) I know for sure that I am HIV-contaminated. We categorised this into HIV-negative (1,2), unknown (3), and HIV-positive (4,5) status. The questionnaire enquired about the HIV status of every sex partner with all the question: 'Do you know whether this partner is HIV-infected?' with similar answer alternatives as above. Perceived concordance in HIV status within partnerships was categorised as; (1) concordant; (2) discordant; (3) unknown. Women escorts near Booragoon, WA. The final group represents all partnerships where the participant didn't 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.