Hiv dating sites in sweden

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Box , Berlin , Germany. Behavioural data from MSM are usually collected in non-representative convenience samples, increasingly on the internet. Epidemiological data from such samples might be useful for comparisons between countries, but are subject to unknown participation biases. Results are calculated and presented by 5-year age groups for MSM aged 15— New HIV diagnoses rates ranged between 0. Self-reported rates from EMIS were consistently higher, with prevalence ranging from 2.

Internet samples of MSM were skewed towards younger age groups when compared to an age distribution of the general adult male population. The highest discrepancies between survey and surveillance data regarding HIV-prevalence were observed in the oldest age group in Sweden and the youngest age group in Portugal. Internet samples are biased towards a lower median age because younger men are over-represented on MSM dating websites and therefore may be more likely to be recruited into surveys.

Men diagnosed with HIV were over-represented in the internet survey, and increasingly so in the older age groups. A similar effect was observed in the age groups younger than 25 years. Self-reported peak prevalence and peak HIV diagnoses rates are often shifted to higher age groups in internet samples compared to surveillance data. Adjustment for age-effects on online accessibility should be considered when linking data from internet surveys with surveillance data.

Most HIV surveillance systems in Europe provide reasonably good data on number of new diagnoses among men having sex with men MSM [ 1 , 2 ]. Data on HIV prevalence are less readily available and less comparable due to different estimation methods and sampling biases. Comparable data on HIV prevalence and incidence among MSM across countries or across different surveys are important to assess population effects of prevention efforts, develop prevention policies and target interventions.

Data on sexual risk behaviours among MSM are increasingly collected by online surveys [ 3 ]. In , the European MSM Internet Survey EMIS demonstrated the feasibility and utility of collecting data from MSM from 38 European countries with the same questionnaire — simultaneously available online in 25 languages — and using the same recruitment methods [ 4 ].

For example, in EMIS, although a broad range of websites were used for recruitment, participation rates varied substantially even between countries with similar household internet access. Substantial differences between national samples were also observed regarding median age, even between countries with very similar socio-cultural, political and economic background and similar histories and starting points of the HIV epidemic among MSM — like e.

Germany and the Netherlands, two neighbouring countries in the centre of Europe [ 4 ]. In addition to men using these sites not being representative of all MSM and likely not being used equally across the age range , an unknown participation bias will also be in operation. For both these reasons the age distribution of samples recruited on these sites may differ from the actual age distribution of MSM. Because partner numbers and sexual activity decline with age [ 7 ], older men in particular may be expected to be under-represented.

In previous analyses we have looked into discrepancies between self-reported EMIS data and surveillance data on the prevalence and incidence of diagnosed HIV among MSM by comparing on a country level [ 5 ], Marcus U, et al.: In cross-country comparisons household access to the internet was a major determinant of participation rates and survey surveillance discrepancies SSD. By adjusting for these differences, cross-country comparisons in findings from internet surveys can be made with greater validity.

Among the 38 countries with sample sizes larger than respondents in EMIS we selected the following countries in alphabetical order: Countries were selected to represent a variety of European sub-regions and varying EMIS participation rates. We set the lower and upper age limits of both the EMIS sample and the surveillance data to be 15 years and 65 years. For the Czech Republic, as the only country from an eastern European sub-region, we also analysed the data for the narrower age range of 15 to 49 years, because the HIV epidemic among MSM in the eastern parts of Europe started about 10—15 years later than in the western parts, leading to a different age distribution of HIV infections in the MSM population.

Data on new HIV diagnoses in were taken from national infectious disease surveillance systems. Cases with unknown risk factors for HIV acquisition were proportionately redistributed based on known cases. For surveillance measures of HIV prevalence we used diagnosed infections only in order to compare with self-reported prevalence, which is also a diagnosed prevalence.

The total size of the adult male population aged 15 to 64 years or 15 to 49 years for Czech Republic was taken from national population statistics [ 11 - 16 ]. This estimate is consistent with the upper limit of the confidence interval of men reporting male sexual partners in the previous 12 months in repeated telephone surveys in representative samples of the general population in Germany conducted by the German Federal Agency of Health Promotion BZgA [ 17 ] and with published results from a large British national probability survey conducted in [ 18 ].

Barros, personal communication], while a Czech study from found a proportion of 1. For males below the age of 20 the proportion of MSM was estimated based on the proportion of EMIS respondents in the national samples reporting their first sexual experience with another man before the age of 20 [ 4 ]. For these men the proportion was estimated to be 2.

EMIS was a large scale pan-European internet survey conducted in The methodology has been described in more detail elsewhere [ 20 ]. In brief, a network of five primary and 77 secondary partners working in MSM sexual health across academia, public health and community organizations in 38 European countries developed a collaborative English language survey. The survey was translated into 24 other languages, and promoted through gay dating websites and through gay community organizations.

Among other questions, survey participants were asked about the year of birth, their age when they first had sex with a man, the result of their last HIV test, and the recency of that test if it was negative, or the year of first diagnosis if it was positive. Assuming a stable proportion of MSM in the adult male population once a homosexual debut has occurred, the age distribution of the EMIS samples was compared to the age distribution of the general population, taking into account a reduced proportion of MSM below the age of Self-reported prevalence rates per hundred EMIS respondents, regardless of having been tested for HIV and new diagnoses rates in per EMIS respondents were compared with the prevalence and incidence of diagnosed infection calculated from surveillance data and population estimates.

Particularly for age-group data on new HIV diagnoses in the numbers can get quite small and precision of SSD calculation is thus affected by chance effects. Therefore for comparisons of countries we used the best fitting 2 nd order polynomic trendlines imposed on the data curves. Thus this estimate may be slightly too high. The rate of new diagnoses with HIV in ranged between 0. Contrastingly, self-reported prevalence in EMIS respondents ranged between 2.

The rate of respondents reporting being newly diagnosed with HIV in varied between 0. Values above 1 mean that the respective age group was relatively over-represented among EMIS respondents. The Czech and the Portuguese samples had the lowest median age; the Dutch sample the highest. In the Czech Republic and Portugal men younger than 20 were still over-represented compared with the general population.

In Sweden, MSM up to the age of 30 were less well reached by the recruitment websites than in the other countries. Men aged above 40 were reached particularly badly in the Czech Republic and particularly well in the Netherlands. The curves were U or J-shaped with higher SSD values for age groups which were relatively under-represented. The curves for the countries in western parts of Europe were very similar, while the curves for the Czech Republic regardless of which MSM population estimate was used showed larger differences for the higher age groups.

The curve for the Czech Republic was J-shaped and shorter, because no infections were diagnosed in EMIS participants younger than 20 and older than 45 in However, this may be mainly due to low numbers of newly diagnosed HIV infections in the EMIS sample particularly in higher age groups and resulting chance effects on SSD for higher age groups.

The proportional age distributions of large internet samples of MSM recruited mainly via gay social media dating websites were skewed towards younger age groups — except for males younger than 20 years - when compared to the age distribution of adult males. The proportion of men accessible on Internet dating sites declines once they get older than 45 years.

Particularly among men older than 45 years it was observed that those who are still accessible and participate in an HIV-related survey are increasingly biased towards higher lifetime and recent risks for HIV. This biased age representation in internet samples results in a peak of self-reported HIV prevalence and new HIV diagnoses in an older age group than measured by surveillance data.

From the six countries analysed here, this happened in four countries when we considered HIV prevalence, and all six countries when we considered new HIV diagnoses. In most age groups and most countries — except the relatively overrepresented young age groups in the Czech Republic and Portugal — both HIV-related SSDs were higher than 1. A fourfold higher risk for an STI diagnosis among MSM participating in a community based internet study compared with MSM from a population based probability sample was also reported from a UK study [ 22 ].

While we have supporting data on sexual debut to explain the paucity of younger men, we have no data that could explain reduced accessibility of older age groups. More research will be required to elucidate the reasons for this. We speculate that lower internet literacy, less sexual partner change, and increasing proportions living in settled relationships may be among these factors. If we take into consideration that older survey participants were more likely to be at higher risk for HIV, self-reported partner numbers for older survey participants probably over-estimate partner numbers of older MSM in the population.

Previous research in Germany has shown that regarding geographical distribution of newly diagnosed cases of HIV, large internet samples can be representative of MSM populations [ 23 ]. The discrepancy between skewed age distribution of internet samples and good representation of new HIV diagnoses suggests that internet samples may very adequately represent the sexually active MSM population most at risk for HIV. The example of the Czech Republic demonstrates that when we increase the estimate of the percent of the overall population that is MSM, the SSD value also increase, if we decrease this estimate, so does the SSD value.

Ultimately the interpretation of the relation between these two factors depends on the conceptualization of the issue or the definition of the MSM population: Connectedness in this sense has two dimensions: This would imply that the size of this epidemiologically connected population is not stable, but increased in recent years due to wider availability of internet access, and will further increase in countries with low levels of household internet access. That such an expansion of the MSM population may have occurred is suggested by epidemiological data from Germany: From this perspective, low SSD values would signal a highly connected population, high SSD values a less well connected population.

However, this remains speculation and requires further research. Figure 6 a: Proportional increase by population size of the place of residency Figure 6 b: Proportional increase by age group. It would be interesting to repeat a survey like EMIS and to look at changes particularly in countries with increasing household access to Internet. Also, it would have been interesting to analyse SSDs for more countries in eastern parts of Europe.

However, for many smaller countries the EMIS samples were too small for this kind of analysis numbers of men with HIV in age groups become too small , and particularly for the larger countries Russia, Ukraine, Poland, Romania surveillance data with regard to the size of the MSM transmission group are unreliable. One way to circumvent the issue of smaller sample sizes would be to use cumulated diagnoses numbers over several years for SSD calculations.

While the above interpretation of SSDs explains well the differences observed between western and eastern Europe and between a less densely populated country like Sweden and densely populated countries like Germany and England, it would not explain the SSD differences between the Netherlands and countries in the other western parts of Europe. The higher SSDs in the Netherlands, together with the lower participation rates, may indicate real differences in selection biases of survey participants.

A possible reason for a different self-selection bias could be the high frequency of national MSM Internet surveys in the Netherlands yearly , and the launch of a national survey for MSM shortly before the launch of the European survey EMIS in which may have resulted in survey fatigue effects in the target population. Our paper on the limitations of data from internet convenience samples itself has some limitations, not least because we are using data from an internet convenience sample, which we know are not representative.

There are also representation limitations to our other sources of data, censuses and HIV surveillance, most crucially that the prevalence estimates from surveillance data from the six countries are based on different methods. While the estimates for Germany, the Netherlands and UK on the one side and for Czech Republic, Portugal and Sweden on the other side may be largely comparable, there may be some differences between these two groups of countries. In the datasets for MSM in clinical care, men with an early HIV diagnosis not meeting the thresholds for starting antiretroviral treatment may be slightly under-represented.

This may disproportionally affect younger age groups. However, since SSD values particularly for the younger age groups are already quite low in these countries, it seems unlikely that diagnosed HIV prevalence is substantially underestimated. Last but not least, our knowledge of the proportion of the male population who are homosexually active is weak, especially across the age range.

Increasing underrepresentation of older men on internet dating sites was associated with an increasing bias towards men with diagnosed HIV.

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Box , Berlin , Germany. Behavioural data from MSM are usually collected in non-representative convenience samples, increasingly on the internet. Epidemiological data from such samples might be useful for comparisons between countries, but are subject to unknown participation biases. Results are calculated and presented by 5-year age groups for MSM aged 15— New HIV diagnoses rates ranged between 0. Self-reported rates from EMIS were consistently higher, with prevalence ranging from 2.

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