Unprotected sex and the Internet: Is meeting place related to risk?: Unprotected sex and the Internet: Is meeting place related to risk? Tom Perdue Statistical Center for HIV/AIDS Research andamp; Prevention Fred Hutchinson Cancer Research Center, Seattle Hanne Thiede DVM MPH Public Health-Seattle andamp; King County Linda Valleroy PhD Duncan MacKellar MA MPH Centers for Disease Control and Prevention


Acknowledgements: Acknowledgements Seattle Young Men’s Survey Team: David Miller, Jason Naki, Richard Newman, Russell Campbell, Damon Jameson, Barry Kosloff, Dana White, Robert Yoon, Justin Haines, Misha Williams, Jennifer Davis Johns Hopkins University School of Hygiene andamp; Public Health Susan Sherman


Presentation Objectives: Presentation Objectives Present analysis on associations between sex partner venue type and HIV risk behavior Discuss why finding sex partners on the Internet might be related to risk Talk about how we might approach behavioral interventions


Background/Rationale: Background/Rationale Goal of this type of analysis: to more precisely characterize risk behavior in order to inform prevention efforts Recent research suggests increased risk behavior among those who meet sex partners via the Internet: Klausner et al, 2000 McFarlane et al, 2000 Kim, et al, 2000


Background/Rationale : Background/Rationale Implications for targeted intervention efforts. Use of Young Men’s Survey data to explore the association between sex partner venues HIV-related risk behavior.


Methods: Methods Young Men’s Survey: CDC-sponsored HIV risk behavior survey in 7 US cities, 1994-2000 Phase 2: 23-29 year old men (6 cities; 1998-2000) Venue based sampling method to approximate a probability sample Behavioral questionnaire HIV/STD testing


Methods: Methods Sex partner venue item (Seattle only): 'Where did you meet your 3 most recent new male sex partners?' Specific locations collapsed into four categories: Bars and dance clubs Sex venues Social environments Internet


Methods: Methods Sexual risk defined as: Unprotected anal sex in last 6 months with: Non-monogamous partner, or Partner of unknown HIV status


Results: Results 431 respondents met 1183 sex partners: 47% were met at bars/clubs 36% at social environments 12% on the Internet 5% at sex venues


Results: Results No differences by venue type in age, race, education, employment, income, or living situation Meeting sex partners at sex venues was associated with history of STD (42% vs. 26%, pandlt;.05) Meeting sex partners at bars or dance clubs was associated with being high on drugs or alcohol during sex in last 6 mo. (69% vs. 58%, pandlt;.05)


Results: Results Those who met partners on the Internet were less likely to report sex while high on drugs or alcohol in the last 6 mo (45% vs. 69%, pandlt;.05) Those who met partners on the Internet were more likely to report unprotected anal sex with non-monogamous/unknown serostatus partner in last 6 mo (16% vs. 9%, pandlt;.05)


Results: Results Odds of reporting risky sex by venue where partners were met Adjusted for sex while high on drugs or alcohol,* STD history**


Discussion: Discussion Social network approach provides a useful framework for describing HIV risk behavior: Behavior influenced by social context Patterns of behavior may vary by networks, groups, and environments As these patterns can be described and predicted, they have implications for prevention efforts


Discussion: Discussion Social networks are influential structures in gay community; venues may serve as proxies for social networks Gay venues reflect network structures and norms HIV risk behavior may vary by gay venue type Patterns may be useful for focusing prevention efforts


Discussion: Discussion Risk behavior significantly associated with meeting sex partners on the Internet, but not other venues Possible interpretations: As a new 'venue, ' the Internet may lack developed norms or identified peer leaders


Discussion: Discussion Possible interpretations Internet may be a place where different subgroups (with differing behavioral norms) mix Anonymity of Internet may facilitate temporary abandonment of safer behavior Ability to 'reinvent' self to attract sex partners Fantasies initiated online may extend to physical encounter Lack of social sanction for risky behavior


Discussion: Discussion How to approach intervention? Internet may present unique opportunities for targeted programs Messages tailored to risk Addressing social norms in cyberspace Adapting peer influence approaches Recruiting chat room regulars as peer opinion leaders


Conclusions: Conclusions In Seattle, sexual risk behavior among young MSM was associated with meeting partners thought the Internet HIV prevention efforts should address the risk associated with meeting sex partners online Further research to more precisely characterize factors related to risk needed as we continue to improve and tailor HIV prevention efforts