Young Internet-using men who have sex with men AND who meet their sexual partners both online and offline have greater numbers of partners, appear more likely to contract HIV, and report higher substance use rates than those who meet their partners exclusively online or offline, according to new research at the University of Minnesota.
A greater percentage of the group reported unprotected anal intercourse (43 percent) in the past three months, according to the research. A smaller number of those who met partners exclusively online (29 percent) or exclusively offline (34 percent) reported having unprotected anal sex in the past three months.
Men who have sex with men who met partners exclusively offline reported the fewest number of partners, but the greatest number of partnerships involving unprotected anal intercourse (49 percent). Meeting partners both online and offline and being drunk or high during the last sexual encounter increased the odds of having more partners and engaging in unprotected anal intercourse.
"We've known since about 2000 that the Internet has dramatically changed HIV risk for gay men and other men who have sex with men," said Simon Rosser, Ph.D., principal investigator on the study and professor in the School of Public Health's Division of Epidemiology and Community Health. "But the early reports were small case studies with very broad results. What is so exciting about this paper is that we starting to understand some of the more subtle differences so we can get beyond broad generalizations to a real understanding of the risk, and then design effective responses."
Young men, ages 18-24, who have sex with men are disproportionately affected by the HIV/AIDS epidemic in the United States. In 2003, male-to-male sexual contact accounted for 74 percent of HIV diagnoses among young males between the ages of 13 and 24 years in the United States. And the estimated annual number of HIV cases among young men rose from 1,763 in 1999 to 2,443 in 2003.
Researchers surveyed 770 Internet-using young men who have sex with men about their sexual risk behaviors to examine whether risk for HIV differed between those who met their partners exclusively online, exclusively offline, or both online and offline. Those who participated completed a 45-minute online survey regarding sex and Internet use and must have had sex in the past three months.
"The Internet is a popular and easy way for men who have sex with men to meet partners, and our findings suggest that online sex seeking neither promotes nor discourages unprotected anal intercourse," said Keith Horvath, Ph.D., assistant professor in the Division of Epidemiology and Community Health and investigator on the study.
Rather than focusing on the dangers of online sex seeking, Internet-based programs, similar to offline interventions, should encourage at-risk young men who have sex with men to decrease the frequency at which they engage in unprotected anal intercourse, reduce their numbers of sexual partners, avoid alcohol and other substance use in sexual situations, and seek HIV testing, Horvath said.
More than one-quarter of the men in the study had not been tested for HIV.
"There is a need and a demand for online health promotion and disease prevention services, and the Internet creates an opportunity to access large numbers of otherwise difficult-to-reach and vulnerable people," Horvath said.
As part of the broader study, Rosser has led a group of investigators to develop one of the world's first online HIV risk reduction interventions, called "SexPulse." A randomized controlled trial testing the effects of SexPulse, currently in progress, will be completed later this year.
The study results are published online in the American Journal of Public Health. The study was funded by the National Institute of Mental Health.
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