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Right now, recent data show that more than 80% of sexually active MSM who meet new partners are meeting online in San Francisco, and then what Deb mentioned is approximation that allows people in dense urban areas who are interested to meet up very quickly in a short amount of time.GR: I just want to add that we have been doing online qualitative interviews with gay and bisexual men or men who have sex with men they meet in Internet chat rooms, or that we were recruiting from Internet chat rooms, and even the guys in rural America are saying that, you know, "I can get online, and in 45 minutes, I can have someone tied up to my bedpost..." So, you know, this is not just in San Francisco or New York; we are seeing this phenomenon in many other places in the country as well.Whereas a lot of people in their profiles will put down "safer sex only," then they meet up, that means we do not have to have a discussion about it because, let's say I responded to an ad that said "safer sex only" or we both wrote "safer sex only." However, for me, "safer sex" is "no unprotected anal intercourse" and, for you, "safer sex" is "no anal intercourse at all." And then that is not being discussed. MV: So, is there a misperception with the Internet where it seems clear that you can say, "I'm HIV-negative, STD-free" but that does not get into when you were last tested or what that means for you, and so that it appears that it is all out there in the open but it is really not being addressed?That is probably not the best example, but let's say for the other person, let's say they won't even have oral sex without a condom. Then you go out and try to find somebody else who potentially has your same thoughts and beliefs. JK: Yes, I think Al Cooper down at Stanford and Michael Ross in Houston, talk about why the Internet is so popular based on these five A's. The Internet is very accessible to many people, particularly in this demographic, particularly here in San Francisco.

I am going to go ahead and begin with the first set of questions. Greg Rebchook: Sure, I can start addressing that question about evidence that MSM recruited from online venues or using chat rooms have higher rates of, or they are reporting higher rates of, unprotected anal intercourse with their partners than men in other venues. Our own data actually show that even when you are controlling for the number of sexual partners that men are having, that Internet use still contributes to unprotected sex significantly, even controlling for the number of sex partners. Jeff Klausner: We first identified the association of Internet use and STD transmission in 1999 during an outbreak investigation of a cluster of syphilis cases among gay men here in San Francisco.Joining me today are several individuals, all of whom either as public health officials, researchers, safe sex advocates or some combination thereof, have a particular interest and expertise in Internet chat room use among MSM. Frank has worked on men's sex and health issues for more than 15 years. He is assistant research psychologist and has studied and worked on a number of community-based interventions among gay men.He is co-creator of a new website called Safe Sex City.com, which is a cyber-community geared towards creating a community of like-minded MSM who are committed to promoting and practicing of safe sex. He has conducted research on the role of the Internet in the sexual lives of MSM and has found a number of interesting trends that I am sure he will share with us in our discussion today.I wanted to start the discussion more with evidence because there might be people who are skeptical or do not really understand what evidence there is out there that men who have sex with men and meet their sexual partners online have higher rates of unprotected sex and sexually transmitted diseases. We did a case-control study, which is kind of your typical type of evaluation to determine what risk factors are associated with cases and non-cases.In this investigation, we found that 67% of these syphilis cases versus 19% of matched men who were non-syphilis cases had met recent partners in the chat room, and this was a statistically significant association.

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