Love Matters: Online partner-seeking and HIV risks among Young Men who Have Sex with Men José A. Bauermeister, MPH, PhD Assistant Professor Health Behavior & Health Education School of Public Health University of Michigan
Presentation Outline • HIV/AIDS among YMSM in the United States • Online partner-seeking among YMSM • Virtual Love Study • Online partner-seeking and HIV risks • Romantic Ideation and HIV risks • Conclusions, Limitations, and Future Directions
Estimated Number of New HIV Infections, Extended Back-Calculation Model, by Transmission Category, 1977– 2006 Hall , I., Song, R., Rhodes, P. et al. (2008) Estimation of HIV incidence in the United States. JAMA, 300(5), 520-529.
CDC. (2008). Subpopulation estimates from the HIV Incidence Surveillance System – US, 2006. MMWR, 57(36), 985-989.
Envisioning Network-Level Prevention "The smallest indivisible human unit is two people, not one; one is a fiction. From such nets of souls societies, the social world, human life springs." - Tony Kushner Afterword to “Perestroika” Angels in America
Network structures influence health A F B A A C A E A D EXPOSURE OVER TIME D C E A B F • Wohlfeiler, D., & Potterat, J. J. (2005). Using gay men's sexual networks to reduce STD/HV transmission. Sexually Transmitted Diseases, 32(10). S48-S52.
Network Interventions What do people want? How do you intervene? What constructs to identify? Is it ethical?
Romantic Same-Sex Relationships • Romantic relationships are a critical component of human development. • Structural changes have made same-sex relationships more acceptable and visible, creating opportunities for YMSM to consider same-sex dating as a viable relationship type earlier in the life course.
The New Romantics “Kids today, eh? It’s all sex, drugs, and emotronica, or whatever they call it. […] Everyone knows gay youngsters are more promiscuous than a busload of bunnies in a poppers factory. They’re always having furtive sex in unsavory places because, you know, society doesn’t understand them and stuff. They’ll never have the chance to find true love, because their lives are an endlessly escapist, impossible quest for bigger and better cock. Right, sonny? Wrong, granddad.[…] Their lives are very different to those who were teenagers 18 years ago. Today’s young gay men inhabit a world where their sexual identity is accepted by most and protected by law. They’ve grown up with mainstream representations of gay men as the norm. They have a new ideal – love, fidelity, commitment, marriage and children. They are the New Romantics – and they aren’t afraid to express their sexuality or their emotions” (Gregory, 2008; pg. 66)
Dating Behavior among YMSM • Same-sex attraction is common • Opposite-sex attraction is common • Pursuit of sexual and romantic relationships • SSR associated with psychological well-being Bauermeister, J.A., Johns, M.M., Sandfort, T., Eisenberg, A., Grossman, A., & D’Augelli, A. (2010). Same-sex relationship trajectories and psychological well-being among gay, lesbian, and bisexual youth.Journal of Youth & Adolescence, 39(10), 1148-1163.
Dating Behavior among YMSM • Romantic partner-seeking behaviors may have a unique set of implications for HIV prevention for YMSM. • May promote opportunities that encourage serial dating, and/or decrease the number of casual sexual encounters.
Online Environment: Risks • Increased expression of inhibited desires and a heightened sense of trust and intimacy. • MSM who use the Internet to meet partners may report higher levels of sexual risk behaviors than MSM who meet sexual partners in bars and clubs. • Multiple sexual partners • Inconsistent condom use • Serodiscordant partners Liau, A., Millet, G.A., Marks, G. (2006). Meta-analytic examination of online sex-seeking and sexual risk behavior among men who have sex with men. STDs, 33(9), 576–84.
Online Environment: Risks • Focus on casual sex encounters. • MSM may have other motivations (e.g., looking for closeness, intimacy, companionship) to seek partners online. • increasing use and popularity of social networking and dating sites
Online Environment: Promotive • Individuals attempt to make the best impression when pursuing romantic partners. YMSM may: • engage in socially desirable behaviors (e.g., condom use) • decrease the number of partners with whom they have unprotected sex • May reduce the likelihood of YMSM meeting partners in venues (e.g., bars and clubs) where drugs and alcohol are present.
“Virtual Love: E-dating and HIV/AIDS Risk among Young Men who have Sex with Men (YMSM)”, Small Grant from the University of Michigan’s Office of the Vice-President for Research (PI: Bauermeister). “HIV/AIDS risk among young men who use the Internet”. National Institute of Mental Health (1K01MH087242-02; PI: Bauermeister).
Study Aims • Quantitative Phase (N = 447) • Assess the psychometric properties of developed scales. • Identify YMSM’s past experiences using the Internet • Examine the scales’ association to YMSM’s sexual risk behaviors, mental health, and Internet use Qualitative Phase (N = 34) • Describe YMSM’s dating experiences online • Understand YMSM’s desired relationship components
Eligibility • To be eligible, participants had to report: • Being between the ages of 18 and 24 • Having used a dating website in the past 3 months • Having been sexually active with a male partner met on a dating website in the past 6 months • Being single
Sample • Total Cases Observed • N=548 • Unique Entries • (N = 437) • Suspicious Entries • (N = 111) • Full Cases • (N = 359) • Full Missing • (N = 52) • Partial Missing • (N = 26) • Partial Missing • (N = 5) • Full Cases • (N = 98) • Full Missing • (N = 8) • True • (N = 62) • Invalid • (N =5) • Invalid • (N = 36) Pooled Valid Entries (N = 447) Invalid Entries (N = 41) Bauermeister, J.A., Pingel, E., Zimmerman, M.A., Couper, M., Carballo-Diéguez, A., & Strecher, V. (under review). Data quality in web-based HIV/AIDS research: Handling Invalid Data.
Measures: Sexual Behavior Sexual Practices Assessment Schedule # of male partners in the past two months # of male partners for URAI # of male partners for UIAI
Measures: Internet Use Provided definitions of • Date: getting to know another man for a potential romantic relationship • Hookup: having a no-strings attached sexual encounter with another man • Online partner-seeking frequency • Occasions (0 = Never, 7 = More than once a day) • Recoded into a 4-point scale • Time: Average number of hours per week spent online looking for potential romantic partners and casual sexual partners, respectively
Measures: Demographics • Age (in years) • Highest level of education completed • Occupation • Race/Ethnicity
Sample • 431 YMSM (M = 21.49, SD = 1.94) • Sexual Identity: Gay (88%) • Race/Ethnicity: • White/European American (73.9%) • Hispanic/Latino (8.9%) • Asian Pacific Islander (7.5%) • Black or African American (6.1%) • Other (3.5%) • Some college (M = 4.23, SD = 1.28, Md = 4), with two-thirds of the sample reported being currently in school • Twelve participants reported being HIV+
Sample • Four partners in the past two months (M = 3.83, SD = 5.78, Md= 2). • 60% reported engaging in RAI (N = 252) or IAI (N = 242) with 1+ partner in past two months • No differences by race, age, educational attainment, sexual identity, or occupation.
Online Partner-Seeking • Hours spent online seeking: • Romantic partner (Md = 3h; M = 6.19, SD = 8.16) • Casual partner (Md = 2h; M = 4.26, SD = 7.01) • Internet vs. FtF socializing at bars or clubs • 37% the Internet has not replaced FTF socializing • 33% the Internet has somewhat replaced interactions at bars or clubs
Internet Use • Greater number of men met face-to-face for dating was associated with: • Frequency of Internet use to meet romantic partners (r = .24, p < .01) • Hours spent online seeking romantic partners (r = .30, p < .01) • Hours spent online seeking casual sex partners (r = .12, p < .05) • Greater number of men met face-to-face for casual sex was associated with: • Frequency of Internet use to hookup (r = .57, p < .01) • Hours spent online seeking casual sex (r = .54, p < .01) • Hours spent online seeking romantic partners (r = .16, p < .01) • Number of men met face-to-face after chatting online for dates and hookups (r= .34, p < .01)
Data Analytic Strategy • Poisson Regressions • Corrected for overdispersion • Differences in mean number of partners across four groups • Low Romantic/Low Casual • High Romantic/Low Casual • Low Romantic/High Casual • High Romantic/High Casual
REF REF REF N = 76 N=126 N =47 N =120 N = 54 N=74 N =32 N =88 N = 50 N=66 N =33 N =87 Bauermeister, J.A., Leslie-Santana, M., Johns, M.M. , Pingel, E. , & Eisenberg, A. (in press). Mr. Right and Mr. Right Now: Romantic and casual partner-seeking online among young men who have sex with men. AIDS and Behavior. Published Ahead Online.
Conclusions • Consistent with past research, greater casual partner-seeking online was associated with MSM’s HIV risk. • Online romantic partner-seeking was protective in some contexts, but not others. • The relationship between number of partners and online partner-seeking behaviors is conditional on how often YMSM pursue romantic and casual partners
Conclusions • Lower and comparable # of partners among youth in the LR-LC and HR-LC. • HR-LC may have greater investments in pursuing a romantic relationship and may be more selective in their partner selection. • Make good impression on potential romantic partners by showing that they engage in safer sex behaviors • Possess greater psychological well-being or condom negotiation skills
Conclusions • YMSM in the HR-HC group reported comparable # of partners than YMSM in the LR-HC category • Romantic partner-seeking neither increased nor decreased YMSM’s HIV risk • YMSM who seek casual sex partners often may increase their number of sexual opportunities
Recommendations • HIV prevention programs should • Account for concurrent pursuit of casual and romantic partners • Provide scenarios that equip YMSM with strategies to negotiate condoms with both romantic and casual partners successfully
The question remains… How may we encourage YMSM to reduce UAI with concurrent partners in their sexual networks?
Conceptualizing Relationships • YMSM’ssexual networks are often categorized into dichotomous partner groups • casual sex partners • romantic partners • Likelihood of engaging in UAI may depend on partner type. • What if they are “single”?
Triangular Theory of Love(Sternberg, 1986) • Intimacy • Passion • Commitment
Intimacy(emotional) • Characterized by feelings of • closeness • emotional support • connectedness • Manifests as • interpersonal trust • communication • social support
Passion(motivational) • Characterized by physical arousal • Desire • Pleasure • Sexual satisfaction • Manifests through touching and sexual consummation
Commitment(cognitive) • Characterized by decisions to be in, and maintain or dissolve, a relationship • Manifests as • exclusivity, whether emotional or sexual • active participation in the relationship during times of stress
Romance, Flings, & Friendship • Idealized components are correlated with actual relationships: • Romance (e.g., high intimacy and commitment, and varying passion over time) • Flings (e.g., high passion and low commitment and intimacy) • Friendships (e.g., high intimacy, low passion and commitment)
Romantic Ideation and HIV risk • Youth who can envision aspects of their future are less likely to engage in risk behaviors. • Can romantic ideation inform HIV prevention messages?
[χ2 (df = 164, N = 394) = 351.55; NFI = .93, NNFI = .95, CFI = .96, RMSEA = .05] Bauermeister, J.A., Johns, M.M., Pingel, E., Eisenberg, A., Leslie-Santana, M. A., & Zimmerman, M.A. (underreview). MeasuringLove: Sexual MinorityYouths’ Ideal RomanticCharacteristics.
Measures: Ideal Relationship • Ideal Relationship Characteristics (Z-scored factors) • Intimacy & Passion (r = .15, p < .01) • Intimacy & Commitment (r= .13, p < .01) • Commitment & Passion (r = .19, p < .01) • Idealized sexual negotiation • “How important would it be for you to be in a monogamous relationship with your partner?” • “How important would it be for you to be sexually exclusive with your partner?” • Two items were strongly correlated (r= .78, p < .01) • Moderately correlated with the three idealized constructs (r’s between .27 and .48, p < .01).
Romantic Ideation • Mean differences on triadic love constructs • Younger participants (less than 21 years old; M = -0.18, SD = 1.05) placed less importance on Intimacy than Older participants (21 years old or older; M = 0.09, SD = .80). • Bisexual men (M = -0.45, SD = 1.04) ascribed less importance to Commitment than Gay men (M = 0.07, SD = .81).
Idealized sexual negotiation • Over 80% of the sample reported that it would be important that their idealized relationship was monogamous • Close to 75% of the sample reported it was important that their idealized relationship be sexually exclusive • When compared to gay-identified men (M = 4.40, SD = .98), bisexual men ascribed less importance to a monogamous relationship (M = 3.94, SD = 1.33) • Bisexual men (M = 3.79, SD = 1.37) were also less likely than gay men (M = 4.34, SD = 1.07) to rate that sexual-exclusivity was important in their ideal relationship)
Romantic Ideation • Negative correlations between • Intimacy and Sexual Partners (r = -0.12, p < .05), • Commitment and URAI partners (r = -0.14, p < .01) • Positive association between: • Romantic partner-seeking and Commitment (r=.15, p<.01) • Romantic partner-seeking and Passion (r = .09, p < .10)