Over 90% of gay men using the internet to seek sexual partners are supportive of some form of online partner notification, or referral to sexual health resource, to inform them of a sexual health risk, according to a large US study published in the February edition of Sexually Transmitted Diseases.
Online partner notification was less acceptable to HIV-positive men. The investigators suggest a number of reasons why this might be the case, including fears about confidentiality and the criminalisation of HIV exposure in some jurisdictions, or a greater willingness on the part of HIV-infected men to inform their partners directly about potential exposures.
Gay men remain one of the groups most affected by HIV and evidence from Europe, the US and Australia shows that rates of many sexually transmitted infections are increasing amongst gay men.
There is therefore a continuing need for appropriate HIV and sexual health information to be targeted at gay men. Partner notification has long been an integral part of sexual health services. But uptake of partner notification amongst gay men is historically low for a number of reasons, not least because gay men’s sexual partners are often anonymous, or because gay men feel stigmatised by sexual health providers.
Large numbers of gay men use the internet to seek sexual partners. There is some evidence that the men who do so have a high prevalence of risky sexual behaviours.
A chat-room on a gay website was successfully used for partner notification after an outbreak of syphilis in San Francisco. Investigators from the Harvard School of Public Health therefore wished to determine the acceptability of online partner notification amongst gay men who use the internet to seek sex.
In October 2005 1848 gay men were recruited to a study via a banner advertisement on a popular gay men’s sex-seeking site. The men provided demographic information, details of their HIV infection status, sexual health history, and answered questions about the acceptability of online partner notification and the provision of sexual health information.
The men were aged between 18 and 70 (mean, 36 years), 83% were white, and just over 50% were college educated. Twenty percent of the men said they were HIV-positive, 70% HIV-negative and 10% did not know their HIV status. A total of 35% of men reported a history of sexually transmitted infections.
Most men said that they would be willing to use the internet for some form of partner notification. The most acceptable service was a website providing sexual health information that was linked to from an email from the health department informing me of a potential exposure to an infection. Some 90% of HIV-negative men and 70% of HIV-positive men said that they would access such a website.
But only a third of HIV-negative men and 27% of HIV-positive men said that they would use the health department to contact their sexual partners by email.
HIV-positive men were significantly less likely than HIV-negative men to use partner notification services than HIV-negative men, but were more likely to notify their sexual partners directly of a potential sexual risk.
Men who were HIV-negative who had never had a sexually transmitted infection were the group who found online partner notification and referral to online sexual health information most acceptable (p < 0.01), followed by men of unknown HIV status with no history of sexually transmitted infections (p < 0.05).
“The current study demonstrated broad support for internet partner notification services among men who have sex with men of any HIV serostatus who seek partners on the internet”, write the investigators.
But the investigators note that HIV-positive men were generally less enthusiastic about online partner notification and referral to sexual health information on the internet. They suggest three reasons why this may be the case: concern about confidentiality; concerns about the criminalisation of non-disclosure of HIV infection status to sexual partners in some US states; and a willingness to take greater responsibility for personal notification of partners.
The investigators also note that HIV-positive gay men, through regular attendance at specialist medical clinics, may also have good access to sexual health information and therefore do not need online referral to additional information after a possible exposure to an infection.
They conclude that online partner notification has the potential to “significantly curb recent increases in sexually transmitted [infections] and HIV incidence among” gay men.
Mimiaga M J et al. HIV and STD status among MSM and attitudes about internet partner notification for STD exposure. Sexually Transmitted Infections 35: 111 – 116, 2008.