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Add a new group to those at risk for sexually transmitted diseases (STDs): men and women who use the Internet to make sexual connections.
According to a recent study of clients seeking HIV testing at a Denver HIV counseling and testing site, those who sought sex partners over the Internet reported a higher level of other sexual risk-taking behavior compared with those who did not use the computer for such purposes.1
What does this mean for health care providers?
"The take-home message we would like to see promoted is that Internet sex-partner seeking does appear to be riskier than looking for partners in other venues," says one of the study’s co-authors, Sheana Salyers Bull, PhD, MPH, former behavioral scientist with the Denver Public Health Department and now an associate scientist with the Denver-based AMC Cancer Research Center. "Practitioners can ask their clients if they do seek partners on-line and urge them to take additional precautions with these partners to prevent STD transmission."
Let patients know that seeking sex partners on the Internet puts them at risk for STDs, HIV, and unintended pregnancy, states lead author Mary McFarlane, PhD, a research psychologist at the Atlanta-based Centers for Disease Control and Prevention (CDC) National Center for HIV, STD, and TB Prevention, Division of Sexually Transmit-ted Disease Prevention.
"Internet-initiated sex can be risky because clients may feel as though they know a great deal about intended partners, when in fact, much of this knowledge may be false," observes McFarlane. "Internet-initiated sex may also put clients at risk for violence, as people can masquerade or misrepresent themselves on the Internet."
Advise patients who intend to meet their Internet contacts face-to-face to do so in a well-lit, well-traveled area, such as a popular coffee shop, says McFarlane. Bring along a friend if possible, and let a third party know about the intended meeting as a safety precaution, she adds.
Cyberseekers take risks
When clients seeking HIV testing at the Denver Public Health Department began telling providers they had met partners on-line through chat rooms and bulletin boards, awareness was raised about this newly emerging risk environment.
"This anecdotal information was interesting, because it appeared that partners could be identified more quickly than through traditional means, e.g., bars or bathhouses," says Bull. "We were interested to learn if this manner of partner-seeking incurred any increased risk for STD transmission."
The Denver cross-sectional study looked at almost 900 clients, the majority of whom were male, heterosexual, and between the ages of 20 and 50. Compared with those who did not use the Internet to make sex connections, cyberseekers were more likely to be male and homosexual and reported more previous STDs, partners, anal sex, and sexual exposure to partners known to be HIV positive.
Researchers are looking at a broader popula- tion through an Internet-based self-administered anonymous survey, known as the SexQuiz.2 More than 4,600 people responded to the survey between April 3, 2000, and Aug. 3, 2000. The survey covered 68 items in an effort to assess sexual risk behaviors with non-Internet and Internet partners.
While substantial information on the likelihood of STD infection from Internet partners is still unknown, and while risks are common, effective strategies for on-line STD prevention are needed, the scientists state. A three-year grant from the Washington, DC-based Association of Teachers of Preventive Medicine and funds from the CDC will allow the researchers to develop and test an on-line STD/HIV prevention intervention targeting men having sex with men, says Bull.
Get message out on Net
The Internet offers fast and efficient encounters resulting in sexual contact, which might translate into more efficient disease transmission, say Bull and McFarlane.3 However, the Internet also offers many possibilities for innovative technological approaches to promote STD and HIV prevention, they note.
When an outbreak of syphilis occurred in San Francisco among users of an Internet chat room, public health officials were able to alert chat room participants of potential disease exposure, use Internet aliases to contact individuals, and issue Web alerts, rather than direct personal contact, to raise awareness.4
The public health establishment should explore the potential value of the Internet as a tool for health communication, according to an editorial by Kathleen Toomey, MD, MPH, director of the Division of Public Health, Georgia Department of Human Resources, and Richard Rothenberg, MD, professor of family and preventive medicine at the Emory University School of Medicine, both in Atlanta.5
"Public health systems need to be prepared to deal with the consequences of activities involving these new communication media," observe Toomey and Rothenberg. "The opportunity for STD prevention (at least for this segment of the population, which has grown up using the Internet) will truly become lost in cyberspace unless public health can develop new ways to better educate sexual risk takers and provide effective interventions with or without the assistance of these new technologies."
1. McFarlane M, Bull SS, Rietmeijer CA. The Internet as a newly emerging risk environment for sexually transmitted diseases. JAMA 2000; 284:443-446.
2. Bull SS, McFarlane M, Fitch J. Risk behaviors related to Internet sex partner solicitation: Results from an on-line survey. Presented at the 2000 National STD Prevention Confer-ence. Milwaukee; December 2000.
3. Bull SS, McFarlane M. Soliciting sex on the Internet: What are the risks for sexually transmitted diseases and HIV? Sex Transm Dis 2000; 27:545-550.
4. Klausner JD, Wolf W, Fischer-Ponce L, et al. Tracing a syphilis outbreak through cyberspace. JAMA 2000; 284:447-449.
5. Toomey KE, Rothenberg RB. Sex and cyberspace — virtual networks leading to high-risk sex. JAMA 2000; 284:485-487. n