Are Internet Dating Sites Endangering Public Health?

Americans use online dating sites and apps more than any other group of people. There are tons of online dating sites and apps out there, including Match.com, eHarmony, Tinder, and Adam4Adam. Each dating site caters to different desires. For example, eHarmony prides itself on establishing long-term connections among users; whereas, Tinder is notorious for the casual hook-up. Furthermore, Adam4Adam is an online gay dating site.

Many people enjoy meeting others online, and online dating brings together people who may have otherwise never met each other. There are countless stories of people meeting a future spouse or significant other on an online dating site.

Nevertheless, there is a dark side to online dating: Many experts worry about the increased risks of developing a sexually transmitted infection (STI) associated with meeting an online hook-up. These concerns are especially pronounced among men who have unprotected anal intercourse with other men who are not primary partners—a behavior known as “barebacking.” In fact, experts tie the recent rise in gonorrhea, chlamydia and syphilis rise to the reemergence of barebacking.

Users first set up a personal profile on an online dating site. An online profile can consist of the following:

• sociodemographic info
• personal likes
• personal dislikes
• interests
• types of partners desired
• types of relationships desired
• sexual orientation
• sexual likes and dislikes

After reading a profile, users can express interest in one another—for example, a user can “swipe right” on Tinder or “wink” on Match.com. If the interest is mutual, users can go on to message each other through the online dating platform and either continue the relationship online or meet in the real world.

Public health experts and clinicians alike are particularly concerned about unprotected sex and STI transmission among people who use Internet dating sites and apps for sex only. Please understand that these experts are less concerned about people who use such technology to establish long-term monogamous relationships.

The Internet can be a rapid and efficient means to hook up. Earlier research gives us a pretty clear picture of people who use Internet dating sites for straight-up sex. These users tend to be gay men who prefer anal and oral sex. They also tend to have a greater number of lifetime sexual partners than do people who don’t use the Internet to seek out sex. Interestingly, most people who use the Internet for sex apparently use condoms; however, a substantial number don’t, which is where the concern arises.

Of note, women who use Internet dating sites to set up sexual liaisons tend to be white and older. They are more likely to use condoms and test regularly for STIs.

Findings from studies linking Internet dating sites and STIs are mixed. Furthermore, although this issue is of great concern among many, there still isn’t a lot of research on the topic. One big question with respect to the association is whether people who tend to prefer unprotected sex—specifically, unprotected anal intercourse or barebacking—use the Internet to fulfill this desire or whether Internet dating sites themselves somehow promote this practice.

In a 2008 review article titled “Men Who Have Sex With Men and Recruit Bareback Sex Partners on the Internet: Implications for STI and HIV Prevention and Client Education,” author Christopher W. Blackwell suggests that men who have sex with men frequently use the Internet to more easily seek out partners for barebacking. Ironically, many of these men advocate for safe sex practices on their profiles. The author goes on to suggest that one way to discourage such encounters is to incorporate preventive health guidance into an Internet dating site’s platform. Such interventions may take the form of individual outreach, chat, banner advertisements and creation of complementary educational sites.

Results from a large Dutch study published in 2016 suggest that among men who have sex with men, there is no overall association between the use of Internet dating sites and unprotected anal intercourse. Of note, participants in the study were recruited at an STI clinic in Amsterdam.

In this Dutch study, researchers specifically found that this lack of association was clear among men without HIV. Among men with HIV, there was a nonsignificant association between online dating and unprotected anal intercourse. Finally, among men who were unsure of their HIV status—a smaller subset of participants—unprotected anal intercourse was more common with others met online than it was with offline relationships.

The researchers also found that concordance of HIV status was a predictor of unprotected anal intercourse. In other words, participants were careful that they would only have unprotected anal intercourse with people who had the same strain of HIV. This distinction is important because drug-resistant strains can be spread among people with HIV. In plain terms, a person with HIV that can be treated with antiretroviral therapy can go on to be infected with another type of HIV that is resistant to such therapy thus boding a much worse outcome. Apparently, men in this study checked with each other as to which strains they carry (a practice called serosorting) before barebacking.

After the AIDS epidemic of the 1980s, many men stopped barebacking and started using condoms. More recently, however, the practice is reemerging and has been documented with increased frequency among white, black and Latino men living in New York City, San Francisco, Los Angeles, Miami, and other big U.S. cities. Moreover, men of all ages are now having unprotected anal intercourse, including middle-aged men who lived through the AIDS epidemic and used condoms for a long time after the epidemic.

There’s probably no single reason why men choose to have unprotected anal intercourse. Instead, this behavior is complex and caused by a combination of factors.

1. Men who bareback find the practice more stimulating, pleasurable and intimate.
2. The Internet has made it easier to find anonymous partners with whom to have unprotected anal intercourse. There are sites that are devoted to finding barebacking partners, and users can choose others based on HIV status.
3. Barebacking may be a symbol of sexual freedom, rebellion, and empowerment.
4. Men who have sex with men no longer view HIV as a deadly disease. Instead, they see it as treatable. With the threat of death no longer looming high, these men may be less concerned about the risk of being infected with HIV and think that if they get HIV, then they can get treatment. This reasoning is flawed because (1) not all strains of HIV are treatable and (2) chronic antiretroviral treatment is not without adverse effects, including nausea, vomiting, skin rashes, diarrhea, and peripheral neuropathy.
5. Use of party drugs—such as ecstasy, GHB, ketamine, and crystal meth—has been linked to barebacking.
6. Barebacking may be used to cope with stress and anxiety. Additionally, depression may also contribute to this practice in some.
7. Body imaging, self-esteem, and self-worth may contribute to barebacking. Specifically, men who agree to this practice may seem more attractive to a sexual partner.
8. Men who have returned to the practice of barebacking after years of using condoms cite “safe sex fatigue.”
9. Younger generations of gay men who have not experienced the AIDS epidemic may not realize how small the trade-off is between the albeit less pleasurable and less intimate use of condoms and the assuredness of avoiding HIV infection. Older generations, who remember the AIDS epidemic, are glad to pay this small price to remain disease free.
10. A rationalization for barebacking may be that by being infected with HIV, an otherwise HIV-negative person may lessen AIDS anxiety. In other words, there would no longer be any reason to worry about getting HIV if you already have it.
11. In an article titled “Condomless Sex: Gay Men, Barebacking, and Harm Reduction,” author Michael Shernoff writes the following: “Internalized homophobia can contribute to barebacking by creating an unconscious sense that a gay man is unimportant and undervalued, thus increasing his sense that he is expendable, and so too are the men with whom he has sex and from whom he seeks love and validation.”

Of all the above factors, the pleasure and intimacy of having unsafe sex likely trump all other reasons to participate in unprotected anal intercourse. However, to simply attribute barebacking to personal needs is reductive. Decisions as whether to participate in this practice are much more nuanced.

If you’re using Internet dating sites to establish a long-term connection with another person, the risk of developing an STI is likely no greater than meeting a potential partner offline.

If you’re using Internet dating sites to solely seek out sex, please be very careful and use condoms and get tested for STIs regularly. In particular, research shows that many bisexual and gay men who use these sites actively look for barebacking opportunities, and some of these men have HIV.

Although it’s unlikely that any individual person would intentionally spread HIV to another man, many people with HIV don’t yet know that they’ve been infected. Please don’t feel pressured to forego condom use and remain vigilant in your insistence to use a condom with a sexual partner whose status is unknown. Remember that even though we have effective treatments for HIV, and this disease isn’t the automatic death sentence that it once was, it is still a chronic and very serious infection that requires lifelong treatment replete with uncomfortable and sometimes debilitating adverse effects.

On a final note, just because public health experts are most concerned about the association between online dating sites and STIs in gay men, please don’t think that women aren’t at risk, too. In fact, rates of HIV are very high among black women.

Women seeking short-term sexual encounters must also insist on protection and get tested regularly. First, the risk of HIV and other STIs is ever-present with any type of unprotected intercourse. Second, sexuality is fluid, and many people who use online dating sites for casual hook-ups are bisexual. These people can confer risk to women with whom they have sex from not only other women but also other men, too. And once again, research findings suggest that there are a substantial number of HIV-positive men who seek out barebacking experiences online, many of who don’t know that they have HIV.