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It is a lot harder when you are working face-to-face because you have to sort of summon up the effort to talk to somebody and to break the ice and to ask them to come home with you; whereas the Internet, everybody is there for the same reason; it is very quick, it is very easy.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.The Internet affords anonymity (There is a great New Yorker slide that says, "On the Internet, no one knows you're a dog.") So you can be whoever you want to be on the Internet.Internet partnering has become very acceptable, so that it has become the new relative norm of how to meet partners.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.You get on line, you want to get laid, you can have somebody at your house within an hour -- probably less in San Francisco! If you are experience is one that you are not crazy about, you can get back online and you can find somebody else to come over or to go to their house afterwards.Frank Strona: One of the things to keep in mind with Internet behavior is there is a perception of anonymity.

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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.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.I wanted to start the discussion more with evidence because there might be people who are skeptical or do not really understand what evidence there is out there that men who have sex with men and meet their sexual partners online have higher rates of unprotected sex and sexually transmitted diseases. We did a case-control study, which is kind of your typical type of evaluation to determine what risk factors are associated with cases and non-cases.

In this investigation, we found that 67% of these syphilis cases versus 19% of matched men who were non-syphilis cases had met recent partners in the chat room, and this was a statistically significant association.

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.