Search

This paper addresses how London gay men use the internet to meet sexual partners, or for e-dating. Based on qualitative interviews conducted face-to-face or via the internet, this research develops an account of how information technologies mediate the negotiation of identity and risk in connection with sexual practice. E-dating itself is a bricolage, or heterogeneous DIY practice of internet-based-communication (IBC). A central aspect of IBC is 'filtering' in and out prospective e-dates based on the images and texts used to depict sexual identities. Interpretations and depictions of personal HIV risk management approaches in IBC are framed by the meanings of different identities, such as the stigma associated with being HIV positive. This paper argues for a sexualities perspective in a theory of network society. Further, HIV prevention in e-dating can potentially be addressed by considering the interplay of the HIV prevention imperatives associated with different HIV serostatus identities. There is a case for encouraging more explicit IBC about risk in e-dating and incorporating the expertise of e-daters in prevention activity. There is also a need to rethink traditional conceptions of risk management in HIV prevention to make space for the risk management bricolage of network society. [ABSTRACT FROM AUTHOR]

An invitation to take part in a web survey of sexual behaviour appeared on two popular websites for gay men in the UK in May and June 2003. As soon as men began the survey, their responses were recorded. If they quit before the end, the point at which they stopped was identified. Men clicked into the survey a total of 4,271 times and 2,752 (64%) respondents completed it. The median last question reached by respondents who dropped out was question number 20 out of 158. Multivariate analysis indicated that drop out was related to ethnic group, openness about sexual orientation and age. The results suggest that MSM who use the Internet to seek sexual partners may be younger, more likely to be from an ethnic minority and less open about their sexuality than web surveys indicate. This has implications for the development of online HIV and STI interventions.

The objective was to examine how many young men who have sex with men (MSM) meet their first sexual partner through the Internet and whether this has increased over time. In 2003, 2505 MSM surveyed on UK Internet sites completed a self-administered questionnaire. Data were analysed for 810 MSM who were under 30 years old at the time of the survey and who first had sex with another man between 1993-2002. During this period there was a significant increase in the percentage of MSM who met their first male sexual partner through the Internet (2.6-61.0%). There was a corresponding decrease in the percentage who met their first sexual partner at a gay venue (34.2-16.9%), school (23.7-1.3%), a public sex environment, through small ads or telephone chatlines (10.5-1.3%). An increasing number of young MSM appear to meet their first sexual partner through the Internet. Online sexual health interventions should be developed targeting men early in their sexual careers.

Objectives: The objectives of this study were to examine the extent to which HIV-positive gay men in London intentionally seek unprotected anal intercourse ("barebacking") and the contribution this makes to total sexual risk., Study Design: In 2002 to 2003, HIV-positive gay men surveyed in an HIV outpatient clinic or on the Internet were asked whether they had intentionally looked for anal sex without a condom in the previous 12 months., Results: Of 481 men in the clinic, 59 (12.3%) said they had intentionally looked for anal sex without a condom, 34 (7.1%) only with another HIV-positive man and 25 (5.2%) with a man of unknown or discordant HIV status. Overall, 85 men reported unprotected anal intercourse (UAI) with a casual partner of unknown or discordant HIV status; 20 (23.5%) had intentionally looked for UAI with such a partner, whereas the remaining 65 (76.5%) had not. Of 66 men surveyed on the Internet, 32 (48.5%) said they had intentionally looked for anal sex without a condom., Conclusion: Although barebackers made a disproportionate contribution to sexual risk, three-fourths of high-risk sex reported by HIV-positive gay men in London was not intentional. The Internet sample overestimated the prevalence of barebacking among HIV-positive gay men because of sampling bias.

Serosorting is an HIV risk reduction strategy whereby some gay men only engage in unprotected anal intercourse with casual partners of the same HIV status. There was no evidence of an increase in serosorting among HIV-negative gay men in London between 1998 and 2005 (1.7%, 1.2%; test for a trend P = 0.1). By way of comparison, the percentage of HIV-positive gay men who reported serosorting more than doubled during this time (6.8%, 17.7%, P < 0.01).

Aim: To examine the use of crystal methamphetamine (crystal meth) and its association with high-risk sexual behaviour among gay men in London., Design: Cross-sectional surveys using self-administered questionnaires., Settings: National Health Service (NHS) out-patient human immunodeficiency virus (HIV) treatment clinic in London; NHS HIV testing/sexual health clinics in London; central London gyms., Participants: HIV-positive gay men attending the HIV treatment clinic in 2002-03 (n = 388); HIV-negative gay men attending the HIV testing/sexual health clinics in 2002-03 (n = 266); gay men using the gyms between January and March 2003 (n = 445), 2004 (n = 653) and 2005 (n = 494)., Measurements: Percentage of gay men who reported: (i) using crystal meth in the previous 12 months; (ii) using other recreational drugs (e.g. cocaine, ecstasy, ketamine); (iii) high-risk sexual behaviour in the previous 3 months., Findings: The percentage of gay men who had used crystal meth in the previous year varied by sample (HIV treatment clinic, 12.6%; HIV testing/sexual health clinics, 8.3%; gyms, 19.5%; P < 0.001) but did not change over time in the gyms (19.8%, 20.7%, 17.8%; P = 0.5). In all samples, the majority of men used crystal meth only once or twice a year. Most crystal meth users (> 80%) had taken other recreational drugs. Crystal meth and other drug users were more likely to report high-risk sexual behaviour than other men, e.g. HIV treatment clinic sample: crystal meth users, 34.7%; other drug users, 18.9%, non-users, 10.6%, P < 0.001. Cause and effect could not be established., Conclusion: Among gay men in London surveyed in clinics, approximately one in 10 reported using crystal meth in the previous 12 months (HIV-positive men 12.6%; HIV-negative men 8.3%). Most men used it infrequently--only once or twice a year. There was no evidence of increasing use of crystal meth between 2003 and 2005.

Heterosexual women (n = 330), heterosexual men (n = 319) and gay men (n = 331) attending a London HIV-testing clinic in 2002-03 completed a confidential self-administered questionnaire concerning their sexual behaviour and use of the Internet for seeking sexual partners (response rate 70%). One-in-twenty (5%) heterosexual women and one-in-ten (10%) heterosexual men had used the Internet to look for sexual partners in the previous 12 months compared with nearly half (43%) the gay men (P<0.001). Rates of high-risk sexual behaviour with a casual partner were elevated among those who used the Internet to look for sex (compared with those who did not). However, people who looked for sex through the Internet were just as likely to meet their high-risk casual partners offline as online. Our findings suggest that high-risk heterosexual women and men are selectively using the Internet to look for sex rather than the Internet per se leading to riskier sexual behaviour.

Access to the Internet has increased dramatically over the past decade as has its use for meeting sexual partners (e-dating), particularly among gay men. Between June 2002 and January 2004, 128 gay/bisexual men living in London were interviewed one-to-one about their experience of e-dating, sexual risk and HIV prevention. The men were recruited both online (through the Internet) and offline (in clinics and the community); 32 men were HIV-positive, 59 HIV-negative, while 13 had never had an HIV test. A key finding was that both identity as well as anonymity are vital to e-dating. Through a process of online filtering and sero-sorting, HIV-positive men are able to meet other positive men for anal sex without condoms. While this does not present a risk of HIV transmission to an uninfected person it does have implications for the potential transmission of other STIs such as syphilis and LGV. Through e-dating, HIV-positive gay men can also avoid abuse, discrimination and sexual rejection. Our findings do not support the suggestion that the attraction of e-dating is that it affords absolute anonymity. We found that the gradual expression of identity is vital for e-dating among gay men. Internet-based HIV prevention campaigns need to take account of the different ways in which gay reflexively manage aspects of their identity online.

Among gay men surveyed annually in central London gyms, the percentage reporting high-risk sexual behaviour with a casual partner increased from 6.7% in 1998 to 15.2% in 2001 (P < 0.001). However, between 2002 and 2005 the percentage reporting high-risk sexual behaviour with a casual partner remained stable for HIV-negative and never-tested men (P > or = 0.3), with some evidence of a decline for HIV-positive men (adjusted odds ratio 0.69 per year, 95% confidence interval 0.48, 0.99, P = 0.047).

Objective: 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 (through the Internet) rather than offline (in bars, clubs, etc)., Methods: 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 behaviour. 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)., Conclusions: 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.

Background: The Internet provides a new meeting ground, especially for gay men, that did not exist in the early 1990s. Several studies have found increased levels of high risk sexual behaviour and sexually transmissible infections (STI) among gay men who seek sex on the Internet, although the underlying processes are not fully understood. Research funded by the UK Medical Research Council (2002-2004) provided the opportunity to consider whether the Internet represents a new sexual risk environment for gay and bisexual men living in London., Methods: The objectives of the Internet and HIV study are to: (i) measure the extent to which gay men living in London seek sexual partners on the Internet; (ii) compare the characteristics of London gay men who do and do not seek sex on the Internet; (iii) examine whether sex with Internet-partners is less safe than with other sexual partners; (iv) compare use of the Internet with other venues where men meet sexual partners; (v) establish whether gay men use the Internet to actively seek partners for unprotected anal intercourse; (vi) determine the potential for using the Internet for HIV prevention. These objectives have been explored using quantitative and qualitative research methods in four samples of London gay men recruited and interviewed both online and offline. The four samples were: (i) gay men recruited through Internet chat rooms and profiles; (ii) HIV positive gay men attending an NHS hospital outpatients clinic; (iii) gay men seeking an HIV test in an NHS HIV testing or sexual health clinic; (iv) gay men recruited in the community., Results: Quantitative data were collected by means of confidential, anonymous self-administered questionnaires (n>4000) completed on-line by the Internet sample. Qualitative data were collected by means of one-to-one interviews (n = 128) conducted either face-to-face or on-line., Conclusion: The strength of the Internet and HIV study is its methodological plurality, drawing on both qualitative and quantitative research among online and offline samples, as well as taking advantage of recent advances in web survey design. The study's findings will help us better understand the role of the Internet in relation to gay men's sexual practice.

Objective: To compare the characteristics of men who have sex with men (MSM) surveyed online (through gay Internet chat rooms and profiles) and offline (in community venues) in London, UK., Methods: In February and March 2002, 879 MSM completed a self-administered pen-and-paper questionnaire distributed in central London gyms (offline sample). In May and June 2002, 1218 London MSM completed a self-administered questionnaire online, accessed through Internet chat rooms and profiles on gaydar and gay.com., Results: Compared with men surveyed offline, those surveyed online were significantly less likely to only have sex with men (89 vs. 94%), to be in a relationship with a man (44 vs. 52%), or to have been tested for HIV (68 vs. 80%) (P < 0.001). Men recruited online were also younger (mean age, 34 vs. 36 years) and less likely to have had a higher education (67 vs. 79%) (P < 0.001). However, differences between online and offline samples were less pronounced for HIV-positive men and more pronounced for HIV-negative men and those who had never been tested for HIV. Regardless of HIV status, men recruited online were more likely to report high-risk sexual behavior (i.e., unprotected anal intercourse with a partner of unknown or discordant HIV status) than men surveyed offline (32 vs. 22%, P < 0.001). Men recruited online were also significantly more likely to have used the Internet to look for sex (85 vs. 45%, P < 0.001); for HIV-positive and negative men, seeking sex on the Internet was associated with high-risk sexual behavior (P < 0.01). In multivariate analysis, after controlling for confounding factors, being surveyed online was independently associated with high-risk sexual behavior for HIV-negative and never-tested men (HIV-negative men, adjusted odds ratio for online vs. offline samples, 1.73; 95% CI, 1.23, 2.42; P < 0.01; never-tested men adjusted odds ratio 2.45; 95% CI, 1.40, 4.29; P < 0.01). This was not the case for HIV-positive men (adjusted odds ratio for online vs. offline samples, 1.32; 95% CI, 0.69, 2.50; P = 0.4)., Conclusion: The Internet offers valuable opportunities for conducting behavioral surveillance among MSM because it reaches some men who may not be easily accessed in the community yet who are at high risk for HIV and sexually transmitted diseases. Comparisons of the social, demographic, and behavioral characteristics of online and offline samples must, however, take into account the confounding effects of HIV status and seeking sex on the Internet.

Objective: To examine whether HIV optimism (i.e. optimism in the light of new HIV drug therapies) can account for the recent increase in high-risk sexual behaviour among London gay men., Methods: Gay men (n = 2938) using London gyms were surveyed annually between 1998 and 2001. Information was collected on HIV status, unprotected anal intercourse (UAI) in the previous 3 months, and agreement with two statements concerning the severity of and susceptibility to HIV infection. Those who agreed were classified as 'optimistic'., Results: Between 1998 and 2001, the percentage of men reporting high-risk UAI (i.e. UAI with a casual partner of unknown or discordant HIV status) increased: HIV-positive men 15.3-38.8%; HIV-negative men 6.8-12.1%; never-tested men 2.1-7.7%; (P < 0.01). Overall, less than a third were optimistic. In cross-sectional analysis, optimistic HIV-positive and -negative men were more likely to report high-risk UAI than other men (P < 0.05). However, the increase in high-risk UAI between 1998 and 2001 was seen in those who were optimistic and those who were not (P < 0.05). In multivariate analysis, the modelled increase in high-risk UAI over time remained significant after controlling for HIV optimism (P < 0.01), with no significant interaction between optimism and time., Conclusion: Among London gay men, no difference was detected between those who were optimistic and those who were not in the rate of increase in high-risk sexual behaviour between 1998 and 2001. Our findings suggest that HIV optimism is unlikely to explain the recent increase in high-risk sexual behaviour in these men.

Aim: To examine, by HIV status, the use of anabolic steroids among London gay men and their effect on physical and mental health., Design: Cross-sectional survey using self-administered questionnaire., Setting: Six gyms in central London., Participants: 772 gay men using the gyms in January-February 2000., Measurements: Proportion of gay men who reported (i) using steroids, (ii) sharing injecting equipment, (iii) experiencing side-effects and (iv) having suicidal thoughts or feeling depressed., Findings: Of 772 gay men, 117 (15.2%) had used and 90 (11.7%) had injected steroids in the previous 12 months: HIV positive men (steroid use) 31.7% (40/126), HIV negative men 14.5% (69/477), never-tested for HIV 4.7% (8/169) (p < 0.001). No one reported sharing needles or syringes. HIV positive men were more likely to have used steroids for medical reasons than other men (24.3% versus 5.9%, p=0.01). Nearly all steroid users (96.4%) reported side effects including testicular atrophy (51.0%), insomnia (47.7%), depression between cycles (25.2%) and hypertension (19.0%). Steroid users were more likely to have had suicidal thoughts in the previous 6 months than non-users (22.6% versus 11.2%, adjusted odds ratio after controlling for HIV status 1.84; 95% CI 1.10-3.12, p=0.02) or to have felt depressed (49.1% versus 38.5%, adjusted OR 1.52, 95% CI 1.01-2.30, p=0.047), Conclusion: One in seven gay men surveyed in central London gyms in 2000 said they had used steroids in the previous 12 months. HIV positive men were more likely to have used steroids than other men, some therapeutically. Side effects were reported widely and steroid use was associated with having had suicidal thoughts and feeling depressed, although cause and effect could not be established. Our findings suggest that steroid use among gay men may have serious consequences for both physical and mental health.

Objective: To examine the association between seeking sex on the Internet and sexual risk behaviour among gay men in London., Methods: In January-February 2000, gay men in London gyms were asked to complete self-administered questionnaires concerning use of the Internet, history of sexually transmitted diseases (STD) and recent unprotected anal intercourse (UAI). Internet sex seekers were compared with other men, also with Internet access, who did not seek sex in this way., Results: Of 743 gay men included in the analysis (121 HIV-positive, 465 HIV-negative, 157 never-tested), 80.9% (601) had access to the Internet. Among those who had access, 34.4% (207) had used the Internet to find a sexual partner; this did not vary significantly by HIV status (P = 0.3). Internet sex seekers were more likely to have had an STD (HIV-negative men, 26.9 versus 17.5%, P = 0.04) or gonorrhoea (HIV-positive men, 22.2 versus 5.8%, P = 0.04) in the previous year than other men with Internet access. HIV-negative Internet sex seekers were also more likely to report non-concordant UAI in the previous 3 months [23.1 versus 11.8%; adjusted odds ratio (aOR), 1.9; 95% confidence interval (CI), 1.2--3.5; P = 0.01]. HIV-positive Internet sex seekers were more likely to report UAI with another positive man (37.8 versus 7.4%; aOR, 7.9; 95% CI, 1.8--34.6; P = 0.006)., Conclusion: Seeking sex on the Internet was associated with recent STD and high-risk sexual behaviour among HIV-positive and -negative gay men in London. The contribution of seeking sex on the Internet to the recent increase in high-risk behaviour among London gay men merits further investigation.

Objective: To examine optimism in the light of recent advances in HIV treatment among gay men and its association with sexual risk behavior., Methods: An anonymous questionnaire was completed by gay men who visited gyms in central London in March and April 1998 regarding their HIV status, unprotected anal intercourse (UAI) in the previous 3 months, and their response on a five-point linear scale to two measures of optimism: "I am less worried about HIV now that treatments have improved," and "I believe that new drug therapies make people with HIV less infectious.", Results: Two thirds of the men (67.5%, 522 of 773) did not agree with the statement, "I am less worried about HIV now that treatments have improved," and only 42 (5.4%) said they agreed quite a lot or a lot. HIV-positive men were more likely to agree with this statement than HIV-negative men (p = .001) and men who had never been tested (p < .001). There was no association between agreement with this statement and frequency of UAI among HIV-positive or never-tested men (p > .3); there was, however, a positive association among HIV-negative men who reported UAI with a partner of unknown or discordant status (p = .003). The vast majority of men (81.4%; 634 of 779) did not agree with the statement, "I believe that new drug therapies make people with HIV less infectious." Regardless of HIV status, no significant association was seen between agreement with this statement and frequency of UAI (p > .1 for all comparisons)., Conclusion: Most gay men surveyed in central London gyms did not endorse the optimism statements concerning improved treatments or reduced infectivity. Although HIV-positive gay men were more likely to be optimistic than other men, there was no association between their optimism and sexual risk behavior. Among HIV-negative men, optimism around improved treatments (but not around reduced infectivity) was associated with UAI with a partner of unknown or discordant HIV status. For some HIV-negative men in London, optimism in the light of recent advances in HIV treatment may have triggered, or have been used as a justification for, sexual risk-taking.

Aims: To examine the injecting and sexual risk behaviours of gay men in London who use anabolic steroids or other fitness-enhancing substances (referred to as AS)., Design: Cross-sectional survey using self-administered questionnaire., Setting: Five gyms in central London., Participants: 1004 gay men using the gyms during September-October 1997., Measurements: Proportion of men who report (i) injecting AS, (ii) sharing needles and (iii) HIV status-unknown unprotected and intercourse (UAI)., Findings: Of 1004 men, 136 (13.5%) were current users of AS (range across the five gyms, 2.7-21.2%, p < 0.001), and 81 (8.1%) injected AS (range 0.4-17.5%, p < 0.001). None said they shared a needle with other users and more than 90% said they always used disposable units from sealed packets. Among current AS users, 20.9% (28/136) reported status-unknown UAI compared with 12.9% (107/827) of never-users (p = 0.02), a differential which remained significant after adjusting for confounding factors (adjusted odds ratio = 1.75, 95% CI 1.05, 2.91, p = 0.03)., Conclusions: While nearly one in 10 gay men in this study injected anabolic steroids or other fitness-enhancing substances, none reported sharing needles. Steroid users were, however, more likely to report status-unknown UAI than other men, a differential that remained after adjusting for confounding factors. Since any change in injecting practice could dramatically increase the risk of HIV transmission in this population, behavioural surveillance to monitor risk behaviours among gay men using anabolic steroids is recommended, as are targeted HIV prevention programmes.

Objective: To examine whether gay men in a relationship have adopted negotiated safety as an HIV risk reduction strategy., Methods: A confidential, anonymous questionnaire was completed by 1004 gay men attending gyms in central London in September-October 1997. Information was sought on sociodemographic characteristics, HIV testing and sexual risk behaviour. Men reporting unprotected anal intercourse (UAI) in the previous 3 months were classified as 'status-unknown' if they did not know their own HIV status, that of their UAI partner(s) or both. Men who knew their own and their UAI partner's HIV status were classified as 'status-known'., Results: Of the 1004 men surveyed, 986 provided complete information on relationship, personal HIV test history and HIV status of UAI partner. Over half (539) said they were currently in a relationship with another man, of whom 173 reported UAI in the previous 3 months; 140 (80.9%) with their main partner only, 18 (10.4%) with a casual partner only and 15 (8.7%) with both their main and casual partners. Of the 140 men reporting UAI only with their main partner, 62 (44.3%) did not know their own HIV status or that of their partner. Overall, a quarter (26.0%) of the men in a relationship reported UAI only with their main partner in the previous 3 months; 11.5% status-unknown UAI, 14.5% status-known UAI. In a multivariate logistic model, both age and being in a relationship were significantly associated with UAI (status-unknown and status-known)., Conclusion: Gay men in a relationship, surveyed in central London gyms, have for the most part adopted the first principle of negotiated safety: only to have UAI with their main partner. However, not all have embraced the second principle: to establish HIV seroconcordance. Nearly half the men reporting UAI only with their main partner were unaware of their own HIV status, their partner's or both. As a consequence, more than one in 10 men in a relationship reported high-risk (i.e. status-unknown) UAI with their main partner. Because the study population, from central London gyms, was not randomly selected, these findings may not be generalizable to all gay men in London. Nonetheless, HIV prevention programmes should continue to encourage gay men in a relationship to seek an HIV test and establish seroconcordance if they wish to have UAI with each other.