Aids Guide for Health Care Workers

New skills required to operate in the world of cybersex

Research suggests Internet increases risk

Research and data presented at the 2003 National HIV Prevention Conference, held July 27-30, 2003, in Atlanta suggest that community-based organizations (CBOs); health care, treatment, and prevention clinics; and other public health organizations might need to consider initiating outreach programs to reach men who have sex with men (MSM) who use the Internet as a venue for meeting anonymous sexual partners.

The California Department of Health Services has collected surveillance data that show an increasing trend of MSM using the Internet to meet sexual partners and then engaging in high-risk sexual activities.

For example, both syphilis cases and the incidence of HIV have risen in just the past two years among the population of MSM who cruise the Internet for sexual partners. The data show that 23% of the California MSM who had secondary or primary syphilis in 2002 met their sexual partners via the Internet, vs. 21% who met their partners in bathhouses, and 9% who met partners in sex clubs.1

An on-line study, conducted by investigators with the Center for AIDS Prevention Studies at the University of California, San Francisco, shows that three out of four MSM reported having recent sex, including unprotected sex, with someone they met on-line within the previous two months, and 11% of these MSM said they were infected with HIV. Unprotected anal intercourse was reported by 39% of the respondents.2

Other recent research demonstrates that CBOs and others can reach the high-risk MSM population through on-line interventions and virtual outreach.

Several Internet HIV prevention programs have succeeded in reaching this population through sending trained outreach workers into MSM chatrooms, such as the chatroom, where men meet men and often schedule sexual encounters.

In a study conducted by the Internet Sexuality Information Services Inc. (ISIS) of San Fran-cisco, outreach counselors, who also were the study’s investigators, were able to answer an average of 15 questions per hour while logging into the chatroom. Furthermore, by posting a banner ad campaign on-line, ISIS brought 32,370 links between people seeking information and the San Francisco Department of Health Web site. Also, there were 212 exchanges of prevention information during the 57 hours of Internet outreach on three other sites, and there were 35 coupons redeemed among those distributed on-line for free syphilis testing. Investigators concluded that one-on-one outreach in chatrooms was more effective than larger, on-line presentations.3

The PowerON web site of Seattle also has reported success in reaching high-risk MSM. Called Prevention Organizations With Empowerment Resources On the Net, PowerON also has outreach counselors visit MSM chatrooms to provide HIV information and to direct men to the PowerON web site for access to more than 7,000 pages of health care and HIV prevention information. In a survey of 36 men, four out of five of whom used the Internet to find sexual partners and all of whom visited the PowerON web site, respondents said they found the site useful and would recommend it to their friends.4

Another successful pilot Internet intervention program, called SexEd4U, targets MSM in on-line chatrooms, using certified HIV prevention counselors to visit chatrooms and answer questions, make referrals, and send additional prevention information to chatroom participants. The project, started by the Midwest AIDS Prevention Project of Ferndale, MI, reached an average of three MSM during each one-hour on-line discussion.

According to the creators of PowerON and SexEd4U, one of the most important aspects of designing an Internet HIV prevention intervention is to make certain that outreach counselors are trained in both HIV prevention and Internet use, particularly how to use chatrooms.

As such, PowerON has provided its volunteers and counselors with this guide to what chatroom shorthand, symbols, and abbreviations mean. Reprinted with permission from Jeffrey Neil Weldon, program director of the Friend-to-Friend Project and Power ON, of the HIV/AIDS Project Development and Evaluation Unit of the School of Social Work at the University of Washington in Seattle, here is a summary of the guide to Internet MSM chatroom talk:

The Meaning of All Those Symbols and Shorthands Revealed!

If you’re new to chat, you may find this summary of on-line etiquette and shorthands useful. When you first enter a chatroom, most members give a brief greeting, or wave (::waving:J and grin (:D), or just a simple "hi." You may want to just hang around and listen without talking. Get the feel of the room. This is called "lurking" and is perfectly acceptable.

Typing in all caps is considered shouting, so please spare everyone’s ears and your vocal chords. Vulgarity is unacceptable anywhere, anytime. Nuff said. Because on-line chat usually is a text-only medium, it makes the conveyance of emotion somewhat difficult. People use shorthands in this "faceless" medium to express feelings and show actions or "body language." You’ll find shorthands used in chat, on message boards, in electronic mail — everywhere! Tilting your head to the left or turning your screen on its side will help you see most of the shorthands : ) < —- See? Two eyes and a mouth! (For a list of some of the most popular symbols and abbreviations, see chart.)


1. Lo T. Venues for infection: Trends in places where California MSM syphilis cases meet sex partners. Oral presentation at the 2003 National HIV Prevention Conference. Atlanta; July 2003. Presentation #T3-B0604.

2. Rebchook G. Exploring the sexual behavior and Internet use of chatroom-using men who have sex with men (MSM) through on-line qualitative and quantitative research. Oral presentation at the 2003 National HIV Prevention Conference. Atlanta; July 2003. Presentation #M1-A0202.

3. Levine D. Internet-based interventions for syphilis prevention among gay and bisexual men. Presented at the 2003 National HIV Prevention Confer-ence. Atlanta; July 2003. Presentation #MP-066.

4. Weldon J. The Internet as a tool for delivering a comprehensive prevention intervention for MSM Internet sex seekers. Presented at the 2003 National HIV Prevention Conference. Atlanta; July 2003. Abstract #WO-C1104. 

AIDS Guide for Health Care Workers is written especially for the person working in the health care setting. It explains important issues concerning AIDS in a thorough, yet easy-to-understand style. Although the material is copyrighted, the publisher grants you permission to photocopy AIDS Guide for Health Care Workers and distribute it throughout your facility. We encourage dissemination of this information.