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The Internet’s role as modern bathhouse is being scrubbed
On-line hookups increasingly popular among MSM
Nearly as quickly as 21st century technology is creating a new problem in the HIV/AIDS epidemic, the same technology offers a solution.
Some new epidemiological data, combined with anecdotal evidence and research, show that men who have sex with men (MSM) increasingly are meeting men in Internet chatrooms where they schedule what are called "real-time" sexual encounters or hookups. The relatively new venue for meeting sexual partners works nearly as fast as a meeting at a bar or bathhouse, according to researchers and prevention counselors.
The good news is that researchers and HIV prevention organizations already are developing programs that target MSM who look for sex via the Internet, and some of these have found efficient ways of reaching high-risk populations and providing interventions prior to their engaging in risky sexual behavior.
This trend of MSM meeting through the Internet has contributed to alarming increases in syphilis cases in California where the number of MSM with primary or secondary syphilis has increased from 162 reported cases in 2000 to 857 cases in 2002, says Terrence Lo, MPH, an epidemiologist with the California Department of Health Services in Berkeley.
The state’s syphilis rate has increased from one case per 100,000 population in 2000 to three cases per 100,000 in 2002, he says.
Since California has had no changes in how syphilis is reported within that time frame, the increase suggests that more people, and particularly MSM, are engaging in unprotected sex and that the Internet has played a major role in this problem, Lo says. "We’re definitely alarmed by this trend.
"HIV and syphilis are interrelated, and some of the risk factors such as unprotected sex are similar for HIV and syphilis," he explains. "Also, having syphilis has been shown to facilitate the transmission of HIV by three-to-five times; so yes, the current syphilis epidemic would most likely have an effect on the HIV epidemic as well."
State data also show that 66% of the MSM whose syphilis was reported in 2002 were HIV-positive, and this percentage also has increased in recent years, according to Lo. "In 2000, 53% of the MSM with primary or secondary syphilis were HIV-positive; and in 2001, 63% were HIV-positive."
No return address?
The Internet’s role in this also is apparent from the data. In the first half of 2001, 12% of the MSM with syphilis reported meeting their partners over the Internet; by the first half of 2003, this percentage increased to 40%, he points out.
Looking at the surveillance data more closely, health officials found that the percentage of MSM who reported the Internet was their only source of meeting sexual partners had increased from 4% in 2002 to 17% in the first half of 2003, Lo says.
"What we’re finding is that people who meet partners off the Internet have a higher number of sex partners than those who said they didn’t, and they have a higher number of nonlocatable partners, which is problematic for us," he adds. "We can’t find them for testing and counseling."
Surveillance data confirm what researchers are finding when sampling MSM who use Internet chatrooms to meet sexual partners.
In a new study, investigators recruited MSM from Internet chatrooms and interviewed 91 people on-line, both with a research assistant asking questions and through having them fill out a survey. All participants were older than 18, sexually active, and using the Internet for sex purposes, says Gregory Rebchook, PhD, investigator for the Center for AIDS Prevention Studies at the University of California, San Francisco.
"Nearly everyone said they thought the Internet allowed them to increase their number of sexual partners and provided a convenient mechanism for finding sex quickly," he says.
About 58% of the men surveyed reported unprotected anal sex within the last two months, and 39% reported unprotected anal sex with partners they had met on-line, Rebchook adds. "Men in our study spent an average of 20 hours a week on-line for personal purposes."
Also, the men reported having had an average of seven sexual partners within the last two months, and 11% of the men surveyed said they were HIV-positive, while the HIV status of 15% of the participants was unknown, he says.
"The reasons why risk behavior and HIV incidence are going up are multifaceted; and so the Internet may be part of that, but it’s not the only part," Rebchook explains. "I think the context in which HIV risk behavior happens now is different from what it was five years ago."
Besides the new Internet trend, other changes that have played a role in the current epidemic include treatment optimism due to the antiretroviral drugs, the increase in party drug use, and the greater number of people living with HIV infection, he says.
Data and studies such as these suggest that more interventions should focus on Internet sex-seekers, using the same technology in outreach projects. "By providing anonymity, the Internet allows counselors to discuss issues some men might be reluctant to discuss in other settings." Rebchook points out. "Our study underscores the need for using the Internet for prevention."
A number of community-based organizations and other groups have started these types of prevention projects, sometimes on shoestring budgets:
PowerOn in the Seattle area and SexEd4U in Ferndale, MI, are two good examples of interventions that reach MSM in chatrooms at the precise moments when they may be making a decision to have anonymous sex.
Another new intervention is the Internet Sexuality Information Services Inc. (ISIS), which provides syphilis elimination services to MSM in San Francisco through a contract with the city and county. Also, ISIS collaborates with the California Department of Public Health to coordinate an on-line Syphilis Action Coalition in the Bay Area.