HIV-positive gay men in London use the internet to meet other HIV-positive men for unprotected anal sex, according to a study published in the June 10th edition of AIDS. The study also revealed that gay men were no more likely to meet casual partners of unknown or different HIV status for unprotected anal sex on-line rather than off-line.
"Gay men are increasingly using the internet to look for sex", write the investigators from the City University in London. Earlier studies have shown that gay men seeking sex through the internet are more likely to have had a sexually transmitted infection and to have engaged in sexual behaviours which involve a risk of the transmission of HIV or a sexually transmitted infection. A previous study has also indicated that HIV-positive gay men who looked for sex through the internet were more likely to have had unprotected anal sex with another HIV-positive man.
These earlier studies were not, however, able to establish if the men were having unprotected sex with men they had actually met on-line. "Unravelling the nature of the association between seeking sex on the internet and high risk sexual behaviour is essential for developing effective on-line interventions", note the investigators.
Accordingly, the investigators examined whether there was an increased risk of gay men having unprotected sex with partners they met on-line compared to partners they met off-line.
Four samples of gay men were recruited to the study. These samples were:
- Gay men using internet chatrooms or profiles on gay.com or gaydar.co.uk.
- HIV-positive men attending a specialist HIV out-patient clinic.
- Gay men attending for an HIV test.
- Gay men using gyms in central London.
Recruitment to the study took place in 2002 and 2003. All the men completed a questionnaire enquiring about their age, ethnicity, education, relationship status, sexual orientation, HIV status, how optimistic they felt about HIV treatment, drug use and history of sexually transmitted infections. HIV-positive men were asked to say if they were taking HAART, what their viral load was, and if they disclosed their HIV status to their casual sexual partners.
The men were also asked to say if they had had unprotected anal sex in the previous three months, if this was with a casual or main partner, and what the HIV status of this partner was.
Unprotected anal sex was concordant if the partner was of the same HIV status, and non-concordant if the partner was of a different or unknown status.
Men who said they used the internet to seek sex were asked whether they had had unprotected anal sex with a man they had met through the internet in the previous three months and if so, with how many individuals. Unprotected sex with casual partners met on the internet was classified as concordant or non-concordant.
All the men were also asked if they had had unprotected anal sex during the previous three months with a man they had met off-line (in a setting such as a bar, club, or sauna), and if so, with how many individuals. Unprotected anal sex with men met off-line was classified as concordant or non-nonconcordant.
A total of 4015 men completed the questionnaires.
Internet use
In all samples, the vast majority of men (86 – 99%) had internet access. Amongst the clinic samples, 43% of HIV-positive men and 46% of HIV-negative men had used the internet to look for sex.
Overall, just over half (52%) of men recruited at the gym had used the internet to look for sex, but there were significant differences in the gym samples according to HIV status. Three quarters of HIV-positive men used the internet to find sex compared to 51% of HIV-negative men and 36% of never tested men (p
Unsurprisingly, 90% of men in the internet sample said they used the internet to look for sex.
A large number of men in all samples (76 – 97%) who looked for sex using the internet also said that they looked for sex off-line.
Unprotected anal sex
HIV-positive men in the clinic and gym samples who used the internet to look for sex were significantly more likely to report unprotected anal sex with men of the same HIV status than other men (p
The investigators also established that in both the clinic and gym samples, HIV-positive and HIV-negative men who used the internet to find sex were more likely to report non-concordant unprotected anal sex with a casual partner than other men (p
Where internet sex seekers met their casual unprotected sex partners
In all samples, HIV-positive men who looked for sex through the internet were significantly more (p
What’s more, the investigators found that amongst the HIV-positive clinic sample, men said that they were more likely to disclose their HIV status to men met on-line (24%) than men met off-line (14%, p
Non-concordant unprotected sex
There was no evidence that gay men, whether HIV-positive, negative or untested, were more likely to meet partners for discordant unprotected anal sex on-line rather than off-line. For example, among HIV-negative men in the internet sample, 10% reported non-concordant unprotected anal sex with men met on-line only, 11% with men met off-line only, and 6% with men met on- and off-line. "In fact," note the investigators, "for HIV-negative men in the clinic and gym samples, the reverse pattern was seen; they were more likely to report non-concordant unprotected anal sex with a casual partner met off-line."
"What is new about this study is that we can establish whether the excess risk of HIV and sexually transmitted infections seen among gay men who looked for sex through the internet actually occurred with the men they met on-line", write the investigators.
"In our study, HIV-positive men who looked for sex through the internet were more likely to meet other HIV-positive men with whom they had (concordant) unprotected anal intercourse on-line rather than off-line ", note the investigators. They add "Men who looked for sex through the internet were no more likely to meet their non-concordant unprotected anal intercourse partners on-line than off-line. This was seen for HIV-positive, HIV-negative and never-tested men alike."
The investigators suggest that the internet may provide a safe space for HIV-positive men to disclose their health status, thus facilitating "filtering" or "serosorting’ of sexual partners.
"Our findings have allowed us to better understand the association between seeking sex on the internet and sexual behaviour among gay men…[it] provides a foundation on which to build and evaluate internet-based interventions among gay men in London and other major metropolitan areas with large gay communities", conclude the investigators.
Bolding G et al. Gay men who look for sex on the internet: is there more HIV/STI risk with on-line partners? AIDS 19: 961 – 968, 2005.