AEGiS-NHIVPC: Risk Factors for Sexually Transmitted Diseases among Men who have Sex with Men Recruited through the Internet: A Nested Case-Control Study

National HIV Prevention Conference

Atlanta, Georgia, USA — July 27 - 30, 2003

Risk Factors for Sexually Transmitted Diseases among Men who have Sex with Men Recruited through the Internet: A Nested Case-Control Study

Natl HIV Prev Conf 2003 July 27-30:abstract no. M1-A0201
Hirshfield S, Chiasson M, Remien RH
Medical and Health Research Association of New York City, Inc., New York, NY

BACKGROUND/OBJECTIVES:: A resurgence in the transmission of HIV and other sexually transmitted diseases (STD's) among men who have sex with men (MSM) is a cause for concern. This study was undertaken to learn more about risk factors that may be associated with the recent increase in transmission.

METHODS: To investigate risk factors for incident STD's, a nested case-control study was conducted using data from a large cross-sectional Internet survey of MSM who meet new sexual partners on the Internet. In June-July 2002, 2,934 MSM recruited through chat room banners on a gay website completed an anonymous, 60-item online questionnaire about sexual, drug- and alcohol- using behaviors during a recent six-month period. Newly diagnosed STD's that were reported included syphilis (N=10), genital herpes (N=9), genital warts/anal warts/ HPV (N=64), gonorrhea (N=48), hepatitis A (N=5), B (N=10), and C (N=7), chlamydia (N=28), non-gonococcal urethritis (N=24), and trichomonas (N=1). Statistical differences were assessed using Chi-square tests and odds ratios.

RESULTS: Overall, 164 (5.6%) subjects reported being diagnosed with an STD during the study; 2 controls were selected at random for each case, making a total sub-sample of 492. By age group, 45% were 18-29, 28% were 30-39, and 27% were 40+. Most men were white (84%) and almost half (48%) had at least a college degree. Most reported meeting new sexual partners online (84%); 9% were HIV+. Regarding multiple STD's, 18 men had 2 STD's, 9 had 3 or more. Cases were almost twice as likely as controls to report being HIV+ (13% vs. 7%, OR 1.86, p<.05). Compared to the men aged 40+, the two younger age groups were significantly more likely to have an STD (18-29: OR 1.82, p<.05; 30-39: OR 1.79, p<.05). MSM with STD's were also significantly more likely to have unprotected anal intercourse (UAI) (OR 3.55, p<.001), to have had 10 or more sex partners during the study period (OR 2.22, p<.001), to have used club drugs [Ketamine, Ecstasy, GHB, Crystal Meth] (OR 2.77, p<.001), to use drugs prior/during sex (OR 2.10, p<.001), and to be drunk 1-3 days on average (OR 1.92, p=.001).

CONCLUSIONS:

HIV+ men were over-represented in the STD group, whose multiple high-risk drug and sexual behaviors demonstrate the importance of targeted primary prevention. There is a need for the integration of HIV/STD and substance use prevention into primary healthcare settings. Furthermore, these findings have implications for structural interventions that may facilitate healthier sexual behaviors among this network of MSM. As the Internet facilitates meeting new sex partners, potentially increasing transmission of HIV and other STD's, web-based and community-based behavioral interventions and safer sex messages are urgently needed.

030727
M1-A0201

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