Interventions can ease dangers of cybersex

Counselors educate while in chatrooms

Successful Internet prevention programs need to reach the population most at risk for HIV and which uses the Internet as a major avenue for meeting anonymous sexual partners. Several regional programs have found ways to do this, including at least one that operates on a shoestring budget.

Although some will say the outreach intervention essentially is the same as what has been used for years in bars and bathhouses, the methods are very different and require counselors to receive unique training.

For instance, both PowerON of Seattle and SexEd4U of Ferndale, MI, provide counselors with training in how to deflect sexual propositions and with information about Internet abbreviations commonly used in chatrooms.

While the traditional outreach for gay bars and bathhouses might involve having counselors visit these locations and dispense condoms and information to patrons, the on-line HIV prevention counselors sign into chatrooms where men who have sex with men (MSM) make appointments with other men for anonymous sex.

Men will say in these chatrooms that they’re looking for RT (or real-time sex), meaning they want to hook up with someone within an hour, says Jeffrey Neil Weldon, program director of the Friend-to-Friend Project and PowerON of the HIV/AIDS Project Development and Evaluation Unit of the School of Social Work at the University of Washington in Seattle,

Here’s a brief look at how PowerON and SexEd4U programs work:

SexEd4U

The Midwest AIDS Prevention Project of Ferndale, MI, expanded its prevention services into the area of Internet interventions after Michael Odom, SexEd4U project director, read about similar programs operating on the West and East Coasts.

"I thought this was a great way to create a program as an outreach to a community, so we came up with the premise and were going to jump in with guns blazing," he says.

SexEd4U counselors are certified by the state of Michigan as HIV counselors, and the outreach project’s mission can be described by the acronym BEEF:

Becoming a resource

Effective communication

Establishing trust/rapport

Facilitating referrals

"We searched for resources in the community, including HIV social support, housing, emergency financial assistance, HIV testing sites in each county; and we compiled a list that could be easily transferred to the Internet," Odom says.

The goal was to find out as much as possible about Michigan resources for MSM so that HIV counselors could quickly answer any questions that arise as they have discussions with men in the Internet sex chatrooms.

For example, the Internet counselors often are contacted by teenage boys who have never had sex, but identify themselves as gay or bisexual. "We refer them to the Lesbian, Gay, Bisexual, Transgender (LGBT) teen center, which also is on-line but is an actual community center in metro Detroit," he says. "It’s a safe haven for people of their own age to relate to and come to terms with their sexuality."

SexEd4U counselors sign into MSM chatrooms, using SexEd4U as their pseudonym. One of the challenges in the initial stages of the intervention was to advertise to MSM what SexEd4U was about, so that the chatroom participants would be familiar with it and would know that the information they received came from a certified HIV counselor.

"We sent out press releases to gay publications and newspapers to announce that SexEd4U was legitimate and sponsored by the Midwest AIDS Prevention Project," Odom explains. "We had to establish that trust and rapport."

Whenever HIV counselors found that some of the same questions came up time and again, they decided to create a topic-of-the-month feature in which one topic is fully researched with files ready to send to anyone who has questions about it. Chatroom users are told about the topic of the month and encouraged to ask questions about it.

For instance, in January there was the topic of HIV and oral sex; in February, the topic was rimming. In March and April — at the request of the state health department — the topic was syphilis, Odom says.

The Internet counselors are trained to understand the chatroom terminology and get answers promptly because about 80% of the people using these MSM sex chatrooms are looking for casual and anonymous sex partners and won’t waste much time with other agendas, Odom says.

"Sometimes, people will even tell you, Hey, you’re taking the space of some hot guy in here,’" he continues. "So what we do is — we want our counselors to be personable."

Counselors have a rare opportunity to provide just the right HIV-prevention advice needed before two MSM engage in risky sex. Counselors are trained to ask the users only the questions necessary to provide them with the most accurate answer and to not become embroiled in a sexual pick-up type of conversation by bringing the conversation back to HIV and safe sex education. And when users have direct questions, a prompt, practical answer is the key.

For instance, a chatroom user asks a counselor: "What lubricants can I use with latex condoms?"

The counselor answers: "You can use water or silicon-based lubricants with all latex condoms. Stay away from petroleum jellies, hand lotions, baby oils, Vaseline, and any type of product that has oil in it because it breaks down the condom itself and can cause it to rip or tear."

About 15 minutes after the counselor sends the answer, the chatroom user might be answering his door to man he hooked up with, and when that man pulls out a condom with Vaseline, the chatroom user can say that he had just learned that Vaseline doesn’t work, Odom explains.

Timely information

"The prevention message is at the time the on-line person needs it most because they’re making their arrangements right then and there, and they may be hooking up on-line in the next 15 minutes," he says.

Interactive on-line interventions such as SexEd4U can be replicated in other parts of the country, and if they are staffed by paid employees of a community-based organization or health clinic, they could operate on a small budget, Odom suggests.

SexEd4U receives no grants or extra funding. It’s fueled by a core group of committed HIV counselors who are willing to devote some of their weekday and even weekend time to going on-line to visit these chatrooms and offer educational services to men who may be hooking up with an anonymous sexual partner within that hour, he explains.

The project started by targeting weekday chatroom users, but now is expanding to include night and weekend chatroom users, Odom says.

"We’re in the process of starting a marketing campaign to talk about SexEd4U to promote the program, and we’ve created an electronic postcard for it," he says.

The postcard is sent by volunteers to 10 of their friends, who also forward it to more people, he says. SexEd4U, in the past year, has averaged three MSM interventions during each one-hour on-line discussion, and the program has made referrals to local agencies for HIV testing, treatment, and other services, Odom adds.

PowerON

PowerON, developed by staff at the HIV/AIDS Project Development and Evaluation Unit in the School of Social Work at the University of Washington in Seattle, was created to target the highest risk category of Internet sex seekers, Weldon says.

"We realized that those individuals had high-speed modems, and we needed to compete with existing porn sites that have that same level of activity," he says. "So what we decided was to go with a flash site, which is more interactive and has moving elements."

While more traditional HIV prevention sites lack frills and look as though they were designed by government agencies, the PowerON project was aiming for something more enticing, Weldon explains. "We knew that saying it was about HIV prevention wouldn’t interest people, so we marketed it as a gay health site," he says.

The five pages most accessed out of the web site’s more than 7,000 pages include the HIV self-assessment that gives health statistics on a person’s risk for HIV infection based on responses to various questions, Weldon says.

"If you said you slept with 15 to 20 guys in six months, it gives you a gauge of your risk level, according to race and demographics," he explains. "We found that this was the No. 1 accessed page on the whole site, so we found that individuals really are very interested in basic HIV prevention information."

The second top-rated page is one on negotiating sexual safety, and the third is about sexually transmitted diseases. The fourth most visited page shows men how to put on a condom, and the fifth has information about drugs and sex, he says.

PowerON was designed as a way to improve referrals to HIV and other agencies. Its $150,000, two-year budget pays for the referral site research and web site design, as well as for the collection of prevention material, according to Weldon.

"Costwise, the first year is much more costly because of start-up costs; but this year, we’re proposing a much bigger budget because we’re involving four collaborative partners, all that deal with communities of color and populations using crystal methamphetamine," he says.

Each agency involved will allocate four hours a week in outreach to specific communities that can be accessed through on-line counseling, Weldon adds. The idea is to have counselors visit on-line MSM web sites, and notifying web site users of their presence through a screen icon that says "Outreach worker available," he explains. The user could click on the icon and have an instant virtual conversation with the outreach worker, who could direct the person to the web site or to additional information.

PowerON’s basic web site design, which took about eight months to launch, could be duplicated inexpensively by other community and health care organizations, Weldon points out.

"What we’ve done is design the site so it can be duplicated from different city to different city, and we propose that it be a regional or national thing, like having a PowerON Los Angeles," he says. "We’ve collected information from all different web sites around the world, and it could be tailored and replicated."

For example, PowerON’s very efficient and thorough referral service might require the greatest amount of start-up manpower, but maintaining it would be fairly simple. The traditional system of self-referring often is inefficient and can lead to frustration as people seeking information are turned away from a particular agency because they don’t fit that agency’s target population.

Through PowerON’s web site referral service, people are sent directly to the agency and even the very staff member who can best help them with whatever it is they need, Weldon explains.

PowerON staff had collected information and direct names and phone numbers of counselors for every type of agency that might offer services to the targeted HIV and MSM population. It’s updated monthly, so users easily may find the very person who can help them with a particular problem or issue, he says.

About one-third of the people who visit the PowerON web site will visit the referral section, which was a surprising affirmation that the project’s goals were being met, Weldon says.

The web site received more than 55,000 hits in the first two months in a county where the target population numbers 50,000, he notes. "Individuals were returning to the site consistently, and that was an important thing to know."

Another feature of the PowerON web site is its role model postcard in which volunteers send out 10 a month to friends. They can send information from the web site that they think will interest their friends, Weldon says.

"We recruited three steady role models who represent the gay, bisexual, and transgender communities, and they shared their personal testimonies about how the web site helped them," he says. The role models do not work in the on-line chatrooms, as do the outreach workers, but their stories help to draw more people to the web site, Weldon adds.

Chatroom training

Outreach workers visit MSM chatrooms to discuss HIV prevention and suggest that people visit the web site, explaining what it is and what the organization is trying to do with it, Weldon says. Since outreach workers are entering a highly charged sexual atmosphere in which other chatroom users may try to recruit them for sexual acts, PowerON has a three-hour training session for workers. Also, there is a software system that tracks conversations between outreach workers and chatroom users, he says.

"So our volunteers know that happens, and we give them training on how to de-escalate sexual situations and how to turn that person’s interest around and direct the person to the web site," Weldon says. "They’re not to turn the user away with a hard and cold approach."

Internet HIV prevention interventions have two main advantages over traditional interventions: The first is that they reach people at a time when they are seeking an anonymous sexual partner. The second advantage is that they give people anonymity for their questions and problems, he notes.

Often, the people who contact PowerON wouldn’t have sought the same information in a traditional environment because they wouldn’t have wanted to be identified as an MSM or they wouldn’t have wanted to look stupid to the outreach worker they meet face to face, Weldon says.

"They couldn’t access it in the traditional environments because it might expose something about their character, so the anonymity meant no one knew who they were, as opposed to having a one-on-one conversation with an outreach person they might see on the street or in a bar," he explains. "Then there is the marginalization of some of the subpopulations, so this was a venue in which they felt comfortable."

(For more information, contact:

PowerON: HIV/AIDS Project Development and Evaluation Unit of the School of Social Work at the University of Washington, Seattle. Web site: http://depts.washington.edu/poweron.

The Midwest AIDS Prevention Project, Fern-dale, MI. Web site: www.aidsprevention.org/index.htm.)