Internet Partner Selection and Risky Sexual Behavior in MSM
Internet Partner Selection and Risky Sexual Behavior in MSM
Introduction Men who have sex with men (MSM) who identify sex partners over the internet are more likely than other MSM to report having unprotected anal intercourse (UAI). It is unclear whether the internet facilitates pursuit of high-risk sex or whether MSM seeking sex online are a higher-risk population than other MSM. To summarise evidence as to whether internet-based partner selection predisposes MSM to high-risk behaviour, we conducted a meta-analysis of observational studies comparing MSM's UAI risk in online-initiated encounters to their UAI risk in offline-initiated encounters.
Methods We systematically searched published, peer-reviewed literature to identify studies reporting MSM participants' engagement in UAI with online-identified and offline-identified male partners. We calculated pooled odds ratios for any UAI and for seroadaptive UAI practices with partners identified online relative to partners identified offline.
Results We included 11 studies representing 39 602 sexual encounters. Odds for any UAI, seroconcordant UAI and serodiscordant UAI with strategic positioning were higher in online-initiated than offline-initiated encounters. Odds for UAI in group sex were higher in online-initiated encounters only among HIV-positive MSM. Effect sizes for all outcomes were greater among HIV-positive than HIV-negative MSM. Effect sizes were greatest when bathhouses, saunas and sex resorts were treated as offline comparison venues.
Conclusions Encounters initiated online have elevated odds for entailing UAI and seroadaptive UAI practices. Online-delivered behavioural interventions should address insufficiency of risk-reducing practices involving UAI relative to consistent condom use and promote frequent HIV testing among MSM seeking UAI partners online.
Internet-based platforms are increasingly prominent interfaces for sexual networking among men who have sex with men (MSM). Early in the HIV epidemic, bars, bathhouses, and cruising grounds were key venues for MSM to find sex partners. In contrast, by 2005 nearly half of MSM in the USA and UK had initiated sexual encounters online. Incidence rates of sexually transmitted infections (STIs) including HIV rose among MSM concurrently with emergence of online partner selection (OPS) venues. Popularisation of OPS additionally coincided with increasing prevalence of unprotected anal intercourse (UAI) among MSM, and notably among HIV-positive MSM. MSM who seek sex online are more likely to report engaging in UAI, to have HIV, and to seroconvert than MSM who do not seek sex online. These factors may suggest OPS has mediated STI and HIV resurgence among MSM by facilitating UAI partnership formation.
MSM are more likely to discuss HIV status and sexual preferences with prospective partners when meeting online than offline. These online interactions may guide MSM in identifying UAI partners. Intentional UAI pursuit is of public health concern as MSM increasingly adopt behavioural risk-reduction strategies that do not incorporate consistent condom use, and as incidence rates for STIs including HIV rise concurrently. Here we define selective UAI practices that MSM perceive to be risk-reducing as HIV-seroadaptive behaviours. 'Serosorting' is prominent among these and involves pursuing UAI exclusively with partners reporting HIV-seroconcordant status. Serosorting is imperfect for preventing HIV transmission because MSM who serosort may acquire HIV and transmit it to uninfected partners prior to receiving a positive test outcome. Among HIV-positive MSM, serosorting elevates probability for acquiring bacterial STIs or multivariant HIV infection. Strategic positioning in HIV-serodiscordant UAI (SDUAI) encounters additionally represents high-risk seroadaptive behaviour and involves HIV-negative MSM engaging selectively in insertive (penile/'top' role) UAI with receptive (anal/'bottom' role) HIV-positive partners to reduce risk for HIV transmission. Collectively, seroadaptive behaviours including these are more prevalent than consistent condom use among MSM.
Elevated prevalence of UAI in MSM's online-initiated encounters may signal that OPS accentuates sexual risk-taking. To address whether such accentuation occurs, numerous studies have evaluated MSM's relative odds for UAI with internet-identified and offline-identified partners. To summarise evidence for risk accentuation in online-initiated encounters, and to characterise shortcomings across studies to inform research priorities, we sought to synthesise current outcomes quantitatively. Specifically, our objective was to determine whether MSM have elevated odds for UAI and seroadaptive UAI practices in online-initiated encounters.
Abstract and Introduction
Abstract
Introduction Men who have sex with men (MSM) who identify sex partners over the internet are more likely than other MSM to report having unprotected anal intercourse (UAI). It is unclear whether the internet facilitates pursuit of high-risk sex or whether MSM seeking sex online are a higher-risk population than other MSM. To summarise evidence as to whether internet-based partner selection predisposes MSM to high-risk behaviour, we conducted a meta-analysis of observational studies comparing MSM's UAI risk in online-initiated encounters to their UAI risk in offline-initiated encounters.
Methods We systematically searched published, peer-reviewed literature to identify studies reporting MSM participants' engagement in UAI with online-identified and offline-identified male partners. We calculated pooled odds ratios for any UAI and for seroadaptive UAI practices with partners identified online relative to partners identified offline.
Results We included 11 studies representing 39 602 sexual encounters. Odds for any UAI, seroconcordant UAI and serodiscordant UAI with strategic positioning were higher in online-initiated than offline-initiated encounters. Odds for UAI in group sex were higher in online-initiated encounters only among HIV-positive MSM. Effect sizes for all outcomes were greater among HIV-positive than HIV-negative MSM. Effect sizes were greatest when bathhouses, saunas and sex resorts were treated as offline comparison venues.
Conclusions Encounters initiated online have elevated odds for entailing UAI and seroadaptive UAI practices. Online-delivered behavioural interventions should address insufficiency of risk-reducing practices involving UAI relative to consistent condom use and promote frequent HIV testing among MSM seeking UAI partners online.
Introduction
Internet-based platforms are increasingly prominent interfaces for sexual networking among men who have sex with men (MSM). Early in the HIV epidemic, bars, bathhouses, and cruising grounds were key venues for MSM to find sex partners. In contrast, by 2005 nearly half of MSM in the USA and UK had initiated sexual encounters online. Incidence rates of sexually transmitted infections (STIs) including HIV rose among MSM concurrently with emergence of online partner selection (OPS) venues. Popularisation of OPS additionally coincided with increasing prevalence of unprotected anal intercourse (UAI) among MSM, and notably among HIV-positive MSM. MSM who seek sex online are more likely to report engaging in UAI, to have HIV, and to seroconvert than MSM who do not seek sex online. These factors may suggest OPS has mediated STI and HIV resurgence among MSM by facilitating UAI partnership formation.
MSM are more likely to discuss HIV status and sexual preferences with prospective partners when meeting online than offline. These online interactions may guide MSM in identifying UAI partners. Intentional UAI pursuit is of public health concern as MSM increasingly adopt behavioural risk-reduction strategies that do not incorporate consistent condom use, and as incidence rates for STIs including HIV rise concurrently. Here we define selective UAI practices that MSM perceive to be risk-reducing as HIV-seroadaptive behaviours. 'Serosorting' is prominent among these and involves pursuing UAI exclusively with partners reporting HIV-seroconcordant status. Serosorting is imperfect for preventing HIV transmission because MSM who serosort may acquire HIV and transmit it to uninfected partners prior to receiving a positive test outcome. Among HIV-positive MSM, serosorting elevates probability for acquiring bacterial STIs or multivariant HIV infection. Strategic positioning in HIV-serodiscordant UAI (SDUAI) encounters additionally represents high-risk seroadaptive behaviour and involves HIV-negative MSM engaging selectively in insertive (penile/'top' role) UAI with receptive (anal/'bottom' role) HIV-positive partners to reduce risk for HIV transmission. Collectively, seroadaptive behaviours including these are more prevalent than consistent condom use among MSM.
Elevated prevalence of UAI in MSM's online-initiated encounters may signal that OPS accentuates sexual risk-taking. To address whether such accentuation occurs, numerous studies have evaluated MSM's relative odds for UAI with internet-identified and offline-identified partners. To summarise evidence for risk accentuation in online-initiated encounters, and to characterise shortcomings across studies to inform research priorities, we sought to synthesise current outcomes quantitatively. Specifically, our objective was to determine whether MSM have elevated odds for UAI and seroadaptive UAI practices in online-initiated encounters.
