The Internet has become increasingly popular for seeking sex partners , especially among men who have sex with men (MSM) [2–5]. In 1999, the Dutch MSM Monitoring Study (DMMS) showed that 17% of respondents reported chatting . In 2002, this percentage had increased to 46% . Results from sexually transmitted infection clinics have shown that among MSM who were diagnosed with syphilis, increasing proportions use the Internet to find sexual partners [8–10]. Studies that have investigated Internet MSM samples reported that these are usually younger and comprise more bisexual men in comparison with traditionally recruited MSM samples [2,3,11–14].
A limited number of studies have compared the sexual behaviour of MSM from Internet samples with traditional samples [1,2,11–15], using a variety of sampling strategies, and with varying sample sizes (283 ≤ N ≤ 2097). Four of the studies found that Internet MSM reported more casual partners [2,3,11,13], whereas two did not find a difference [12,15]. Two studies showed that Internet MSM were likely to report more sexually transmitted infections [2,13], whereas one study did not find a difference . Finally, three studies reported more unprotected anal intercourse with casual partners among Internet MSM [2,13,14], and two other studies found no difference [11,12].
The present study investigated chatting, dating, and sex with e-dates among Dutch MSM. Second, we compared the online sample with a traditional MSM sample, i.e. the 2002 wave of the DMMS (N = 1238) .
Participants were enrolled through the major gay chat room in the Netherlands (www.chatboy.nl), and were asked to complete an online questionnaire.
The interactive online questionnaire contained the following measures: Demographics: age, educational level, cultural background, steady partner status, sexual preference, HIV testing, HIV status; Chatting and dating behaviour: frequency of chatting, number of dates and sex with e-dates in preceding 6 months; Sexual behaviour, general and with e-dating: number of casual sexual partners in the preceding 6 months, anal intercourse, condom use; Sexual behaviour with last e-date: anal intercourse, condom use, disclosure of HIV status before having sex.
In addition, social–cognitive variables were measured that will be reported elsewhere.
The questionnaire was uploaded to a secure website, only accessible to visitors of Chatboy. The link between Chatboy and the survey site consisted of a banner on the homepage, and the round-the-clock presence of a chat room visitor with the nickname ‘E-Dating Survey 2002’. Clicking this ‘visitor’ showed a graphics banner, plus an invitation to participate in the survey by clicking the banner.
The entry page of the survey site was visited approximately 12 000 times during the period 28 March to 23 April 2002. This number includes multiple visits, and is therefore an overestimation of the number of unique visitors. From the introduction page, visitors could choose to participate by clicking an ‘Enter’ button.
Of those visitors arriving at the survey site 8960 (75%) continued to the questionnaire by clicking the ‘Enter’-button. This is again an overestimation because of multiple visits. The first questionnaire page contained answering instructions and a button to go to the first question. Nearly 90% of visitors (8050) continued to this first question. Approximately two-thirds of them (5302) completed and submitted the questionnaire.
The response rate was thus approximately 45% of all visitors of the survey website, and 59% of those who continued on to the questionnaire. As the total number of visitors to Chatboy in the data collection period was unknown, the response rate compared with that denominator cannot be provided.
The 5302 cases were subjected to a rigorous data cleaning process. The checks included unrealistically short completion times relative to the number of questions that had to be answered, multiple questionnaires from the same IP address [every computer connected to the Internet is assigned a unique number known as an Internet Protocol (IP) address], and inconsistent answering patterns.
This cleaning process led to 318 cases being removed, resulting in 4984 cases that were used in the analyses below.
Because of the large sample size, differences were tested using a P value of 0.01.
The mean age was 33.2 years (median 32, SD 10.05, range 14–77). The majority (58%) had a higher educational level, 42% a lower educational level. Most respondents (81%) reported a Dutch cultural background, 15% a combination of a Dutch/non-Dutch background (e.g. Dutch-Moroccan), and 4% a non-Dutch background. Most respondents (80%) reported being mostly or exclusively attracted to men (hereafter gay men), whereas 20% were attracted to men and women or mostly to women (hereafter bisexual men).
Almost half of all respondents (49%) were in a steady relationship. Of those, 73% had a relationship with a man and 27% had a relationship with a woman. The large majority (92%) reported sex with men in the 6 months preceding the assessment. These men reported a median of four sex partners (mean 8.4, SD 14.1, range 1–300). Among men who reported casual partners, 57% reported engaging in anal sex with casual sex partners, and 23% reported unprotected anal intercourse. Of all respondents, 44% had ever been tested for HIV. Among tested men, 6% reported being HIV-positive.
Chatting and dating behaviour
More than a quarter of the respondents (26%) chatted daily, 56% at least once a week, and 18% less frequently. The majority of the sample (88%) reported experience with e-dating. Men with e-dating experience reported a median of three e-dates during the previous 6 months (mean 5.3, SD 9.00, range 0–190). Among men who report e-dating, 89% had also engaged in sex with one or more e-dates.
Last e-date with sex
Respondents who reported experience with sex with e-dates (78% of total sample) were asked about their last sexual encounter with and e-date. Most men (56%) had the date immediately after the chat session, 44% later. Non-disclosure of HIV status: in 79% of encounters neither the respondent nor the sex partner disclosed their status between the chat and sex.
Of all the respondents who had had sex with e-dates (78% of total sample), approximately half had had anal sex with their last e-date, and 15% reported unprotected anal intercourse with their last e-date. This percentage was significantly higher among men younger than 24 years (18%) compared with men aged 33 years and over, among men with a lower educational level (17%), among non-Dutch men (19%), and among HIV-positive men (39%); see Table 1. As we asked whether respondents had disclosed their HIV status before sex with their last e-date, we were able to correct for positive–positive sex. This lowered the percentage of unsafe sex among HIV-positive men from 39 to 28%. This percentage is still significantly higher compared with HIV-negative men or never-tested men (see Table 1).
The Internet sample compared with the Dutch MSM Monitoring Study
Finally, we compared demographics and sexual behaviour with casual partners between the Internet sample and the 2002 DMMS. Men in the Internet sample were substantially younger compared with the DMMS. Furthermore, the Internet sample comprised considerably more men with a mixed Dutch/non-Dutch cultural background or a non-Dutch cultural background (Internet sample 19%, DMMS 5%), and more bisexual men (Internet sample 20%, DMMS 5%). Fewer men in the Internet sample had ever had an HIV test compared with men in the DMMS (44 and 53%, respectively). Differences in educational level were not significant (see Table 2).
A slightly higher percentage in the DMMS reported anal sex with casual partners in the 6 months preceding assessment, compared with the Internet sample (61 versus 57% respectively, ns). The level of unprotected anal sex with casual partners was comparable between the samples (Internet sample 23%, DMMS 21%). The median number of casual sex partners was significantly higher in the DMMS compared with the Internet sample (five versus four).
The present study succeeded in attracting over 5000 MSM through the Internet within a month, and to collect detailed information on chatting and dating behaviour. The Internet sample was substantially younger than our offline MSM sample, comprised considerably more bisexual men, and men with a mixed or non-Dutch cultural background. The Internet is obviously providing a more convenient and confidential means of meeting people and finding sexual partners, and is leading to a greater diversity in those men seeking sex with men. This may cause changes in traditional sexual networks, with possible subsequent implications for HIV transmission.
In contrast to several studies [2,3,11,13,14], and in line with other studies [12,15], we did not find differences in the level of unprotected anal intercourse with casual partners between the online and offline samples. Whether or not the Internet attracts more risk-taking MSM thus remains inconclusive. However, it should be noted that sampling differences may contribute to these discrepant results.
Higher rates of unprotected anal sex were observed among younger men, men with a lower educational background, and men with a mixed cultural or a non-Dutch background. These demographic characteristics are usually related to sexual risk-taking behaviour . Common explanations include that these men have been less exposed to preventative interventions , and that the available information may not be tailored to their needs or cognitive capacities . Therefore, special attention for these risk groups continues to be warranted. Finally, among HIV-positive men, a significantly higher proportion reported unprotected anal intercourse with their last e-date compared with HIV-negative and never-tested men. Furthermore, after controlling for positive–positive disclosure, the proportion of HIV-positive men who had had unprotected anal sex with their last e-date was still twice as high.
These findings call for increased efforts to target preventative interventions at MSM who visit Internet chatrooms. There is limited experience with Internet-based interventions. So far, one randomized controlled trial targeting MSM has been reported , which resulted in safer sexual behaviour in the experimental condition compared with the control group. A focus on HIV-positive MSM seems sensible given the higher levels of unprotected sex.
The present study had several limitations. First, the response was self-selected and we were not able to assess the differences between responders and non-responders. Moreover, the exact response rate could not be computed because the number of multiple visits to our survey site was unknown. On the other hand, traditional surveys are usually similarly hampered. Second, the data were obtained from chatters, a subgroup of MSM, and the results can therefore not be generalized to the total MSM population. Finally, we had to rely on self-reports regarding HIV status and behavioural variables.
In conclusion, we believe that this study contributes to the insight into an important new meeting place for MSM. As we have shown, Internet chatting and subsequent dating are increasingly popular, and substantial levels of risk-taking sex were observed. Consequently, the opportunities for online HIV-preventative interventions for this target group should be considered.
Sponsorship: This study was financially supported by AIDS Fonds, the Netherlands, and the Public Health Fund, the Netherlands.
1. Bull SS, McFarlane M. Soliciting sex on the Internet
: what are the risks for sexually transmitted diseases and HIV? Sex Transm Dis 2000; 27:545–550.
2. Benotsch EG, Kalichman SC, Cage M. Men who have met sex partners via the Internet
: Prevalence, predictors and implications for HIV prevention. Arch Sex Behav 2002; 31:177–183.
3. Kim AA, Kent C, McFarland W, Klausner JD. Cruising on the Internet
highway. J Acquir Immune Defic Syndr 2001; 28:89–93.
4. Jayaraman GC, Read RR, Singh A. Characteristics of individuals with male-to-male and heterosexually acquired infectious syphilis during an outbreak in Calgary, Alberta, Canada. Sex Transm Dis 2003; 30:315–319.
5. Rietmeijer CA, Bull SS, McFarlane M, Landrigan Patnaik J, Douglas JM. Risks and benefits of the Internet
for populations at risk for sexually transmitted infections (STIs). Sex Transm Dis 2003; 30:15–19.
6. Hogeweg JA, Hospers HJ. Monitoring Study 2000 [in Dutch].
Maastricht: Maastricht University; 2000.
7. Hospers HJ, Dörfler TT, Zuilhof W. Monitoring Study 2003 [in Dutch].
Amsterdam: Schorer Foundation; 2003.
8. Ashton M, Sopwith W, Clark P, McKelvey D, Lighton L, Mandal D. An outbreak no longer: factors contributing to the return of syphilis in Greater Manchester. Sex Transm Infect 2003; 79:291–293.
9. 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
10. Klausner JD, Wolf W, Fischer-Ponce L, Zolt I, Katz MH. Tracing a syphilis outbreak through cyberspace. JAMA 2000; 284:447–449.
11. Lau JTF, Kim JH, Lau M, Tsui HY. Prevalence and risk behaviors of Chinese men who seek same-sex partners via the Internet
in Hong Kong. AIDS Educ Prev 2003; 15:516–528.
12. Ross MW, Tikkanen R, Månsson S. Differences between Internet
samples and conventional samples of men who have sex with men
: implications for research and HIV interventions. Soc Sci Med 2000; 51:749–758.
13. Tikkanen R, Ross MW. Technological tearoom trade: characteristics of Swedish men visiting gay Internet
chat rooms. AIDS Educ Prev 2003; 15:122–132.
14. 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; 35:421–426.
15. Rhodes SD, DiClemente RJ, Cecil H, Hergenrather KC, Yee LJ. Risk among men who have sex with men
in the United States: a comparison of an Internet
sample and a conventional outreach sample. AIDS Educ Prev 2002; 14:41–50.
16. Hospers HJ, Kok GJ. Determinants of safe and risk-taking sexual behavior among gay men: a review. AIDS Educ Prev 1995; 7:74–96.
17. Janssen M, De Wit J, Hospers H, Stroebe W, Kok G. Tailoring safer sex messages to lower-educated young gay men: the impact on cognitions and intention. Psychol Health Med 2004; 9:115–131.
18. Davidovich U, De Wit JBF, Stroebe W. The effect of an Internet intervention for promoting safe sex between steady male partners – results and methodological implications of a longitudinal randomized controlled trial online.Paper presented at the 15th International AIDS Conference
. Bangkok, 11–16 July 2004 [Abstract WePeC6115].