The public health perspective: Building the HIVe

Professor Jonathan Elford
Published Online: April 15, 2012
Full Text: HTML, PDF (176 KB)

Just over ten years ago researchers in Europe and the USA reported that an increasing number of gay men were using the Internet to meet sexual partners.   Our own research among gay men in London found that in 2000 just over a quarter of the men we surveyed in gyms had used the Internet to meet sexual partners during the previous 12 months.   More than ten years on, that figure has more than doubled.

The initial public health focus was whether the Internet represented a new risk environment.   Several studies had found increased levels of high-risk behaviour among gay men who looked for—and found—sexual partners through the Internet.  But the underlying processes and drivers were not understood.

The association between seeking sex on the Internet and high-risk sexual behaviour raised a number of important questions at the time.  Did the excess risk for HIV and other sexually transmitted infections (STIs) occur with sexual partners whom men actually met through the Internet?  Or did the association reflect the fact that high-risk men were selectively using the Internet to look for sex?  In other words, did the Internet somehow amplify risk or did self-selected groups of men use the Internet for meeting partners?  Did the Internet attract a constituency of men who had little contact with the established gay scene or health promotion agencies?  For example, men who did not use bars and clubs, bisexual men, or men from remote geographic regions?  And in the midst of all this, what was the Internet’s potential for HIV education, prevention and sexual health promotion?

Over a decade later, we have some answers to these questions.  Concerning risk, the Internet appears to provide opportunities for risk reduction as well as for risk enhancement.  It has become evident that the Internet provides an important platform for gay men living with HIV to meet one another and to mutually disclose their HIV status in a relatively safe environment.  The Internet has also become an important source of information on HIV and other STIs while the opportunities for HIV prevention and online interventions appear to be unlimited particularly among men who would otherwise be hard to reach.  The papers in this issue of Digital Culture & Education (DCE) are testimony to the Internet and other digital technologies’ potential for community-led interventions with a public health focus.

In addition the Internet provides new opportunities for conducting population surveys among gay men. Most European countries now conduct behavioural surveillance among gay men by means of online surveys accessed through a myriad of websites.  The EMIS project (European Men’s Internet Survey) demonstrated the power of the Internet as a research tool by recruiting more than 180,000 men who have sex with men from 38 European countries in just a few months in 2010.  One of the advantages of online surveys is their ability to reach men who do not use gay community venues or who are geographically dispersed.

A recent editorial in a British newspaper noted that the Internet “makes the argument for the power of collaboration over competition, for openness over secrecy”.  Nowhere is this better illustrated than in the papers of this special issue of Digital Culture & Education (DCE) on Building The HIVe.

Biographical Statement

Professor Jonathan Elford, School of Health Sciences, City University London has conducted behavioural, epidemiological and social research in relation to HIV and sexual health, both online and offline.  His research focuses on the two groups most affected by HIV in the United Kingdom; men who have sex with men (MSM) and black African heterosexual men and women.


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