Navigating condom use and HIV status disclosure with partners met online: A qualitative pilot study with gay and bisexual men from Craigslist.org

Abstract

We conducted face-to-face semi-structured interviews with 50 men recruited off the New York City men-seeking-men section of Craigslist.org. Participants discussed their favorite venues for meeting sex partners (n = 28 said the Internet), and we focused on these men’s responses to probes regarding decisions around condom use and HIV status disclosure with online partners. A majority indicated they set a priori rules for themselves to always use condoms, and cited the Internet as their favorite venue in part because it helped them sort for like-minded partners. Participants indicated that having in-person conversations around condom use and HIV was often difficult, and that the Internet was a convenient medium to facilitate the process. Notable differences were observed in how HIV-positive and HIV-negative men navigated serostatus disclosure—HIV-negative men were less subtle in starting the conversation. Finally, participants described a common narrative around distrust with online partners, which is one reason why they consistently use condoms. These data suggest that features which allow men to easily indicate, and filter for, condom use preferences should be built into (or maintained on) profile-based sexual networking sites and sexual bulletin board sites.

INTRODUCTION

Gay and bisexual men and other men who have sex with men (MSM) represent between 2–5% of the United States’ population; however, in 2010, they accounted for 61% of new HIV cases, and 75% of all diagnoses among males (CDC, 2010; Prejean et al., 2011). In urban centers like New York City (NYC), which are often home to concentrated gay and bisexual communities, disparities are even more evident—compared to other men in NYC, MSM have a 140-fold higher risk to be newly diagnosed with HIV and/or syphilis (Pathela et al., 2011). These figures underscore the need to understand the factors that contribute to HIV transmission risks in MSM.

Since the 1990s, researchers have studied gay and bisexual men’s use of the Internet, investigating the Internet’s role to potentiate HIV transmission risks as well as serve as a medium through which to deliver HIV prevention and education (Chiasson et al., 2006; Klausner, Wolf, Fischer-Ponce, Zolt, & Katz, 2000; Mustanski, Lyons, & Garcia, 2011). The Internet is appealing to gay and bisexual men for seeking sex partners because of its accessibility, affordability, anonymity, safety, and privacy (Chiasson et al., 2007; Chiasson et al., 2006). Many gay and bisexual men use the Internet for dating and meeting sex partners, and there are a substantial number of membership-based social-sexual networking websites (e.g., Manhunt.net, Adam4adam.com) in addition to online bulletin boards (e.g., Craigslist.org)—though much research is based on the former (Grov, Hirshfield, Remien, Humberstone, & Chiasson, in press-a; Horvath, Rosser, & Remafedi, 2008b; Klein, 2008; Liau, Millett, & Marks, 2006) and emerging research interest on the latter (Grov, 2010, 2012; Grov & Crow, 2012; Moskowitz & Seal, 2010). Studies suggest that an increasing percentage of gay and bisexual men are using the Internet to meet partners (Liau et al., 2006; Rosser, West, & Weinmeyer, 2008), thus it is important to consider if the Internet plays a role in sexual risk-taking behavior and decision making. There is, however, mixed evidence about whether the Internet facilitates HIV and STI transmission (Mustanski, 2007).

Within the framework of epidemiological risk perspective, the Internet increases the opportunity for casual sex, and consequently the potential for HIV and STI transmission because it can facilitate rapid interactions with multiple sex partners (Bull & McFarlane, 2000; Garofalo, Mustanski, McKirnan, Herrick, & Donenberg, 2007; Mustanski, 2007). Gay and bisexual men who use the Internet to meet sex partners not only have a greater frequency of sexual behavior; they also tend to have more sexual partners—Chiasson et al. (2007) found that 66% of their sample reported having sex with more partners after they started meeting partners online than they had before. Likewise, Mustanski (2007) reported that a history of online sex-seeking was associated with having greater numbers of sexual partners, including one-time sexual partners (though not necessarily greater HIV risk behavior with online partners).

Though studies have suggested that utilizing the Internet to meet sex partners may increase risk for HIV and STI transmission, some researchers have argued that it can serve as a medium for harm reduction and a powerful venue for HIV prevention (Rosenberger, Reece, Novak, & Mayer, 2011a). Gay and bisexual men can disclose their HIV statuses to partners and negotiate specific sexual acts prior to meeting their partners in person (Carballo-Dieguez, Miner, Dolezal, Rosser, & Jacoby, 2006; Horvath, Nygaard, & Rosser, 2009; Horvath, Oakes, & Rosser, 2008a). In a qualitative study of MSM and Internet use, Horvath, Nygaard, and Rosser (2009) found that the most commonly reported strategy used by their participants to determine the HIV status of their sexual partners was ‘checking their online profiles’ (85%). Other strategies were talking about it immediately before sex (82%), “talking after sex” (42%), and “guessing” (29%). HIV status disclosure may be an important precursor to serosorting (i.e., only having partners of the same status) as a strategy to reduce HIV risk (Dubois-Arber, Jeannin, Lociciro, & Balthasar, 2011; Horvath et al., 2008a; Snowden, Raymond, & McFarland, 2011); however, researchers have called into question the effectiveness of serosorting, especially if it is being done as a replacement for condom use (Golden, Stekler, Hughes, & Wood, 2008). Researchers have noted that, given the impersonal nature of the Internet, some individuals may misrepresent personal characteristics they perceived to be undesirable to their potential partners (Ross, Rosser, Coleman, & Mazin, 2006). These can include physical characteristics (e.g., weight, height, penis size). HIV-positive men may conceal or be deceptive about their serostatus to avoid stigma (Adam et al., 2011; Elford et al., 2010), while other men may misrepresent their status as HIV-negative, yet they have not tested recently.

In response to the rising rates of HIV among MSM, there has been growing interest to better understand how the Internet, as a sex-seeking venue, may affect HIV status disclosure and condom use (Grov et al., in press-a). Much prior work in this area has focused on samples of men recruited on profile-based websites such as Manhunt.net and Gay.com (Chiasson et al., 2007; Hirshfield et al., 2010; Rosenberger et al., 2011b, 2012; Rosser et al., 2009a; Rosser et al., 2009b) or community-based samples of gay and bisexual men who reported having used the Internet (Grov, Parsons, & Bimbi, 2007; Mustanski et al., 2011). With few exceptions (Grov, 2010; Grov & Crow, 2012; Moskowitz & Seal, 2010), little work has been done with men recruited on bulletin board hook-up websites (e.g., Craigslist.org), yet some research suggests this population may be distinct from other groups (Grov, 2012).

The infrastructure of Craigslist is different from traditional profile-based websites; Craigslist does not contain internal correspondence mechanisms such as internal chatting (instant messaging or email). Instead, Craigslist users browse and post public listings and respond to ads via their personal email addresses. Public listings can remain online for up to a week and are ‘pushed down’ the list by newer posts. Craigslist also does not require any type of membership or subscription, and does not charge fees for use of its personals. With the exception of automated filters to prevent inclusion of a phone number or URL in the body of an ad, Craigslist is not moderated by a central administrator. Instead, the Craigslist community moderates itself. Users can “flag” for removal ads that they deemed inappropriate.

One study estimated between two and four thousand ads were posted in the New York City men-seeking-men section every day (Grov, 2010). Given the high frequency of sex-seeking behavior on Craigslist, it would be imperative to understand how this population uses the Internet to navigate facets that contextualize HIV transmission risks such as HIV status disclosure and discussions around condom use.

Current Study

To that end, we conducted face-to-face semi-structured interviews with 50 men recruited off the New York City (NYC) men-seeking-men section of Craigslist.org. In this pilot study, participants discussed their favorite venues for meeting sex partners (n = 28 said the Internet), and we focused on these men’s responses to probes regarding decisions around condom use and HIV status disclosure with partners met online. Our findings seek to contribute to HIV prevention research by identifying how gay and bisexual men communicate about HIV and navigate condom use with their online partners.

METHOD

Participants and Procedures

Data for this study are taken from Project Score, a pilot study investigating the various places where sexually active MSM meet their sex partners. One of our goals was to recruit 50 men off the men-seeking-men section on Craigslist.org in NYC. Eligibility criteria included: biologically male, at least 18 years of age, and having reported at least two new male sex partners within the last 30 days. Those eligible were invited to participate in a face-to-face interview at our research office.

Following guidelines for time-space sampling (MacKellar, Valleroy, Karon, Lemp, & Janssen, 1996; Parsons, Grov, & Kelly, 2008; Stueve, O’Donnell, Duran, Sandoval, & Blome, 2001), the research team first identified the most socially-viable times during which to recruit on Craigslist—determined as having an adequate magnitude of the target population at the venue (Kelly, Parsons, & Wells, 2006). Drawing from our previous research with MSM on Craigslist (Grov, 2010, 2012; Grov & Crow, 2012), we determined that the hours between 7am and 2am were the most viable in which to encounter the target population. The team divided these times into one-hour increments (e.g., 7am–7:59am, 8am–8:59am, and 9am–9:59am). Between fall 2010 and spring 2011, and using multiple levels of randomization, the research team used a random digit generator to (1) select a day of the week in which to post (out of all seven days), (2) select a borough/neighborhood within NYC, and (3) select a time-increment to post. We weighted/matched borough selection based on NYC census population estimates (e.g., 31% of the NYC population resided in Brooklyn, while only 6% resided in Staten Island) (NYC Department of City Planning, 2009).

At the date and time randomly selected, a member of the research staff posted an ad for the study in the men-seeking-men (M4M) section of the randomly selected borough/neighborhood. The research team used one of three ‘headlines’ in the ads: “Answer a few questions about your sex life,” “Let’s talk about sex,” or “Participate in a sex research study.” The content of body text of each ad was the same; it described the study and instructed men to respond to the ad via email. The researchers opted to post ads on Craigslist versus simply responding to ads already posted in an effort to also reach those men who exclusively browse and respond to personals, but may not have posted ads themselves. Research staff responded to email inquiries promptly, providing instructions on how to join the study. Staff rescreened participants via phone and those still eligible (target and eventual n = 50) were scheduled for an assessment. Sampling procedures have been described in greater detail elsewhere (Grov, Ventuneac, Rendina, Jimenez, & Parsons, in press-b). The Brooklyn College Institutional Review Board approved all study procedures.

MEASURES

Participants reported their age (in years), HIV status, sexual identity, and race or ethnicity (response options are shown in Table 1). Participants also completed semi-structured, qualitative interviews that were audio-recorded and transcribed by research staff. Participants indicated their ‘favorite’ venues for meeting sex partners, followed by detailed narratives about that venue. The interview protocol included probes for how participants met their partners, how they discussed HIV (if at all), and how negotiated condom use (if at all) with partners met through their favorite venues. We also asked men if they felt meeting partners online increased/decreased their risk for HIV (i.e., if they were less or more likely to use condoms with partners met online).

Table 1.

Sample characteristics of men who said the Internet was their favorite venue for meeting sex partners (n = 28)

	n	%
Race or Ethnicity
White	14	50.0
Latino	7	25.0
African American	4	14.3
Mixed/Multiracial	2	7.1
Unreported	1	3.6
HIV status
Negative	19	67.9
Positive	6	21.4
Unknown	3	10.7
Age
21–29	11	39.3
30–50	11	39.3
>50	6	21.4
Sexual Identity
Gay	23	82.1
Bisexual	5	17.9

One interview was lost due to equipment failure. Of the remaining 49 men we recruited off Craigslist, 57% (n = 28) indicated the Internet was their favorite venue. The remaining men reported that their favorite venue was gay bars/clubs (n = 8), public cruising (n = 7), through friends/social network (n = 3), sex parties (n = 2), and the smart phone application Grindr (n = 1). The present study focused on narratives of 28 men who said the Internet was their favorite venue to meet sex partners.

Analytic Strategy

All interviews were transcribed verbatim, and a second staff member verified transcriptions against their original recordings. We used NVIVO software to facilitate the coding and analysis of our data. The research team reviewed initial transcriptions to develop a codebook. Coding staff were then trained to use the codebook and assigned identical transcriptions to code. The lead research scientist then reviewed coded transcriptions for overlap and discrepancies. Any discrepancies were discussed with coding staff and consensus was reached over the application of a particular code. In the first round of coding, minimal discrepancies were identified and 100% consensus was reached after a second round of coding. Transcriptions were then randomly assigned to coding staff.

Using the principals of thematic analysis, the research team reviewed transcriptions and codes for narratives around navigating condom use and discussions of HIV with sex partners met online. Thematic analysis has shown to be an effective method for evaluating qualitative data of many varieties (Miles & Huberman, 1994; Patton, 1990). Each theme outlined in the results was endorsed by several participants. In an effort to contextualize responses, we also included participant’s age, race or ethnicity.

RESULTS

The participants ranged in age from 21–56 years (see table 1). Half were persons of color, 67.9% were HIV-negative, and a large majority identified as gay (82.1%). Participants described meeting partners on a variety of websites including profile-based sexual networking sites (e.g., Adam4adam.com, Manhunt.net, BGCLive.com), profile-based social networking sites (e.g., Facebook.com) as well as online bulletin boards (i.e., Craigslist.org). All but one participant specifically mentioned using Craigslist in the context of their interviews. In analyzing the data, we identified four themes: two concerned condom use, and two concerned HIV status disclosure. Across all themes, a recurring narrative about trust (and lack thereof) was evident.

The Internet lets me sort for partners who have a similar interest in condoms

With regard to how men felt around their decisions to use condoms with partners met online, a majority of men (n = 22, 78.6%) responded that they would use a condom with their partner regardless of whether he was met online or not. The predominant sentiment from these participants was that they made an a priori decision to use condoms all the time; thus, it was not an issue for them:

“I always use condoms all the time for anal sex so that is not even an issue of where I meet someone.”(56, White, HIV-negative).

“You can post an ad or reply to an ad [on Craigslist]. Usually the ad will say what they are looking for and what they are into. I usually respond to ads that say [they are looking] to use condoms. But there are also people who post ads that they are looking to go bareback, which is not using a condom.”(26, White, HIV-negative).

Both participants indicated that condom use is a priority; the second participant later explained that he uses Craigslist ads to find partners who exclusively use condoms (i.e., did not respond to ads that included references to barebacking).

We asked participants to describe how they are always able to honor their commitment/rule to use condoms. Many indicated that they bring condoms with them if traveling to a partner, or have condoms on them (i.e., in their home) if a partner is traveling to them. To avoid confusion over condom use, participants did not respond to ads (in the case of Craigslist) or profiles (in the case of profile-based websites) that referenced a desire to engage in bareback or “raw” sex. In some cases, participants said they would not even “approach” someone online who had not mentioned his condom use preference (i.e., ambiguity).

Although these participants said the Internet does not influence their decision to use condoms, these men indicated that they select venues that make it easier for them to find partners interested in also using condoms. In essence, they avoid venues where they perceived barebacking was prevalent, and (in the case of many HIV-negative participants) avoided venues where they perceived the population in attendance were likely to be HIV-positive. Often, these participants contrasted meeting men online against meeting partners in public cruising settings, at sex parties, or bathhouses. They described these venues as “sleazy,” “sketchy,” or “dirty.” In contrast, many men indicated that the Internet was a useful tool to find partners who also wanted to use condoms.

You cannot trust people online

Not all participants held universal rules around condom use nor felt ambiguous about the Internet’s role in their own condom use. For 17.9% of participants (n = 5), lack of trust and familiarity with online partners served as motivating factors for condom use.

“I am more likely to use a condom because they are complete strangers. While I trust people in general, Craigslist more or less allows you [to] kind of make up personalities and make up situations, and so people can lie a lot. Because of that possibility, I lean towards being more cautious [with these men].” (23, Multi-racial, HIV-negative)

“You do not know anything about the person. The person could lie to you. And the truth is that you can ask [what their HIV status is], but they can say anything. I use condoms because I do not trust the people I meet online.” (38, Latino, HIV-negative)

The sentiment the second participant illustrated around HIV status disclosure—that asking direct questions could still result in inaccurate responses—was a theme articulated by many participants, and played an important role in men’s decisions whether to discuss HIV status with online partners. Participants also contextualized their feelings of mistrust by describing prior experiences meeting partners offline who had misrepresented physical characteristics about themselves (specifically weight/muscularity, age, and penis size). Extrapolating this, participants believed that their online partners would similarly not be honest about their HIV status.

One participant described how the Internet made it easy to search for partners who are not interested in using condoms (i.e., barebacking) and felt the Internet was more of an “anything goes” environment. Other participants used terms like “uninhibited” to describe the environment:

Interviewer: “So how do you think it influences whether or not you use a condom?” Participant: “I would say to the negative. Uh, there are a lot of [web]sites that are much more prominent … Like, the bareback, the raw. There’s barely any mention of condoms and when that one health ad[vertisement] come[s] up, it’s so overseen because it’s just some cute guy that’s, like, part of the background. It’s not necessarily a forefront of an image. To me bareback is more prevalent than anything else online.” (22, White, HIV-positive).

Discussing HIV is difficult

Seven (25.0%) men responded that they did not discuss HIV with partners they met online because they were uncomfortable with the topic. For these men, condom use was paramount because they assumed all their partners had a different HIV status or may have an STI.

“I normally do not bring up the discussion. I find it intrusive to just come out and ask somebody, ‘Do you have some kind of disease?’ But, I just make sure that I’m not gonna’ have unsafe sex with that person. I understand that people can just lie so I don’t see the point of asking them. I really don’t have any guarantee that they’ll tell me the truth anyway. So it’s better to just go on the safe route.”(40, African-American, HIV-negative)

“On Craigslist? I never discuss that there. They don’t ask me either so the only thing I can do is to use a condom. I am not usually comfortable asking those questions, but I always try to have sex with a condom.” (57, Latino, HIV-positive)

For these men, asking about someone’s HIV status was perceived to be an invasion of privacy; they considered condom use to be a more effective HIV prevention strategy than status disclosure.

Six participants (21.4%) described how they would not initiate discussions of HIV status with a potential partner until they were certain sex was going to occur. These men described how they often simultaneously chat with (i.e., court) several potential partners online at once, and that HIV status disclosure only became important when they were ready to “seal the deal.”

“It usually comes up when I feel like we are about to do something. When I feel like we are about have sex, I ask their HIV status. (28, Latino, HIV-negative)

For many of these men, conversations around HIV happened in person, as opposed to online. Some men described their strategy to steer the conversation to HIV status by first talking about other facets of intimate relationships, such as past relationships, recent breakups, and the cause of the breakup.

“We usually have that discussion right before intercourse. I usually ask people about their last relationships, or the last time they met someone. And it’ll just go from there.” (21, Latino, HIV-negative)

Finally, a third group of men (n = 5, 17.9%) men responded that they do not discuss HIV with partners because that information would be in their ad or profile. Some of these men described sorting through ads/profiles in order to identify men who had a similar HIV status. For these men, profile information was considered a tacit way of disclosing HIV status, and thus they did not find it necessary to have an additional conversation.

“Their HIV status is often included in the text of the profile, so it is presumably communicated. I practice safe sex all the time. (53, White, HIV-negative)

“People will usually post in their advertisement what their status is. It will be in the ad. Like ‘HIV-negative clean person’ or ‘[HIV]-positive clean person’ or like, whatever. To be ‘clean’ means you don’t have anything. But if someone were to write, ‘HIV-positive clean’ it means that they’re on medication and it’s [their viral load] under control. They’re undetectable [viral load] and they don’t have anything else [STIs]. They could be totally lying of course.” (26, White, HIV-negative)

Another term participants used (in their own profile/ad) and searched for (in other’s profiles/ads) was “DDF,” an abbreviation for “drugs and disease free.” Language around “clean” and “DDF” as a means of sorting for HIV and STI status was mentioned by six participants; however, although HIV-positive participants were familiar with this language (“clean” and “DDF”) only HIV-negative men described using it to sort for potential partners. The theme of distrust with regard to the accuracy of information was evident across participants, including those who relied solely on information posted in profiles. Participants reinforced their need to use condoms with their online partners.

Discussing HIV is easy…if you are HIV negative

Nine participants (32.1%) indicated it was easy for them to discuss HIV, particularly with their online partners. These men often cited the perceived anonymity of the Internet and the reduced fear of rejection. They reported being direct with their partners online—usually initiating the conversation—and always doing so online (prior to meeting them), versus waiting until they were with partners face-to-face. These men would often steer the conversation to HIV status disclosure by asking directly, “What is your HIV status?” One participant said:

“Yes, I am usually comfortable and I always bring it up. It is not a sensitive topic for me, and I am not judgmental.” (44, White, HIV-negative)

All the individuals articulating this theme reported being HIV-negative. These men felt that HIV was not a sensitive topic, and they felt comfortable enough to initiate conversations around it. Some also articulated that HIV “is not a death sentence anymore,” and overtly indicated that they were not judgmental towards people who were HIV-positive. Ironically, when asked later in the interview whether they would have sex with someone who was HIV-positive, seven out of nine said that they would not.

These participants felt that potential partners would be more sincere about their HIV status online because they did not know the individual (i.e., anonymity), and they would not feel as badly if they were rejected because of being HIV-positive (i.e., impersonal).

“Simple question, ‘What is your status? Positive? Negative? Unknown?’ [But] In person, it becomes a little more delicate. In person, you have a tendency of always wanting a person to like you. You want to be liked on the Internet too, but the rejection factor on the Internet is lower. I think people are a little bit more sincere if they answer the question online.” (39, Hispanic, HIV negative)

DISCUSSION

Drawing from qualitative interviews with a sample of 28 men recruited off Craigslist, this pilot study investigated how men used the Internet to navigate condom use and HIV status disclosure with their online partners. Several themes emerged. A majority of men indicated they set a priori rules for themselves to always use condoms with their partners, and subsequently cited the Internet as their favorite venue in-part because it helped them sort for partners who also wanted to use condoms. Participants indicated that having face-to-face conversations around condom use and HIV status is often difficult, and that the Internet is a convenient medium to facilitate the process. Such findings add to the growing body of research highlighting how the Internet is a useful tool that some gay and bisexual men use to help them avoid situations that may place them at risk for unprotected anal sex (Mustanski et al., 2011; Rosenberger et al., 2011a).

Although HIV-positive and HIV-negative men appeared to use the Internet similarly with regard to finding partners that had common interest in condom use, notable differences were observed in how HIV-positive and HIV-negative men navigated serostatus disclosure. Both HIV-positive and HIV-negative men searched for partners of similar status (‘serosorting’), and posted their own HIV status in their profiles/ads as a method of tacit disclosure (c.f., Horvath et al., 2009); however, HIV-negative men appeared to be less subtle in starting the conversation with a potential partner. An HIV-negative man most likely has less fear of rejection because of his status, in addition to a desire to maintain his HIV-negative status.

Despite this comfort, there appeared to be underlying HIV stigma in the ways that men, particularly HIV-negative men, approached status disclosure. First, participants highlighted that potential partners may lie (intimating an HIV-positive partner would say he is HIV-negative to avoid rejection, though not the other way around) (Ross et al., 2006). Second, participants subscribed to colloquialisms such as “clean” and “DDF” when describing both HIV and STIs. It is our interpretation that this language has underlining connotations that imply someone who is HIV-positive is somehow “dirty” (i.e., not-clean) or “diseased” (i.e., not-DDF). This second point is reified in that only HIV-negative men appeared to use this language, and HIV-positive men understood what it meant. We noted that one HIV-negative participant clarified how it is possible for an HIV-positive man to be “clean” (in that he was STI free), but this appeared to be an exception.

Finally, there was an underlying sentiment that emerged across themes with regard to distrust (c.f., Ross et al., 2006). Participants recognized that the Internet still has many components that continue to foster anonymity and impersonality. As a result, participants still felt an overall sense of distrust in their online sex partners, particularly with regard to HIV status disclosure. Participants highlighted how this feeling of distrust contributed to their consistent condom use with their online partners. Participants recognized that although status disclosure is often easier online, it does not negate the need for condom use. Participants, particularly HIV-negative participants, appeared to serosort for men of the same status, but not a means of eschewing condoms. These results perhaps suggest that gay and bisexual men recognize serosorting is not entirely effective, which has been supported by research (Golden et al., 2008; Snowden, Raymond, & McFarland, 2009).

There are several limitations worth noting. The sample was small and limited to men recruited on the men-seeking-men section of Craigslist.org in NYC. Craigslist also maintains other listings (e.g., casual encounters) that are not exclusively dedicated to men-seeking-men; however, MSM may also use this forum. In the interest of focusing on how men navigated condom use and HIV status disclosure with online partners, we limited data analysis to those interviews in which men described the Internet. Other commonly reported venues in this sample included gay bars/clubs and public cruising; however, with insufficient sample sizes to reach data saturation (Guest, Bunce, & Johnson, 2006). We recognize the limits of asking men about their “favorite” venue, as this may not necessarily be the venue they most often use. Given that this was a pilot study, we were limited in the amount of participants we could recruit off Craigslist, and this would be an arena for future study. For recruitment, we adapted time-space sampling for a virtual environment. In physical spaces, time-space sampling often involves actually approaching potential participants. We opted not to ‘approach’ men on Craigslist (i.e., respond to their ads), and instead posted our own ads to the bulletin in an effort to reach men who solely browse ads but may not post themselves. Next, we did not explicitly ask men to differentiate condom use for oral sex versus anal sex; however, participants often described their condom use as a behavior only applicable for anal sex. Finally, all the limits of self-reported data (e.g., social desirability) and recall biases apply.

Regardless of these limitations, these findings provided more insight into understanding how gay and bisexual men navigate discussions of HIV and condom use with their online partners. To our knowledge, this is the first qualitative study of gay and bisexual men exclusively from Craigslist, thus adding a unique contribution to research with new populations of men who seek sex online. Our findings that men often search for partners based on condom use preferences and rely on profile/ad text to disclose HIV status has implications for website developers/moderators and prevention programs seeking to use the Internet. These data suggest that features which allow men to easily indicate and filter for condom use preferences should be built into (or maintained on) profile-based sexual networking sites and sexual bulletin board sites. It is noteworthy that many profile-based websites (e.g., Manhunt.net, Adam4adam.com) already maintain these features, while online bulletin boards (e.g., Craigslist) often do not—bulletin board users must singly scan ad text/photos for language/imagery that intimates condom use preferences. As a caveat, enabling men to search for partners who only want to use condoms might consequentially allow men to more easily find partners who do not want to use condoms; thus, implementation of any condom use preferences search features should be carefully considered.

Given the stigmatization of HIV, as evidenced in our data, we recommend that website owners/moderators proceed with caution with regard to facilitating online status disclosure. On one hand, our data suggest men find it difficult to discuss HIV, and thus rely on what is posted in profiles/ads to make critical decisions around serosorting (suggesting this is an important feature). On the other, some participants in our study said they used condoms regardless of their partner’s self-reported HIV status (suggesting that facilitating status disclosure may not be necessary for these men). It is our recommendation that website owners/moderators continue to partner with community-based groups and researchers as they develop the next generation of online sexual networking infrastructure for gay and bisexual men, and work diligently to reduce the potential for HIV stigma and bias in online communities.