A new meeting place: chatting on the Internet, e-dating and sexual risk behaviour among Dutch men who have sex with men

Predictors of Face and Body Visibility in Online Dating Applications Among Young Men Who Have Sex with Men

In this study, we explored the factors relating to face and body visibility in young men who have sex with men (YMSM) from online dating applications. Research on visual self-presentation in online dating applications, especially in YMSM, remains scarce. The sample consisted of 339 young men (ages 18-24 years) who had casual sex with one or more male partners from online dating applications. Participants completed an online survey asking how visible their face and body were on their profile pictures. For body visibility, participants rated the visibility of their upper and lower body separately. We also computed difference scores between face and body visibility to measure face visibility in relation to body visibility (e.g., showing more-visible face compared to body). Predictors included self-rated attractiveness, fear of being identified on the applications, and motives for application use. Participant age and duration of application use were statistically controlled in all analyses. Results showed that higher perceived attractiveness related to higher upper- and lower-body visibility on profile pictures. Greater fear of being identified related to lower face visibility and less-visible face relative to upper- and lower-body visibility. Having a relationship motive was associated with higher face visibility. Older age and longer duration of application use were associated with more-visible face relative to lower body. The findings contribute to the literature on visual self-presentation in online dating applications in young and vulnerable sexual minorities.

Attractiveness, profile-picture face visibility and unprotected receptive anal intercourse in young men who have sex with men using online dating applications

Background We examined links among face visibility on dating-profile pictures, self-perceived attractiveness, condom use self-efficacy, and unprotected receptive anal intercourse (URAI) in 223 young men who have sex with men (YMSM; ages 18-24 years) using online dating applications (e.g. Grindr).

METHODS

Participants reported their face visibility on their main dating-profile picture, attractiveness, condom use self-efficacy, and frequency of URAI in the past 3 months. Number of casual sex partners and pre-exposure prophylaxis (PrEP) use were statistically controlled in all analyses.

RESULTS

Using a mediated moderation model, we found that a significant attractiveness-by-face-visibility interaction for URAI was fully mediated by condom use self-efficacy. Specifically, lower face visibility on profile pictures related to lower condom use self-efficacy, which in turn related to higher URAI, but only among highly attractive YMSM.

CONCLUSIONS

Our findings suggest that attractive YMSM who show less-visible faces on their dating profiles could be at particularly high risk for sexually transmissible infections. This study has potentially important clinical implications because dating applications have become one of the most common ways for YMSM to find sexual partners.

Online Dating and Problematic Use: A Systematic Review

Despite the constant growth in the use of online dating sites and mobile dating applications, research examining potential problematic use of online dating has remained scarce. Previous research has obviated problematic use of online dating in favour of users’ personality correlates and scams through online dating services. A systematic review was carried out using PsycINFO and Web of Science databases to gather previous findings that address potential problematic use of online dating by (i) identifying use and motivations, (ii) assessing users’ personality correlates, (iii) outlining negative correlates of use, (iv) examining sexual and impulsive behaviour, (v) exploring substance use and behavioural addictions in relation to online dating, and (vi) examining problematic use of online dating, resulting in 43 studies. Findings suggest that personality correlates such as neuroticism, sociability, sensation-seeking, and sexual permissiveness are related to greater use of online dating services. Sex-search and self-esteem enhancement are predictors of problematic use of online dating. Previous research coincides with online dating risks (e.g. fear of deception) and objectification tendency due to online dating services (sites and apps) design. Observations regarding methodological weaknesses and future research implications are included.

Sex, Drugs, and Impulse Regulation: A Perspective on Reducing Transmission Risk Behavior and Improving Mental Health Among MSM Living With HIV

Unprotected sexual contact continues to be a main cause of HIV transmission and poses certain key populations at increased risk for HIV infection. One of the populations at high risk are men who have sex with men. A subset of MSM engages in chemsex, whereby consumption of illicit drugs is used to facilitate or enhance sexual activity. This practice can have several negative consequences, such as sexually transmitted infections (including HIV) and mental health problems (including compulsive sexual behavior, addiction, and mood disorders). In this article, we provide our perspective on the current situation that medical professionals dealing with MSM living with HIV often feel empty-handed in how to deal with these behavioral and psychological issues. Close collaboration between somatic and mental health professionals is key to address treatment needs of people living with HIV, regarding the negative consequences of chemsex and their overall quality of life. In this article, we discuss possibilities for psychological treatment, including behavioral skills training to improve impulse control and reduce compulsive sexual behaviors among MSM living with HIV who persistently engage in sexual transmission risk behavior, based on our experience with implementing such an intervention. Important barriers and facilitators for further implementation of behavioral interventions will be discussed. Reduction of HIV transmission risk behavior is needed to achieve the WHO aim to end HIV as a public health threat by 2030. We propose that close collaboration between somatic and mental health professionals and implementation of behavioral interventions for risk populations are key to achieve this goal.

Online HIV prevention intervention on condomless sex among men who have sex with men: a web-based randomized controlled trial

Background

Given the widespread use of the Internet among men who have sex with men (MSM) and high risk of Internet-facilitated sexual behaviors, Internet-based interventions to reduce sexual risk are urgently needed.

Methods

We recruited 1,100 participants from online and randomly assigned to two groups. One group received online HIV intervention services. Online HIV intervention was developed through mix-method formative research, measures included scenarios experiencing intervention and HIV information dissemination. Self-reported condomless anal sex with a male in the past three months was measured to evaluate the intervention effect.

Result

Of the 1,100 participants, the majority were aged between 21 and 30 years old (62%), had a college degree or higher (80%), were single (88%), and self-identified as homosexual (78%). The estimated risk difference of condomless sex with a male in the past three months between groups was 9.3% (95% confidence interval (CI): 1.1, 17.5%). Using multiple imputations intention-to-treat, the estimated risk difference was 8.9% (95%CI: 1.2, 16.6%). Modification effects were found between intervention and characteristics including: educational attainment (p = 0.012), marital status (p = 0.005) and awareness of AIDS-related knowledge (p = 0.010).

Conclusion

Internet appears to be a promising approach to disseminate HIV prevention amongst MSM. Interactive online intervention appeals to MSM and poses a great potential for reducing HIV risky behavior.

Trial registration

ChiCTR1800014260 (retrospectively registered 2 Jan, 2018).

Electronic supplementary material

The online version of this article (10.1186/s12879-019-4251-5) contains supplementary material, which is available to authorized users.

Variations in Recruitment Yield and Characteristics of Participants Recruited Across Diverse Internet Platforms in an HIV Testing Study of Young Adult Men-Who-Have-Sex-With-Men (YMSM)

The Internet is a commonly used medium for recruiting geographically dispersed, smaller populations quickly, such as young adult men-who-have-sex-with-men (YMSM). One approach to improve reach and representativeness is to employ multiple Internet platforms to recruit this hard-to-reach population. The utility of this approach has not been studied adequately, and its impact on the study sample recruited is not yet known. Using data from a study of 18- to 24-year-old HIV-uninfected, Black, Hispanic, and White United States (US) YMSM, this investigation compared advertising and enrollment metrics and participant characteristics of those recruited across Internet platforms. Of the 2,444 participants, their median age was 22 years old; 21% were Black, 37% Hispanic, and 42% White; 90% had been tested for HIV at least once in their life; and 87% reported prior condomless anal intercourse (CAI) with another man. There were noticeable differences across platforms in the number of people accessing the study website, meeting study eligibility requirements, consenting to participate, consenting to participate per day of advertising and per click, as well as costs of advertising per consented participant. Participants recruited also varied across platform by race/ethnicity, geographic area of residence in the US, health-care insurance status, years of formal education, history of HIV testing, and CAI by partner type and sexual positioning. The investigation results indicate that the Internet platforms used for recruitment significantly impact not only enrollment but also diversity and characteristics of the sample obtained and consequently, the observations and conclusions rendered.

Does online dating lead to higher sexual risk behaviour? A cross-sectional study among MSM in Amsterdam, the Netherlands

Background

Men having sex with men (MSM) frequently use the Internet to find sex partners. We examined the association between unprotected anal intercourse (UAI) with partners dated online and with partners dated offline (met elsewhere), and examined whether differences can be explained by self-perceived HIV status of the index and knowledge of partnership characteristics.

Methods

MSM were recruited at the Sexually Transmitted Infections Clinic in Amsterdam, in 2008–2009. Participants completed a questionnaire concerning sexual behaviour. Only men reporting both online and offline casual sex partners were included. We assessed the association between online/offline partner dating and UAI, using random-effects logistic regression analysis.

Results

Five hundred seventy-seven men (351 HIV-negative, 153 HIV-positive, and 73 HIV-unaware) reported UAI in 26 % of 878 online, and 23 % of 903 offline casual partnerships. The crude OR of online dating for UAI was 1.36 (95 % CI 1.03–1.81). HIV-positive men were more likely to report UAI than HIV-negative men (49 % vs. 28 % of partnerships). Adjusted for demographic characteristics, online dating had no significant effect on UAI among HIV-negative and HIV status-unaware men, but HIV-positive men were more likely to have UAI with online partners (aOR = 1.65 [95 % CI 1.05–2.57]). After correction for partner and partnership characteristics the effect of online/offline dating on UAI among HIV-positive MSM was reduced and no longer significant.

Conclusions

Online dating was not significantly associated with UAI among HIV-negative MSM. HIV-positive MSM were more likely to practise UAI with partners dated online; however, after correction for partner and partnership characteristics, online partnership acquisition was not associated with a significantly increased risk of UAI.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-016-1637-5) contains supplementary material, which is available to authorized users.

Outbreak of syphilis in men who have sex with men living in rural North Wales (UK) associated with the use of social media

OBJECTIVES

To describe an outbreak of infectious syphilis in rural North Wales and the control measures implemented.

METHODS

Following reports of an increase of syphilis in North Wales, a multidisciplinary Outbreak Control Team (OCT) was established. A multilevel prevention and control response was initiated, including: active case surveillance, partner notification and treatment, sexual network analysis, awareness raising with professionals and affected communities, point-of-care syphilis testing at a sauna and a health promotion campaign targeting users of men who have sex with men (MSM) social network mobile phone applications (apps).

RESULTS

Four cases of infectious syphilis were diagnosed in clinics in North Wales per 100 000 population in 2013 compared with a mean of one case per 100 000 in the preceding decade. Diagnosed cases peaked in January 2014, declining in the first half of 2014. Initial cases were clustered in the westerly rural counties of North Wales and were predominantly white men, self-reporting as MSM (median age: 34 years, range: 17-61). Point-of-care testing at a sauna did not identity further new infections, suggesting that the cluster was relatively focused and had probably been detected early. The use of apps to find sexual partners was a feature of the network affected. A health promotion campaign, initiated by the OCT, targeting men using MSM apps reached 92% of the 755 men messaged.

CONCLUSIONS

The outbreak was successfully controlled. However, it is difficult to determine which of the interventions implemented were most effective. Future outbreaks should be used as an opportunity to evaluate interventions using apps.

A Pilot Trial of a Sexual Health Counseling Intervention for HIV-Positive Gay and Bisexual Men Who Report Anal Sex without Condoms

Background

Even in the presence of promising biomedical treatment as prevention, HIV incidence among men who have sex with men has not always decreased. Counseling interventions, therefore, continue to play an important role in reducing HIV sexual transmission behaviors among gay and bisexual men and other men who have sex with men. The present study evaluated effects of a small-group counseling intervention on psychosocial outcomes and HIV sexual risk behavior.

Method

HIV-positive (HIV+) peer counselors administered seven 2-hour counseling sessions to groups of 5 to 8 HIV+ gay and bisexual men. The intervention employed information provision, motivational interviewing, and behavioral skills building to reduce sexual transmission risk behaviors.

Results

There was a significant reduction in condomless anal sex (CAS) with HIV-negative and unknown HIV-status partners, from 50.0% at baseline to 28.9% of the sample at 3-month follow-up. Findings were robust even when controlling for whether the participant had an undetectable viral load at baseline. Significant reductions were also found in the two secondary psychosocial outcomes, loneliness and sexual compulsivity.

Conclusions

The findings provide preliminary evidence that this intervention may offer an efficient way of concurrently reducing CAS and mental health problems, such as sexual compulsivity and loneliness, for HIV+ gay and bisexual men.

Trial Registration

ClinicalTrials.gov NCT02546271

High risks of HIV transmission for men who have sex with men--a comparison of risk factors of HIV infection among MSM associated with recruitment channels in 15 cities of China

Objective

While the HIV epidemic varies greatly by region and population group throughout China, the HIV incidence among men who have sex with men (MSM) continues to rise at an alarmingly fast pace. We seek to analyze the risk factors associated with HIV infection among MSM recruited from different channels in large urban centers across China, in an attempt to shed light on the design of future targeted intervention strategies.

Methods

A total of 33,684 MSM from 14 cities and one province were recruited from July to December 2011. Demographic (e.g. age, marital status, education) and behavioral (e.g. condom use, HIV testing history) data were collected using information collection cards. Blood samples were also collected to test for HIV and Syphilis.

Results

Participants were recruited from five different channels, and all demonstrated distinct characteristics. The overall rate of positive HIV screening was 6.27% and the rate of syphilis infection was 6.50%. Participants recruited from bathhouses had the highest HIV (11.80%) and syphilis infection rates (11.20%). Participants who were infected with syphilis had the highest HIV-positive screening rate (13.75%; 95% CI OR, 2.33-3.06). living in the southwest region of the country (11.64%; OR=2.76, 95%CI OR 2.19-3.47), Being >20 years of age (P<0.001), living in the southwest region of the country (OR=2.76, 95%CI 2.19-3.47), not having sex with female over the previous 3 months (OR=1.27, 95%CI 1.09-1.48), no condom use during the last anal intercourse (OR=1.54, 95%CI 1.39-1.70) and other factors were all associated with a higher probability of having an HIV-positive test result.

Conclusion

Depending on the way they are recruited, more targeted interventions are required to prevent the spread of HIV/AIDS among MSM with different characteristics and behaviors. Results from this study could provide evidence for researchers to conduct further studies and policy-makers to establish more effective and strategic interventions for MSM in China.

Partner notification among men who have sex with men and heterosexuals with STI/HIV: different outcomes and challenges

Partner notification effectiveness among index clients diagnosed with HIV, syphilis and/or gonorrhoea at sexually transmitted infection (STI) clinics was evaluated between 2010 and 2012. We explored percentages of identifiable, notified and tested partners by sexual preference and gender. Partner notification trends were studied using the national STI database. Men who have sex with men (n = 304), heterosexual men (n = 33) and women (n = 35) reported, respectively, 6.7, 3.8 and 2.3 partners per index. Percentages of identifiable partners differed between groups (men who have sex with men: 46%, heterosexual men: 63%, women: 87%, p < 0.001). The percentage of notified partners (of those identifiable) was lowest for heterosexual men (76%; men who have sex with men: 92%; women: 83%; p < 0.001). STI positivity rates among notified partners were high: 33%-50% depending on sexual preference. Among men who have sex with men, having HIV was associated with not notifying all identifiable partners. Percentages of notified clients at STI clinics increased between 2010 and 2012: from 13% to 19% among men who have sex with men, from 13% to 18% among heterosexual men and from 8% to 11% among women (p < 0.001 for all groups). The percentage of STI/HIV detected through partner notification increased among men who have sex with men (from 22% to 30%) and women (from 25% to 29%; p < 0.001). Unidentifiable partners among men who have sex with men, lower partner notification effectiveness for HIV and the relative large proportion of heterosexual men not notifying their partners appear to be important partner notification challenges.

Understanding internet sex-seeking behaviour and sexual risk among young men who have sex with men: evidences from a cross-sectional study

OBJECTIVE

Internet sex-seeking is common among young men who have sex with men (MSM). However, research examining its association with risky sexual behaviour has produced mixed findings, possibly due to various operational definitions of internet sex-seeking which fail to account for its multi-dimensionality. This study purposed to: (1) examine if the way internet sex-seeking behaviour is operationalised influences its association with risky sexual behaviour (unprotected anal intercourse (UAI) and casual sex) and (2) determine the association of each operational definition with sexual risk.

METHODS

We recruited 263 sexually-experienced young MSM (18-29 years) and operationalised internet sex-seeking behaviour in four ways: (i) ever used the internet to meet other men, (ii) currently own a profile on a website dedicated to meeting other men, (iii) ever physically met a man you initially met online and (iv) ever had sex with a man you met online. Using binomial regression, we examined the association of each operationalisation with UAI and casual sex.

RESULTS

Only MSM who reported physically meeting a man they met online and those who ever had sex with a man they met online were more likely to report a history of UAI (p<0.05), while MSM who engaged in all forms of internet sex-seeking were more likely to engage in casual sex (p<0.05). However, the strength of these associations varied according to the mode of operationalisation.

CONCLUSIONS

The way internet sex-seeking is operationalised in research is differentially associated with sexual risk. Against this backdrop, the utility of these operational definitions in future research and inferences drawn from such research must be interpreted with caution. Findings have important implications for sexual health research and methodology, survey development, sexual health prevention interventions, and evaluating sexual risk among young MSM.

Prevalence of unprotected anal intercourse in men who have sex with men recruited online versus offline: a meta-analysis

Background

Men who have sex with men (MSM) are a high risk population for human immunodeficiency virus (HIV) infection. Our study aims to find whether MSM who were recruited online had a higher prevalence of self-reported unprotected anal intercourse (UAI) than those who were recruited offline.

Methods

A meta-analysis was conducted from the results of published studies. The analysis was stratified by the participants’ geographic location, the sample size and the date of the last reported UAI.

Results

Based on fourteen studies, MSM who were recruited online (online-based group) reported that 33.9% (5,961/17,580) of them had UAI versus 24.9% (2,700/10,853) of MSM who were recruited offline (offline-based group). The results showed that it is more likely for an online-based MSM group to have UAI with male partners than an offline-based MSM group [odds ratio (OR) = 1.35, 95% CI = 1.13-1.62, P < 0.01]. The subgroup analysis results also showed that the prevalence of UAI was higher in the European subsample (OR = 1.38, 95% CI = 1.17-1.63, P < 0.01) and in sample sizes of more than 500 individuals (OR = 1.32, 95% CI = 1.09-1.61, P < 0.01) in the online group compared to the offline group. The prevalence of UAI was also significantly higher when the time of the last UAI was during the last 3 or more months (OR = 1.40, 95% CI = 1.13-1.74, P < 0.05) in the online group compared to the offline group. A sensitivity analysis was used to test the reliability of the results, and it reported that the results remained unchanged and had the same estimates after deleting any one of the included studies.

Conclusions

A substantial percentage of MSM were recruited online, and they were more inclined to engage in UAI than MSM who were recruited offline. Targeted interventions of HIV prevention programs or services are recommended when designing preventive interventions to be delivered via the Internet.

The GAy MEn Sex StudieS: design of an online registration of sexual behaviour of men having sex with men and preliminary results (GAMESSS-study)

BACKGROUND

There has been limited investigation of the sexuality and sexual dysfunction in homosexuals by the sexual medicine community. The purpose of this article is to describe the methodology of the online GAy MEn Sex StudieS (GAMESSS) on the sexual behaviour and sexual dysfunctions of Belgian men who have sex with men (MSM).

AIM

To describe the methodology of an online study that investigate sexual behaviour and sexual function and dysfunction in a sample of Belgian MSM.

METHODS

An internet-based survey on sexual behaviour and sexual dysfunctions was administered to MSM between April and December 2008. The questionnaire was a compilation of the Kinsey Scale for Sexual Orientation, the Index of Premature Ejaculation (IPE), the Erection Quality Scale (EQS), the Female Sexual Function Index (FSFI), the Brief (Male) Sexual Function Inventory (BSFI) and the Gay Men Sexual Addiction Screening Test (G-SAST). The analytic sample comprised 1,830 Belgian men aged 18 years or older, who reported having sex with men.

CONCLUSION

The use of an online questionnaire is a convenient way to gather information from a hidden population such as MSM. The anonymity of the participants is guaranteed. The collected data can be easily analyzed. With this online study, we aim to detect variables in sexual behaviour (SB) and sexual dysfunction (SD) that can help to improve care for MSM. Belgian MSM have a very active and varied sex life. They are rather promiscuous and do not always practice safe sex. This behaviour poses a high risk of spreading sexually transmitted diseases. Additional research in this MSM population is needed.

Effects of Internet popular opinion leaders (iPOL) among Internet-using men who have sex with men

Background

The Internet has become a popular venue for facilitating sex networking for men who have sex with men (MSM).

Objective

The study aimed to evaluate the effectiveness of Internet popular opinion leaders (iPOL) in disseminating information about the human immunodeficiency virus (HIV), increasing the frequency of HIV testing, and reducing risky behaviors among MSM in Taiwan.

Methods

A quasi-experimental study with a nonequivalent control website for comparison was used to estimate the effectiveness of iPOL. A community-level intervention, iPOL, was conducted at the Facebook social networking website and at top1069 as a control. The iPOLs actively disseminated HIV-related information via the platform of Internet opinion leaders and AIDS information center, and discussed and responded to questions or replied to Internet-using MSM.

Results

A total of 369 iPOLs posted 432 articles and 503 replies to others, influencing 959,088 persons on Facebook. A total of 1037 MSM, 552 (53.23%) from an intervention website and 485 (46.76%) from a control website, participated in the follow-up study survey (response rate 96%). At the 6-month follow-up after the intervention was conducted, MSM who visited the intervention website were more likely to receive HIV-related information (25.49% versus 10.47%, P<.001), discuss HIV issues with others (41.88% versus 23.79%, P<.001), review articles about HIV (90.58% versus 79.73%, P<.001), and be asked about or discuss HIV-related questions (51.11% versus 31.78%, P<.001) than those on the control website. In addition, MSM were more likely to have HIV tests within 6 months (43.89% versus 22.31%, P<.001) and consistently use condoms during anal sex with online sex partners than those using the control website (34.15% versus 26.19%, P=.004).

Conclusions

The study showed the feasibility and effectiveness of the iPOL intervention as an online HIV prevention program. These findings underscore the importance of disseminating HIV information online, as well as the challenges inherent in the efforts of iPOL to reduce HIV-related risky behaviors among Internet-using MSM.

Online sex-seeking, substance use, and risky behaviors in Taiwan: results from the 2010 Asia Internet MSM Sex Survey

We conducted an online behavioral survey to estimate the prevalence of online sex-seeking and substance use behaviors and to compare risky behaviors among men using different venues to seek sex with men. A cross-sectional online survey, the Asia Internet MSM Sex Survey, was conducted online from January 1 to February 28, 2010. Of the 1,645 participants enrolled from Taiwan, 72.4% reported the Internet as the main way of seeking sexual partners, 73.9% had had sex with partners found online, and 16% had used recreational drugs in the previous 6 months. There was no evidence to suggest that men who looked for sex through the Internet were more likely to engage in unprotected anal intercourse with their casual partners than those using other gay venues. Having had online sex partners in the previous 6 months was significantly associated with being young [adjusted odd ratio (AOR) = 0.97, 95% CI: 0.95-0.99], having had no steady partners in the previous year (AOR = 0.24, 95% CI: 0.15-0.39), having had more than five partners in the previous 6 months (AOR = 4.57, 95% CI: 2.95-7.11), having used recreational drugs in the previous 6 months (AOR = 2.24, 95% CI: 1.30-3.87), and having had an STI in the previous 6 months (AOR = 4.24, 95% CI: 1.59-11.30). In conclusion, because the Internet is a popular meeting place for MSM in Taiwan, effective and targeted prevention programs should be developed to minimize the HIV transmission risk in the Internet era.

HIV Sexual Risk Behavior and Health Insurance Coverage in Men Who Have Sex with Men

Research on the association between health insurance coverage and sexual risk behavior among men who have sex with men (MSM) is sparse. We hypothesized that MSM with health insurance would be less likely to engage in risky sexual behavior based on previous research showing that insured persons increase contact with providers which can improve health knowledge, decrease tendency to engage in unhealthy behaviors, and raise awareness about health risks. As part of a study testing an online HIV prevention intervention, we collected information on health insurance and sexual behavior from MSM (n=650). Overall, men with health insurance had a 28% reduced prevalence of unprotected anal intercourse male partners (UAIMP) in the 90 days prior to the survey. Potential explanations include access to healthcare providers and awareness of sexual health. Additional research is needed to identify the mechanism through which health insurance is protective.

HIV testing, gay community involvement and internet use: social and behavioural correlates of HIV testing among Australian men who have sex with men

A significant minority of Australian men who have sex with men (MSM) have never been tested for HIV and many men do not test as often as recommended. Using data from 1770 HIV-negative and untested MSM collected in a national, online survey, we compared men who had never tested for HIV with those who had tested over 12 months ago and men who had tested over 12 months ago with those that had tested in the past year. Two multivariate logistic regression models were constructed. Compared with men tested over 12 months ago, untested men were younger, less educated, less likely to have unprotected anal intercourse with a regular male partner, less likely to have sought advice from a doctor, nurse or community organisation, more likely to expect HIV-negative disclosure, had fewer gay friends and spent more time using social networking websites. Compared with men who had tested over 12 months ago, men who had tested within the last year were younger, more likely to expect HIV-negative disclosure and disclose to casual partners, more likely to have sought advice from a doctor or nurse, had attended gay pools, gyms or beaches and had more gay friends and more male sex partners. Our findings suggest that the Internet and sex education in schools are important ways to promote HIV testing to untested MSM. Testing reinforcement messages delivered through gay community outreach and primary care will reach previously tested MSM.

Predictors of HIV disclosure among untested, HIV-negative and HIV-positive Australian men who had anal intercourse with their most recent casual male sex partner

We analysed HIV disclosure between Australian men who have sex with men (MSM) who reported anal intercourse with their last casual male partner. Of 804 MSM included in the analysis, 413 reported HIV disclosure and 391 reported no disclosure. After identifying bivariate associations with HIV disclosure, we developed three models of HIV disclosure (one for untested, one for HIV-negative and one for HIV-positive MSM). A range of factors was found to be associated with HIV disclosure. Having previously had sex with the last casual male partner and expecting HIV-negative and HIV-positive men to disclose before sex were predictors of HIV disclosure shared by more than one serostatus group. As unprotected anal intercourse was more common among MSM who disclosed (across all serostatus groups), we suggest caution should be exercised before encouraging HIV disclosure as a prevention strategy. Nondisclosure remains more strongly associated with safe sex among Australian MSM.

Using the Internet in Pursuit of Public Sexual Encounters

The current study investigated a subgroup of 112 men who have sex with men who use the Internet in search of partners for sex venue encounters to understand what types of venues they frequent and whether their behaviors are associated with an increased risk of HIV/STI transmission. An initial cluster analysis revealed two patterns of Internet use—low and high frequency—among these men. Although frequency of Internet use to find partners for venue encounters did not cluster with venue attendance, there was a trend among high-frequency Internet users to attend gyms, public bathrooms, and sex clubs more than low-frequency users. Furthermore, high-frequency users attended more venues, preferred venues where multiple partners can be found, and were marginally more likely to engage in unprotected anal sex across venues compared with low-frequency users. Knowing that some venue users initiate venue encounters on the Internet may be useful in targeting appropriate HIV/STI interventions.

When do online sexual fantasies become reality? The contribution of erotic chatting via the Internet to sexual risk-taking in gay and other men who have sex with men

Seeking sexual partners online is associated with sexual risk-taking among men who have sex with men (MSM), but it is not well understood how this use of the Internet is implicated in potential sexual risks. The present study explores whether fantasizing about unprotected anal intercourse (UAI) during online chatting is associated with UAI with partners met online. An online survey of 2058 MSM in France included assessments of UAI with partners met online, responses to erotic chatting about UAI, intentions to use condoms, attitudes regarding UAI, practicing UAI with casual partners, alcohol and drug use with sex and biographical characteristics. While intentions to use condoms with casual partners were high, one-third (32.1%) of respondents reported UAI with partners met online. Responding positively to online chatting about UAI was significantly associated with UAI with partners met online, controlling for intentions, attitudes, behavior and biographic characteristics. These findings suggest that, while MSM may not go online to seek UAI, some engage in online fantasizing about UAI that is associated with possible sexual risk-taking. This speaks critically to the assumption that online fantasizing has no behavioral implications, and underscores the importance of human immunodeficiency virus prevention that addresses the dynamics of online chatting.

Central and East European migrant men who have sex with men in London: a comparison of recruitment methods

Background

Following the expansion of the European Union, there has been a large influx of Central and East European (CEE) migrants to the UK. CEE men who have sex with men (MSM) represent a small minority within this population that are none-the-less important to capture in sexual health research among the CEE migrant community. This paper examines the feasibility of recruiting CEE MSM for a survey of sexual behaviour in London using respondent driven sampling (RDS), via gay websites and in GUM clinics.

Methods

We sought CEE MSM to start RDS chain referral among GUM clinic attendees, our personal contacts and at gay events and venues in central London. We recruited CEE MSM (n = 485) via two popular websites for gay men in Britain (March-May 2009) and at two central London GUM clinics (n = 51) (July 2008-March 2009).

Results

We found seventeen men who knew other CEE MSM in London and agreed to recruit contacts into the study. These men recruited only three men into the study, none of whom recruited any further respondents, and RDS was abandoned after 7 months (July 2008-January 2009). Half of the men that we approached to participate in RDS did not know any other CEE MSM in London. Men who agreed to recruit contacts for RDS were rather more likely to have been in the UK for more than one year (94.1% vs 70.0%, p = 0.052). Men recruited through gay websites and from GUM clinics were similar.

Conclusions

The Internet was the most successful method for collecting data on sexual risk behaviour among CEE MSM in London. CEE MSM in London were not well networked. RDS may also have failed because they did not fully understand the procedure and/or the financial incentive was not sufficient motivation to take part.

A relative profile of HIV-negative users of French websites for men seeking men and predictors of their regular risk taking: a comparison with HIV-positive users

The Net Gay Barometre is a biennial survey among users of France's most popular websites for men who have sex with men (MSM). Given the recent increases in HIV infection and sexual risk practices among French MSM, this study aims to: (1) create a socio-sexual profile of HIV-negative men (HIV-); (2) identify predictors of regular unprotected anal intercourse (RUAI) in this group, and responding to a call for stratifying analyses of online samples of MSM by HIV status; and (3) perform the former two aims by comparing HIV- men with HIV-positive men (HIV+). Statistical analyses were conducted with 11,771 HIV- men and 2130 HIV+ men who completed the online survey between December 2008 and March 2009. Regarding the first aim, fewer HIV- men, relative to HIV+ men, were exposed to factors conducive to sexually transmitted infection; in the previous 12 months, smaller proportions of this group had gone to venues where sexual encounters were possible, engaged in an esoteric sexual activity, had a high number of casual partners, and practiced unprotected anal sex, RUAI or barebacking. However, multivariate regression analyses identifying predictors of RUAI in each group revealed common predictors: sensation-seeking, esoteric activities, oral contact with sperm, and barebacking (in a couple), although odds were generally higher in HIV+ men. Our findings raise the possibility of a sexual culture accentuating pleasure and adventurism that may gain in amplitude once seroconversion takes place.

Mr. Right and Mr. Right Now: romantic and casual partner-seeking online among young men who have sex with men

Dating is a normative behavior for youth, yet few studies have examined the relationship between romantic partner-seeking and sexual behavior among young men who have sex with men (YMSM). This omission is most notable across studies examining YMSM's partner-seeking behaviors online. In this study, we examined the relationship between sexual behaviors and online partner-seeking behaviors for casual and romantic partners in a sample of YMSM (N = 431; M = 21.49 years old, SD = 1.94) who reported using the Internet to meet other men. Using analysis of covariance (ANCOVA), we found YMSM in the High Romantic/High Casual group had more unprotected partners than YMSM in other categories. YMSM in the High Romantic/Low Casual group had fewer unprotected partners than the High Romantic/High Casual group. We discuss the implications of our findings and conclude that there is a need to further examine romantic partner-seeking among YMSM.

First same-sex partner and the internet

The present study examined the first episode of anal intercourse of young gay and bisexual men (YGBM) who were in the midst of their coming-out. Cross-sectional data regarding the first episode of anal intercourse were extracted from Outcomes, a longitudinal study on coming-out and sexual behavior of YGBM in the Netherlands. Overall, 45% of respondents reported unprotected anal intercourse (UAI) with their first same-sex partner. Rates of UAI did not significantly differ between meeting place (offline vs. online) and partner status (steady, regular or casual).

An exploratory study of Muslim adolescents' views on sexuality: Implications for sex education and prevention

BACKGROUND

This paper describes the results of an exploratory qualitative study on Muslim adolescents' views on sexuality in the Netherlands.

METHODS

Data were gathered from an Internet forum on which 44 Muslim and 33 non-Muslim adolescents discussed sexuality as it relates to Islam. These discussions were subsequently analyzed for content using Nvivo 2.0.

RESULTS

Our analysis revealed several issues that are relevant for the design of future sex education programs targeting Muslim youth. Apart from some expected outcomes regarding, for example, taboos on sexuality, sex outside marriage, abortion, homosexuality and conservative gender roles, our analyses showed that in cases of disputes 1) discussions were polarized, 2) opponents used the same Qur'anic passages to support their views, and 3) the authority of an Imam was questioned when his interpretation of Qur'anic passages was not in line with the views of participants.

CONCLUSIONS

Our findings show that current approaches to sex education among Muslim youth are likely to be unsuccessful given the rigidity of sexual norms in Muslim society. In addition, we also identified new barriers to sex education among Muslim youth (e.g. lack of respect for an Imam who opposes a youth's views on sexuality).

A pilot intervention utilizing Internet chat rooms to prevent HIV risk behaviors among men who have sex with men

OBJECTIVES

Chat room-based prevention interventions for human immunodeficiency virus (HIV) are being implemented to reduce the risk of HIV exposure, infection, and re-infection among men who have sex with men (MSM).

METHODS

Our community-based participatory research partnership implemented a chat room-based intervention known as Cyber-Based Education and Referral/Men for Men (CyBER/M4M). We collected both quantitative and qualitative data to describe the characteristics of chat-room participants ("chatters") and their HIV risks and prevention needs, and to document intervention delivery.

RESULTS

Of the 1,851 chatters who participated in the 18-month intervention, 210 completed the online assessment. The mean age was 30 years. Although the majority self-identified as gay, 25.8% self-identified as bisexual. More than half self-identified as white and one-third as black or African American. A total of 8.6% reported being HIV-positive and 14.8% reported never having been tested for HIV. Grounded theory analysis of transcripts from chat-room instant-message discussions identified 13 thematic categories related to chatter characteristics, prevention needs, and intervention delivery. Chatters were looking for sexual partners, were not open about their orientation, lacked basic information about HIV, had questions about how to be tested, and perceived a lack of general community resources to meet their needs. Furthermore, CyBER educators had to understand and respect the online culture, build trust, and deliver well-crafted and focused messages.

CONCLUSIONS

Chat room-based interventions hold promise to systematically reach Internet communities of MSM, a group that is particularly at risk for infection with HIV and other sexually transmitted diseases.

Sexual Risk Behaviors with Female and Male Partners Met in Different Sexual Venues Among Non-Gay-Identified, Non-Disclosing MSMW

Despite considerable interest in the sexual behavior of non-disclosing men who have sex with men and women (MSMW), little is known about where they meet their male and female partners and whether their sexual risk behavior differs with partners met in different sexual venues (e.g., bars, Internet, parks). These issues were examined among 46 non-gay-identified MSMW who had not disclosed their same-sex behavior to female partners (i.e., men on the "down low"). The prevalence of unprotected vaginal sex was nearly identical with women met in bars/clubs as with women met through friends, work, or the neighborhood. In contrast, the prevalence of unprotected anal sex was higher with male partners met on the Internet, in bars/clubs, and through friends/work/neighborhood as compared with partners met in parks/restrooms or gyms. This is largely due to MSMW avoiding anal sex in parks, restrooms, and gyms, in favor of oral sex. These findings provide important insights into the role of venues on sexual risk and the locations where risk reduction interventions for MSMW may be provided.

First anal intercourse and condom use among men who have sex with men in Switzerland

The aim of this study was to analyze the circumstances of first anal intercourse (FAI) among men who have sex with men (MSM) and to identify factors associated with condom use at this event. We conducted a cross-sectional survey among a convenience sample of MSM living in Switzerland (N = 2,200). Anonymous questionnaires were distributed using Swiss gay communication channels (newspapers, associations, websites) and gay bathhouses. We gathered data on age at FAI, age of the partner, degree of familiarity with him, place of first meeting, and sociodemographic indicators. We did not ask whether FAI was insertive, receptive, or both. Data were stratified by birth year classes (birth cohorts). The median age at FAI fell from 24.5 years among men born before 1965 to 20.0 years among those born between 1975 and 1984 (p < .001). In each birth cohort, between 20 and 30% reported a partner 10 years older or more. Of eight variables examined in multivariate analysis, two were positively associated with condom use: age of participants at FAI and low degree of familiarity between partners. Conversely, large age discrepancy between partners was negatively associated with condom use. In conclusion, our data showed that early initiation of anal intercourse and large age discrepancy were associated with risk taking: a pattern of initiation that may facilitate HIV transmission from older to younger cohorts of MSM. Since age at FAI is on the decrease, there is an urgent need to heighten awareness of prevention actions regarding sexual debut of MSM.

HIV sexual risk behavior by men who use the Internet to seek sex with men: results of the Men's INTernet Sex Study-II (MINTS-II)

This study sought to identify the magnitude of HIV risk in a diverse sample of Men who use the Internet to seek Sex with Men (MISM), and test if specific subpopulations are at sufficiently increased risk to warrant tailored interventions. A sample of 2,716 American MISM, stratified by race/ethnicity, completed an Internet survey of online and offline sex seeking behavior during the last 3 months. Across most demographics, a minority of MISM reported unprotected anal intercourse with male partners (UAIMP). Across all demographics, risk of UAIMP substantially increased with partners met online. Other predictors of increased online partner risk include being 30-39 years old, having children, not living in the Northeast, and low income. HIV-positive men and African Americans reported increased online and offline partner risk. To address higher risk of UAIMP, online HIV interventions should prioritize the needs of MISM, especially HIV-positive men, with content focused on online-mediated liaisons.

Sexual coercion among gay and bisexual men in Aotearoa/New Zealand

Until recently, sexual coercion among gay men has been regarded as virtually oxymoronic. Discourses of male sexuality as ever-present and driven, and discourses of masculinity that portray men as in control and invulnerable, converge to almost disavow the possibilities that sex could be unwanted by men, or that men could be vulnerable to being pressured into sex against their will. This article reports on interviews with 19 gay and bisexual men about their experiences of forced, coerced, or unwanted sex. We identified four general patterns in these accounts: (1) incidents involving physical force; (2) experiences in which a man's ability to refuse sex was compromised by intoxication; (3) dynamics where young and inexperienced men were coerced or pressured into unwanted sex; and (4) situations in which men felt obligated to engage in unwanted sex. Specific issues included barriers to reporting sexual assault, power dynamics in intergenerational sex, and the difficulty of refusing unwanted sex. Importantly, many of the factors identified as driving sexual coercion relate not to gay sexuality per se, but rather to masculine sexuality. Conversely, some of the factors relating to men's vulnerability to coercion were exacerbated by some features of gay sexual culture; in particular those aspects associated with existing in a marginalized territory within a wider heteronormative context.

Frequent and systematic unprotected anal intercourse among men using the Internet to meet other men for sexual purposes in France: results from the "Gay Net Barometer 2006" survey

For men who have sex with men (MSM), the Internet has imposed itself in the past decade as the place to be to meet other men with similar interests for sex or just to surf in search of excitement. This is a biennial study on the MSM in France. Between December 2005 and February 2006, 15,085 MSM completed an online questionnaire on their social and sexual uses of the Internet. Participants in the "The Gay Net Barometer 2006" study responded to questions related to their sexual and sexual risk behaviours. One third of respondents reported at least one event of unprotected anal intercourse while 11.1% reported frequent or systematic unprotected anal intercourse. These sexual risk behaviours were associated with various sociodemographic and sexual variables in addition to the recruitment website. The study suggests Internet users are not a homogeneous group and intervention targeting of them should be based on an in-depth understanding of the sexual cultures operating within websites.

Circuits, networks, and HIV risk management

Drawing on a survey of men who have sex with men conducted at Toronto's largest gay and lesbian event (N = 947), this study examines the characteristics of men who report that they like to participate in the "bareback scene" and cruise "bareback Web sites" by comparing them with men who (a) report having had at least one incident of unprotected anal intercourse but no bareback connections, or (b) report consistently protected anal intercourse (UAI). Overall, 62.0% of the surveyed men reported having had a casual male partner in the last 6 months, 14.2% of whom reported having had UAI. Including these men, with men who report UAI with or without ejaculation, with casual or regular partners, accounts for 40.6% of the sample. MSM in bareback scenes or Web sites form a circuit insofar as they are significantly overrepresented in a set of bars, baths, parks, and Web sites, that aligns closely with one of the circuits identified in a factor analysis of venues attended by men in the sample. They also show a distinctive pattern of beliefs and perceptions of appropriate norms for sexual conduct, and are more likely to have had five or more partners in the last 6 months.

The Internet, HIV serosorting and transmission risk among men who have sex with men, San Francisco

In a community-based, time-location sampling survey in San Francisco, Internet-met partners were not more likely to be HIV seroconcordant among HIV-negative and HIV-positive men who have sex with men (MSM) compared with partners met at bars and dance clubs. In addition, HIV-negative MSM were more likely to have unprotected anal intercourse with potentially serodiscordant partners met on the Internet compared with those met at bars and dance clubs (adjusted OR 1.5, 95% CI 1.1-2.0, P = 0.01).

Web-based HIV/AIDS behavioral surveillance among men who have sex with men: potential and challenges

With more men who have sex with men (MSM) seeking sexual partners through the Internet, the Internet has been characterized as a newly emerging risk environment for HIV transmission. Meanwhile, the flourishing of gay websites provides a good opportunity for health professionals to conduct systematic HIV/AIDS behavioral surveillance among MSM. Effective methods to recruit online MSM users have been developed, and online surveys have suggested many practical advantages over surveys in the traditional gay community. Although surveys among MSM via the Internet have a few limitations and risks, online surveillance can still be viewed as a feasible and convenient approach, especially in countries where the HIV/AIDS epidemic is concentrated in high-risk populations and where the conducting of such surveillance in traditional gay venues is difficult.

Men who have sex with men in Great Britain: comparison of a self-selected internet sample with a national probability sample

OBJECTIVES

To compare the characteristics of a self-selected, convenience sample of men who have sex with men (MSM) recruited through the internet with MSM drawn from a national probability survey in Great Britain.

METHODS

The internet sample (n = 2065) was recruited through two popular websites for homosexual men in Great Britain in May and June 2003. This sample was compared with MSM (n = 117) from the National Survey of Sexual Attitudes and Lifestyles (Natsal), a probability sample survey of adults resident in Great Britain conducted between May 1999 and February 2001.

RESULTS

No significant differences were observed between the samples on a range of sociodemographic and behavioural variables (p>0.05). However, men from the internet sample were younger (p<0.001) and more likely to be students (p = 0.001), but less likely to live in London (p = 0.001) or report good health (p = 0.014). Although both samples were equally likely to report testing for HIV, men from the internet sample were more likely to report a sexually transmitted infection in the past year (16.9% v 4.8%, adjusted odds ratio 4.14, 95% CI 1.76 to 9.74; p = 0.001), anal intercourse (76.9% v 63.3%; p = 0.001) and unprotected anal intercourse in the past 3 months (45% v 36.6%; p = 0.064).

CONCLUSIONS

The internet provides a means of recruiting a self-selected, convenience sample of MSM whose social and demographic characteristics are broadly similar to those of MSM drawn from a national probability survey. However, estimates of high-risk sexual behaviour based on internet convenience samples are likely to overestimate levels of sexual risk behaviour in the wider MSM population.

Changes in HIV prevalence and sexual behavior among men who have sex with men in a northern Chinese city: 2002-2006

OBJECTIVE

To examine HIV prevalence and sexual behavior changes among MSM in Harbin.

METHODS

Three community-based cross-sectional surveys among MSM were conducted based on the same protocol and methodology in 2002, 2004 and 2006 in Harbin, China. Men who were eligible were interviewed with a standard questionnaire. Urine samples were collected to screen their HIV status.

RESULTS

Among the MSM in Harbin, an increased trend was observed towards more self-identifying as homosexual (from 58% to 80%) and more living with a male partner (from 12% to 41%) over the study period. Although there was a trend towards a reduction in the rate of never using a condom and an increase in the rate of always using condoms during anal sex in the past six months, the prevalence of unprotected anal intercourse (UAI) was still at a high level (from 90% in 2002 to 72% in 2006). The HIV prevalence in 2006 (2.2%, 15/674) was higher than that in other study years, but no statistically significant change was detected.

CONCLUSIONS

Although an increase in condom use and a decline in drug use, STD infection and commercial sex have been monitored under current HIV prevention strategies, the MSM in Harbin is still highly vulnerable to HIV transmission given a high level of UAI and an increasing number of male sexual partners over the study period.

Social-cognitive determinants of HIV risk-taking intentions among men who date men through the Internet

The present study was set up to investigate social-cognitive determinants of HIV-risk precautionary intentions among men who have sex with men (MSM), who meet sex partners on the Internet. Participants were enrolled through the major gay chat room in The Netherlands, www.chatboy.nl, and were asked to complete an online questionnaire. Theory of Planned Behaviour variables attitude, subjective norm, and perceived control explained 55% of the variance in intention to use condoms for anal sex with future e-dates. Adding descriptive norm, personal norm and anticipated regret explained 70%. Sexual fantasies and HIV-status had unique effects on intentions. Differences between high and lower intenders are presented. Limitations of the study are discussed and objectives for an intervention to promote condom use are given.

Tip of the Iceberg: young men who have sex with men, the Internet, and HIV risk

OBJECTIVES

We examined the prevalence of Internet use for meeting sexual partners (Internet partners) and HIV risk behaviors associated with this use among young men who have sex with men (aged 16-24 years).

METHODS

A sample of 270 young men who have sex with men completed a computer-assisted survey. We used bivariate chi(2) analyses and hierarchical logistic regression to assess factors associated with Internet-facilitated sexual encounters.

RESULTS

Using the Internet to meet sexual partners was common; 48% of our sample had sexual relations with a partner they met online. Of these, only 53% used condoms consistently, and 47% reported having sexual partners older (>4 years) than themselves. Regression analyses showed increased age, White race/ethnicity, history of unprotected anal intercourse, multiple anal intercourse partners, and engaging in sexual activity at a sex club or a bathhouse were associated with meeting sexual partners through the Internet. Only history of unprotected anal intercourse was associated with risky sexual behaviors with Internet partners (P<0.025).

CONCLUSIONS

Young men who have sex with men and who seek partners online also engage in other behaviors that place them at risk for HIV and other sexually transmitted infections.

Using the Internet to find offline sex partners

We aimed to expand upon the demographic characteristics and gender differences among those who have met someone on the Internet who they later met offline and had sex with as well as any relationship with cybersex, sexually transmitted infections, and online sexual problems. We analyzed data collected through an online questionnaire in 2002 in Sweden including a total population of 1836 respondents of which 1458 used the Internet for sexual purposes. Of those, 35% men and 40% women reported to have met offline sex partners online. The majority reported an occurrence of one to two times, whereas 10% reported six or more times. The analysis suggested women aged 34-49 and 50-65 years, homo- and bisexual men, and singles more likely to have this experience. They were also more likely to have engaged in cybersex. No relationships were found with sexually transmitted infections or online sexual problems. The results suggest that using the Internet to find sex partners may be less hazardous for the general Internet users than pointed out by prior research about this behavior often focusing on specific sub groups of Internet users.

The effectiveness of individual-, group-, and community-level HIV behavioral risk-reduction interventions for adult men who have sex with men: a systematic review

This article presents the results of a systematic review of the effectiveness and economic efficiency of individual-, group-, and community-level behavioral interventions intended to reduce the risk of acquiring sexually transmitted HIV in adult men who have sex with men (MSM). These results form the basis for recommendations by the Task Force on Community Preventive Services on the use of these interventions. Sexual risk behavior and condom use were the outcomes used to assess effectiveness. Intervention effectiveness on biological outcomes could not be assessed because too few studies of adequate quality have been published. The evidence found in our review shows that individual-level, group-level, and community-level HIV behavioral interventions are effective in reducing the odds of unprotected anal intercourse (range 27% to 43% decrease) and increasing the odds of condom use for the group-level approach (by 81%). The Task Force concluded that the findings are applicable to MSM aged 20 years or older, across a range of settings and populations, assuming that interventions are appropriately adapted to the needs and characteristics of the MSM population of interest. Based on findings from economic evaluation studies, the Task Force also concluded that group- and community-level HIV behavioral interventions for adult MSM are not only cost effective but also result in actual cost savings. Additional information about other effects, barriers to implementation, and research gaps is provided in this paper. The recommendations based on these systematic reviews are expected to serve the needs of researchers, planners, and other public health decision makers.