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As part of that study, we continued to monitor the use of Internet chat rooms and Internet sites among syphilis case patients and non-patients seen at the STD clinic in San Francisco and how about half of new cases have met recent partners online and the Internet sites have continued to be a place where we focus prevention efforts.Frank Strona: One of the things to keep in mind with Internet behavior is there is a perception of anonymity.

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.

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.

Deb Levine is the Executive Director of Internet Sexuality Information Services, or ISIS, which has contracted with the City and County of San Francisco to provide syphilis elimination services to men who have sex with men in the City, and also to identify their partners on the Internet.

The downside of that is, more often than not, in such small locations that we have, you end up knowing who the people are even before you see the face shot, and once you get more and more comfortable and you find less and less fear based on whatever program you are in, you start to change those images.

But I really do think a lot of it is based on comfort level of perceived anonymity. I do not want to start off by blaming the Internet and saying, you know, "This medium is the reason that there are higher transmission rates." It is yet another way that men can meet men and a lot of the people who are meeting men on the Internet are also meeting men in bars and clubs and bath houses and parks and everywhere else. Adding to that, though, the Internet allows men to meet each other faster.It is a cultural norm to be able to put a photograph in the profile out there that does not have a face, it does not have a name associated and I think that there is a level of personal safety that you believe you have, giving the fact that you think people cannot identify you.So you can write your profile as a modified code, hoping other people will read it the same way and then you can have a combination of emails exchanged or messages exchanged that allows you to kind of refine where and what behavior you choose to go to and then, if you want to have that next step, you can display your face.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.Okay, so then you get together and you think that you are going to have a particular kind of experience, you are already there, you are already aroused, you give up some of the discussion because it is much easier to just follow through and then afterwards you are like, "Man, you know? Internet access to places where you can meet sex partners is very affordable.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.

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