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Frank Strona: One of the things to keep in mind with Internet behavior is there is a perception of anonymity.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.

The other reason why I think that there are problems with communication via the Internet, is -- and I think it is really just a continuum of what is happening offline -- is that safer sex does not seem to hold much meaning on the Internet anymore.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.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.It was actually one of the first published studies of a strong association between Internet sex partnering and syphilis transmission.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.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.

It is a lot cheaper to just go online and go to a chat room than to get up, go out of the house and go to a bar or a club or some other venue.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.ISIS has worked with online providers to provide online prevention initiatives. have documented high rates of unprotected sex among men recruited from online venues and there are several European studies that have looked at comparing, guys who say that they actually are using chat rooms to those that are not using chat rooms and there is a lot of information, a lot of data, showing that the chat room users are actually reporting higher rates of unprotected sex than the non-chat room users.Most of us are here because we are probably familiar with the recent studies that report high rates of unprotected sex and outbreaks of STDs among men who meet other men in Internet chat rooms.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.Whereas a lot of people in their profiles will put down "safer sex only," then they meet up, that means we do not have to have a discussion about it because, let's say I responded to an ad that said "safer sex only" or we both wrote "safer sex only." However, for me, "safer sex" is "no unprotected anal intercourse" and, for you, "safer sex" is "no anal intercourse at all." And then that is not being discussed. MV: So, is there a misperception with the Internet where it seems clear that you can say, "I'm HIV-negative, STD-free" but that does not get into when you were last tested or what that means for you, and so that it appears that it is all out there in the open but it is really not being addressed?

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