HIV disclosure & subsequent sexual behaviors among men who have sex with men (MSM) who meet online

1. HIV disclosure & subsequent sexual behaviors among men who have sex with men (MSM) who meet online Jef St. De Lore1 Hanne Thiede, DVM, MPH2 Allen Cheadle, PhD1 Gary Goldbaum, MD, MPH2 1University of Washington, 2Public Health – Seattle & King County

2. Background • 34 - 91% of MSM find partners online • Chat rooms • Websites • E-mail • In Seattle, rates rose from 12% to 40% over the last 4 years • Meeting sex partners online is associated with higher sexual risk. However, few studies have: • examined how the Internet affects HIV status discussions • distinguished between sexual risks with online and off-line partners.

3. Outline of Presentation • Overview of methods • Results of qualitative analysis: • Internet and HIV disclosure • HIV disclosure and sexual risk

4. Data Source • Seattle Area MSM Study (SAMS), a risk behavior study of MSM • Data collection: June 2002 - May 2005 • Recruited 215 from HIV testing sites • Eligibility: ≥ 18 years old, sex with a male partner in last 6 months, able to complete interview in English • Men with HIV- and HIV+ results were enrolled in the study

5. Data collection • Quantitative data (computer surveys) • SES data • sexual and substance-use risk behavior • Qualitative data (semi-structured interviews) • Perceived HIV transmission event • Another high-risk sexual event • Most recent sexual encounter

6. 2. HIV test & results (+ or -) 3.SAMSinterview 1. Period before HIV diagnosis Interview Reference Period Time

7. Sample

8. Grounded Theory Analysis • Open Coding: Identify broad categories • HIV Disclosure • Sexual Risks • Attitudes on the Internet • Axial Coding: Patterns in the data • Where did HIV disclosure occur? • What helped/hindered disclosure? • Selective Coding: Develop theory • HIV disclosure behaviors in relationship to Internet use and safe sex practices

9. Greater ease in talking online • More comfortable environment to talk • Less nervous asking questions • Okay to be more blunt in discussions “You are not face to face so you can talk to the person and ask blunt questions or be more honest with your feelings. All you see are words so you can ask questions that you might not ask and not be embarrassed. ” (30s, White)

10. Internet facilitates perceivedtrust & honesty • More information discussed • Talked longer with potential partners “Trustworthy, honest - a nice decent guy. He talked about [sex, HIV status] and I respected that.” (40s, White) • 4 participants disagreed and thought partners would lie about issues like HIV status and sexual risk “You can trust them but look where it got me [HIV+].” (30s, White)

11. Internet allows prescreening partners • Online profiles give useful information • Find out HIV status, sexual position “You’re able to look at the person at a glance: their picture, HIV status, what [sexual] position they are... And it’s easier to presort before you even had the conversation about HIV status with them.” (30s, White)

12. HIV disclosure and subsequent behaviors with partners met online UAI = unprotected anal intercourse

13. HIV disclosure and sexual risks • 17 study participants took more risks with the sex partner discussed in their interview • 6 said partner said he was HIV negative. • 3 hoped it would lead to a long term relationship. • 4 felt alcohol and drugs affected their decision • 3 felt a “connection,” comfort, and/or trust • 3 thought self immune to HIV • 5 thought self might be HIV positive

14. HIV disclosure and sexual risks (continued) • Serosorting • 13 would change behavior if a partner disclosed he was HIV positive. • Condoms for anal intercourse • Oral instead of anal intercourse • No sex with partner “I would have done a whole lot less [if he had said he was HIV positive]. Even though I was drunk, I would have made sure that I used condoms during anal sex and I probably wouldn’t have given him oral sex.” (20s, White)

15. No HIV disclosure • 8 did not discuss HIV status with their sex partner • Being influenced by substance use • Not wanting to offend a sex partner • Not wanting to spoil the moment • Concern sex partner might not be honest

16. Perceived HIV status, disclosure & sexual risk • 23 thought they were negative • 16 discussed HIV status  • 5 had low risk sex • 1 tested HIV+ • 10 had high risk sex with perceived HIV- partner • 7 tested HIV+ • 1 had high risk sex with HIV+ partner • He tested HIV-

17. Limitations • Secondary data analysis • No control over the questions or probes • Internet was not specific focus of study • Nothing asked about the men they chose not to have sex with • Potential recall bias • Possibly influenced by recent report of test results

18. Conclusions • Disclosure facilitated by the internet: • Greater ease in communication • Allowed prescreening partners through online profiles • Some don’t trust the information exchanged online • No clear relationship between HIV disclosure and subsequent behaviors • Some modified sexual behaviors based on HIV status • Perceived trust and honesty led some to high risk behaviors • More research is needed on how the Internet can facilitate accurate HIV disclosure and safer sexual behaviors

19. Acknowledgments Matthew Golden MD MPH SAMS staff: Rebecca Hutcheson Kim Houk Jason Naki Centers for Disease Control and Prevention Richard Jenkins PhD Ron Stall PhD Jim Carey PhD • HIV/AIDS & STD Programs, Public Health - Seattle & King Co. • One-on-One Program, Public Health - Seattle & King Co. • Madison Clinic, Seattle Gay Clinic, Primary Infection Clinic • All who participated as study participants