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Health Officials Put Safer-Sex Message Online
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NY Times
By DAVID TULLER
SAN FRANCISCO, Oct. 25 - When health officials here discovered a few years ago that several gay men who tested positive for syphilis all met sexual partners through the same online chat room, the incident highlighted what many health experts feared: trysts arranged on the Internet were fueling the spread of sexually transmitted diseases among gay men.
The concern has since been heightened by research suggesting that men who meet male sexual partners online are more likely than other gay men to engage in risky sex and to have a history of sexually transmitted diseases, including H.I.V. And the practice of meeting sexual partners online has become so popular that it is referred to by some men as "gay takeout."
But health officials and educators say that the trend, while alarming, also presents them with an opportunity to disseminate safer-sex advice, and prevention and treatment information about sexually transmitted diseases in innovative ways.
In the last few years, public and private agencies in many cities have begun online health promotion strategies to reach gay men, including placing banner advertisements on sexually oriented Web sites, engaging in online discussions of safer-sex strategies, and allowing Internet users to download laboratory slips for sexually transmitted disease testing.
"The public health community has been reporting that the Internet surpasses bars and bathhouses as the most frequent place where sexual partners meet for the first time," said Dr. Ronald Valdiserri, deputy director of the National Center for H.I.V., S.T.D. and T.B. prevention at the federal Centers for Disease Control and Prevention in Atlanta.
"In public health, we like to go where the action is, so it's a critical venue," he said.
Because Internet intervention is still in its infancy, most of the efforts have been started by local agencies, with little data to guide them on effective strategies. Many health workers say these programs can be particularly useful in reaching men in rural areas, young gay men and others who may not want to identify themselves or visit a gay community center.
"I think the anonymity is extremely helpful," said Lyndon Cudlitz, 21, education and outreach coordinator for Outright, a Maine gay rights group that posts profiles of peer counselors who can answer questions about safer sex and other health-related issues. "Because we never know who it is, they can ask any kind of question without needing to feel embarrassed.''
The question of how to reach men online has grown in urgency with studies suggesting that men who find sexual partners through the Internet have a different profile from other gay men. According to a study from the Los Angeles Department of Health, two-thirds of men who met male sexual partners online were H.I.V. positive.
They were also three and a half times as likely to have anonymous sex and twice as likely to use injection drugs as men who met partners elsewhere. A San Francisco study found that 39 percent of 91 men surveyed about their online activities reported having had unprotected anal intercourse with men they had met online.
Public and private agencies in San Francisco have developed some of the most varied approaches to online prevention. Health educators in the city have started a Web site, www.safesexcity.com, that includes links to health resources, profiles of men who do not want to engage in risky behavior, and discussion forums. San Francisco's health department has also created a Web site, www.stdtest.org, where people can print out laboratory slips that allow them to get tested anonymously for syphilis, with electronic notification of the results.
Deborah Levine, director of Internet Sexuality Information Services, a San Francisco nonprofit group that helped establish the program, said that about two dozen men were using the service each month.
The information services group and the health department also recently established a program to allow men who have tested positive for a sexually transmitted disease to send electronic notes, anonymously if they prefer, to sexual partners.
"A lot of people are really reluctant to tell public health officials or doctors who all their sexual partners are, so this gives them an opportunity to contact them," Ms. Levine said.
Earlier this year, the health department also helped to finance an advertising campaign intended for gay Internet users. The campaign featured billboard advertisements in the city's Castro district highlighting ambiguous terminology used by men seeking sexual contacts in online forums, and set up a Web site at www.be-clear.org.
The premise of the campaign was that many men who are H.I.V. negative are seeking other men who are negative, while men who are H.I.V positive are seeking other H.I.V. positive men. Terms like like "clean" or "disease free," commonly used in Internet postings, are often too vague to help men negotiate their risk, say campaign organizers.
The campaign encouraged people to ask directly about H.I.V. status and sexually transmitted diseases and to be explicit about the activities they are interested in, said Raul Cabra, founder of Cabra Diseno, the marketing firm that created the campaign.
"What's problematic is that the language people use is a bit sloppy," Mr. Cabra said, adding that they were hoping "to provide ways in which they explain what they want plainly and directly."
Health educators concede that, despite the wealth of online efforts, they are not sure which techniques work best, or if they work at all.
"We really don't have any specific intervention we can hang our hats on and say, 'This is what works,' " said Dr. Jeffrey Klausner, director of the sexually transmitted disease clinic at the San Francisco Department of Public Health.
Dr. Klausner is the author of "Ask Dr. K.,'' a sex information and advice column that is posted on the health department's Web page as well as on gay.com. Recent questions Dr. Klausner has answered include "Can H.I.V. get into my cut?" "Will soap and mouthwash protect me?" and "How safe is oral sex?"
Dr. Klausner and other health officials say they try to work with the owners of popular Web sites, not always successfully. But the site managers say that health officials do not always understand the needs of their customers and tend to lecture rather than simply inform.
"A lot of our customers want to know, if they've decided to take a risk, here's how to minimize the risk of transmission," said a spokesman for Advanced Membership Services, which runs M4M-USA.com Web site. "But a lot of public health agencies just want us to be a stern parent and to preach to our customers."
Some sites, like manhunt.net and gay.com, have been praised by health officials for their willingness to address health concerns. Manhunt, for example, has recently run advertisements, produced by the Gay Men's Health Crisis in New York, warning about the dangers of crystal methamphetamine use.
Several agencies have posted the profiles of health educators on Manhunt's Web site, and health officials in Massachusetts have been allowed to contact sexual partners of Manhunt members who have found out that they have a sexually transmitted disease.
But site owners have also imposed some limits. Health professionals in chat rooms can respond to questions posed to them but they are not allowed to contact members first, even if they think those members are engaging in unsafe activities.
"If our customers feel as if their right to practice sex as they choose is infringed upon, it endangers the whole program," said Stephen Adelson, director of operations for Online Buddies, which runs Manhunt. "We're really trying to find a balance between providing health education and outreach and respecting members freedom of speech and choice."
CDC NEWS
"Health Officials Put Safer-Sex Message Online"
New York Times (10.26.04)::David Tuller
In response to Internet-linked STD transmission, public and community agencies in many cities have begun to disseminate information on safe sex and STD prevention, screening and treatment on Internet sites where men go to arrange sexual encounters with other men.
Research suggests that men who meet through the Internet have a different profile than other gay men. A recent Los Angeles Department of Health study found two-thirds of men who met male sex partners online were HIV-positive; the men were 3.5 times as likely to have anonymous sex; and twice as likely to use injection drugs as men who met partners by other means. In a San Francisco survey of 91 men about their online activities, 39 percent reported having unprotected anal sex with partners they met online.
"The public health community has been reporting that the Internet surpasses bars and bathhouses as the most frequent place where sexual partners meet for the first time," said Dr. Ronald Valdiserri, deputy director of CDC's National Center for HIV, STD and TB Prevention.
Because of their relative novelty, Internet interventions that local agencies engage in often lack the guiding data on what works. Some health workers say the interventions are particularly useful for reaching rural areas, gay male youths and those who wish to remain anonymous.
Online health promotions targeting gay men have included placing banner advertisements on sex-themed Web sites and offering online discussions concerning safe sex strategies and downloadable STD laboratory testing slips.
Government and private agencies in San Francisco have established the most varied online prevention approaches. One campaign the city backs encourages people to explicitly ask about partner HIV status and STDs, as well as anticipated sexual behavior. Terms like "clean" or "disease free" frequently used in Internet postings may be too vague for people to properly negotiate safety, said campaign organizers.
However, some private gay Web-site owners impose limits to the interventions. In some chat rooms, outreach workers can respond to questions only if members ask for advice. "If our customers feel as if their right to practice sex as they choose is infringed upon, it endangers the whole program," said Stephen Adelson, director of operations for Online Buddies, which operates the Manhunt site.
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