Gay Men Who Look for Sex on the Internet: Are They at Higher Risk for Acquiring HIV or Other Sexually Transmitted Diseases?

Increasingly, gay men are using the Internet to look for sexual encounters. Numerous studies in the US, Europe and Australia have found elevated levels of high risk sexual behavior among gay men who seek and meet sexual partners through the Internet.

Gay men who look for sex through the Internet are more likely to have had a sexually transmitted infection (STI) than other men and also more likely to report sexual behavior that presents a risk for HIV/STI transmission. In London, HIV positive men who looked for sex through the Internet were also more likely to say they had had unprotected anal intercourse (UAI) with a casual partner who, like themselves, was HIV positive.

This does not present a risk of HIV transmission to an uninfected person. However, for HIV positive men themselves it could have a negative impact on their prognosis due to co-infection with an STI or a drug-resistant strain of HIV.

The objective of the present study was to examine whether the excess risk for HIV and sexually transmitted infection (STI) seen among gay men who look for sex through the Internet occurs with men they meet online rather than offline (in bars, clubs, etc).

In 2002-2003, 4225 London gay men were surveyed in an HIV treatment clinic, HIV testing clinic, gyms and on UK Internet sites (gaydar and gay.com). All men completed a self-administered questionnaire concerning Internet use and sexual risk behavior. Unprotected anal intercourse (UAI) with a partner of unknown or discordant HIV status was classified as non-concordant.

Results

Between 40 and 50% of men surveyed in the clinics and gyms used the Internet to look for sex.
HIV positive men who looked for sex through the Internet were more likely to report UAI with HIV-positive casual partners they met online rather than offline (clinic sample: met online only 9.9%, met offline only 3.8%, McNemar P < 0.05).
Regardless of HIV status, however, men who looked for sex through the Internet were no more likely to report UAI with non-concordant casual partners they met online than offline (eg, HIV negative men, Internet sample: met online only 9.7%, offline only 11.1%, McNemar P = 0.6).

Based on the results, the authors conclude, "In London, HIV positive gay men appear to meet casual UAI partners of the same status through the Internet. This presents a risk for STI transmission. However, gay men were no more likely to meet casual UAI partners of unknown or discordant HIV status - which presents a risk for HIV transmission - online rather than offline.

Discussion

What is new about this study is that it could establish whether the excess risk for HIV and STI seen among gay men who looked for sex through the Internet actually occurred with men they met online. Previous studies were not able to do this.

The study shows that HIV positive men who looked for sex through the Internet were more likely to meet online, rather than offline, other HIV-positive men with whom they had (concordant) UAI. For men reporting UAI with casual partners of unknown or discordant HIV status, however, we saw a different pattern.

Men who looked for sex through the Internet were no more likely to meet their non-concordant UAI partners online than offline. This was seen for HIV positive, HIV negative and never-tested men alike.

Why might HIV positive men be more likely to meet online rather than offline other HIV positive men with whom they have unprotected sex? One explanation may be that the Internet provides HIV positive men with a relatively safe environment where they can disclose their HIV status.

Compared with offline venues such as bars and clubs, HIV-positive respondents found the Internet to be less stigmatizing. Through a process of 'filtering' and 'serosorting' on the Internet, HIV-positive men were able to establish concordance in a way that could not happen easily offline.
The Internet may therefore lend itself to targeted interventions among HIV-positive men around the health risks of 'positive-positive' sex.

In closing the authors note, "Our study 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."

City University London, MRC Social and Public Health Sciences Unit, Glasgow, and the Royal Free and University College Medical School, London, UK.

06/03/05

Reference
G Bolding and others. Gay men who look for sex on the Internet: is there more HIV/STI risk with online partners? AIDS 19(9):961-968, June 10, 2005.