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Jonathan Elford City University London

HIV risk and prevention: the role of the Internet. Jonathan Elford City University London. London gay men who used the Internet to look for a sexual partner. %. p<0.001. Elford et al, AIDS 2005;19:2171-2174. Sexually transmitted infections.

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Jonathan Elford City University London

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  1. HIV risk and prevention: the role of the Internet Jonathan Elford City University London

  2. London gay men who used the Internet to look for a sexual partner % p<0.001 Elford et al, AIDS 2005;19:2171-2174

  3. Sexually transmitted infections The Internet has been implicated in several outbreaks of sexually transmitted infections (STI) among men who have sex with men (MSM) in Canada and the USA

  4. Internet and sex Is seeking sex through the Internet contributing to the spread of STIs and HIV beyond that which occurs when MSM meet partners in offline venues such as bars, clubs, saunas, parties etc?

  5. Meta-analysisLiau A, Millett G, Marks G. Meta-analytic examination of online sex seeking and sexual risk behavior among men who have sex with men Sexually Transmitted Diseases 2006 • Searched electronic databases • 22 studies published 2000-2005 • USA, UK, Netherlands, Sweden

  6. What percentage of MSM have used the Internet to look for sexual partners? Offline recruitment (11 studies) Weighted average 40% (23% - 57%) Online recruitment (9 studies) Weighted average 85% (64% - 99%)

  7. Online and offline • In large towns and cities most gay men who look for sex through the Internet also look for, and meet casual partners in bars, clubs and other offline venues • There are some men who only look for sex through the Internet but, in large urban areas they are a minority Mettey et al 2003; Taylor et al 2004; Murphy et al 2004; Bolding et al 2005

  8. What percentage of MSM have actually had sex with partners found online? Offline recruitment (3 studies) Weighted average 30% (22% - 33%) Online recruitment (5 studies) Weighted average 82% (78% - 94%)

  9. Is the prevalence of sexual risk behaviour higher among MSM who use the Internet to look for sex than MSM who do not? • 8 studies • MSM who used the Internet to look for sex were more likely to report high risk sexual behaviour (6 studies) • Combined OR 1.7, 95% CI 1.2, 2.4

  10. London, HIV negative men, “unsafe sex” (UAI with a casual partner of unknown or discordant HIV status) Reported unsafe sex (%)

  11. London, HIV negative men, “unsafe sex” (UAI with a casual partner of unknown or discordant HIV status) Reported unsafe sex (%)

  12. London, HIV negative men, “unsafe sex” (UAI with a casual partner of unknown or discordant HIV status) Reported unsafe sex (%) p<0.05

  13. London, HIV negative men, “unsafe sex” (UAI with a casual partner of unknown or discordant HIV status) Reported unsafe sex (%) p<0.05 p<0.05 Bolding et al, AIDS 2005;19:961-968

  14. London, HIV positive men,“serosorting”(UAI with a seroconcordant casual partner) Reported serosorting (%)

  15. London, HIV positive men,“serosorting”(UAI with a seroconcordant casual partner) Reported serosorting (%)

  16. London, HIV positive men,“serosorting”(UAI with a seroconcordant casual partner) Reported serosorting (%) p<0.001

  17. London, HIV positive men,“serosorting”(UAI with a seroconcordant casual partner) Reported serosorting (%) p<0.001 p<0.001 5% Bolding et al, AIDS 2005;19:961-968

  18. Two hypotheses • Self-selection hypothesis High risk men may gravitate to the Internet • Accentuation hypothesis Seeking sex through the Internet may in some way amplify risk behaviour Liau et al, Sex Trans Dis 2006;33

  19. HIV positive gay men • In London, HIV positive gay men were more likely to meet online, rather than offline, other HIV positive men for unprotected sex (serosorting) • Compared with offline venues (bars, clubs, etc), the Internet provides a relatively safe environment where HIV positive men can disclose their status

  20. Internet and serosorting • By serosorting on the Internet HIV positive men could establish concordance in a way that could not happen so easily offline (accentuation) • While serosorting can reduce the risk of HIV transmission between sexual partners, it still carries an STI risk

  21. Accentuation Our data suggest that serosorting on the Internet contributes to STI transmission risk among HIV positive gay men in London Bolding et al, AIDS 2005;19:961-968 Davis et al, Culture Health & Sexuality 2006;6:161-174

  22. HIV transmission risk • In London, HIV positive and negative men who looked for sex through the Internet were more likely to report “unsafe sex” than other men • But they were just as likely to meet their “unsafe sex” casual partners offline as online

  23. Internet and HIV • Most London gay men who looked for sex through the Internet (online) also looked for & met casual partners offline • So they were just as likely to report “unsafe sex” with a casual partner they met in a bar or club as on the Internet • No evidence that the Internet, per se, creates a risk for HIV transmission

  24. Self-selection Our data suggest that, in relation to HIV transmission, high risk men gravitate towards the Internet rather than the Internet accentuating HIV risk Bolding et al, AIDS 2005;19:961-968 Davis et al, Culture Health & Sexuality 2006;6:161-174

  25. Implications for HIV/STI prevention • Considerable percentage of MSM use the Internet to look for sexual partners • Those who do have a riskier sexual behaviour profile than other men (self selection or accentuation) • Internet offers potential for HIV/STI prevention

  26. Attitudes towards STI/HIV prevention on the Internet among MSM in the UK Bolding et al, AIDS Care 2004;8:993-1001

  27. Attitudes towards STI/HIV prevention on the Internet among MSM in the UK Bolding et al, AIDS Care 2004;8:993-1001

  28. Attitudes towards STI/HIV prevention on the Internet among MSM in the UK Bolding et al, AIDS Care 2004;8:993-1001

  29. Internet and STI/HIV preventionXVI International AIDS Conference • Gay cruise.com (Netherlands) • MINTS II (USA) • DIPEx website on HIV (UK) • Mysexycity.com (USA)

  30. Internet and STI/HIV prevention • primary prevention • secondary prevention (people living with HIV)

  31. Unanswered questions • Effectiveness of Internet-based HIV prevention initiatives • Lessons learned from other Internet interventions (eg CBT online for depression)? • MSM and the Internet in Africa, Asia, Latin America?

  32. Conclusion 2000-2006 • Most research focused on Internet and sexual risk 2006-2012 • Increasing research into effectiveness of online interventions

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