Biomedical subjects

Jonathan Elford

Publications and source records attributed to Jonathan Elford.

24 records · Page 2Linked to original sources

PubMed2004

Web-based behavioral surveillance among men who have sex with men: a comparison of online and offline samples in London, UK.

OBJECTIVE: To compare the characteristics of men who have sex with men (MSM) surveyed online (through gay Internet chat rooms and profiles) and offline (in community venues) in London, UK. METHODS: In February and March 2002, 879 MSM completed a self-administered pen-and-paper questionnaire distributed in central London gyms (offline sample). In May and June 2002, 1218 London MSM completed a self-administered questionnaire online, accessed through Internet chat rooms and profiles on gaydar and gay.com. RESULTS: Compared with men surveyed offline, those surveyed online were significantly less likely to only have sex with men (89 vs. 94%), to be in a relationship with a man (44 vs. 52%), or to have been tested for HIV (68 vs. 80%) (P < 0.001). Men recruited online were also younger (mean age, 34 vs. 36 years) and less likely to have had a higher education (67 vs. 79%) (P < 0.001). However, differences between online and offline samples were less pronounced for HIV-positive men and more pronounced for HIV-negative men and those who had never been tested for HIV. Regardless of HIV status, men recruited online were more likely to report high-risk sexual behavior (i.e., unprotected anal intercourse with a partner of unknown or discordant HIV status) than men surveyed offline (32 vs. 22%, P < 0.001). Men recruited online were also significantly more likely to have used the Internet to look for sex (85 vs. 45%, P < 0.001); for HIV-positive and negative men, seeking sex on the Internet was associated with high-risk sexual behavior (P < 0.01). In multivariate analysis, after controlling for confounding factors, being surveyed online was independently associated with high-risk sexual behavior for HIV-negative and never-tested men (HIV-negative men, adjusted odds ratio for online vs. offline samples, 1.73; 95% CI, 1.23, 2.42; P < 0.01; never-tested men adjusted odds ratio 2.45; 95% CI, 1.40, 4.29; P < 0.01). This was not the case for HIV-positive men (adjusted odds ratio for online vs. offline samples, 1.32; 95% CI, 0.69, 2.50; P = 0.4). CONCLUSION: The Internet offers valuable opportunities for conducting behavioral surveillance among MSM because it reaches some men who may not be easily accessed in the community yet who are at high risk for HIV and sexually transmitted diseases. Comparisons of the social, demographic, and behavioral characteristics of online and offline samples must, however, take into account the confounding effects of HIV status and seeking sex on the Internet.

Adult↗

PubMed2003

If HIV prevention works, why are rates of high-risk sexual behavior increasing among MSM?

Systematic reviews of HIV prevention research provide clear evidence that behavioral interventions can influence the sexual behavior of men who have sex with men (MSM). However, if HIV prevention works, why are rates of high-risk sexual behavior increasing among MSM in major European, Australian, Canadian, and U.S. cities? The evidence generated by systematic reviews alone may not provide a clear answer to this question. This is because (a) it is uncertain whether experimental interventions shown to be effective in one setting, place, or moment in time can be repeated successfully in another; (b) we have limited understanding of the processes that underlie the interventions; (c) interventions shown to work in an experimental study may not necessarily be effective in everyday life. To answer the question, we need to be alert to the changing risk environment in which men have sex with other men. We also need to develop a new program of research addressing the transferability, sustainability, and effectiveness of sexual health promotion among MSM. Randomized controlled trials will remain one of the optimal means of evaluating behavioral interventions in such a program. By further strengthening the evidence base, we may identify opportunities for innovative as well as effective HIV prevention initiatives.

Controlled Clinical Trials as Topic↗

PubMed2002

High-risk sexual behaviour increases among London gay men between 1998 and 2001: what is the role of HIV optimism?

OBJECTIVE: To examine whether HIV optimism (i.e. optimism in the light of new HIV drug therapies) can account for the recent increase in high-risk sexual behaviour among London gay men. METHODS: Gay men (n = 2938) using London gyms were surveyed annually between 1998 and 2001. Information was collected on HIV status, unprotected anal intercourse (UAI) in the previous 3 months, and agreement with two statements concerning the severity of and susceptibility to HIV infection. Those who agreed were classified as 'optimistic'. RESULTS: Between 1998 and 2001, the percentage of men reporting high-risk UAI (i.e. UAI with a casual partner of unknown or discordant HIV status) increased: HIV-positive men 15.3-38.8%; HIV-negative men 6.8-12.1%; never-tested men 2.1-7.7%; (P < 0.01). Overall, less than a third were optimistic. In cross-sectional analysis, optimistic HIV-positive and -negative men were more likely to report high-risk UAI than other men (P < 0.05). However, the increase in high-risk UAI between 1998 and 2001 was seen in those who were optimistic and those who were not (P < 0.05). In multivariate analysis, the modelled increase in high-risk UAI over time remained significant after controlling for HIV optimism (P < 0.01), with no significant interaction between optimism and time. CONCLUSION: Among London gay men, no difference was detected between those who were optimistic and those who were not in the rate of increase in high-risk sexual behaviour between 1998 and 2001. Our findings suggest that HIV optimism is unlikely to explain the recent increase in high-risk sexual behaviour in these men.

Adult↗

PubMed2002

Use of anabolic steroids and associated health risks among gay men attending London gyms.

AIM: To examine, by HIV status, the use of anabolic steroids among London gay men and their effect on physical and mental health. DESIGN: Cross-sectional survey using self-administered questionnaire. SETTING: Six gyms in central London. PARTICIPANTS: 772 gay men using the gyms in January-February 2000. MEASUREMENTS: Proportion of gay men who reported (i) using steroids, (ii) sharing injecting equipment, (iii) experiencing side-effects and (iv) having suicidal thoughts or feeling depressed. FINDINGS: Of 772 gay men, 117 (15.2%) had used and 90 (11.7%) had injected steroids in the previous 12 months: HIV positive men (steroid use) 31.7% (40/126), HIV negative men 14.5% (69/477), never-tested for HIV 4.7% (8/169) (p < 0.001). No one reported sharing needles or syringes. HIV positive men were more likely to have used steroids for medical reasons than other men (24.3% versus 5.9%, p=0.01). Nearly all steroid users (96.4%) reported side effects including testicular atrophy (51.0%), insomnia (47.7%), depression between cycles (25.2%) and hypertension (19.0%). Steroid users were more likely to have had suicidal thoughts in the previous 6 months than non-users (22.6% versus 11.2%, adjusted odds ratio after controlling for HIV status 1.84; 95% CI 1.10-3.12, p=0.02) or to have felt depressed (49.1% versus 38.5%, adjusted OR 1.52, 95% CI 1.01-2.30, p=0.047) CONCLUSION: One in seven gay men surveyed in central London gyms in 2000 said they had used steroids in the previous 12 months. HIV positive men were more likely to have used steroids than other men, some therapeutically. Side effects were reported widely and steroid use was associated with having had suicidal thoughts and feeling depressed, although cause and effect could not be established. Our findings suggest that steroid use among gay men may have serious consequences for both physical and mental health.

Adult↗

PubMed2002

Surfing for sex.

Explore the source record for details and available documents.

Humans↗

PubMedDate not supplied

Sex and the Internet: gay men, risk reduction and serostatus.

Access to the Internet has increased dramatically over the past decade as has its use for meeting sexual partners (e-dating), particularly among gay men. Between June 2002 and January 2004, 128 gay/bisexual men living in London were interviewed one-to-one about their experience of e-dating, sexual risk and HIV prevention. The men were recruited both online (through the Internet) and offline (in clinics and the community); 32 men were HIV-positive, 59 HIV-negative, while 13 had never had an HIV test. A key finding was that both identity as well as anonymity are vital to e-dating. Through a process of online filtering and sero-sorting, HIV-positive men are able to meet other positive men for anal sex without condoms. While this does not present a risk of HIV transmission to an uninfected person it does have implications for the potential transmission of other STIs such as syphilis and LGV. Through e-dating, HIV-positive gay men can also avoid abuse, discrimination and sexual rejection. Our findings do not support the suggestion that the attraction of e-dating is that it affords absolute anonymity. We found that the gradual expression of identity is vital for e-dating among gay men. Internet-based HIV prevention campaigns need to take account of the different ways in which gay reflexively manage aspects of their identity online.

Adult↗