Differential processes of ‘Internet’ versus ‘real life’ sexual filtering and contact among men who have sex with men

Introduction

The dimensions of HIV-related behaviors in men who have sex with men (MSM) regarding courtship or negotiating for sex are complex. AIDS has killed over 576,000 people in the U.S. since the beginning of the epidemic illustrating the fact that HIV looms over every sexual encounter among MSM (National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (CDC), 2010). The Centers for Disease Control and Prevention (CDC) indicate that MSM carry the highest burden of HIV in the U.S., manifesting 53% of all new HIV infection. According to the CDC, the MSM risk group account for 4% of the male population (age 13 and older), with a rate of 44 times that of other men. In the U.S., MSM are the only risk group where HIV new infections has been increasing since the early 1990’s (National Center for HIV/AIDS, Viral hepatitis, STD, and TB Prevention (CDC), 2010).

Americans search for romance on the Internet and according to responders of the Pew Internet & American Life Project survey, about 16 million (11%) of the total Internet population have used the Internet to meet people online (Madden & Lenhart, 2006). On-line daters are defined as Internet users meeting people on-line or who have gone to an on-line dating website. On-line daters report dating websites help people find a better match because they have access to a larger pool of potential dates (Ross, 2005) and tend to identify with more liberal social attitudes (Madden & Lenhart, 2006). Statistics on Internet dating include both success in proving to be a helpful tool for finding life partners, and challenges of misleading dating profiles (Viegas, 2010).

Behavioral research among MSM has traditionally viewed the Internet as incorporating risk factors for this population including recruiting through the Internet (Bolding, Davis, Sherr, Hart, & Elford, 2004; Daneback, Månsson, & Ross, 2007; Kok, Hospers, Harterink, & De Zwart, 2007; Konstan, Rosser, Ross, Stanton, & Weston, 2005; Tikkanen & Ross, 2003), subcultural (Elford, Bolding, & Sherr, 2002; Elford, Bolding, Davis, Sherr, & Hart, 2004; Evans, Wiggins, Mercer, Bolding, & Elford, 2007; Ross, Rosser, & Mazin, 2006) e-dating (Bolding, Davis, Hart, Sherr, & Elford, 2007; Davis, Hart, Bolding, Sherr, & Elford, 2006a; Hospers, Kok, Harterink, & de Zwart, 2005; Kaufman & Phua, 2003; Tikkanen & Ross, 2000) filtering, where e-daters choose to meet with other potential e-daters (Bolding et al., 2007; Davis et al., 2006a; Hospers et al., 2005; Kaufman & Phua, 2003) and between online (Internet) and In Real Life (IRL) sexual negotiation (Horvath, Bowen, & Williams, 2006; Ross, Rosser, & Stanton, 2004; Ross, Rosser, McCurdy, & Feldman, 2007). Sex is a significant aspect of the lives of MSM as they navigate through the complexities of relationships and courtship guided by the drive for emotional and physical connection with another person. Navigation under the best circumstances is challenged by dating ritual, and sexual experiences and filtering of potential partners (Halkitis, Gomez, & Wolitski, 2005). The process of relationship is complex as the Internet brings socio-structural factors of reducing feelings of alienation (Horvath et al., 2006), discourse and first experience (Agwu & Ellen, 2009; Bolding et al., 2007; Tikkanen & Ross, 2000) and high levels of unprotected anal intercourse (UAI) (Bauermeister, Leslie-Santana, Johns, Pingel, & Eisenberg, 2011; Horvath et al., 2006; Tikkanen & Ross, 2000; van Kesteren, Hospers, & Kok, 2007). Ross (2005) noted that negotiation may be easier on the Internet due to the lack of embarrassing social cues and lowered impact of rejection. MSM do not seek HIV infection, although the complex phenomena of ‘barebacking’ is to have intentional unsafe anal sex (Halkitis & Parsons, 2003; Shernoff, 2006). However, this is usually between self-reported HIV seroconcordant partners (Dawson et al., 2005).

Filtering is a term used to sort by sexual interest on the Internet. This term refers to risk reduction strategy whereby some MSM only engage in unprotected anal intercourse with partners of the same HIV status, also known as serosorting (Elford, Bolding, Sherr, & Hart, 2007; Yarber, Sayad, & Strong, 2010). The use of the Internet in negotiating for sex has HIV/ STD transmission implications because of the efficient, rapid way of finding partners, which raises network and epidemiological risk. Filtering is manifested on the Internet rather than negotiated face-to-face (FTF). The Internet allows for pairing of preference for safer sex. Filtering criteria involve risk characteristics, serostatus, as well as a person’s appearance and other demographic characteristics (Davis, Bolding, Sherr, Hart, & Elford, 2004). How men maneuver around risk scenarios on-line involves using chatting, messaging, and Internet-dating profiles for condom-use/non-use (Davis et al., 2004). Identity as well as anonymity promotes the process of Internet filtering creating an environment for HIV-positive men to meet other HIV-positive men for unprotected anal intercourse (UAI). Although HIV transmission may be is reduced through accurate serosorting, the potential transmission of STIs such as Chlamydia, gonorrhea, genital herpes, HPV, Lymphogranuloma venereum (LGV) and syphilis are implicated (Davis, Hart, Bolding, Sherr, & Elford, 2006b) as are reinfection with other strains of HIV, many of which may be drug-resistant.

According to Davis et al., (2006b), filtering has three main themes: (1) pre-empting, (2) matching, and (3) declaring. Pre-empting eliminates the need for a discussion of safer sex as the information is, for example, provided in the Internet profile, a biographical sketch. Matching is an extension of pre-empting and reaffirms the profile with on-line chat, to participate in an online discussion in a chat room, therefore allowing for the matching of preferences between partners. The third stage, declaring, manifests in making intentions clear in Internet profile information. For example, where condom use is in the Internet profile so the prospective partner expects to find practitioners of condom use in the pool of possible partners (Davis et al., 2006b).

Positioning for complementary interest is a term used to sort by sexual interest on the Internet referring to specific sexual acts or preferences. This process of matching sexual interest leads to a connection of like, where one’s sexual act is the partners’ desire or the desire of both. The starting point is to review, match, and choose the desired position for complementary interest.

Few studies have examined the process of developing sexual relationships on the Internet and compared to that in real life (IRL) (Bolding et al., 2007). This study examines the process to provide insight into how MSM develop their courtship, engage in negotiations for sex, and choose sexual partners in different modalities, and examines the comparative sexual risks taken between Internet vs IRL negotiation.

Methods

A cross-sectional survey was provided to participants recruited on-line in a nationwide self-selected convenience sample of MSM.

Population

An on-line survey entitled “The Men’s Sexual Health Survey” was available to all men visiting selected gay/MSM websites, chatrooms, and personal ads in 2005.

Inclusion criteria for this study were that men were over 18 years of age, U.S. residents, English speaking, and completed at least the first tier of the survey. Data were collected on all male visitor volunteers. Respondents came from all 10 HHS U.S. health regions.

Procedures

An on-line questionnaire was developed using Microsoft FrontPage and Access software. The instrument was an anonymous, self-administered survey designed and developed based on literature reviews, to measure issues of sexual behaviors and sexual safety among MSM who use the Internet to mediate sexual encounters. Pilot studies identified most commonly used gay and bisexual websites as those having chatrooms, listserves and personal ads. Websites were contacted through emailed contact letters and telephone in order to request their participation. Links to the survey were housed in the following Internet sites: Adult FriendFinder.com, AOL.com, Blackplanet.com, BlackVoices.com, Chat Planet, Cruisingforsex.com, Ebonymale.com, Gay.com, Gayweb.com, Manhunt.net, MSM.com, Planetout.com, Swingersmeetingplace.com, Ultimatebareback.com, and Yahoo.com.

When respondents visited participating study websites they could click on the survey link and they were taken to a new website with an introductory page that included the survey title, “The Men’s Sexual Health Survey”, a criterion stating that the survey is for men only, ages 18 and over. Information was provided regarding the survey with an estimation that it took 30-40 minutes average to complete, depending on modules taken. All answers were kept anonymous and confidential. For those interested, respondents could access the survey after completing an on-line consent form for their agreement to be in the study. Respondents who chose not to participate were taken to a page that says, “Thank you for your time. If you change your mind, please feel free to return.”

Measurement

The on-line survey was adapted from a previous questionnaire developed by the Boston University School of Public Health, Denver Health Department Division of STDs and HIV, and The University of Texas School of Public Health with funding provided by the CEC-funded pilot studies. Survey questions of sexual orientation identification, types of sexual partners and behaviors were worded in such a way that respondents felt comfortable in disclosing sexual behaviors they do not identify with. The survey items included demographic information (i.e., age, gender, ethnicity, relationship status, sexual orientation, education level, and state they live in) as well as behavioral risk questions for the previous 12 months on the number of partners, change in sex partners, substance use, types of sexual activity, condom use, and STD/HIV testing and treatment history. The survey also included a series of open-ended questions, which had text boxes for respondents to type in their answers. Respondents had the ability to type as much or as little as they felt appropriately answered the question based on their experiences with meeting sex partners on-line. Open-ended questions were used to solicit experiences of meeting men through the Internet for sexual encounters, the on-line screening processes used to determine who to meet face-to- face, use of email communication to negotiate sexual safety, and condom use. The web surveys were collected continuously over a six month period intended to cover seasonal or vacation fluctuations in website visitors.

Methods for this Study and Analysis

A total of 1000 subjects enrolled were considered eligible for the study if logged on to the site, over 18 years of age, and consented to the survey. When the number commencing the questionnaire reached 1,000, the site was closed to further recruitment. A sample power analysis was run indicating that the data from 850 subjects would be able to detect differences at p < .05 in this group. Dropout was expected so the number was expanded to 1,000 which was Institutional Review Board (IRB) approved. For analysis the sample was divided by situations, having the same respondent describe different events labeled as last Internet-met partner and last IRL-met partner. Two sets of data were extracted for the same individual, one for the ‘in real life’ (IRL) encounters and one for the ‘internet’ encounter. The difference in the process (filtering and contact) between IRL and Internet are then described. It is necessary to define these clearly because the Internet encounter subsequently results in an IRL encounter. Therefore, we are talking about the process of encounter from initial contact through to sexual contact.

Questions from the ‘Men’s Sexual Health Survey’ included: When was the last time you met a new male partner in-person for sex (not through the Internet or a phone sex/personals line)? How long did you know each other before getting together for sex? Before you had sex which of the following, if any, happened? When you talked on the phone, which of the following, if any happened? When you met face- to-face, what kind of sex occurred? We met but did not have sex. Mutual masturbation (jerking each other off); receptive oral sex (you sucked your partner; insertive oral sex (your partner sucked you); receptive anal sex (your partner fucked you). If yes, did he use a condom? Did you want him to use a condom; insertive anal sex (you fucked your partner). If yes, did you use a condom? Did you intend to use a condom? Rimming or being rimmed; other sexual activities.

The following questions had to do with meeting a man via the Internet. What did you do to make yourself feel safe from harm when meeting in person for the first time a man you met through the Internet? Which of these partner traits are important to you when using the Internet to find partners (Profile). About how long did you communicate with each other via the Internet before getting together for sex? Did you use the Internet to talk about anal sex (fucking) or oral sex (sucking) before meeting face-to-face? When you met face-to-face, which of the following occurred? Mutual masturbation (jerking each other off); Receptive oral sex (you sucked your partner); Insertive oral sex (your partner fucked you); Insertive anal sex (you fucked your partner). Rimming or being rimmed. Did you intend to use a condom? Did you use a condom? Did you want him to use a condom?

The analysis for this paper is a comparison of IRL with Internet dating (last partner recruited by each method) among the MSM. Analysis includes a panel of demographic variables (Tables 1 - 3), sexual behavior variables (Tables 4 - 5), and attitudinal variables, using t-tests for continuous data and chi- square for prevalence (Tables 6 - 8). Flow charts of MSM meeting partners IRL and on the Internet (Figures 1 and 2) are presented. All analyses were carried out in SPSS version 15.0 using a 5% level of significance (2-tailed) unless otherwise noted. The study was approved by the appropriate University and CDC Committees for the Protection of Human Subjects (IRBs).

Results

All 1000 subjects were males over 18 years of age, currently living in the U.S. and had engaged in anal or oral sex with a man in the past 12 months. The demographics are shown in Table 1. The majority of this sample were White (83%) followed by Hispanic (9%) and Black (4%). Most of the subjects were paid employees (84%) and nearly a third of respondents earned >50,000 US dollars. Ninety-two percent of the study participants were born in the United States.

Table 1. Distribution of Sample by Racial/Ethnic Groups.

Table 2. Distribution of Sample by Education Level.

Table 3. Distribution of Sample by Income.

Table 4. Places Where MSM Find Sex.

The most common sexual relationship reported was ‘not in a relationship’ (48%) followed by ‘having multiple partners’ (23%). Sexual orientation of the sample was gay (78%) and bisexual (12%). The disclosure of homosexuality was most frequently communicated to male friends (64%) and male partners (sexual, other than committed) (63%), least frequently to female partners (3%), and in between to co- workers (50%), family members (57%) and healthcare professionals (50%).

Only one-third of the participants thought that it is easier to talk about using condoms on the Internet than IRL or on the phone. Ninety percent thought that it is easiest to find married men for sex on-line and 81 percent thought that it is easiest to find partners for unprotected sex on-line. More than half of the participants thought that there is no difference as to which group (Married straight men, Unmarried straight men, Bisexual men, Openly gay men, No difference) is more likely to give them HIV or other STDs. The average time spent communicating via the Internet before having sex was an average of 8.2 hours or a median of 1 hour. The most frequent means to know that a man was ‘safe’ to meet for sex was “gut feeling” (41%), followed by asking a lot of questions (40%), seeing a photo first (33%), followed by talked on the phone (26.4%). More than 91 percent of the participants had exchanged photos over the Internet or used a webcam (n = 503) and in 91 percent of the cases, seeing a photo influenced their decision to meet in person. Only a third of participants (34%), said that they would meet a person they have met over the Internet without seeing a picture first. More than three-fourths of the participants had already used the Internet to decide about the sexual activities, oral and anal sex, and condom use for anal sex that would occur when they would meet face-to-face. Most had communicated for a while, revealed and known the HIV and sometimes STD statuses over the Internet, but only 18 percent had “cyber sex” (sharing a fantasy online while masturbating) before meeting. Over half of the participants had talked over the phone about sexual activities after meeting online but very few of them talked about HIV and STD status and a mere 15 percent had “phone sex”.

Only 15 percent of the people had met several times before having sex and 33 percent felt that they already had a relationship with the man they met online but not face-to-face. There are 608 respondents with complete data who could be included into either group (Internet or IRL). Among the 608, 143 (24%) are “IRL” sex partners and 465 (76%) Internet sex partners. Of the 143 IRL partners, 48 are non-main partners and 95 main partners. Of the 465 Internet partners, 277 are non-main partners and 188 main partners. In the past 60 days, respondents reported finding significantly more of their partners online than IRL (Internet 4.67, SD = 9.03; IRL 1.44, SD = 5.93, t = -6.50. df = 601, p = .000).

Internet Use

The average number of days per week the subjects logged on to the Internet was over 6 with 38% reporting spending 2-4 hours on the Internet per day, followed by 18.5% spending 5-7 hours per day. The most common place used to access the Internet was at home (69%) followed by workplace (40%) and school (13%). More than 93% of the sample had ever logged on to the Internet to look for a sex partner with an average of 22 days in the last 60 days. When it came to using the phone line to look for sex partners, 66.5% of the participants responded in the affirmative. Though the most common sites used from home were chat sites to connect for sex followed by general information sites, at work place the most common sites visited were general information websites followed by non-sexual chat sites. The most common sites used to connect for sex were Gay.com (59%), Manhunt.net (37%), Yahoo.com (29%), AOL.com (27%), and Crusingforsex.com (18%). Fifty-nine percent of the participants had been to chat rooms to look for sex partners and an equal percentage had browsed profile information for the same. Eighty-five percent of the subjects (n=585) had created at least one profile containing sexual information for chat rooms they visited to find sex partners. Almost half of the sample reported mentioning their HIV status (n = 461) in their profiles. Almost half of the participants also reported mentioning their desire for both insertive (n = 461) and receptive oral (n = 421) sex in their profiles. When on the Internet, the majority of the subjects reported spending their time chatting with other MSM.

Participants reported less than half (37%) ever having sex with a female (n = 374) with their first heterosexual experience at an average age of 17.9 years. For the rest of the questions about sexual experiences with females, less than 25% of the subjects answered and this number kept decreasing for more specific questions. Hence no statistical analysis was done for those data.

Male Sexual Behavior

The average age for the first sexual experience with a male was 17.5 years with the most recent experience occurring within the past 7 days. The mean number of how many partners respondents reported in their lifetime was 171 (n = 685) with a range from 1 to 3000. Of these, a mean of 66.5 partners were met on-line (range = 0 to 2000) and a mean of 5.4 (n = 659) were met on a phone sex or personals line. In the past 60 days, the subjects had a mean of 5.4 male sex partners of whom 4.7 were met on the Internet.

Participants reported 14 percent (n = 135) meeting their main partner on-line. Only 3.4 percent (n = 34) reported their main male partner has HIV or AIDS while 22.9 percent (n = 229) reported knowing their main partner’s STD status and/ or history. Less than nine percent reported using a condom the last time having anal sex with their main partner.

Over half of the participants (n = 612) reported having anal sex with other male partners (not their main partner) in the past 60 days of which 33 percent (n = 331) were met on-line. The sexual behaviors with other male partners differed from those met IRL and on the Internet (Table 6). More participants knew the HIV status of their Internet partners as compared to IRL (Table 7). Forty-two percent did not use condoms the last time they had anal sex with these IRL male partners and 39.2% for other Internet partners.

Differences Between the Internet and IRL Relationships

There are similarities and differences between IRL relationship development (Figure 1) and Internet relationships (Figure 2). Courtship on the Internet among MSM consists of a range of experiences as the courtship process can be a brief 10-15 minutes or a long-lasting process. The Internet Flow chart constructed from the data, link between the virtual identity, being on or simulated on a computer and the real, as MSM move from cyber space to relationships off-line. The IRL flow chart depicts meeting and assessing in negotiation of identity and risk while “looking someone in the eye”. The Internet Flow Chart and IRL Flow Chart portray distinctive steps in negotiating for sex or forming an environment for courtship. Self-disclosure is a strategic communication process in seduction as interaction and communication create a process of knowing someone else and letting them know oneself in return. Part of the process in meeting MSM includes filtering/ screening for sexual practices and use or non-use of condoms for anal sex. The Internet presents a fast screening tool for large numbers of potential sex partners in a short time. In self-presentation or disclosure, requesting knowledge of HIV/STDs status can parallel condom use. In both IRL and Internet relationships, the conversations could direct serosorting and condom use. The flow chart (Figures 1 & 2) is a description of steps identified in the filtering encounter that logically evolved. This description is a picture that depicts the encounter with points of divergence between Internet and IRL partner seeking and negotiation.

Figure 1. IRL process of relationship among MSM. Some n’s vary due to missing data.

Figure 2. Internet process of relationship among MSM.

Sex Partner Seeking on the Internet

The ‘Process’ of Relationship Among MSM on the Internet begins with the Safety Check activity where a participant checks on whether a particular prospective partner is “safe”. Padgett’s definition is employing an online method in order to determine if a person is physically safe (i.e., not abusive) to meet in person (Padgett, 2007). This Safety Check branches off the Profile review, which is a tool to create a representation on the Internet. Representations can include descriptions of race, age, height, weight, geographical location and photograph. Additionally one may provide the HIV status, the desired HIV status of future partners, a preference of sexual role (bottom, top, or versatile), whether one is partnered or single, and if a long-term relationship is sought (Shernoff, 2006). Profile leads to the Chat activity, which is defined as a participant being able to talk on the Internet in an informal or familiar manner. To “Chat” is to be involved in an online discussion with others in a chat room or to partake in synchronous conferencing, i.e., digital communication happening at the same time, and occasionally in asynchronous conferencing. Chat or communicating can lead into three activities: Cybersex, telephone contacts, and/ or face-to-face (FTF). Cybersex is sex-oriented exchanges and conversations on-line, utilizing material of a sex-oriented nature available on-line. Terms include computer sex, net sex, or internet sex regarding an encounter where two people communicate remotely via the Internet and send sexually explicit text describing a sexual activity. Masturbation is usually present and can be enhanced by webcams for real- time video. This has been described as being where one participant describes online what he wants the other participant to do and may achieve orgasm (Ross, 2005). Chat can lead to the Phone activity, where a participant can utilize the phone in meeting, greeting, and getting to know potential or present partners in pursuit of a relationship. This stage is utilizing dialogue for the purpose of courtship or negotiation for sex by phone. Chat can also lead to FTF, the term used to describe meeting someone in person or in real life (IRL) being the real physical presence as opposed to meeting on the Internet. Both Cybersex and Phone can lead to Phone Sex which is sex-oriented conversations by phone. This is a social utility of an auditory nature for the purpose of talking about sex or acting out sexual fantasies and sexual arousal. FTF can lead to After FTF but before sex, which is the time period where people can meet, date, have conversations before moving to the phase of having sex. This part of the process is short in some relationships or part of a courtship nature in others. FTF can also lead to Sex.

Sexual Activities

The multiple steps in the flow chart(s) are related with participants making choices to enter one or more activities with decision points made. The strengths of the decision points are reflected in the percentages and the number of participants in the flow chart (Figures 1 and 2). These flow charts illustrate the process and decision flow and highlight decision making in certain areas, illuminating sexual choices or condom use.

IRL

The “Process” of Relationship among MSM IRL (the traditional way of meeting MSM) is a picture of courtship or negotiation for sex for those that do not meet on the Internet. The interpersonal dynamics depict sexual encounters with different boundaries as the participants navigate through the intricate flow of sexual relationships and courtship on a more traditional connection.

The first activity, Last time you met a new male IRL, defines a foundational timetable of emotional or physical connection between a MSM and a partner. This leads to the next activity How long before sex? This activity defines the timetable to the sexual activity. Leonard & Ross discuss the importance of the last sexual encounter as, in a large sample, providing an easily recollectable event that can provide an average “snapshot” of sexual activity (Leonard & Ross, 1997). The next activity Face to Face (FTF) No Sex defines the time of meeting, courtship, or dating with no sex involved. This time period is brief in some relationships and of a courtship hue in others. This part of the process includes making decisions about sex and choosing their sexual partners. A choice can be made to connect with the partner by phone or go straight to sex. The Phone activity is the use of the phone in meeting, and getting to know potential or present partners in pursuit of a relationship. The phone is a tool used to dialogue for the purpose of courtship or negotiation for sex by phone. The Phone activity can go straight to sex or to phone sex. The question specified “Did you talk on the phone before having sex?” The Phone Sex activity is sex-oriented conversations by phone. This is a social utility of an auditory nature for the purpose of talking about sex or acting out sexual fantasies and sexual arousal. FTF and Phone can lead to Face to Face (FTF) with Sex, being the act of or behavior with a sexually motivated nature. Sex leads to multiple choices in parallel to the flow chart of the Process among MSM on the Internet: MM, RIM, Oral Receptive, Oral Insertive, Anal Receptive, Anal Insertive, and Other. Again activities regarding condom use are replicated in both flow charts.

The purpose of these flow charts is to illustrate the complexities of sexual relationships and courtships, and potential decision points for safe sex negotiation, of MSM in both Internet venues and IRL. The “Process” flow charts illustrate the steps of partner selection of MSM and provide a picture to show the same person in different events (Internet vs IRL) making choices. This illustrates how the same participant may follow different patterns in sexual partner acquisition on the Internet and IRL, and demonstrate points in this flow where safer decisions may be promoted.

The Internet (Figure 1) and IRL (Figure 2) flow charts also depict sexual activities listed as “Other”. The participant was asked ‘When you met face-to-face, which of the following occurred?’ Other sexual activities (Table 5) were checked and the respondent specified different sexual activities from traditional kissing and touching to the more esoteric. The Internet had a much higher number of ‘other’ sexual listings (n = 40) and activities than IRL (n = 16).

Table 5. Respondents reports of Non-Traditional Sexual Activity.

Sexual Activities

The results of Discussion of Status are shown in Table 8. Status is defining one’s being HIV positive or negative, if a person has STDs (other than HIV), and condom use. Status leads to serosorting, the method of seeking only to engage in sexual activities, with partners of the same reported HIV status as oneself (Yarber, Sayad, & Strong, 2010). Data suggest differences between the last Internet event and IRL event. All the variables exhibited different prevalence except for ‘Understood we were going to have unprotected sex’. Data suggest more communication on the Internet than IRL, in regards to self-revealing information.

The results of Comparison of Sexual Experiences with Internet vs. IRL Partners, are shown in Table 6 suggest no difference in prevalence regarding Mutual Masturbation, Oral Receptive or Oral Insertive behaviors. Data suggest no differences between Internet vs. IRL regarding Rimming, Receptive Anal Sex and Insertive Anal Sex. There were no differences in condom use suggesting differences in practices but not protective behaviors.

Table 6. Comparison of Sexual Experiences with Internet Partners and In Real Life (IRL) all Partners.

Table 7. Comparison of Sexual Experiences with no Main Partner, Internet (I) Partners and In Real Life (IRL) Partners.

Table 8. Discussion of HIV Status with Internet and IRL Partners.

Discussion

This is one of the first studies to examine the process of MSM negotiating for sex regarding the Internet and IRL, using a self-selected, convenience sample at a national level of MSM recruited through the Internet. Previous investigations have looked at the Internet but none have yet systematically explored the different steps, the process of courtship and compared it to the IRL process.

The flow charts of Internet and IRL dating portray the process of filtering, courtship and/or negotiating for sex (including positioning). The flow charts compare MSM’s sexual risk behaviors as they unfold in both environments. The Figures present sexual encounters as interactions that create predictable sequences or “scripts”. The Internet flow chart portrays these collective patterns that specify sexual sequences and behaviors: these sequences constitute “filtering” and “sexual positioning”. As Gagnon and Simon note, interpersonal scripts are patterns of interaction that allow one to function in sexual situations (Irvine, 2003). Both the Internet and IRL flow charts pattern the interpersonal script that Gagnon and Simon (1984) wrote “is a process that transforms the social actor from being exclusively an actor to being a partial scriptwriter or adapter shaping the materials of relevant cultural scenarios into scripts for behavior in particular contexts” (p. 53).

The differences seen here between Internet and IRL suggests discussion of HIV/STD status to be different for all variables except “Understood we were going to have unprotected sex,” meaning no condom use. There was more communication on the Internet in regards to self-revealing information on variables relating to reducing risk (HIV/STD status, preference for safe sex, condom use) which enable “filtering” (including serosorting). The data indicate more steps in the Internet process compared to IRL processes prior to face-to-face contact, and these largely constitute affective confirmation of mutual attraction (photo, chat, phone, cyber- and phone-sex) while they may also contribute to information-seeking and sexual negotiation. Compared with IRL, the Internet process appears more complex and provides for multiple steps to filter and position with regard not only to HIV/STD risk but also to negotiate position for complementary sexual interests. It appears that the concern on the Internet is to confirm the “chemistry” as well as the risk, whereas IRL the “chemistry” has already been established (Ross et al., 2007).

The higher percentage of “Discussed what kinds of things we like to do when having sex with men” suggest complementary positioning. The data revealed items related to disclosure of HIV/ STD, and sexual practice questions “Found out his HIV status”, “Revealed my HIV status”, ‘‘Found out if he had STDs (other than HIV)”, “Revealed if I had STDs (other than HIV),” and “we talked about using condoms” indicates strategic positioning for perceived risk reduction. In Table 8, all variables were higher in the Internet situation for discussion of HIV/STD status except for ‘understood we were going to have unprotected sex.’

Data on comparison of sexual experiences with Internet partners versus IRL reveal differences in Rimming, and Receptive Anal Sex, in the direction of higher levels in the Internet initiated encounter compared to IRL initiated encounter. There were differences in condom use only for insertive anal sex. This suggests filtering and complementary positioning in negotiation on the Internet, which could indicate profile content issues as well as negotiation as risk reduction processes. However, the process of filtering may be compromised because the most frequent means of knowing that a man was “safe” was reportedly “gut feeling”, and seeing a photo (which may both address affective, rather than rational, decision- making). The processes of asking a lot of questions, and talking on the phone, may be based on more rational decision-making. A third of the Internet encounter sample felt that they already had a relationship with the man they had met on-line but not yet face-to-face, confirming that for a sizeable proportion, accelerated intimacy was operating (Ross et al., 2007).

These data have several limitations. Men recruited while actively seeking or cruising websites for sexual partners through websites such as Gay.com, Manhunt.net, Yahoo.com, and Crusingforsex.com might be expected to be more sexually active than those recruited from the general population. A larger sample of MSM identified through a random probability survey might provide greater confidence in generalizability. Drop-out rate before the end of the questionnaire, is approximately 48% in these data as noted by Jain & Ross (2008). Data published previously suggest that less than one percent of those who see the banners complete the questionnaire, and thus this is a selective sample. Ross (2003) noted that more than 1,700,000 banners in a study of Internet dropout, 0.62 percent linked to the website; and of these only 34 percent commenced the survey, and one half of these completed the survey (Ross, Daneback, Månsson, Tikkanen, & Cooper, 2003). Because data included MSM who just had Internet partners, and MSM who just had IRL partners, there is a degree of overlap in these data between those respondents and respondents who had both IRL and Internet partners in the past 60 days.

An additional limitation is that these data were collected in 2005 and since then, webcams have become much better established as a means of communicating visual images and thus the “chemistry” element differences between Internet and IRL meeting has been reduced. Further, cues are also available in FTF meetings even if not explicitly discussed, although these are much more easily misread or missed in comparison with more direct elicitation on the Internet. These data suggest that IRL and Internet sexual encounters initiated on the Internet are independent with regard to discussion of HIV/STD status and condom use, as well as many sexual behaviors in Internet-generated compared to IRL-generated sexual encounters.

These data establish a pattern of MSM’s courtships or negotiation for sex and a pattern of partner acquisition. Data suggest more negotiation on the Internet and decisions being made based on un- verifiable information. Second, data suggest many negotiation opportunities which could lend to interventions to advise people how to negotiate safely.

Acknowledgement

This study was funded by grant from the U.S. Centers for Disease Control and Prevention to the University of Texas, Boston University and the Denver City Health Department. This paper formed part of the first author’s Ph.D dissertation at the University of Texas under the supervision of the second author. The authors wish to thank Drs. Seth Welles, Mary McFarlane, Cornelius Rietmeijer, Rachel Kachur, and Don Allensworth-Davies for their assistance in the study of which these data were part. This study was funded by ASPH grant #S3211-23/24.