To be able to examine the possible 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 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 features (age difference, ethnic concordance, lifestyle concordance, and HIV concordance). In version 3, we adapted also for partnership sexual risk behavior (i.e., sex-associated drug use and sex frequency) and partnership kind (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 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. Backpage Escorts near Mantua Nova Scotia. We performed a sensitivity analysis limited 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 important associations. As a rather large number of statistical evaluations were done and reported, this approach does lead to an elevated danger of one or more false-positive organizations. Investigations were done using the statistical programme STATA, version 13 (STATA Intercooled, College Station, TX, USA).
Characteristics of online and offline partners and ventures 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 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 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 internet partners (50.9% vs. Backpage escorts nearest Mantua. 41.3%; P 0.001). Sex-related material use, alcohol use, and group sex were less often reported with online partners.
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 strongly correlated 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 association of online dating using three different reference groups, one for each HIV status. Backpage escorts near Nova Scotia. 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 guys no association was evident between UAI and online partnerships (OR = 1.07 95 % CI 0.71-1.62). Among HIV-unaware guys, UAI was more common in online when compared with offline partnerships, though not statistically significant (OR = 1.65 95 % CI 0.79-3.44).
In multivariate model 3 (Tables 4 and 5 ), additionally including variables concerning sexual behaviour in the venture (sex-associated multiple drug use, sex frequency and partner type), the separate effect of online dating location 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 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 guys (aOR = 2.55 95 % CI 1.11-5.86) (Table 5 ).
The amount of sex partners in the preceding 6months of the index was also 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 venture (OR = 16.29 95 % CI 7.07-37.52 for >10 sex acts within the partnership compared to only one sex act). Other variables significantly associated with UAI were group sex within the venture, and sex-connected multiple drug use within venture.
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. Backpage escorts near me Mantua. 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 non-significant association between online dating and UAI (aOR = 1.62 95 % CI 0.96-2.72). Backpage escorts closest to Mantua. Only among men who suggested they weren't informed of their HIV status (a little group in this study), UAI was more common with on-line than offline associates.
Among HIV positive men, in univariate analysis UAI was reported significantly more often with online associates than with offline associates. 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 responsible for the increased UAI in online established ventures. This could be because of 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 any of the multivariate models. Among HIV-oblivious guys, online dating was connected with UAI but just significant when adding partner and venture variables to the model.
A key 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 prevented bias caused by potential differences between men just dating online and those just dating offline, a weakness of several previous studies. By recruiting participants at the largest STI outpatient clinic in the Netherlands we could include a great number of MSM, and prevent potential differences in men sampled through Internet or face-to-face interviewing, weaknesses in a few previous studies 3 , 11
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 because of the fact that most earlier studies compared sexual behaviour of two groups of MSM rather than comparing two sexual behavior patterns within one group of men. However it can also reflect secular changes; possibly in the beginning of online dating a more high-risk group of men used the Internet, and over time online dating normalized and not as high risk MSM now also use the Net for dating.
For HIV-unaware men the impact of dating place on UAI did not change by adding partner features, but it improved when adding lifestyle and drug use. It's hard to assess the actual 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 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 debatable if they are HIV positive and engage in UAI with HIV-negative partners 12 Formerly Matser et al. reported that 1.7% of the unaware and sensed HIV negative MSM were examined HIV positive. The study population included the MSM reported in this study 15
Because conclusions on UAI appear to be partly based on sensed HIV concordance, accurate knowledge of one's own and the partner's HIV status is very important. In HIV-negative guys and HIV status-oblivious men, decisions 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 and the HIV window phase during which individuals can transmit HIV but cannot be diagnosed with the commonly used HIV tests. Hence serosorting cannot be regarded as a very powerful method of avoiding 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. Backpage escorts nearby Mantua Nova Scotia.
Relationship online may offer other opportunities for communication on HIV status than dating in physical environments. Facilitating more online HIV status disclosure during partner seeking makes serosorting easier. However, serosorting may increase the load of other STI and WOn't prevent HIV infection entirely. Interventions to prevent HIV transmission should especially be directed at HIV-negative and unaware MSM and stimulate timely HIV testing (i.e., after risk events or when experiencing symptoms of seroconversion illness) as well as regular testing when sexually active.
New research should stay up-to-date as it pertains to rapid changing dating processes as well as sero-adaptive behaviours (like viral sorting and pre exposure prophylaxis). With every new way of dating and preventive opportunities, the rules of engagements will change. Our data are 8years old and net-based dating has developed since then. Backpage Escorts Near Me Malagawatch Nova Scotia. Backpage Escorts Near Me Maple Grove Nova Scotia. However these results are useful, as they reveal how internet-based partner acquisition can result in more information on the sex partner, and this might affect on the frequency of UAI.
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
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