To be able to examine the possible mediating effect of more info on partners (including perceived HIV status) on UAI, we developed three multivariable 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 venture characteristics (age difference, ethnic concordance, lifestyle concordance, and HIV concordance). In model 3, we adapted additionally 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 location 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 fresh six-category 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 Harbourfront Ontario. We performed a sensitivity analysis restricted 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 organizations. As a rather large number of statistical evaluations were done and reported, this approach does lead to an elevated risk of one or more false positive associations. Investigations were done utilizing the statistical programme STATA, version 13 (STATA Intercooled, College Station, TX, USA).
Characteristics 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 online partners was more often reported as understood (61.4% vs. 49.4%; P 0.001), and in on-line ventures, perceived HIV concordance was higher (49.0% vs. 39.8%; P 0.001). Participants reported that their on-line 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 Harbourfront. 41.3%; P 0.001). Sex-associated substance use, alcohol use, and group sex were less often reported with internet partners.
In univariate analysis, UAI was significantly more likely to occur in online than in offline partnerships (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 impact 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 distinct reference classes, 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 internet 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 variables concerning sexual behavior in the partnership (sex-related 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 guys (aOR = 0.94 95 % CI 0.59-1.48). The effect of online dating on UAI became stronger (and critical) for HIV-unaware men (aOR = 2.55 95 % CI 1.11-5.86) (Table 5 ).
The amount 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 partnership compared to only one sex act). Other variables significantly associated with UAI were group sex within the partnership, and sex-related multiple drug use within venture.
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 risk of UAI than offline dating. Backpage Escorts nearby Harbourfront. For HIV-negative guys 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). Backpage Escorts closest to Harbourfront. Just among men who suggested they weren't conscious of their HIV status (a small group in this study), UAI was more common with on-line than offline partners.
Among HIV-positive men, in univariate analysis UAI was reported significantly more often with online partners 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 nonsignificant; this implies that differences in partnership variables between online and also offline partnerships are in charge of the increased UAI in online established partnerships. This may be because of a mediating effect of more info on partners, (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 some of the multivariate models. Among HIV-unaware men, online dating was associated with UAI but only significant when adding partner and venture variables to the model.
An integral strength of the study was that it explored the relation between online dating and UAI among MSM who had recent sexual contact with both online and also offline casual partners. This avoided prejudice due to potential differences between guys only 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 lot of MSM, and avoid potential differences in guys sampled through Internet or face to face interviewing, weaknesses in certain previous studies 3 , 11
Online dating wasn't correlated with UAI among HIV-negative guys, a finding in agreement with some previous studies, largely 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 behavior patterns within one group of guys. Nevertheless it might also reflect lay changes; perhaps 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 today additionally make use of the Net for dating.
For HIV-unaware men the effect of dating place on UAI didn't change by adding partner features, but it improved when adding lifestyle and drug use. It is difficult to evaluate the real risk for HIV for these guys: do they act as HIV-negative men that want to protect themselves from HIV infection, or as HIV-positive guys trying to shield 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 problematic if they're HIV-positive and participate in UAI with HIV negative partners 12 Formerly Matser et al. reported that 1.7% of the oblivious and perceived HIV-negative MSM were tested HIV positive. The study population included the MSM reported in this study 15
Because decisions on UAI appear to be partially based on sensed HIV concordance, accurate knowledge of one's own and the partner's HIV status is essential. In HIV-negative men and HIV status-unaware men, judgements 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 and the HIV window period during which individuals can transmit HIV but cannot be diagnosed with the commonly used HIV tests. Consequently serosorting can't be regarded as a very successful method of avoiding 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 perceived HIV-negative concordant status are in order, irrespective of whether this concerns online or offline dating. Backpage escorts nearest Harbourfront Ontario.
Dating online may offer other opportunities for communicating on HIV status than dating in physical environments. Facilitating more on-line HIV status disclosure during partner seeking makes serosorting simpler. However, serosorting may increase the load of other STI and will not prevent HIV infection entirely. Interventions to prevent HIV transmission should notably be directed at HIV negative and oblivious MSM and stimulate timely HIV testing (i.e., after danger events or when experiencing symptoms of seroconversion illness) as well as routine testing when sexually active.
New research should stay up to date as it pertains to rapid changing dating approaches and sero-adaptive behaviours (like viral sorting and pre exposure prophylaxis). With each new way of dating and preventive chances, the rules of battles will change. Our data are 8years old and net-based dating has developed since then. Backpage Escorts Near Me Harbord Village Ontario. Backpage Escorts Near Me Hardrock Ontario. Nevertheless these results are useful, as they demonstrate how internet-based partner acquisition can lead to 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'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
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