AIDS and Behavior

, Volume 14, Issue 6, pp 1353–1361 | Cite as

Reconsidering the Internet as an HIV/STD Risk for Men Who Have Sex with Men

  • Samuel M. JennessEmail author
  • Alan Neaigus
  • Holly Hagan
  • Travis Wendel
  • Camila Gelpi-Acosta
  • Christopher S. Murrill
Original Paper


Previous studies linking online sexual partnerships to behavioral risks among men who have sex with men (MSM) may be subject to confounding and imprecise measurement of partnership-specific risks. We examined behavioral risks associated with having only online, only offline, or both online and offline partners in the past year, the confounding effects of multiple partnerships, and partnership-specific risks among a sample of MSM from New York City recruited offline in 2008. Overall, 28% of 479 participants had an online partner in the past year, but most of those (82%) also had an offline partner. Having an online partner was associated with past-year unprotected anal intercourse (UAI) and other risks, but not after controlling for multiple partnerships. There were slightly higher levels of risk within offline partnerships, but differences were largely attributable to MSM who had both offline and online partners. Last sex partners met offline were more likely to be HIV-serodiscordant and engage in concurrent substance use with the participant. This suggests that online partnerships may not be an independent cause of behavioral risks, but a marker for risks occurring independent of Internet use.


HIV AIDS MSM Behavioral risk Internet Online 



This work was funded by a cooperative agreement between the New York City Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention (Grant #U62/CCU223595-03-1). The authors would like to acknowledge Blayne Cutler and Sarah Brockwell of the NYC DOHMH and Elizabeth DiNenno, Amy Drake, Amy Lansky, and Isa Miles of the CDC for their contributions to the NHBS study design locally and nationally, as well as all the contributions of the NYC NHBS field staff.


  1. 1.
    Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2007. Vol. 19. Accessed 1 June 2010.
  2. 2.
    Hall HI, Song R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA. 2008;300(5):520–9.CrossRefPubMedGoogle Scholar
  3. 3.
    New York City Department of Health and Mental Hygiene. New HIV diagnoses rising in New York City among young men who have sex with men. Press Release #079-07, November 2007. Accessed 1 June 2010.
  4. 4.
    Crepaz N, Marks G, Liau A, et al. Prevalence of unprotected anal intercourse among HIV-diagnosed MSM in the United States: a meta-analysis. AIDS. 2009;23(13):1617–29.CrossRefPubMedGoogle Scholar
  5. 5.
    Wolitski RJ, Valdiserri RO, Denning PH, Levine WC. Are we headed for a resurgence of the HIV epidemic among men who have sex with men? Am J Public Health. 2001;91(6):883–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Koblin BA, Husnik MJ, Colfax G, et al. Risk factors for HIV infection among men who have sex with men. AIDS. 2006;20(5):731–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Chmiel JS, Detels R, Kaslow RA, Van Raden M, Kingsley LA, Brookmeyer R. Factors associated with prevalent human immunodeficiency virus (HIV) infection in the Multicenter AIDS Cohort Study. Am J Epidemiol. 1987;126(4):568–77.PubMedGoogle Scholar
  8. 8.
    Herbst JH, Sherba RT, Crepaz N, et al. A meta-analytic review of HIV behavioral interventions for reducing sexual risk behavior of men who have sex with men. J Acquir Immune Defic Syndr. 2005;39(2):228–41.PubMedGoogle Scholar
  9. 9.
    Rietmeijer CA, McFarlane M. Web 2.0 and beyond: risks for sexually transmitted infections and opportunities for prevention. Curr Opin Infect Dis. 2009;22(1):67–71.CrossRefPubMedGoogle Scholar
  10. 10.
    McFarlane M, Bull SS, Rietmeijer CA. The Internet as a newly emerging risk environment for sexually transmitted diseases. JAMA. 2000;284(4):443–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Liau A, Millett G, Marks G. Meta-analytic examination of online sex-seeking and sexual risk behavior among men who have sex with men. Sex Transm Dis. 2006;33(9):576–84.CrossRefPubMedGoogle Scholar
  12. 12.
    Benotsch EG, Kalichman S, Cage M. Men who have met sex partners via the Internet: prevalence, predictors, and implications for HIV prevention. Arch Sex Behav. 2002;31(2):177–83.CrossRefPubMedGoogle Scholar
  13. 13.
    Elford J, Bolding G, Sherr L. Seeking sex on the Internet and sexual risk behaviour among gay men using London gyms. AIDS. 2001;15(11):1409–15.CrossRefPubMedGoogle Scholar
  14. 14.
    Wilson PA, Cook S, McGaskey J, Rowe M, Dennis N. Situational predictors of sexual risk episodes among men with HIV who have sex with men. Sex Transm Infect. 2008;84(6):506–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Berg RC. Barebacking among MSM Internet users. AIDS Behav. 2008;12(5):822–33.CrossRefPubMedGoogle Scholar
  16. 16.
    Blackwell CW. Men who have sex with men and recruit bareback sex partners on the Internet: implications for STI and HIV prevention and client education. Am J Mens Health. 2008;2(4):306–13.CrossRefPubMedGoogle Scholar
  17. 17.
    Bolding G, Davis M, Sherr L, Hart G, Elford J. Use of gay Internet sites and views about online health promotion among men who have sex with men. AIDS Care. 2004;16(8):993–1001.CrossRefPubMedGoogle Scholar
  18. 18.
    Elford J, Bolding G, Davis M, Sherr L, Hart G. Web-based behavioral surveillance among men who have sex with men: a comparison of online and offline samples in London, UK. J Acquir Immune Defic Syndr. 2004;35(4):421–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Rietmeijer CA, Bull SS, McFarlane M, Patnaik JL, Douglas JM Jr. Risks and benefits of the Internet for populations at risk for sexually transmitted infections (STIs): results of an STI clinic survey. Sex Transm Dis. 2003;30(1):15–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Bolding G, Davis M, Hart G, Sherr L, Elford J. Gay men who look for sex on the Internet: is there more HIV/STI risk with online partners? AIDS. 2005;19(9):961–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Chiasson MA, Hirshfield S, Remien RH, Humberstone M, Wong T, Wolitski RJ. A comparison of on-line and off-line sexual risk in men who have sex with men: an event-based on-line survey. J Acquir Immune Defic Syndr. 2007;44(2):235–43.CrossRefPubMedGoogle Scholar
  22. 22.
    Horvath KJ, Rosser BR, Remafedi G. Sexual risk taking among young Internet-using men who have sex with men. Am J Public Health. 2008;98(6):1059–67.CrossRefPubMedGoogle Scholar
  23. 23.
    Millett GA, Peterson JL, Wolitski RJ, Stall R. Greater risk for HIV infection of black men who have sex with men: a critical literature review. Am J Public Health. 2006;96(6):1007–19.CrossRefPubMedGoogle Scholar
  24. 24.
    Al-Tayyib AA, McFarlane M, Kachur R, Rietmeijer CA. Finding sex partners on the Internet: what is the risk for sexually transmitted infections? Sex Transm Infect. 2009;85(3):216–20.CrossRefPubMedGoogle Scholar
  25. 25.
    Fernandez MI, Warren JC, Varga LM, Prado G, Hernandez N, Bowen GS. Cruising in cyber space: comparing Internet chat room versus community venues for recruiting Hispanic men who have sex with men to participate in prevention studies. J Ethn Subst Abuse. 2007;6(2):143–62.CrossRefPubMedGoogle Scholar
  26. 26.
    Gallagher KM, Sullivan PS, Lansky A, Onorato IM. Behavioral surveillance among people at risk for HIV infection in the U.S.: the National HIV Behavioral Surveillance System. Public Health Rep. 2007;122(Suppl 1):32–8.PubMedGoogle Scholar
  27. 27.
    MacKellar DA, Gallagher KM, Finlayson T, Sanchez T, Lansky A, Sullivan PS. Surveillance of HIV risk and prevention behaviors of men who have sex with men—a national application of venue-based, time-space sampling. Public Health Rep. 2007;122(Suppl 1):39–47.PubMedGoogle Scholar
  28. 28.
    Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr. 2005;39(4):446–53.CrossRefPubMedGoogle Scholar
  29. 29.
    Bull SS, McFarlane M, Rietmeijer C. HIV and sexually transmitted infection risk behaviors among men seeking sex with men on-line. Am J Public Health. 2001;91(6):988–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Hirshfield S, Remien RH, Walavalkar I, Chiasson MA. Crystal methamphetamine use predicts incident STD infection among men who have sex with men recruited online: a nested case-control study. J Med Internet Res. 2004;6(4):e41.CrossRefPubMedGoogle Scholar
  31. 31.
    Taylor M, Aynalem G, Smith L, Bemis C, Kenney K, Kerndt P. Correlates of Internet use to meet sex partners among men who have sex with men diagnosed with early syphilis in Los Angeles County. Sex Transm Dis. 2004;31(9):552–6.CrossRefPubMedGoogle Scholar
  32. 32.
    Evans AR, Wiggins RD, Mercer CH, Bolding GJ, Elford J. Men who have sex with men in Great Britain: comparison of a self-selected Internet sample with a national probability sample. Sex Transm Infect. 2007;83(3):200–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Tikkanen R, Ross MW. Technological tearoom trade: characteristics of Swedish men visiting gay Internet chat rooms. AIDS Educ Prev. 2003;15(2):122–32.CrossRefPubMedGoogle Scholar
  34. 34.
    Smith DM, Drumright LN, Frost SD, et al. Characteristics of recently HIV-infected men who use the Internet to find male sex partners and sexual practices with those partners. J Acquir Immune Defic Syndr. 2006;43(5):582–7.PubMedGoogle Scholar
  35. 35.
    Thiede H, Jenkins RA, Carey JW, et al. Determinants of recent HIV infection among Seattle-area men who have sex with men. Am J Public Health. 2009;99(Suppl 1):S157–64.PubMedGoogle Scholar
  36. 36.
    Centers for Disease Control and Prevention. Internet use and early syphilis infection among men who have sex with men—San Francisco, California, 1999–2003. MMWR Morb Mortal Wkly Rep 2003;52(50):1229–32.Google Scholar
  37. 37.
    Balan IC, Carballo-Dieguez A, Ventuneac A, Remien RH. Intentional condomless anal intercourse among Latino MSM who meet sexual partners on the Internet. AIDS Educ Prev. 2009;21(1):14–24.CrossRefPubMedGoogle Scholar
  38. 38.
    Rietmeijer CA, Lloyd LV, McLean C. Discussing HIV serostatus with prospective sex partners: a potential HIV prevention strategy among high-risk men who have sex with men. Sex Transm Dis. 2007;34(4):215–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Reisner SL, Mimiaga MJ, Skeer M, et al. Differential HIV risk behavior among men who have sex with men seeking health-related mobile van services at diverse gay-specific venues. AIDS Behav. 2009;13(4):822–31.CrossRefPubMedGoogle Scholar
  40. 40.
    Gorbach PM, Sopheab H, Phalla T, et al. Sexual bridging by Cambodian men: potential importance for general population spread of STD and HIV epidemics. Sex Transm Dis. 2000;27(6):320–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Morris M, Zavisca J, Dean L. Social and sexual networks: their role in the spread of HIV/AIDS among young gay men. AIDS Educ Prev. 1995;7(5 Suppl):24–35.PubMedGoogle Scholar
  42. 42.
    Laumann EO, Youm Y. Racial/ethnic group differences in the prevalence of sexually transmitted diseases in the United States: a network explanation. Sex Transm Dis. 1999;26(5):250–61.CrossRefPubMedGoogle Scholar
  43. 43.
    Horvath KJ, Nygaard K, Simon Rosser BR. Ascertaining partner HIV status and its association with sexual risk behavior among Internet-using men who have sex with men. AIDS Behav 2009 [Epub ahead of print].Google Scholar
  44. 44.
    Raymond HF, Rebchook G, Curotto A, et al. Comparing Internet-based and venue-based methods to sample MSM in the San Francisco Bay Area. AIDS Behav. 2010;14(1):218–24.CrossRefPubMedGoogle Scholar
  45. 45.
    Nguyen TQ, Gwynn RC, Kellerman SE, et al. Population prevalence of reported and unreported HIV and related behaviors among the household adult population in New York City, 2004. AIDS. 2008;22(2):281–7.CrossRefPubMedGoogle Scholar
  46. 46.
    Chiasson MA, Shaw FS, Humberstone M, Hirshfield S, Hartel D. Increased HIV disclosure three months after an online video intervention for men who have sex with men (MSM). AIDS Care. 2009;21(9):1081–9.CrossRefPubMedGoogle Scholar
  47. 47.
    Noar SM, Clark A, Cole C, Lustria ML. Review of interactive safer sex Web sites: practice and potential. Health Commun. 2006;20(3):233–41.CrossRefPubMedGoogle Scholar
  48. 48.
    Crepaz N, Lyles CM, Wolitski RJ, et al. Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials. AIDS. 2006;20(2):143–57.CrossRefPubMedGoogle Scholar
  49. 49.
    Lyles CM, Kay LS, Crepaz N, et al. Best-evidence interventions: findings from a systematic review of HIV behavioral interventions for US populations at high risk, 2000–2004. Am J Public Health. 2007;97(1):133–43.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Samuel M. Jenness
    • 1
    Email author
  • Alan Neaigus
    • 1
  • Holly Hagan
    • 2
  • Travis Wendel
    • 3
  • Camila Gelpi-Acosta
    • 3
  • Christopher S. Murrill
    • 1
  1. 1.HIV Epidemiology ProgramNew York City Department of Health and Mental HygieneNew YorkUSA
  2. 2.College of NursingNew York UniversityNew YorkUSA
  3. 3.National Development and Research Institutes, Inc.New YorkUSA

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