Sex and the Internet

Because the media have always been used to facilitate inter-personal contacts and the formation of relationships, recent reports about the Internet as a burgeoning sex-seeking environment [1–4] should not come as a surprise. Internet postings are not very different from the sex-seeking contact advertisements placed in newspapers and magazines probably for as long as these media have been circulating. However, the potential of instant interaction with many like-minded people in a relatively anonymous fashion enhances the use of the Internet for sex-seeking purposes. This use will likely further increase as more people are coming on-line. The relative privacy of initiating sex contacts also sets the Internet apart from bars, bath houses and other public sex environments, where the atmosphere may be discouraging to those who are less open about their sexual intentions. Indeed, a participant in a sexually explicit sexual ‘chat’ can terminate the interaction at any time without any negative consequences, whereas this may be more problematic in a ‘face-to-face encounter'. The immediacy of the Internet allows for a virtual encounter to be followed by a physical encounter quickly, and in the sense that there are more partners to choose from and less time to reconsider such a follow-up (as was the case with the old-fashioned newspaper ad), the Internet enhances sex-seeking efficiency in the same way that it has enhanced the efficiency of work, shopping, and leisure activities. In our studies, for example, we found that persons seeking sex on the Internet had greater numbers of sex partners than those who did not seek sex on-line. We also found that more than 65% of persons who were seeking sex on the Internet, actually had sex with an Internet partner and that only 44% of these used a condom the last time they had sex with an Internet partner [2]. Transmission of sexually transmitted infections has also been linked to Internet use. In a recent study from San Francisco, a syphilis outbreak among men who have sex with men (MSM) appeared to be related to on-line recruitment of sex partners [5]. In this issue of AIDS, Elford et al. add to our knowledge with data from a survey they conducted among MSM recruited in London gyms [6]. They too found that Internet sex seeking is very common among MSM, and that Internet sex seeking is part of a high-risk behavioral repertoire. For example, their finding that Internet sex seekers were more likely to have a sexually transmitted disease (STD) and that HIV-seronegative sex seekers are likely to be unaware of the HIV status of their partners, including those they meet via the Internet, raises concern. However, another important finding from their study suggests that HIV-infected MAM are more likely to select seroconcordant partners. To the extent that the Internet helps seroconcordant partners find one another, it may be seen from a public health perspective as having preventive value. This value gains in importance when considering the possibility that increasing numbers of HIV-infected persons are resuming sexual activity as a result of treatment-related improvements in physical and mental well-being. It should be noted, as the authors indicate, that in this study, information on sex partners was not specific as to where they were recruited (via Internet or otherwise), so that no conclusions could be drawn regarding the sero-status of Internet-recruited sex partners. The hypothesis is nonetheless very appealing and clearly deserves further study. Research regarding Internet-related sexual behavior thus far has largely focused on MSM and less on heterosexual men and women. It may be that MSM are currently the group most actively using the Internet for sex-seeking purposes, but there is no reason to believe that this medium is less appealing to heterosexuals, particularly those who are coming of age in the on-line era. Among youth, the combination of hormones, invincibility, and ease of finding sex partners may enhance the epidemics of sexually transmitted infections already highly prevalent in this population. On the other hand, the Internet may also play an important role in prevention of STD/HIV. It would, for example, be important to know to what extent persons who use the Internet to seek sex, also use this medium to access information about HIV and sexually transmitted infections and may thus be receptive to HIV prevention messages. The finding for Elford et al. that sex-seeking HIV-negative men in their study were significantly more likely to also access the Internet for HIV and health information than those not seeking sex [6], is encouraging. In the end, for the purposes of HIV prevention, the risks of Internet use may be balanced by its benefits.