IDSA Report: Coverage of 2004 IDSA Meeting

What you can learn from Internet sex study

CDC official discusses alarming new trend

[Editor’s note: AIDS Alert asked Sevgi O. Aral, PhD, associate director for science in the Division of STD (Sexually Transmitted Disease) Prevention at the Centers for Disease Control and Prevention to discuss a recent study presented at the 2004 annual meeting of the Infectious Diseases Society of America. Her study, poster 841, investigated predictors of sexual risk taking on the Internet. Aral discusses the findings and the public health implications in this Q&A interview.]

AIDS Alert: Would you please explain the chief findings of your study on the Internet and sexual risk-taking predictors.

Aral: The main conclusion is that people who recruit their sex partners through the Internet and have same sex partners, people with those two characteristics, tend to have large numbers of sex partners. And therefore, we concluded that Internet-based, sex partner recruitment and having same sex partners are important predictors of high-risk behaviors.

If you want some specifics, we found that those who had sex with partners they found on the Internet had a larger number of partners compared with other groups. There was an average of 42 lifetime partners and 11.3 partners in the past 12 months. That’s high.

AIDS Alert: What does that tell a scientist, such as yourself?

Aral: That tells me that people who are into many, many partners have a higher probability of using the Internet for sex partner recruitment. And we have a dose response relationship: Those who had sex with Internet partners had 42 lifetime partners, for example. But when we looked at those who searched the Internet for partners, we saw that they had 17 lifetime partners and two partners within the last year. Also, those who met Internet sex partners but didn’t have sex with them had 19 lifetime partners and nearly two partners in the last year.

These things become particularly meaningful when you look at men who have sex with men and Internet-based partner recruitment. With Internet use, we saw a very similar pattern in terms of sexual orientation: People who had opposite sex partners, on average, had nearly 11 lifetime partners; for people who had opposite and same sex partners, their average was 26 lifetime partners; and those who reported only same sex partners had about 41 lifetime partners.

So you have a dose response that starts with 10.7 goes up to 26.4 and up to 40.7 when you look at people who report only same sex partners. And when you look at the two together, we find that people who have same sex partners and have sex with partners they meet through the Internet have the greatest proportions of high-risk behaviors.

So what does that mean? That means we need to better target people who have same sex partners and people who recruit their partners through the Internet.

For example, health departments can work on partner notification, getting to sex partners who have been exposed to a sexually transmitted disease through Internet recruitment, and some health departments have been doing this in San Francisco and Los Angeles.

Prevention efforts may increase partnering with Internet service providers; we may use web sites to provide users with easily accessible and reliable information on HIV and STDs and on testing and treatment for these conditions. We may be able to provide support group chat rooms through the Internet; we could use chat rooms as support groups and put out prevention messages through those chat rooms on the Internet.

Also, in terms of a risk factor, when a person comes into the clinic, we usually try to focus on a few items of information that will tell us whether this person is a high-risk person or not. We need to add the Internet question to our battery of questions to identify high-risk patients and to use as a risk marker. If we ask the question in the clinic situation, we can identify high-risk clinic attendees and differentiate between them and lower-risk clinic attendees.

AIDS Alert: What are some details about the study and its sample size?

Aral: This study was conducted in Seattle in 2004. The respondents were 919 sexually active people. We excluded anyone who wasn’t sexually active, and the age group was 18-39.

It’s interesting; most people do not use the Internet to recruit sex partners. Seventy-five percent of our respondents said they do not use the Internet, so the Internet is a very good risk marker because immediately it [distinguishes] between the majority of sexually active people who at least don’t have very many partners and the minority — the 25% who use the Internet for sex partner recruitment and who also have high-risk behaviors.

AIDS Alert: Were women included in the cohort of people who had sex with same sex partners?

Aral: There were fewer women who reported having same sex partners when compared to men; we excluded women because there were so few of them.

AIDS Alert: What kind of intervention strategies should be used for people who use the Internet for sex partner recruitments?

Aral: That means you need to take a bit longer for that person and ask in a bit more detail about their risk behaviors, particularly receptive unprotected anal intercourse and whether they try to find out about the infection status of partners and whether they use condoms. I think you need to spend a little bit more time counseling them about the importance of the number of partners, unprotected intercourse, whether they have receptive or insertive sex, the importance of anal intercourse which is associated with higher acquisition risk, and the importance of prevention in general and protection.

AIDS Alert: Does the CDC have plans to do any more studies like this?

Aral: The Internet has attracted our attention in a big way, and our division has studies going on about Internet use and the Division of HIV Prevention has studies going on about Internet use. And we’re actively working with Internet providers to see what preventions can be launched through the Internet.

We are talking to them about the role they could potentially play in providing users with easily accessible and reliable information on HIV and STDs and on testing and treatment for HIV and STDs where they could go to receive care information, risk assessment, and testing.

AIDS Alert: Does the Internet promote high risk sex, or is it just convenient for those who are doing it anyway?

Aral: I don’t think the research has been done that would answer that at the individual level. We don’t know whether the Internet increases risk behaviors. I have heard anecdotes about people who are spending every night on the Internet; I don’t know of any research that shows causal link, but at the population level, we do know that the Internet does collapse time and space thereby making the spread of infections throughout a population much faster and more efficient.

So the same behaviors could go across long distances, and they could happen in much shorter time frames — that’s what I mean by saying the Internet collapses time and space. Whereas time and space are very good barriers to spread of infection in populations, you can find somebody in the city you’re traveling to, whereas before the Internet that was very pretty difficult.

We know people use the Internet before they have a meeting in some other city, or before they go on a pleasure trip to another city, they’ll line up partners. And even if someone only is going to spend 24 hours in another city, it’s possible for him to line up partners through the Internet so he can connect with them sexually even in such a short time.

AIDS Alert: Is this a frightening trend to someone working in public health?

Aral: Yes. I’d say, yes.