Australian gay and bisexual men’s online preferences about sex with HIV-positive partners
Garrett Prestage A C , Benjamin Bavinton A , Denton Callander A , Steven P. Philpot A , Iryna Zablotska A , Johann Kolstee A B , Phillip Keen A , Jack Bradley A and Fengyi Jin AA Kirby Institute, University of New South Wales, Kensington, NSW 2052, Australia.
B ACON, 414 Elizabeth Street, Surry Hills, NSW 2010, Australia.
C Corresponding author. Email: gprestage@kirby.unsw.edu.au
Sexual Health 14(3) 221-228 https://doi.org/10.1071/SH16191
Submitted: 20 October 2016 Accepted: 15 January 2017 Published: 16 March 2017
Abstract
Background: Among gay and bisexual men (GBM), ‘serosorting’ is common and involves restricting sex, or at least condomless sex, to partners of the same HIV status. The prevalence of men conveying their serosorting preferences regarding partners they meet online remains unclear. Methods: This study reviewed 57 178 Australian online profiles obtained directly from a popular gay website. Logistic regression was used to identify factors associated with preferences for meeting HIV-positive partners. Results: Men could indicate their preferences from a list of 22 types of partners; 4358 profiles (7.6%) indicated an interest in meeting HIV-positive men. There were 1959 profiles (3.4%) listing a preference for 21 of the 22 types of men, including 1498 men (2.6%) that specifically excluded HIV-positive men. Men who specifically excluded HIV-positive men on their profiles were younger (mean age 34.7 years), less likely to identify as gay (25.6%) and more likely to always prefer ‘safer sex’ (55.3%) than those who specifically included them (mean age 39.6 years; 62.8% gay-identified; 30.9% preferred safer sex; P < 0.001). Men who specifically excluded HIV-positive partners on their profiles were also more likely to live outside major capital cities (P < 0.001). Conclusions: Being younger, living outside major cities, not identifying as gay, always preferring safer sex and either Caucasian or Asian background were associated with excluding HIV-positive men as potential sex partners. These factors may reflect lower social and community engagement with the gay community. The disinclination to include HIV-positive men as potential sex partners may be due to fear of infection, stigma or poor information about HIV.
References
[1] Mao L, Crawford JM, Hospers HJ, Prestage GP, Grulich AE, Kaldor JM, et al ‘Serosorting’ in casual anal sex of HIV-negative gay men is noteworthy and is increasing in Sydney, Australia. AIDS 2006; 20 1204–6.| ‘Serosorting’ in casual anal sex of HIV-negative gay men is noteworthy and is increasing in Sydney, Australia.Crossref | GoogleScholarGoogle Scholar |
[2] Grov CH, Rendina J, Moody RL, Ventuneac A, Parsons JT. HIV serosorting, status disclosure, and strategic positioning among highly sexually active GBM. AIDS Patient Care STDS 2015; 29 559–68.
| HIV serosorting, status disclosure, and strategic positioning among highly sexually active GBM.Crossref | GoogleScholarGoogle Scholar |
[3] Horvath KJ, Nygaard K, Rosser BS. Ascertaining partner HIV status and its association with sexual risk behavior among Internet-using men who have sex with men. AIDS Behav 2010; 14 1376–83.
| Ascertaining partner HIV status and its association with sexual risk behavior among Internet-using men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[4] Grov C, Agyemang L, Ventuneac A, Breslow AS. Navigating condom use and HIV status disclosure with partners met online: a qualitative pilot study with GBM from Craigslist.org. AIDS Educ Prev 2013; 25 72
| Navigating condom use and HIV status disclosure with partners met online: a qualitative pilot study with GBM from Craigslist.org.Crossref | GoogleScholarGoogle Scholar |
[5] Prestage G, Bavinton B, Grierson J, Down I, Keen P, Bradley J, Duncan D. Online dating among Australian gay and bisexual men: romance or hooking up? AIDS Behav 2015; 19 1905–13.
| Online dating among Australian gay and bisexual men: romance or hooking up?Crossref | GoogleScholarGoogle Scholar |
[6] McFarland W, Chen YH, Nguyen B, Grasso M, Levine D, Stall R, et al Behavior, intention or chance? A longitudinal study of HIV seroadaptive behaviors, abstinence and condom use. AIDS Behav 2012; 16 121–31.
| Behavior, intention or chance? A longitudinal study of HIV seroadaptive behaviors, abstinence and condom use.Crossref | GoogleScholarGoogle Scholar |
[7] Kippax S, Race K. Sustaining safe practice: twenty years on. Soc Sci Med 2003; 57 1–12.
| Sustaining safe practice: twenty years on.Crossref | GoogleScholarGoogle Scholar |
[8] Jin F, Crawford J, Prestage GP, Zablotska I, Imrie J, Kippax SC, et al HIV risk reduction behaviours in gay men: unprotected anal intercourse, risk reduction behaviours, and subsequent HIV infection in a cohort of homosexual men. AIDS 2009; 23 243–52.
| HIV risk reduction behaviours in gay men: unprotected anal intercourse, risk reduction behaviours, and subsequent HIV infection in a cohort of homosexual men.Crossref | GoogleScholarGoogle Scholar |
[9] Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011; 365 493–505.
| Prevention of HIV-1 infection with early antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXhtVars7jF&md5=9d5b438e848fffcec39bc07afd963760CAS |
[10] Grulich AE, Bavinton BR, Jin F, Prestage G, Zablotska I, Grinsztejn B, et al. HIV transmission in male serodiscordant couples in Australia, Thailand and Brazil [Poster 1019LB]. Poster presented at the 20th Conference on Retroviruses and Opportunistic Infections, Washington State Convention Center, 23–25 February 2015; Seattle, WA, USA. San Francisco: International Antiviral Society - USA; 2015. p. 599.
[11] Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, van Lunzen J, et al Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA 2016; 316 171–81.
| Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar |
[12] Brenner BG, Roger M, Routy J-P, Moisi D, Ntemgwa M, Matte C, et al High rates of forward transmission events after acute/early HIV-1 infection. J Infect Dis 2007; 195 951–9.
| High rates of forward transmission events after acute/early HIV-1 infection.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2sXksVOlsLc%3D&md5=8725912dcb8ccc39cf7e623784f83cdeCAS |
[13] Miller WC, Rosenberg NE, Rutstein SE, Powers KA. The role of acute and early HIV infection in the sexual transmission of HIV. Curr Opin HIV AIDS 2010; 5 277–82.
| The role of acute and early HIV infection in the sexual transmission of HIV.Crossref | GoogleScholarGoogle Scholar |
[14] Hayes RJ, White RG. Role of acute infection in HIV transmission. Lancet 2011; 378 1913–4.
| Role of acute infection in HIV transmission.Crossref | GoogleScholarGoogle Scholar |
[15] Ratmann O, van Sighem A, Bezemer D, Gavryushkina A, Jurriaans S, Wensing A, et al Sources of HIV infection among men having sex with men and implications for prevention. Sci Translational Med 2016; 8 320ra2–320ra2.
| Sources of HIV infection among men having sex with men and implications for prevention.Crossref | GoogleScholarGoogle Scholar |
[16] Holt M. HIV pre-exposure prophylaxis and treatment as prevention: a review of awareness and acceptability among men who have sex with men in the Asia-Pacific region and the Americas. Sex Health 2013; 11 166–70.
[17] Prestage G, Brown G, Down IA, Jin F, Hurley M. ‘It’s hard to know what is a risky or not a risky decision’: gay men’s beliefs about risk during sex. AIDS Behav 2013; 17 1352–61.
| ‘It’s hard to know what is a risky or not a risky decision’: gay men’s beliefs about risk during sex.Crossref | GoogleScholarGoogle Scholar |
[18] Bavinton BR, Holt M, Grulich AE, Brown G, Zablotska IB, Prestage GP. Willingness to act upon beliefs about ‘treatment as prevention’ among Australian GBM. PLoS One 2016; 11 1–12.
[19] Murphy DA, de Wit JB, Donohoe S, Adam PC. The need to know: HIV status disclosure expectations and practices among non-HIV-positive GBM in Australia. AIDS Care 2015; 27 90–98.
| The need to know: HIV status disclosure expectations and practices among non-HIV-positive GBM in Australia.Crossref | GoogleScholarGoogle Scholar |
[20] de Wit JBF, Murphy DA, Adam PCG, Donohoe S. Strange bedfellows: HIV-related stigma among gay men in Australia. In LiamputtongP, editor. Stigma, discrimination and living with HIV/AIDS: a cross-cultural perspective. Dordrecht, The Netherlands: Springer; 2013. pp. 289–308.
[21] Frost DM, Stirratt MJ, Ouellette SC. Understanding why gay men seek HIV‐seroconcordant partners: intimacy and risk reduction motivations. Cult Health Sex 2008; 10 513–27.
| Understanding why gay men seek HIV‐seroconcordant partners: intimacy and risk reduction motivations.Crossref | GoogleScholarGoogle Scholar |
[22] Smit PJ, Brady M, Carter M, Fernandes R, Lamore L, Meulbroek M, et al HIV-related stigma within communities of gay men: a literature review. AIDS Care 2012; 24 405–12.
[23] Bavinton BR, Jin F, Mao L, Zablotska I, Prestage GP, Grulich AE. Homosexual men in HIV serodiscordant relationships: implications for HIV treatment as prevention research. J Int AIDS Soc 2015; 18 1988
[24] Prestage G, McCann PD, Hurley M, Bradley J, Down I, Brown G. Pleasure and sexual health: The PASH Study. Sydney: National Centre in HIV Epidemiology and Clinical Research, UNSW Australia; 2010. Available online at: http://kirby.unsw.edu.au/sites/default/files/hiv/attachment/PASH2009-final.pdf [verified 23 February 2017].
[25] Xia Q, Molitor F, Osmond DH, et al Knowledge of sexual partner’s HIV serostatus and serosorting practices in a California population-based sample of men who have sex with men. AIDS 2006; 20 2081–9.
| Knowledge of sexual partner’s HIV serostatus and serosorting practices in a California population-based sample of men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[26] Zablotska IB, Holt M, Prestage G. Changes in gay men’s participation in gay community life: implications for HIV surveillance and research. AIDS Behav 2012; 16 669–75.
| Changes in gay men’s participation in gay community life: implications for HIV surveillance and research.Crossref | GoogleScholarGoogle Scholar |
[27] Madeddu D, Grulich A, Richters J, Ferris J, Grierson J, Smith A, et al Estimating population distribution and HIV prevalence among homosexual and bisexual men. Sex Health 2006; 3 37–43.
| Estimating population distribution and HIV prevalence among homosexual and bisexual men.Crossref | GoogleScholarGoogle Scholar |
[28] Prestage G, Ferris J, Grierson J, Thorpe R, Zablotska I, Imrie J, et al Homosexual men in Australia: population, distribution and HIV prevalence. Sex Health 2008; 5 97–102.
| Homosexual men in Australia: population, distribution and HIV prevalence.Crossref | GoogleScholarGoogle Scholar |
[29] Prestage G, Jin F, Zablotska I, Imrie J, Kaldor JM, Grulich AE. Trends in HIV prevalence among homosexual and bisexual men in eastern Australian states. Sex Health 2008; 5 103–7.
| Trends in HIV prevalence among homosexual and bisexual men in eastern Australian states.Crossref | GoogleScholarGoogle Scholar |
[30] Mills TC, Stall R, Pollack L, Paul JP, Binson D, Canchola J, et al Health-related characteristics of men who have sex with men: a comparison of those living in” gay ghettos” with those living elsewhere. Am J Public Health 2001; 91 980
| Health-related characteristics of men who have sex with men: a comparison of those living in” gay ghettos” with those living elsewhere.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MzhvVyqug%3D%3D&md5=9f469f4361304f097d336d6fc036e3c3CAS |
[31] Crawford J, Kippax S, Prestage G. Not gay, not bisexual, but polymorphously sexually active: male bisexuality and AIDS in Australia. In Aggleton P, editor. Bisexualities and AIDS, London: Taylor & Francis; 1996. pp. 44–60.
[32] Flores SA, Mansergh G, Marks G, Guzman R, Colfax G. Gay identity-related factors and sexual risk among men who have sex with men in San Francisco. AIDS Educ Prev 2009; 21 91–103.
| Gay identity-related factors and sexual risk among men who have sex with men in San Francisco.Crossref | GoogleScholarGoogle Scholar |
[33] Jeffries WL. Sociodemographic, sexual, and HIV and other sexually transmitted disease risk profiles of nonhomosexual-identified men who have sex with men. Am J Public Health 2009; 99 1042–5.
| Sociodemographic, sexual, and HIV and other sexually transmitted disease risk profiles of nonhomosexual-identified men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[34] Wegesin DJ, Meyer-Bahlburg HFL. Top/bottom self-label, anal sex practices, HIV risk and gender role identity in gay men in New York City. J Psychol Human Sex 2000; 12 43–62.
| Top/bottom self-label, anal sex practices, HIV risk and gender role identity in gay men in New York City.Crossref | GoogleScholarGoogle Scholar |
[35] Kippax S, Crawford J, Connell R. The importance of the gay community in the prevention of HIV transmission: a study of Australian men who have sex with men. In Aggleton P, Davies P, Hart G, editors. AIDS rights, risks and reasons. London: Palmer Press; 1992. pp. 102–118.
[36] Rawstorne P, Prestage G, Grierson J, Song A, Grulich A, Kippax S. Trends and predictors of HIV-positive community attachment among PLWHA. AIDS Care 2005; 17 589–600.
| Trends and predictors of HIV-positive community attachment among PLWHA.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2MznvVagsA%3D%3D&md5=2c763569ddbefc7498cbbaef79694870CAS |
[37] Mao L, Adam P, Kippax S, Holt M, Prestage G, Calmette Y, et al HIV-negative gay men’s perceived HIV risk hierarchy: imaginary or real? AIDS Behav 2013; 17 1362–9.
| HIV-negative gay men’s perceived HIV risk hierarchy: imaginary or real?Crossref | GoogleScholarGoogle Scholar |
[38] Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia: Annual Surveillance Report 2015. Sydney: The Kirby Institute, UNSW Australia; 2015. Available online at: http://kirby.unsw.edu.au/sites/default/files/hiv/resources/2015%20Annual%20Surveillance%20Report%20of%20HIV%2C%20viral%20hepatitis%2C%20STIs.pdf [verified 23 February 2017].
[39] Jin F, Grulich AE, Mao L, Zablotska I, O’Dwyer M, Poynten M, et al Sexual partner’s age as a risk factor for HIV seroconversion in a cohort of HIV-negative homosexual men in Sydney. AIDS Behav 2013; 17 2426–9.
| Sexual partner’s age as a risk factor for HIV seroconversion in a cohort of HIV-negative homosexual men in Sydney.Crossref | GoogleScholarGoogle Scholar |
[40] Prestage G, Jin F, Bavinton B, Scott SA, Hurley M. Do differences in age between sexual partners affect sexual risk behaviour among Australian gay and bisexual men? Sex Transm Infect 2013; 89 653–8.
| Do differences in age between sexual partners affect sexual risk behaviour among Australian gay and bisexual men?Crossref | GoogleScholarGoogle Scholar |
[41] Wilson D, Hoare A, Regan D, Wand H, Law M. Mathematical models to investigate recent trends in HIV notifications among men who have sex with men in Australia. Sydney: Kirby Institute, UNSW Australia; 2008.