Media Coverage: High Risk Sex in Cyberspace

by Bob Roehr, San Francisco Bay Area Reporter, August 3, 2000

Sex drives the Internet. Fully a third of users log on with lust in mind, says survey research. Porn sites are one of the few types of e-commerce pulling in profits hand over fist. Public health officials are finally waking up to those facts and are beginning to study the phenomena.

Articles in the July 26 issue of the Journal of the American Medical Association suggest that Internet sex may carry a greater risk of exposure to sexually transmitted diseases. No, the one-handed kind of Web sex is completely safe, it's folks who hook up in chat rooms or through bulletin boards and then physically meet to do the dirty who are more disease-prone.

Mary McFarlane and colleagues with the Centers for Disease Control and Prevention looked to see if there was a link between cyberspace and people visiting a STD clinic in Denver. They surveyed 856 clients over a nine-month period that ended in April.

It was a frisky group of all orientations – a quarter claiming seven or more partners over the past 12 months – who engaged in oral sex (89 percent), vaginal sex (74 percent), and anal sex (a surprisingly high 41 percent). One-third identified as gay or bisexual.

The gender bias was readily apparent; women constituted 30 percent of clinic clients, and only 10 percent of the 135 people who said they sought sex partners online.

Gay and bisexual males clearly are leaders (87 percent) among the 10 percent (88 people) who sought and consummated sex through cyberspace. The online sex seekers reported less vaginal sex and more oral and anal sex than those who picked up partners the old fashioned way. They had a greater number of partners and were twice as likely (29 percent) to report having had sex with someone known to be HIV-positive.

On the other hand, they also "were more likely to have used a condom during their last sex act [52 percent versus 38 percent for offline clients]," she said.

"The Internet clearly has had a role in the solicitation of risky sex partners," McFarlane concluded. "Seeking sex on the Internet may be a potential risk factor for STD/HIV."

While the general link between risky behavior and STDs is clear, this study did not measure those outcomes. Thus it is impossible to know the effect of increased condom use by those who engaged in higher risk activity. Still, the low use of condoms among sexually active people, regardless of how they meet their partners, means that new HIV and STD infections will continue to occur.

In a companion article, Jeffrey Klausner and colleagues at the San Francisco Department of Public Health traced an "outbreak" of syphilis through cyberspace, which occurred last summer.

During discussions with two gay men with early-stage syphilis, DPH learned that both had met a majority of their sex partners through a chat room called SFM4M. The department worked with the Internet service provider hosting that site, local publications, and gay organizations to alert the community to the risk of syphilis and the chat room nexus.

America Online refused DPH's request to identify the chat room users, since there was no court order. Some activists were critical of DPH and the Internet service provider, saying they were against gay male sex.

Client visits shot up 18 percent at the city STD clinic the next month. And the total effort identified five additional syphilis infections in men who met through the SFM4M chat room. Through these voluntary efforts, DPH was able to medically screen more than twice as many named sex partners as is common with exposure to syphilis.

"The Internet has become an efficient facilitator of behaviors and practices that have been taking place for many years among certain high-risk individuals," wrote the CDC's Kathleen Toomey and Richard Rothenberg in an accompanying editorial in JAMA.

"The real news is not that such activities are occurring but that the public health establishment had its feet planted firmly in the last century and did not anticipate this inevitable response to the new technology."

They mentioned the closing of gay bathhouses in the 1980s to reduce the risk of HIV transmission and acknowledged that "closing 'virtual' anonymous meetings sites [online] is not even a consideration, much less a controversy." They said these examples reinforce the need for patient confidentiality as "a basic tenet" of public health.

The challenge for doctors is to remember to ask patients with STDs about their Internet habits. Public health officials must learn to use this communications tool as a way to educate and empower sexually active people to protect themselves.

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