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What sort of trends or similarities do you see in terms of behavior, safety, and expectations? One is I do think it is important to recognize that when people are hooking up, when they are meeting each other online and then going home, that it is happening in an environment that has traditionally been isolated from HIV prevention messages and that whatever your perceptions are of the campaigns that are going on currently in the bars and bath houses, there are posters there; there are condoms available there; there are very visible and active campaigns happening in many communities across the U. And at some point, in some of the communities where we were asking people online if they were aware of online HIV prevention campaigns, many of the participants said they were not aware or they had not seen them because, I mean, I think the Internet is so large that it takes a really concerted effort to make your presence known and so that when hookups are being arranged completely outside of the arena that HIV prevention campaigns have hit, I think that is worth talking about.
Participants: Philip Huang, Asian Health Service, Oakland, California; Jeff Klausner, MD, San Francisco Department of Public Health; Deb Levine, Internet Sexuality Information Services, San Francisco; Greg Rebchook, UCSF Center for AIDS Prevention Studies; Frank Strona, Mark Vogel: Welcome to today's roundtable discussion sponsored by HIV In Site and The Center for AIDS Prevention Studies, both at UCSF.
I wanted to start the discussion more with evidence because there might be people who are skeptical or do not really understand what evidence there is out there that men who have sex with men and meet their sexual partners online have higher rates of unprotected sex and sexually transmitted diseases. We did a case-control study, which is kind of your typical type of evaluation to determine what risk factors are associated with cases and non-cases.
In this investigation, we found that 67% of these syphilis cases versus 19% of matched men who were non-syphilis cases had met recent partners in the chat room, and this was a statistically significant association.
It is a lot harder when you are working face-to-face because you have to sort of summon up the effort to talk to somebody and to break the ice and to ask them to come home with you; whereas the Internet, everybody is there for the same reason; it is very quick, it is very easy.
The other reason why I think that there are problems with communication via the Internet, is -- and I think it is really just a continuum of what is happening offline -- is that safer sex does not seem to hold much meaning on the Internet anymore.
What differs from the local sex club, though, in one factor is they are not community-based.
The owners could be in New York or be in Ohio and that is where they launched your national website from, and you could have people all over the country using the site.Whereas a lot of people in their profiles will put down "safer sex only," then they meet up, that means we do not have to have a discussion about it because, let's say I responded to an ad that said "safer sex only" or we both wrote "safer sex only." However, for me, "safer sex" is "no unprotected anal intercourse" and, for you, "safer sex" is "no anal intercourse at all." And then that is not being discussed. MV: So, is there a misperception with the Internet where it seems clear that you can say, "I'm HIV-negative, STD-free" but that does not get into when you were last tested or what that means for you, and so that it appears that it is all out there in the open but it is really not being addressed?That is probably not the best example, but let's say for the other person, let's say they won't even have oral sex without a condom. Then you go out and try to find somebody else who potentially has your same thoughts and beliefs. JK: Yes, I think Al Cooper down at Stanford and Michael Ross in Houston, talk about why the Internet is so popular based on these five A's. The Internet is very accessible to many people, particularly in this demographic, particularly here in San Francisco.Right now, recent data show that more than 80% of sexually active MSM who meet new partners are meeting online in San Francisco, and then what Deb mentioned is approximation that allows people in dense urban areas who are interested to meet up very quickly in a short amount of time.GR: I just want to add that we have been doing online qualitative interviews with gay and bisexual men or men who have sex with men they meet in Internet chat rooms, or that we were recruiting from Internet chat rooms, and even the guys in rural America are saying that, you know, "I can get online, and in 45 minutes, I can have someone tied up to my bedpost..." So, you know, this is not just in San Francisco or New York; we are seeing this phenomenon in many other places in the country as well.The Internet affords anonymity (There is a great New Yorker slide that says, "On the Internet, no one knows you're a dog.") So you can be whoever you want to be on the Internet.