Ronny Tikkanen

Differences between Internet samples and conventional samples of men who have sex with men: implications for research and HIV interventions

The Internet is becoming a new erotic oasis for obtaining sex online or in person. We reviewed the literature on cybersex and compared differences in data from samples of homosexually active men obtained on identical questionnaires from a conventional written questionnaire, distributed through the mailing and contact lists of a large national gay organization in Sweden, and through the same organizations website and chat room. A total of 716 written questionnaires and 678 Internet questionnaires were obtained. The Internet sample was younger, more likely to live in small towns or cities, live with parents or a girlfriend, and have lower formal education. They are less likely to have previous sexual experience solely with other men (one in three of the Internet sample vs. 1 in 14 of the written sample defined themselves as bisexual) and more likely to visit erotic oases such as bathhouses, video clubs and erotic movie houses. They also visited Internet chat rooms more frequently (86% of the Internet sample vs. 50% of the written sample). One third of the Internet sample wanted the opportunity to talk with an expert about HIV compared with a quarter of the written sample. Sexual practices between the two samples were generally similar, although the Internet sample reported significantly less body contact, kissing, hugging, mutual masturbation, and more condom use for anal intercourse with steady partners. Over four times as many of the Internet samples reported sex with women in the past year as the written sample. These data indicate that Internet data collection is feasible and that this mode of data collection, despite the nonrandom and self-selected nature of both types of samples, is likely to be more significantly oriented toward the young, geographically more isolated, and more behaviorally and self-identified bisexual respondent than conventionally distributed written questionnaires.

Looking for sexual compatibility: Experiences among Swedish men in visiting Internet gay chat rooms

Internet chat rooms have become an important new channel for men who have sex with men. Through chat rooms, sexual partners can be met in virtual and in real life. The aim of this article is to explore the questions: Who are the men that visit the Internet gay chat rooms, and what are the experiences in meeting sex partners in real life through these channels? The findings are derived from a large Swedish socio-sexual study of men who have sex with men. The Internet is used along with traditional sampling methods in the study. A total of 716 written questionnaires and 678 Internet questionnaires were obtained. Additional qualitative data from interviews with men who have experience with meeting male sex partners through Internet chat rooms is presented for illustrative purposes. The findings suggest that Internet gay chat rooms may attract younger men, men who identify themselves as bisexual, and men who live outside the major cities. The findings also suggest that it is common to have the experience of m...

Characteristics of men and women who complete or exit from an on‐line internet sexuality questionnaire: A study of instrument dropout biases

This study compared respondents who completed an Internet sexuality questionnaire and those who dropped out before completion. The study was in Swedish and comprised 3,614 respondents over a 2‐week period (53% males, 47% females). There were significant differences between males, of whom 51% dropped out before completion of the 175‐item questionnaire, and females, of whom 43% dropped out. Dropout in both genders followed a curve of negative acceleration. The data suggest that dropout is likely to be significant and gender and demographically biased, and to occur significantly earlier for men than for women. Geography, education, sexual orientation, age, relationship status, living arrangements, and Internet connection speed were related to dropout for men, while only relationship status and living arrangements, which were in the opposite direction from men, were related to dropout in women.

The Effectiveness of MI4MSM: How Useful is Motivational Interviewing as an HIV Risk Prevention Program for Men who have Sex with Men? A Systematic Review

Among men who have sex with men (MSM), the principal risk practice for HIV infection is unprotected anal intercourse, often engaged in under the influence of alcohol and other substances. Both behaviors are targeted through the much-used counseling approach motivational interviewing (MI). We conducted a systematic review of the effectiveness of behavioral interventions adapting the principles and techniques of MI on HIV risk behaviors for MSM. Ten randomized controlled trials, which included 6,051 participants at baseline, were eligible for inclusion. Nine outcomes, of which seven were for sexual behavior outcomes, were sufficiently similar to compute meta-analyses. With the exception of one outcome, drinks per day at short-term follow-up, there were no significant differences between the groups receiving MI and the control groups. The effectiveness of MI as a prevention strategy for HIV risk behaviors among MSM is uncertain and continued work to craft more effective HIV prevention programming for this group should be done.

Reported sexually transmitted infections in Swedish Internet-using men and women.

Although the Internet has become a forum for making sexual contacts, and has been associated with increased sexually transmitted infection (STI) transmission, we have little information of history of STIs in Internet‐based samples. The Internet behaviours that are associated with STI acquisition are poorly understood. We analysed STI histories reported by 904 Swedish men and 931 Swedish women who responded to an Internet‐based survey on sexual behaviour in 2002: 16.6% of men and 22.5% of women reported a lifetime history of STIs, with Chlamydia being the most common for both genders. 3% of men and 5% of women who reported an STI, indicated that they had had more than one. Sources of the STI, where known, were Internet‐acquired partners in only 3% of cases. There were no differences between men and women with or without an STI history regarding the kind of online sexual activities they engaged in, how they found sexual material online, and the reasons they engage in sexual activities. These rates are similar to those reported in a national random study of sexuality in Sweden. Contrary to prior research, these results suggest no relationship between STI and specific Internet characteristics usage patterns. These data suggest that the Internet is not yet a major source of STIs in Swedish men and women. Given these STI histories, the Internet may be a useful medium to include in STI prevention efforts.

Unequal sexual health – Differences between detained youth and their same aged peers

Purpose: To describe sexual health risks in an understudied group, youth in detention, and compare these to sexual health risks among non-detained youth. In addition, variables predicting adverse sexual health outcomes are sought and compared. Methods: In 2009, a self-administered questionnaire on sexuality was conducted amongst youth in Sweden. In 2010, the same Internet-based questionnaire was applied in a study at Swedish detention centres. In this article, sexually active youth aged 15–20 years in the two groups are compared and bivariate logistic regression analyses are conducted in order to find predictors of adverse sexual health outcomes, among detainees and non-detainees respectively. Results: Major differences between the detained and the non-detained concerning a majority of risk-taking variables exist. Conclusions: Although detained youth display several risky sexual behaviors, no specific risk factors are found in a logistic regression analysis. However, this is a vulnerable group. The mere fact that an adolescent is placed at a detention centre should be an imperative for professionals to address the subject of sexual health and safer sex. Furthermore, the results will be used in a forthcoming sex education curriculum tailored especially at detained youth. This is one, but by far not the only way to minimize the health inequalities that are presented in this study.

Party and Play in the Closet? Exploring Club Drug Use Among Swedish Men Who Have Sex With Men

ABSTRACT Background: Men who have sex with men (MSM) is a population that is less frequently the target of drug research in a Scandinavian context. Objectives: This study aims to explore: (1) the existence of club drug use among a sample of Swedish MSM, and (2) associations between club drug use and sociodemographic, sociosexual, and sexual risk behavior. Methods: Data were drawn from a larger European study on MSM and HIV but the analytic sample consisted of the 3,004 MSM who resided in Sweden. SPSS 20.0 statistical software was used to perform the analysis. The primary outcome variable was a dichotomous measure of having used club drugs in the past 12 months vs. not. The independent variables were categorized into three domains, sociodemographic, sociosexual, and sexual risk behavior. The analysis was undertaken as a univariable analysis. Results: Results show that club drug use exists in the Swedish MSM population and is particularly prevalent among gay identified, younger MSM from metropolitan areas, and among men with diagnosed HIV or other STIs. Moreover, club drug use was common among the men that had more sexual partners and took more sexual risks. These men were also more likely to have been diagnosed with an STI. Conclusions/Importance: MSM who use club drugs have to be acknowledged in the Swedish drug policy context, as well as within clinical practice. Further research is needed to develop an understanding of the social and contextual dimensions involved in club drug use among Swedish MSM.

Gay Community Involvement: Its Interrelationships and Associations With Internet Use and HIV Risk Behaviors in Swedish Men Who Have Sex With Men

We measured aspects of “community involvement” chosen for men who have sex with men (MSM) in Sweden (gay places, media accessed, Internet, gay festivals, and social engagement, measured as proportion of gay friends) in two Swedish Internet-based samples from 2006 (n = 3,202) and 2008 (n = 4,715). Data showed low to moderate reliability with a moderate (0.57) alpha coefficient. While there is moderate internal consistency, as might be anticipated from measures of actual community involvement, they can be treated as scales. The Internet scale indicated the lowest reliability, perhaps due to respondents having Internet sites of primary choice, rather than a high level of usage across several sites. A hypothesized lack of correlation between traditional domains of the gay community and the Internet did not appear: correlations between the Internet measure and the other measures were positive and significant, but among the lowest correlations obtained between the community measures, ranging from 0.06 to 0.24. Those who use the Internet extensively are less likely to be involved in other aspects of the community. Sexual risk was associated with high social engagement at sexual meeting sites and with Internet use. Gay community involvement, including the Internet community, may be complex and associated with both increase in HIV sexual risk behaviors (by measuring use of sexual risk sites) and preventive measures (HIV testing).

Experimentals, bottoms, risk-reducers and clubbers: exploring diverse sexual practice in an Internet-active high-risk behaviour group of men who have sex with men in Sweden

Abstract This study aimed to identify sub-groups of men who have sex with men at high risk of HIV infection. Data from the Swedish MSM2013 survey were analysed with a focus on respondents (n = 714) who reported having had unprotected anal intercourse with male casual partner(s) in the past 12 months. Weighted Latent Class Analysis with covariates and distal outcomes was conducted to identify sub-groups of men sharing the same sexual practice characteristics. Four latent classes emerged: experimentals, bottoms, risk-reducers and clubbers. Experimentals appeared to differ most from the other classes. They had extensive experience of barebacking, the use of poppers and fisting. Higher number of casual male sex partners and reporting having HIV were predictors for belonging to experimentals. No evidence for an association between self-rated HIV prevention knowledge and taking less part in risky practices was found. Hence, knowledge-intensive interventions may not be the best fit for reducing HIV transmission. This diversity of men based on similar sexual practice patterns should be taken into account when designing future HIV prevention interventions.

Men, masculinity, and community development in Kenyan slums

There is limited research on masculinity in relation to community development. Using ethnographic and interview data from two slums in Kenya and building on one of the more well-known definitions of community development, we explore men?s narratives of themselves in relation to community development. We highlight how men’s cognizance of the structural and contextual constraints to the development of their communities intersected with both a feeling that they have helped to hamper community development and an adamant sense of their own criticality and centrality in ensuring it. While repudiating the idea that they have to change in order for their community to progress, men also generally hinged community development on their tenacious pursuit of traditional masculinity scripts. The rejection of mainstream masculinity norms as the basis for community progress will not resonate consistently among men. Social and community development work with men that fails to acknowledge them as gendered people may not succeed.