Who is Omitted from Repeated Offline HIV Behavioural Surveillance Among MSM? Implications for Interpreting Trends

Abstract

Repeated behavioural surveillance should sample all epidemiologically relevant subgroups to provide a complete picture of trends in HIV risk behaviours. Web-based recruitment has been mooted but little empirical data exist on country experiences. We describe who is omitted from three rounds of a conventional offline-only surveillance programme among men who have sex with men (MSM) 2006–2011, but recruited subsequently on Internet dating sites, and the implications of this for understanding trends. The latter were younger, less gay identified and less gay community attached. Importantly, they reported different partnering patterns, lower condom use with casual and fuckbuddy-type male partners, and lower rates of HIV testing, compared to MSM routinely captured in offline surveillance. The replacement of offline socio-sexual activity by the Internet among many MSM means that current venue-based surveillance systems may underestimate risk behaviours, overlook trends among unsampled online MSM, and misinterpret trends observed in sampled MSM due to “sample drift” of most-at-risk MSM.

Resumen

El seguimiento continuo del comportamiento debería mostrar todos los subgrupos epidemiológicamente relevantes para dar un cuadro de las tendencias de los comportamientos de riesgo para HIV. El reclutamiento basado en la Web ha sido objeto de debate, pero existen poco datos empíricos sobre las experiencias en diferentes países. Se describen quienes fueron omitidos de un programa convencional de seguimiento solo offline de tres rondas entre hombres que practican sexo con hombres (MSM) 2006–2011 y las implicaciones para entender las tendencias. Los MSM que no pudieron ser reclutados offline y por lo tanto fueron reclutados online fueron más jóvenes, menor número de homosexuales y menos relacionados con las comunidades homosexuales. Es importante destacar que la muestra mostró diferentes patrones de emparejamiento, como ser bajo uso de condón con contactos sexuales casuales, patrones de varones “amigos con beneficios sexuales”, y menores tasas de test para HIV, comparado a MSM tomados rutinariamente durante el seguimiento offline. El reemplazo del patrón “amigos con beneficios sexuales” offline por online entre muchos MSM significa que el actual sistema de seguimiento basado en un lugar puede subestimar los comportamientos de riesgo, pasando por alto las tendencias entre sujetos fuera de la muestra online MSM, y tendencias mal interpretadas observadas en la muestra MSM debido a la desviación de la muestra de MSM de más riesgo.

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Acknowledgments

The authors would like to thank the men who participated in the study and the site operators for allowing us access. We also acknowledge the reviewers for their helpful comments on the manuscript and Sophia Leon de la Barra for Spanish translation. PS conducted the research during tenure of a Health Sciences Career Development Award of the University of Otago. Study funding was provided by the Ministry of Health, the AIDS Epidemiology Group at the University of Otago Medical School and the Research Unit at the New Zealand AIDS Foundation.

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Correspondence to Peter Saxton.

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Saxton, P., Dickson, N. & Hughes, A. Who is Omitted from Repeated Offline HIV Behavioural Surveillance Among MSM? Implications for Interpreting Trends. AIDS Behav 17, 3133–3144 (2013). https://doi.org/10.1007/s10461-013-0485-1

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Keywords

  • MSM
  • Sampling
  • Surveillance
  • Trends
  • Internet