In order to analyze the potential mediating effect of more information on partners (including perceived HIV status) on UAI, we developed three variant models. In model 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 partnership features (age difference, ethnic concordance, lifestyle concordance, and HIV concordance). In model 3, we adapted also for venture sexual risk behavior (i.e., sex-associated drug use and sex frequency) and venture 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-oblivious guys. Backpage Escorts near me Alton Ontario. 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 significant associations. As a rather large number of statistical tests were done and reported, this approach does lead to an elevated danger of one or more false positive associations. Analyses were done utilizing 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 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 known (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 often knew 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 online partners (50.9% vs. Backpage Escorts near me Alton. 41.3%; P 0.001). Sex-related substance use, alcohol use, and group sex were less often reported with online partners.
In univariate analysis, UAI was significantly more inclined 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 connected with UAI (OR = 11.70 95 % CI 7.40-18.45). The effect of dating location 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 categories, one for each HIV status. Backpage escorts near me Ontario. 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 ventures (OR = 1.07 95 % CI 0.71-1.62). Among HIV-oblivious guys, UAI was more common in online in comparison to 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 variants concerning sexual behaviour in the venture (sex-associated multiple drug use, sex frequency and partner type), the independent effect of online dating location on UAI became somewhat more powerful (though not essential) 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 effect of online dating on UAI became more powerful (and critical) for HIV-oblivious men (aOR = 2.55 95 % CI 1.11-5.86) (Table 5 ).
The number of sex partners in the preceding 6months of the index was likewise connected 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-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 associated with a higher danger of UAI than offline dating. Backpage escorts near me Alton. For HIV negative guys 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). Backpage escorts nearest Alton. Just among guys who indicated they weren't conscious of their HIV status (a small 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 frequently with on-line associates than with offline partners. When correcting for associate features, the effect of online/offline dating on UAI among HIV positive MSM became somewhat smaller and became non significant; this suggests that differences in partnership variables between online and offline partnerships are responsible for the increased UAI in online established ventures. This may be due to a mediating effect of more info on partners, (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. Among HIV-unaware men, online dating was associated with UAI but only essential when adding associate and venture variables to the model.
An integral strength of the study was that it investigated the relation between online dating and UAI among MSM who had recent sexual contact with both online and offline casual partners. This avoided prejudice brought on by potential differences between guys just dating online and those only dating offline, a weakness of several previous studies. By recruiting participants at the greatest STI outpatient clinic in the Netherlands we could contain a lot of MSM, and avoid potential differences in men sampled through Internet or face to face interviewing, weaknesses in certain previous studies 3 , 11
Online dating was not correlated with UAI among HIV negative guys, 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 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 represent 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 nowadays additionally make use of the Web for dating.
For HIV-oblivious guys the effect of dating place on UAI did not change by adding partner characteristics, but it improved when adding lifestyle and drug use. It is hard to evaluate the actual risk for HIV for these guys: do they behave as HIV negative men that are trying to shield themselves from HIV infection, or as HIV-positive guys attempting to protect 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 participate in UAI with HIV negative partners 12 Previously Matser et al. reported that 1.7% of the unaware and perceived HIV negative MSM were analyzed HIV positive. The study population comprised the MSM reported in this study 15
Because determinations on UAI appear to be partly based on perceived 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 guys, 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 as well as the HIV window period during which people can transmit HIV but cannot be diagnosed with the commonly used HIV tests. Hence serosorting cannot be regarded as a very successful way 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 perceived HIV-negative concordant status are in order, irrespective of whether this concerns online or offline dating. Backpage Escorts in Alton Ontario.
Dating online may offer other chances for communicating on HIV status than dating in physical surroundings. Easing more on-line HIV status disclosure during partner seeking makes serosorting easier. However, serosorting may raise the burden of other STI and will not prevent HIV infection completely. Interventions to prevent HIV transmission should particularly be directed at HIV-negative and unaware 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.
New research should stay up-to-date as it pertains to rapid shifting dating procedures as well as sero-adaptive behaviours (such as 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 net-based dating has developed since then. Backpage Escorts Near Me Almonte Ontario. Backpage Escorts Near Me Amaranth Station Ontario. Nevertheless these results are useful, as they demonstrate how internet-based partner acquisition may lead to more info on the sex partner, and this might influence 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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