Consistent with the results of some previous studies [14, 15, 20], internet-recruited MSM were more likely than their venue-recruited counterparts to have engaged in UAI and commercial sex, and to report having contracted STD in the last 12 months. The level of perceived HIV risk was however lower among internet-recruited MSM than among MSM recruited from venues. Different recruitment methods may therefore provide different results.
Internet-recruited MSM were less likely than venue-recruited MSM to have multiple MSM sex partners. It is possible that venue-goers meet many potential sex partners face-to-face in bars and saunas etc. and may end up having sex with some of them eventually, whilst internet-based sex networks are often constructed in a virtual reality. Sexual networks are important platforms for both HIV transmission [24, 25] and HIV interventions. Network-based interventions might be more feasible for venue-based respondents than for internet-based respondents. The problem of consuming psychoactive substances or alcohol prior to sexual intercourse was also more severe among venue-recruited MSM respondents than among internet-recruited respondents. Alcohol, drugs, and relevant peer pressure are more likely to prevail in venues. The findings of this study are consistent with those reported in other countries . This suggests that venue-based campaigns should strengthen harm reduction of substance use and alcohol misuse.
Stating whether internet-based or venue-based respondents are at higher risk may oversimplify the issue. The two sampling methods may not be accessing a single population. Some but not all MSM can be accessed via both the internet and venues. Our data did not allow us to assess the degree of overlap. Our data, however, informed us that survey results of risk behaviors in MSM depend on the mode of data collection.
This study represents one of few attempts made to discern the socio-cultural profiles of venue-recruited and internet-recruited MSM. It can be seen that as compared to their counterparts recruited from venues, internet-recruited MSM respondents were less likely to disclose their sexual orientation to family members and to accept their own sexual orientation, and more likely to fear disclosing their sexual orientation to others, and to date/marry a woman in order to hide their sexual orientation. Implementation of face-to-face peer education may hence be more difficult and less feasible for internet-based MSM. Instead, internet-based empowerment efforts may be relevant for this group. Empowerment among MSM would increase condom use . This study has also shown that only a minority of the participants, especially internet-based ones, had family or best friends who were supportive of their sexual orientation, possibly reflecting the severity of social stigma against MSM in Hong Kong.
Our findings indicated no significant between-group differences in service utilization rates. However, reservations and fear related to disclosing one's MSM identity might prevent some internet-recruited MSM from visiting gay venues. Since most MSM studies were based on venue-based sampling methods, the results of which were used to design programs targeting MSM in general, these programs may not be the most appropriate for internet-based MSM.
With respect to factors associated with UAI for venue-recruited and internet-recruited MSM respondents, perceived discrimination was significant for the former group but not the latter; the reverse was true for having some or all friends having MSM behaviors. Having best friends supporting one's MSM sexual orientation was significant for both groups. It is therefore seen that the two groups of MSM have both common and different factors associated with UAI. Social networks and social support may lead to both safer and riskier sexual behaviors [8, 24]. Having best friends to support one's sexual orientation was associated with UAI in both groups; the norm among their peers however may not favor condom use. Furthermore, internet-recruited respondents were relatively lacking in social support and may therefore be more affected by peer influences. This may explain partially why the variable related to having more MSM friends was significant in internet-recruited MSM but not the venue-recruited sample. It is however less clear why perceived discrimination matters in the latter group but not in the former group. Further research is required.
The present study has some limitations. Firstly, convenience-sampling was used as random sampling was not feasible. Many published MSM studies have used similar recruitment methods [e.g., 8]. Secondly, data were self-reported and may be subject to reporting bias, though most sex behavior studies are also self-reported [e.g., 8,14,19,21]. Respondents were assured of strict anonymity and privacy of the interviews. Thirdly, we did not ask about HIV status of the individuals. HIV positive individuals may have higher levels of risk behavior as compared to their HIV negative counterparts. An alternate explanation of our results may hence be due to a higher proportion of HIV positive MSM using the internet to seek sex partners or for sero-sorting. We cannot test this hypothesis with our results and further research is warranted. However, the involved website does not have any special contents catering HIV positive MSM and sero-sorting is unpopular in Hong Kong. HIV positive MSM are also not deferred from seeking partners from gay venues. Therefore, the bias should not be too serious. Fourthly, stronger social desirability bias may occur among venue-recruited participants as compared to internet-recruited participants, who did not need to face an interviewer. Fifthly, it is possible that a higher proportion of internet-recruited participants were living with a regular partner, with whom unprotected anal intercourse is usually more common than with casual partners. There also was a possibility of self-selection bias in the internet-recruited respondents. Finally, biological markers were not collected in this study.