by David Evans
http://www.poz.com/articles/hiv_prevention_internet_401_14435.shtml
News Special Re****ts Treatment News
April 15, 2008
Virtual Prevention: Fighting HIV Online
by David Evans
Describing the state of HIV prevention at a large,
international AIDS conference recently, Ronald Stall,
PhD, of the University of Pittsburgh School of Public
Health, said, "Is HIV prevention working among gay
men in the United States? I think to put it in the
most polite terms, the best thing we can say is not
as well as anyone would like."
A set of key statistics published by the Centers for
Disease Control and Prevention (CDC) on their website
in March of 2008 states it more plainly: The number
of HIV-positive gay and bi***ual men has increased
steadily between 2001 and 2005.
The problem has been well do***ented in various
metropolitan areas. According to the New York City
Department of Health and Mental Hygiene, between 2001
and 2006, HIV diagnoses increased by 32 percent among
gay and bi***ual men aged 30 or younger in the city.
And in a five-city CDC study conducted between June
2004 and April 2005, 40 percent of 462 gay and
bi***ual men tested for HIV were confirmed to be
positive for the virus--62 percent of them didn't
even know they were infected, and a whopping 8
percent were likely infected within six months prior
to testing.
So, what is causing the spike in new HIV diagnoses?
Experts point to several possibilities from "cultural
amnesia around the epidemic" to the age-old
misperception of invincibility among youth to
increased drug and alcohol use to a lack of
sufficient fear of a disease that has been rendered
"manageable" --and survivable--with treatment. Others
point out that in some cities younger gay men aren't
getting tested as often. And since researchers think
that the majority of transmissions in the U.S. happen
during the first weeks and months after infection,
when people still think that they're HIV negative,
less frequent testing means people remain unaware of
their status and pass on HIV to others. All of these
factors undoubtedly leave young people more
susceptible to contracting HIV.
47% of gay and bi***ual men participating in a recent
online POZ/AIDSmeds survey say they meet the majority
of their dating and *** partners online.*
But there's another factor--the Internet. While its
impact on relation****ps, dating and *** is still new
and largely uncharted, most will agree that it has
drastically altered the way people, particularly
those looking for ***, connect. The Internet makes
meeting people more efficient. A single person can
meet hundreds of people within a matter of minutes in
cyberspace--to do the same thing in the real world
takes a lot more time. Meeting online allows people
to skip the stages of getting acquainted, cutting
straight to a ***ual encounter without the preamble
that could provide the time and/or information that
would perhaps lead to a more considered decision. It
may not be coincidental that as the number of
Internet-based dating and *** websites has increased,
so has the numbers of new HIV infections.
Simon Rosser, PhD, a researcher from the University
of Minnesota, who spoke after Stall at the 15th
Conference on Retroviruses and Op****tunistic
Infections (CROI) this past February in Boston,
believes that the rise of the Internet as a place to
easily and efficiently find *** partners is
intimately connected with the increased numbers of
gay men who are becoming HIV positive. He likened the
Internet's impact on *** (rendering it more casual)
to the drastic change that occurred in attitudes
about air travel. While airplanes were once thought
to be the realm of exotic thrill seekers, they are
now commonly used by everyone from grandmas to
babies. "If the Internet has a similar effect on ***,
we have to ask is casual *** about to get a lot more
common and even more casual?" he asked.
While it has yet to be proven that the Internet is a
direct cause of increased HIV infections, the Web has
undoubtedly created an arena that presents new
challenges for those looking to do prevention
outreach work. And some worry that the surge in
online traffic will soon leave many more traditional
venues for hooking up--like parks, baths and
bars--empty. In an article in Xtra West, Terry
Trussler, the research director of Vancouver's
Community Based Research Centre, explained that the
pro****tion of men who spend more than 50 percent of
their free time with the gay community--where
traditional prevention efforts are focused and where
young men can learn about safer-*** norms--decreased
from 62 to 42 percent, and said, "[For] many gay men
who are 20 now, their first ***ual encounter will
have happened through connections made through their
computer."
Rosser, speaking at the conference, concurred,
pointing out that while the gay community has grown
considerably online, the traditional gay
infrastructure is eroding, and since online hookups
are so much more efficient than bars or bathhouse
hookups, gay men are having more *** with more people
than before. More *** means that occasional slipups
or decisions to forgo condoms with a special guy are
also more likely to occur.
Acknowledging the potential link between a rise in
online connections and the spread of HIV, prevention
experts are beginning to examine what can and should
be done to prevent HIV online--perhaps even in those
very settings that seem to contribute to behaviors
that can lead to HIV. One challenge is that most of
the groups in the U.S. responsible for doing HIV
prevention work, and the government agencies that
fund them, have a limited presence in cyberspace.
Critics of current off-line prevention efforts point
out that even if we could deliver new web-based
prevention tools tomorrow, they will have limited
efficacy unless we find ways to integrate them into
the activities that gay and bi***ual men already
enjoy doing, such as participating in
social-networking sites, shopping online and using
the Internet to learn about non-health topics.
49% say that the number of romantic and ***ual
partners they meet online has increased or greatly
increased, compared with the number of "connections"
made five years ago at venues like bars and clubs.*
This ****ft in the way we meet and date online is
leading several ingenious pioneers to try to
capitalize on the Internet's potential to stretch the
boundaries of traditional HIV prevention thinking.
It's too early to tell whether they'll succeed in
changing behavior and reducing new infections, or
even whether they'll be able to convince their fellow
prevention workers to join them on the Web. But
recent statistics point to a critical need to find a
mechanism that will reach those who are looking for
love--and everything else--online. And such a
mechanism should have enough sophistication, fun and
***iness to compete with other things that men are
also doing online, such as checking e-mail,
downloading music and updating their Facebook.com
profile.
Disturbing Trends
Stall's conclusion that HIV prevention wasn't working
well for gay and bi***ual men was based on his
careful scrutiny of all the available data he could
find on HIV incidence, which estimates how many new
infections occur each year. He and his colleagues
found that by the most conservative estimate, 2.39
percent of gay and bi***ual men in the U.S. were
becoming infected annually between 1995 and 2005.
Stall then calculated what would happen to a group of
men who were 20 years old in 1995 and had a 2.39
percent HIV incidence rate. He found that by 2005,
when the men had turned 30, nearly a quarter of them
were likely to be infected with HIV, and that by
2015, when the men would turn 40, over 40 percent
would be HIV positive.
If we consider this hypothetical group of
twentysomethings, HIV wasn't the only thing that
began to affect them in 1995. By then the most
technologically advanced were regularly using the
Internet for e-mail and to find information. By the
end of the century, gay chat rooms were the rage, and
more sophisticated websites devoted to personal ads
for *** and dating were beginning to show up all over
the Web.
Epidemiologists began to see the influence of the
Internet around 2000, when rising syphilis rates
among HIV-positive men were often traced back to
online chat rooms and websites where people could
meet and hook up. Early evidence also suggested that
HIV transmission was being facilitated online. Rosser
says researchers like him began to ask, "Is there
something magical about the Internet? Is it
attracting men of higher risk? What's going on?"
83% agree or strongly agree that they are less likely
to suffer from discrimination, harassment or abuse
due to their HIV status when meeting men through POZ
Personals than more general dating/hookup websites
for people of any HIV status.*
Professor Jonathan Elford, of City University London,
in England, says the Internet has "opened up
op****tunities for conducting research, which didn't
exist 10 years ago," and that "What we do find, is
that men who are recruited through the Internet are
more likely to re****t high levels of risk."
Rosser's own research suggests that HIV-negative men
are not necessarily taking more risks with people
they meet online than they would, say, with someone
they met at a bar or bathhouse, but that because
hooking up online is so much more efficient, they are
having more ***. "In the old days, let's say I might
score five times a week; now I can score 50 times a
week, and we don't think it's just increased it a
little bit, it's increased it a lot," he says.
While increased HIV risks and new diagnoses may cause
some to automatically assume that HIV-positive men
are knowingly having *** with unconcerned and
irresponsible HIV-negative men, experts say this is a
rare phenomenon. In fact, the vast majority of people
with HIV, once they've been diagnosed, cease having
unprotected *** with partners who say they are HIV
negative or don't know their status. Rather, new HIV
cases appear to happen in clusters, among men who
assume they are HIV negative, all of them in the
early-infection stage with very high viral loads.
Since young gay men are having *** more often with
more people, but getting tested for HIV less often,
taking higher risks or slipping up on safer-***
commitments turns into a numbers game that more and
more men are losing.
What's more, "The Internet has now taken over as the
No. 1 venue for meeting ***ual partners for men at
high risk," says Rosser. He's re****ted data from the
Minneapolis St. Paul area that showed 52 percent of
single gay and bi***ual men surveyed met *** partners
online, compared with 47 percent who met partners at
a bar or club, and just 11 percent who met partners
at either a bathhouse or a *** club.
76% say they would be somewhat to very likely to
visit a website devoted to HIV prevention designed
specifically for people living with HIV (as opposed
to those who aren't infected).*
Rosser also feels that the Internet isn't just
affecting HIV transmission among gay and bi***ual
men; it may also be affecting the physical
brick-and-mortar gay community. He has re****ted that
with the exceptions of gay Meccas like San Francisco
or New York, "gay neighborhoods and gay
infrastructure, for instance gay bars, all appear to
be in decline."
Elford doesn't feel that the Internet is replacing
physical venues in the gay community as much as
adding to them. He says, "Most of the men who said
they used the Internet also went to bars and
clubs.... That's what we found in London, and there's
some evidence that the same is probably true in
bigger U.S. cities."
We Need New Tools and New Messages
Though experts may disagree about the effect that the
Internet has had on real-world gay environments, most
agree that the majority of gay and bi***ual men
probably have spent at least some of their time
cruising for *** partners online and that HIV
prevention interventions should increasingly be
focused there.
Researchers have been quick to move some aspects of
their research online, such as surveys and behavioral
surveillance, but few have moved beyond what
currently constitutes the majority of online HIV
prevention efforts, which are mostly limited to
written HIV prevention information, prevention
workers who cruise chat rooms or post ads on
craigslist.com, profiles on Facebook and MySpace and
e-mail notifications to the *** partners of people
who've tested positive for a ***ually transmitted
infection (STI) like HIV or syphilis.
Joshua Tager, senior digital editor for Out and The
Advocate magazines in New York City, says that he
worries that even if prevention experts do manage to
build new online tools, they may fail to work if they
follow the model of existing off-line prevention
efforts, which rarely adhere to the kinds of
guidelines that gay businesses do if they want to be
successful--namely that their products need to be
***y and enjoyable. Rosser, himself one of those
prevention experts, agrees, saying, "One of the
problems [with existing prevention programs] is that
we made them more clinical and we had idiots like me
develop more professional-type seminars and we sort
of left the community out of it, and we actually left
*** out of it." In short, the newer prevention tools
are going to have to go far beyond a simple message
of "use a condom every time" if they are going to
match up with the kind of subtle risk *****sment
strategies that gay and bi***ual men are already
using. And they're going to have to be entertaining
and ***y to get their point across.
35% agree or strongly agree that they predominantly
have *** with other HIV positive men in order to have
unprotected anal *** without worrying about HIV
transmission. Thirty-eight percent disagreed or
strongly disagreed, and 24% neither agreed nor
disagreed.*
Stall and others point out that many HIV-positive men
are already using a strategy called serosorting,
whereby they choose to have *** only with other
HIV-positive men or at least only have unprotected
anal *** with these men, as a way to keep from
passing HIV on to HIV-negative men. This strategy
isn't perfect, as the flurry of syphilis cases among
HIV-positive men around the globe indicates, but it
does mean that HIV-positive men are not putting their
HIV-negative partners at risk. While serosorting may
be great for HIV-positive men who wish to bareback,
its effectiveness for HIV-negative men who'd also
like to try condom-free *** is questionable.
"If someone in their ad says that they're HIV
positive, and another person responds who says that
they're HIV positive, chances are they really are HIV
positive. But if two men say that they're HIV
negative, that depends on when they've had their last
test, and what they've done since their last test.
It's much less reliable," explains Elford.
Another risk-reduction strategy that some gay and
bi***ual men are trying out is called strategic
positioning, whereby HIV-negative men have
unprotected anal *** with partners who are HIV
positive or whose HIV status is unknown, but only as
the insertive partner. As Michael Ross, PhD, from the
University of Texas School of Public Health in
Houston, observes, however, "You know strategic is a
word that George Bush uses all the time in reference
to the war in Iraq, but just because we say that
something is strategic doesn't mean that it makes a
lot of sense."
Yet another factor causing gay and bi***ual men to
weigh the pros and cons of condoms, is a Swiss
proclamation made earlier this year that stated that
for straight monogamous couples, where one is
HIV-negative and the other HIV-positive, HIV
transmission was impossible provided that the
HIV-positive partner was taking antiretroviral drugs,
had an undetectable viral load for at least six
months, and didn't have any other STIs.
Brave New World
New online prevention tools, therefore, need to be
both technologically innovative and offer
sophisticated and comprehensive
***ual-risk-*****sment strategies. But Tager feels
they need to go even further. He says, "If you think
about most HIV prevention workshops, they're always
these stand-alone activities that someone has to make
time and effort to attend. Rarely, if ever, are they
incor****ated into the kinds of activities that most
gay men find enjoyable. I wish that people doing
prevention would ask for the help of [experts in the
field of gay website development] in devising new
prevention efforts. I think we've got a lot to
offer."
Fortunately, the handful of people conducting
research about what will constitute the most
effective online prevention tools have taken Tager's
message to heart. A Dutch group led by Gerjo Kok,
PhD, from the department of experimental psychology
at Maastricht University in the Netherlands, in what
Ross calls "pretty much the gold standard for
interventions at this point in time," has built a
virtual gay cruise ****p to help men navigate and
learn about ***ual decision making. Men get to choose
from one of four attractive animated male pursers,
guiding them through the cruise ****p and helping them
think through a number of ***ual decision-making
scenarios arising from encounters with other animated
****p passengers.
49% find the Internet to be more effective than
traditional venues like bars and bathhouses for
meeting dates and *** partners.*
Most men who participated in the gay-cruise
prevention website liked it. In their evaluations, 86
percent said it was enjoyable, 53 percent said it
helped them to know more about their *** life, and 61
percent said they became more conscious about dating
and ***.
You'd think, given this kind of response, that
there'd already be an online gay-cruise prevention
tool available worldwide. But the release of such a
tool has been held up because there's a problem.
Though Kok and others proved that you can engage and
retain large numbers of gay men to complete an online
intervention, they also recognized that it is
remarkably difficult to find those same men three or
six months later to follow up and see if their
behavior changed as a result of the intervention.
Thus, as innovative as the gay-cruise prevention tool
may be, the researchers were unable to effectively
track whether or not it caused the men who
experienced it to ultimately take fewer HIV risks.
Rosser is leading another team at the vanguard of
online HIV prevention. It's developed an online
interactive health and ***uality environment called
***Pulse that is being rigorously evaluated. ***Pulse
is in its third of 12 months of follow-up; involving
about 600 gay men, though early results are
promising, the project is not yet ready for primetime
as, like with the online cruise ****p, its longer-term
effectiveness is still unproven.
"What we're trying to do with ***Pulse is to come up
with engaging, fun ways that guys can learn about
their ***uality.... I mean there's a real gay
sensibility that is wonderful and relevant to the
online experience [of ***Pulse] that we don't see in
other [prevention] tools. For instance we have
modules on how to chat online, how to get the
information you need in order to make an informed
decision, and one about body image," explains Rosser.
But as excited as Rosser and his multidisciplinary
team are, they are also proceeding cautiously. He
says, "We're trying to be realistic and modest and
study it well, and so maybe if version 1 won't work,
maybe version 5 will."
Rosser also points out that his group is just one of
several others around the U.S. doing this kind of
work. He praises Anne Bowen, PhD, at the University
of Wyoming, for her work on the Internet with rural
men, and Sheana Bull, PhD, at the University of
Colorado, who is building STI interventions that are
based on the principles of social-networking sites
like Facebook or Twitter, where the users generate
their own content.
35% say they spend three or more hours online each
week seeking romantic and ***ual partners.*
Rosser, who has been doing HIV prevention work for 25
years, describes the work he and his team are doing
with a zest and enthusiasm reminiscent of a person
fresh out of graduate school. He credits the
interdisciplinary nature of the work, saying, "You
know the NIH came out with a big re****t round about
2000, and they said that major scientific advances of
the 21st century are unlikely to occur by Simon
Rosser sitting in his office thinking up a brilliant
thought. Rather, they said that the major scientific
advances are likely to occur in multidisciplinary
teams where people from very different backgrounds
are coming together and working together to solve a
common problem."
As exciting and hopeful as these new interventions
sound, they aren't cheap, and as Sheana Bull points
out, we still don't know for sure if they work.
Nevertheless, she says, "My call is more to my own
colleagues to stay ahead of innovations or at least
try to anticipate things that are coming out and
being prepared to do quick evaluations to get
strategies out there to communities. Because they can
take them and run with them more quickly and do more
adaptations than we can in the academic setting."
Perhaps the most beneficial aspect of building online
prevention tools is that once something is proven
effective, there's no need to wait months and years
and spend many thousands or millions of dollars
ramping it up and rolling it out. Of ***Pulse, Rosser
says, "If version 5 works, then we can just hit the
switch and everybody in the world has access. So the
days of having to show demonstrated and effective
programs and then scaling [them] up for everybody to
repeat it--well we don't need to repeat it, because
it's the World Wide Web."
* All responses are from a POZ/AIDSmeds survey
conducted in April 2008.
http://www.poz.com/articles/hiv_prevention_internet_401_14435.shtml
by David Evans
Search: gay, bi***ual, men who have *** with men,
MSM, ***, cyber***, internet, CDC, World Wide Web,
***Pulse, chat rooms, prevention, Stall, Rosser,
Elford, Tager
Previous Comments:
comments 1 - 15 (of 18 total) next > >>
Jim Pickett, Chicago, 2008-04-21 07:24:45
Hello, what about th im****tant work being done on new
prevention technologies?Why gay men, or any of us,
are satisfied with only having condoms to protect
against ***ual transmission of HIV is beyond me. Why
don't we demand more options? It misses the point to
simply complain about why condoms aren't used.
Scientists are studying pre-exposure prophylaxis...
and gels or lubes that could be used to protected
during anal intercourse - called ractal microbicides.
Visit www.rectalmicrobicides.org.
Me, , 2008-04-21 01:50:49
YOU HAVE TO BE KIDDING BE THAT SOMEONE ACTUALLY
THINKS GAY *** = DEATH!!! I COULD SAY ALL THE
HORRIBLE AND FULL OF HATE WORDS I'M THINKING OF.
INSTEAD I'LL JUST SAY THAT IT MUST SUCK TO BE YOU...
POOR LITTLE BEING, MAY GOD OR WHATEVER YOU BELIEVE ON
HAVE MERCI OF YOU.
DD, , 2008-04-20 22:33:00
Profiles for anonymous ***ual encounters run above
and below profiles for anonymous hiv testing by ASO's
in the sites I've visited. Heard last week at an
hiv/aids conference that new infections are estimated
at 58 to 64,000/yr now. It had been 40,000/yr for
about the last 10 years. Ignorance and prejudice are
the cause of the stigma. Straight women are infected
too, Ted. Tell your sons and daughters folks.
robb, milwaukee, 2008-04-20 11:48:10
gay *** doesnt = death, stupidity =death.... think
about it....
L. Andrews, , 2008-04-18 10:36:51
To Ted from Columbus. Gay *** = death? Very 1980's.
I'll update you on a new mantra for 2008. outdated
ignorance and religious based solutions = a very
simple-minded, nasty, unhappy, repressed person.
Please don't spread your sperm into human creation
and I promise I won't die from having enjoyable ***.
L.Andrews, , 2008-04-18 10:21:16
..and it took academics a survey to come to this
conclusion. Reality from a laymen - it was only time
before the effects of disconnecting from real life
interaction combined with a commercialism that plays
down any HIV reality would result in new HIV
infections. When it comes to the internet world we
should also concern ourself with issues of mental
health and start to prepare for a growing generation
that has been declining in social skills and personal
growth since teen-hood. Brave New World!
jckie, LONDON, 2008-04-18 10:11:23
Well what really we should stick on Using condoms
please though your already HIV,OR,NOT GAY MEN PLSE
THERE SO MANY WAYS YOU CAN ENJOY ***,ROMANCE LIKE
PHISICAL TOUCHING. LETS FIGHT THIS DISEASE, IT
SHOULDN'T CONTROLL US, WE,VE GOT MORE POWER THAN IT
DOES, SO WE CAN DEAFEAT IT NO MATTER WHAT,
poz4life, EBay, 2008-04-17 19:23:01
I've got a fabulous idea, how about some studies on
Females and HIV? Every damn study to date has been
geared towards men, gay men & MSM. How about some
studies on how women are contracting the disease, how
we're seeking treatment & how we're getting by?
TD, , 2008-04-17 12:31:31
World views such as Ted's helped fuel this pandemic
in the first place. There's plenty of guilt to go
around without adding more to it. We need to face the
facts - ***uality is a deeply personal, complex part
of every human being. There's no "one size fits all"
solution, if there's even a solution to be found.
RW, , 2008-04-17 11:19:28
Sad these "experts" are completely ignoring the
bigotry and ostrosizing that poz men receive-- often
on these internet sites. Referred to as 'unclean" or
"diseased"... or instantly rejected from even
conversation where their status is revealed.... It is
no wonder therefore that an hiv-negative man would
avoid being tested and finding out that he is part of
this group and the humiliation he would get at the
hands of others. Better to not know and not endure
that. Seriosorting is segregation.
Jose, Miami, 2008-04-17 11:12:52
These studies are extremely idealisitic. HIV
"prevention" simply does not work anymore because
HIV/AIDS has been turned into what doctors are
calling a "manageable disease like diabetes." Open
any gay publication and you will see hunky muscular
men smiling on a beach for an HIV/AIDS medication
advertisement. What is the message delivered here?
You take a pill and you will be fine...continue to
party and have fun and have all the *** you
want...HIV won't kill you anymore.
Stephen, Vancouver, BC, 2008-04-17 09:15:32
I guess this is another ploy for the drug companies
to scare younger men into that old saying ***=death.
How sad. They still haven't isolated the hiv virus
yet. What is one to believe.
jOHNNY SANTELLAN, SANTA ANA, 2008-04-16 18:24:48
stay well
deno, Altadena, 2008-04-16 18:03:19
**Rosser - "In the old days, let's say I might score
five times a week; now I can score 50 times a week,
and we don't think it's just increased it a little
bit, it's increased it a lot," he says.** Isn't this
example on the extremely high side? Where are the
statistics to back that up. That can be very
misleading about the amount of ***ual activity that
is common in the population discussed.
Darin, New Jersey, 2008-04-16 17:45:36
HIV Prevention for "gay men" is a joke! In most
cases, outside major metro areas like NYC, SF, or
Philly, it's non-existent or masquerades as
prevention for "MSM," whatever that is....what is
surprising for someone who spent a decade in the
field, is why experts are so "shocked" or
"surprised." I find that self-serving, patronizing,
and it reflects either naivete or stupidity
comments 16 - 18 (of 18 total) << < previous
Aaron, Yucaipa, CA, 2008-04-16 15:44:27
I really think that the biggest problem with
prevention is not awareness. It's patience. Everyone
I've met has been fully aware of HIV and it's
associated risks. I believe that this issue has to do
with intimacy. When you've dated someone for a few
months, and you're getting very close with them, you
don't want to wait for another few months just to be
sure of an HIV test result. What is needed is a
better test that can come up with results more
quickly.
Michael Buitron, Long Beach, 2008-04-16 14:01:24
There are other reasons not cited for the increase in
HIV among gay men. we have a new, younger group of
participants who have not been socialized into the
community through personal contact with other gay
men, but through a steady diet of abstinence-only
education, a hyper-***ualized media, decreased
funding for prevention that targets gay men, and the
lack of visible evidence of the ramifications of
living with and dying from AIDS.
Ted, Columbus, 2008-04-16 12:50:46
When are bi and homo men going to realize they have a
***ual addiction problem that has nothing to do with
"LOVE". Condom-schmombdom; They still don't work,
that's why women potitioned the government in the
1960-1970's to come up with birth control pills. If
condoms didn't prevent pregnancy, how will they
prevent the much smaller HIV AIDS virus from passing
through the pourous latex while they ride on the
larger sperme host? Abstinance and *** addiction
therepy is the answer. Gay *** = Death
http://www.poz.com/articles/hiv_prevention_internet_401_14435.shtml
by David Evans
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