MSM, Sex, and Internet Chat Rooms: Epicenter of an Epidemic?

On June 23 2004 HIV InSite and the Center for AIDS Prevention Studies convened a panel of experts to discuss the increasing popularity of the Internet in the United States as a medium to meet sexual partners among men who have sex with men (MSM). Mark Vogel, Project Manager, HIV InSite, UCSF Center for HIV Information, convened and moderated the discussion. Participants included: 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, Safesexcity.com

The moderator begins by setting the stage: "Most of us are here because we are probably familiar with the recent studies that report high rates of unprotected sex and outbreaks of STDs [sexually transmitted diseases] among men who meet other men in Internet chat rooms. But we are here to address the questions of why this is the case, what evidence there is to support these studies and these trends, and to set out what makes Internet chat rooms different from other venues."

To highlight just a few of the communication trends emphasised by participants and audience members in this discussion:

• One panelist cited analysis explaining why the Internet is increasingly popular as a means for meeting sexual partners among MSM; he refers to the "5 A's":
  
  1. accessibility - "The Internet is very accessible to many people, particularly in this demographic, particularly here in San Francisco."
  2. affordability - "It is a lot cheaper to just go online and go to a chat room than to get up, go out of the house and go to a bar or a club or some other venue."
  3. anonymity - "You can be whoever you want to be on the Internet."
  4. acceptability - "It has become the new relative norm of how to meet partners. Right now, recent data show that more than 80% of sexually active MSM who meet new partners are meeting online in San Francisco."
  5. approximation - The Internet "allows people in dense urban areas who are interested to meet up very quickly in a short amount of time."

• Another panelist discussed intersections between trends in MSM using the Internet to meet partners ("hook up") and HIV prevention campaign trends: "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.S. 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...hookups are being arranged completely outside of the arena that HIV prevention campaigns have hit..."
• In response to an audience member's request for clarification on the suggestion that the population that traditionally went to sex clubs or adult bookstores is now going to the Internet, one panelist said, "I see the Internet as really opening up a whole new world of sexual networks to a lot of people who maybe never felt comfortable going into sex clubs or never felt comfortable about going into specific bars or venues to meet partners, and this whole thing really started, for me at least, in the Spring of 1999, when I was seeing a patient in the clinic and I said, 'How many sex partners have you had in the past two months?' He said, 'Fifteen.' I said, 'How many have you had in the past year?' He said, 'Fifteen.' I said, 'Well, what happened two months ago?' He said, 'I got online.'..."
• Another panelist addressed some age-specific communication trends, and their impacts: "we put together a community advisory board to build a website recently and one of the younger people on the board was basically saying that he was invited to a sex party that he learned about from the Internet and he went, and, however months later, he got the 'you may have been exposed to [an STD]...' phone call....but the older people in the group were saying, 'In the old days, if we were going to a sex party, we all went and got our STD checkup before and we did afterwards. We didn't even talk about it'....[In contrast, the young] guy basically said, 'I had no idea!' So he had learned about the party online; he did not know about community norms because there is not that same sort of mentoring that used to go on within the gay and bisexual community...So, it is just to think about the age and the communication and again, the difference between online and offline and how norms are changing."
• One audience member said, "I find that in sex clubs, for example, there is no communication at all; it is zero, and, as unclear as communication online is, it is still something, and now there are data from a researcher here at U.C. [the University of California] that show that the Internet is used by HIV-positive guys to serosort as a prevention strategy. So, while I think all the things you guys have said are true, they are also very positive for prevention strategies that can be implemented on the Internet."
• In a related vein, one panelist commented on the use of the Internet for prevention of STDs: "the Internet does provide an opportunity through an example of our online syphilis testing service, where we had about 10 people access new syphilis tests a week through this online syphilis testing service and we can in a more rapid diagnose a new case of syphilis and bring them in to treatment"