Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. UNAIDS/WHO. Guidelines for second generation HIV surveillance. Geneva: UNAIDS/WHO; 2000.

    Google Scholar 

  2. Amon J, Brown T, Hogle J, et al. Behavioral surveillance surveys: guidelines for repeated behavioral surveys in populations at risk of HIV. Arlington: Family Health International; 2000.

    Google Scholar 

  3. Mills S, Saidel T, Bennett A, et al. HIV risk behavioral surveillance: a methodology for monitoring behavioral trends. AIDS. 1998;12(Suppl 2):S37–46.

    PubMed  Google Scholar 

  4. Pisani E, Lazzari S, Walker N, Schwartlander B. HIV surveillance: a global perspective. J Acquir Immune Defic Syndr. 2003;32(Suppl 1):S3–11.

    Article  PubMed  Google Scholar 

  5. Brown T. Behavioral surveillance: current perspectives, and its role in catalyzing action. J Acquir Immune Defic Syndr. 2003;32(Suppl 1):S12–7.

    Article  PubMed  Google Scholar 

  6. Mills S, Saidel T, Magnani R, Brown T. Surveillance and modelling of HIV, STI, and risk behaviours in concentrated HIV epidemics. Sex Transm Infect. 2004;80(Suppl 2):ii57–62.

    Google Scholar 

  7. Cleland J, Boerma JT, Carael M, Weir SS. Monitoring sexual behaviour in general populations: a synthesis of lessons of the past decade. Sex Transm Infect. 2004;80(Suppl 2):ii1–7.

    Google Scholar 

  8. Garnett GP, Gregson S, Stanecki KA. Criteria for detecting and understanding changes in the risk of HIV infection at a national level in generalised epidemics. Sex Transm Infect. 2006;82(Suppl 1):i48–51.

    Article  PubMed  Google Scholar 

  9. Lansky A, Sullivan PS, Gallagher KM, Fleming PL. HIV behavioral surveillance in the U.S.: a conceptual framework. Public Health Rep. 2007;122(Suppl 1):16–23.

    PubMed  Google Scholar 

  10. McGarrigle CA, Fenton KA, Gill ON, Hughes G, Morgan D, Evans B. Behavioural surveillance: the value of national coordination. Sex Transm Infect [Review]. 2002;78(6):398–405.

    Google Scholar 

  11. Dodds JP, Mercer CH, Mercey DE, Copas AJ, Johnson AM. Men who have sex with men: a comparison of a probability sample survey and a community based study. Sex Transm Infect. 2006;82(1):86–7.

    Article  PubMed  CAS  Google Scholar 

  12. Schwarcz S, Spindler H, Scheer S, Valleroy L, Lansky A. Assessing representativeness of sampling methods for reaching men who have sex with men: a direct comparison of results obtained from convenience and probability samples. AIDS Behav. 2007;11(4):596–602.

    Article  PubMed  Google Scholar 

  13. Slaymaker E. A critique of international indicators of sexual risk behaviour. Sex Transm Infect. 2004;80(Suppl 2):ii13–21.

    Google Scholar 

  14. Paquette D, De Wit J. Sampling methods used in developed countries for behavioural surveillance among men who have sex with men. AIDS Behav. 2010;14(6):1252–64.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  CAS  Google Scholar 

  16. Bolding G, Davis M, Hart G, Sherr L, Elford J. Where young MSM meet their first sexual partner: the role of the Internet. AIDS Behav. 2007;11(4):522–6.

    Article  PubMed  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. Zablotska IB, Kippax S, Grulich A, Holt M, Prestage G. Behavioural surveillance among gay men in Australia: methods, findings and policy implications for the prevention of HIV and other sexually transmissible infections. Sex Health. 2011;8(3):272–9.

    Article  PubMed  Google Scholar 

  19. Zhang D, Bi P, Hiller JE, Lv F. Web-based HIV/AIDS behavioral surveillance among men who have sex with men: potential and challenges. Int J Infect Dis. 2008;12(2):126–31.

    Article  PubMed  Google Scholar 

  20. Elford J, Jeannin A, Spencer B, Gervasoni JP, van de Laar MJ, Dubois-Arber F. HIV and STI behavioural surveillance among men who have sex with men in Europe. Euro Surveill. 2009;14:47.

  21. 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(3):669–75.

    Article  PubMed  Google Scholar 

  22. Voetsch AC, Lansky A, Drake AJ, et al. Comparison of demographic and behavioral characteristics of men who have sex with men by enrollment venue type in the National HIV Behavioral Surveillance System. Sex Transm Dis. 2012;39(3):229–35.

    Article  PubMed  Google Scholar 

  23. Sanchez T, Smith A, Denson D, Dinenno E, Lansky A. Developing a web-based HIV behavioral surveillance pilot project among men who have sex with men. Open AIDS J. 2012;6:224–31.

    Article  PubMed  Google Scholar 

  24. Sanchez T, Smith A, Denson D, Dinenno E, Lansky A. Internet-based methods may reach higher-risk men who have sex with men not reached through venue-based sampling. Open AIDS J. 2012;6:83–9.

    Article  PubMed  Google Scholar 

  25. Saxton PJ, Dickson NP, McAllister SM, Sharples K, Hughes AJ. Increase in HIV diagnoses among men who have sex with men in New Zealand from a stable low period. Sex Health. 2011;8(3):311–8.

    Article  PubMed  Google Scholar 

  26. McAllister SM, Dickson NP, Sharples K, et al. Unlinked anonymous HIV prevalence among New Zealand sexual health clinic attenders: 2005–2006. Int J STD AIDS. 2008;19(11):752–7.

    Article  PubMed  CAS  Google Scholar 

  27. Saxton PJ, Dickson NP, McAllister SM, Hughes AJ, Sharples K. HIV prevalence among men who have sex with men in New Zealand 1985–2009: 25 years of public health monitoring. Int J STD AIDS. 2012;23(4):274–9.

    Article  PubMed  CAS  Google Scholar 

  28. Saxton PJ, Dickson NP, Griffiths R, Hughes AJ, Rowden J. Actual and undiagnosed HIV prevalence in a community sample of men who have sex with men in Auckland, New Zealand. BMC Public Health. 2012;12:92.

    Article  PubMed  Google Scholar 

  29. Saxton P, Dickson N, Hughes A. GAPSS 2008: findings from the gay Auckland periodic sex survey. Auckland: New Zealand AIDS Foundation; 2010.

    Google Scholar 

  30. Pequegnat W, Rosser BR, Bowen AM, et al. Conducting Internet-based HIV/STD prevention survey research: considerations in design and evaluation. AIDS Behav. 2007;11(4):505–21.

    Article  PubMed  Google Scholar 

  31. Ross MW, Tikkanen R, Mansson SA. Differences between Internet samples and conventional samples of men who have sex with men: implications for research and HIV interventions. Soc Sci Med. 2000;51(5):749–58.

    Article  PubMed  CAS  Google Scholar 

  32. 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.

    Article  PubMed  Google Scholar 

  33. 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.

    Article  PubMed  Google Scholar 

  34. Zhang D, Bi P, Lv F, Zhang J, Hiller JE. Differences between Internet and community samples of MSM: implications for behavioral surveillance among MSM in China. AIDS Care. 2008;20(9):1128–37.

    Article  PubMed  Google Scholar 

  35. Rosser BR, Oakes JM, Horvath KJ, Konstan JA, Danilenko GP, Peterson JL. HIV sexual risk behavior by men who use the Internet to seek sex with men: results of the Men’s INTernet Sex Study-II (MINTS-II). AIDS Behav. 2009;13(3):488–98.

    Article  PubMed  Google Scholar 

  36. 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.

    Article  PubMed  Google Scholar 

  37. Grov C. HIV risk and substance use in men who have sex with men surveyed in bathhouses, bars/clubs, and on Craigslist.org: venue of recruitment matters. AIDS Behav. 2012;16(4):807–17.

    Article  PubMed  Google Scholar 

  38. 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.

    Article  PubMed  Google Scholar 

  39. 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.

    Article  PubMed  Google Scholar 

  40. Prestage G, Ferris J, Grierson J, et al. Homosexual men in Australia: population, distribution and HIV prevalence. Sex Health. 2008;5(2):97–102.

    Article  PubMed  Google Scholar 

  41. Hughes A, Saxton P. Geographic micro-clustering of homosexual men: implications for research and social policy. Soc Pol J New Zealand. 2006;88:158–78.

    Google Scholar 

  42. Aral SO. Sexual risk behaviour and infection: epidemiological considerations. Sex Transm Infect. 2004;80(Suppl 2):ii8–12.

    Google Scholar 

  43. Garnett GP, Garcia-Calleja JM, Rehle T, Gregson S. Behavioural data as an adjunct to HIV surveillance data. Sex Transm Infect. 2006;82(Suppl 1):i57–62.

    Article  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. AIDS Epidemiology Group, Department of Preventive and Social Medicine, University of Otago, PO Box 913, Dunedin, New Zealand

    Peter Saxton & Nigel Dickson

  2. New Zealand AIDS Foundation, Auckland, New Zealand

    Anthony Hughes

Authors
  1. Peter Saxton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nigel Dickson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anthony Hughes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter Saxton.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-013-0485-1

Keywords

Search

Navigation