MSM and the Internet

The MSM community has embraced the accessibility, anonymity, and reach of online environments. As many as two-thirds of MSM are reported to actively use the Internet (Weatherburn et al., 2003), while up to one-third of MSM use the Internet to find male sex partners (Elford et al., 2001; Kim et al., 2001; Benotsch et al., 2002). The discretion and accessibility inherent in online socializing may make it easier for younger men, and men who do not necessarily identify as gay, to seek other men for sex. The Internet, and the online search engines, chat rooms, message boards, and media-sharing it provides, allow MSM to circumvent the potentially daunting and public ambiance of traditional gay venues, such as clubs, bars, bathhouses, and public sex environments (Rietmeijer et al., 2001; McFarlane et al., 2002). It may be for these reasons that MSM are significantly more likely to sexually engage with an online partner when compared with heterosexual men and women (McFarlane et al., 2000; Bull et al., 2001; Kim et al., 2001). MSM who seek sex partners online are also comparatively younger (Kim et al., 2001; Benotsch et al., 2002), are more likely to identify as bisexual or heterosexual, and are more likely to report sex with women (Ross et al., 2000; Rhodes et al., 2002; Weatherburn et al., 2003).

Accessing online sex environments has been associated with a greater likelihood of engaging in sexual risk behaviors among MSM. MSM who seek sex partners online have been shown to have more casual sexual partners (Kim et al., 2001; Benotsch et al., 2002), report higher rates of unprotected sex (Kim et al., 2001; Benotsch et al., 2002; Hospers et al., 2002), and report sex with an HIV-positive individual (Kim et al., 2001) than their counterparts who seek sexual partners offline. Furthermore, use of recreational drugs, such as MDMA (ecstasy), nitrites (poppers), methamphetamines, and sexual-performance enhancing medications (e.g. Viagra) is reported at significantly higher proportions by MSM who seek sex partners online (Benotsch et al., 2002; Mettey et al., 2003; Hirshfeld et al., 2004; Taylor et al., 2004).

Meeting sexual partners online has also been associated with higher rates of STI among MSM. In 1999, an outbreak of syphilis among MSM in San Francisco was tracked to individuals meeting online (Klausner et al., 2000). Similarly, an investigation into cases of rectal gonorrhea in San Francisco revealed that infected MSM were three times more likely to have met sexual partners online than were uninfected MSM (Kim et al., 2000). Studies of STI clinic clients have also shown that a large proportion of MSM clients use the Internet to find sex partners (Klausner et al., 2000; Hospers et al., 2002; McFarlane et al., 2002; CDC, 2003). At the same time, MSM who use the Internet to seek sex partners are also significantly more likely to report history of an STI than those who do not (Elford et al., 2001; Lau et al., 2003). MSM with a history of an STI are at higher risk for the transmission and acquisition of future STI, including HIV, by way of a documented record of high-risk behavior.

While the Internet has increased the risk of transmission of disease for some MSM, some HIV-infected MSM are employing the Internet as an agent for reducing risk. In this process, known as "serosorting," HIV-positive men seek sex partners online who are also HIV positive (Suarez and Miller, 2001; Hirshfeld et al., 2004), and engage in unprotected anal intercourse (Elford et al., 2001; Weatherburn et al., 2003) with these seroconcordant partners. The virtual anonymity and safety of the Internet enables HIV-positive MSM to disclose their HIV serostatus without fear of stigma, and expect that their online partners will do the same (Elford et al., 2001; Reitmeijer et al., 2001). Although some may argue that serosorting may have an impact in the reduction of HIV transmission, there is evidence that it may also promote the transmission of other STI (Elford et al., 2001), as well as acquisition of drug-resistant strains of HIV. A more troubling phenomenon is that some MSM who are HIV-uninfected report that they are more likely to have unprotected sex with HIV-infected partners (Elford et al., 2001), and sex in exchange for money or drugs (Kim et al., 2001) with men they have met online. Risk behavior among HIV-serodiscordant individuals who meet online increases the risk of HIV and STI transmission, facilitating the efficient propagation of infectious diseases.

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