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Background: Men who use the Internet to seek sex with other men (MISM) are increasingly using the Internet to find sexual health information and to seek sexual partners, with some research suggesting HIV transmission is associated with sexual partnering online. Aiming to "meet men where they are at," some AIDS service organizations (ASOs) deliver online outreach services via sociosexual Internet sites and mobile apps., Objective: To investigate MISM's experiences and self-perceived impacts of online outreach., Methods: From December 2013 to January 2014, MISM aged 16 years or older were recruited from Internet sites, mobile apps, and ASOs across Ontario to complete a 15-minute anonymous online questionnaire regarding their experience of online outreach. Demographic factors associated with encountering online outreach were assessed using backward-stepwise multivariable logistic regression (P<.05 was considered significant)., Results: Of 1830 MISM who completed the survey, 8.25% (151/1830) reported direct experience with online outreach services. Encountering online outreach was more likely for Aboriginal versus white MISM, MISM from Toronto compared with MISM from either Eastern or Southwestern Ontario, and MISM receiving any social assistance. MISM who experienced online outreach felt the service provider was friendly (130/141, 92.2%), easy to understand (122/140, 87.1%), helpful (115/139, 82.7%), prompt (107/143, 74.8%), and knowledgeable (92/134, 68.7%); half reported they received a useful referral (49/98, 50%). Few MISM felt the interaction was annoying (13/141, 9.2%) or confusing (18/142, 12.7%). As a result of their last online outreach encounter, MISM reported the following: better understanding of (88/147, 59.9%) and comfort with (75/147, 51.0%) their level of sexual risk; increased knowledge (71/147, 48.3%); and feeling less anxious (51/147, 34.7%), better connected (46/147, 31.3%), and more empowered (40/147, 27.2%). Behaviorally, they reported using condoms more frequently (48/147, 32.7%) and effectively (35/147, 23.8%); getting tested for HIV (43/125, 34.4%) or STIs (42/147, 28.6%); asking for their partners' HIV statuses (37/147, 25.2%); and serosorting (26/147, 17.7%). Few MISM reported no changes (15/147, 10.2%) and most would use these services again (98/117, 83.8%). Most MISM who did not use online outreach said they did not need these services (1074/1559, 68.89%) or were unaware of them (496/1559, 31.82%)., Conclusions: This is the first online outreach evaluation study of MISM in Canada. Online outreach services are a relatively new and underdeveloped area of intervention, but are a promising health promotion strategy to provide service referrals and engage diverse groups of MISM in sexual health education.

Researchers use protocols to screen for suspicious survey submissions in online studies. We evaluated how well a de-duplication and cross-validation process detected invalid entries. Data were from the Sexually Explicit Media Study, an Internet-based HIV prevention survey of men who have sex with men. Using our protocol, 146 (11.6 %) of 1254 entries were identified as invalid. Most indicated changes to the screening questionnaire to gain entry (n = 109, 74.7 %), matched other submissions' payment profiles (n = 56, 41.8 %), or featured an IP address that was recorded previously (n = 43, 29.5 %). We found few demographic or behavioral differences between valid and invalid samples, however. Invalid submissions had lower odds of reporting HIV testing in the past year (OR 0.63), and higher odds of requesting no payment compared to check payments (OR 2.75). Thus, rates of HIV testing would have been underestimated if invalid submissions had not been removed, and payment may not be the only incentive for invalid participation.

One key component in HIV prevention is serostatus disclosure. Until recently, many studies have focused on interpersonal factors and minimally considered meeting venues as they pertain to disclosure. Using data (N = 3,309) from an online survey conducted across 16 U.S. metropolitan statistical areas, we examined whether HIV serodisclosure varies by online/offline meeting venues in both protected and unprotected anal intercourse encounters. Most of the sample (76.9 %) reported meeting men for sex (last 90 days) both online and offline, versus 12.7 % offline only and 10.4 % online only. After controlling for other variables, we found that the men who meet partners in both online and offline were 20~30 % more likely to report disclosing their HIV status prior to sex than men who met their partners exclusively either offline or online. While previous studies have identified the Internet as a risk environment, our findings suggest bi-environmental partner seeking may also have beneficial effects.

Researchers new to online qualitative health research frequently have questions about how to transfer knowledge of offline data collection to an online environment. In this article, we present best-practice guidelines derived from the literature and our experience to help researchers determine if an online qualitative study design is appropriate for their research project and, if so, when to begin data collection with a hard-to-reach population. Researchers should reflect on administrative, population, and data collection considerations when deciding between online and offline data collection. Decisions must be made regarding whether to conduct interviews or focus groups, to collect data using asynchronous or synchronous methods, and to use only text or to incorporate visual media. Researchers should also reflect on human subjects, recruitment, research instrumentation, additional data collection, and public relations considerations when writing protocols to guide the research team's response to various situations. Our recommendations direct researchers' reflection on these considerations.

Nearly 70 % of HIV+ men who have sex with men (MSM) are estimated to have contracted HIV from a main partner. We examine whether condom use varies by relationship configuration, including open relationships with and without cheating. 656 MSM in committed relationships were recruited through a sexually explicit social networking website. Of the 55 % of MSM who had anal sex with a non-main partner in the past 90 days, two-thirds did not use a condom. Adjusting for covariates, MSM in relationships characterized as open with cheating versus monogamous were more likely to have unprotected anal sex with both main and non-main partners. MSM who perceived that their partner played around or cheated were more likely to have unprotected anal sex with a non-main partner. Prevention messages should attempt to reduce cheating and increase personal responsibility for protecting partners from HIV. Messages should be tailored to reflect open and monogamous relationships.

Online social media and mobile technologies hold potential to enhance adherence to antiretroviral therapy (ART), although little is known about the current use of these technologies among people living with HIV (PLWH). To address this gap in understanding, 312 PLWH (84% male, 69% White) US adults completed an online survey in 2009, from which 22 persons accepted an invitation to participate in one of two online focus groups. Results showed that 76% of participants with lower ART adherence used social networking websites/features at least once a week. Their ideal online social networking health websites included one that facilitated socializing with others (45% of participants) and ones with relevant HIV informational content (22%), although privacy was a barrier to use (26%). Texting (81%), and to a lesser extent mobile web-access (51%), was widely used among participants. Results support the potential reach of online social networking and text messaging intervention approaches.

The Men's INTernet Study II included a randomized controlled trial to develop and test an Internet-based HIV prevention intervention for U.S men who use the Internet to seek sex with men. In 2008, participants (n = 560) were randomized to an online, interactive, sexual risk-reduction intervention or to a wait list null control. After 3 months, participants in both conditions reported varying degrees of change in sexual beliefs or behaviors. Using content analysis and logistic regression, this mixed-methods study sought to understand why these changes occurred. Level of critical self-reflection of assumptions appeared to facilitate the labeling of sexual beliefs and behaviors as risky, which in turn encouraged men to commit to and enact change. New HIV prevention interventions should include activities in their curriculum that foster critical self-reflection on assumptions.

This study examined reasons for non-use of condoms among an online survey sample of 462 non-condom using men who have sex with men to: (1) identify major domains, themes and categories encompassing reasons for non-use of condoms and (2) examine whether reasons varied by role-in-sex (insertive or receptive) and meeting venue (online or offline). A thematic analysis was completed on participant responses to an open-ended question about reasons for non-condom use. Preference for not using condoms and contextual factors were the top two reasons given for not using condoms, followed by a reasoned judgment based on risk assessment, relationship status and interpersonal communication. No major differences were found between men who reported non-condom use at last receptive and insertive anal intercourse. By contrast when meeting online, men were more likely to report reasons for non-condom use that corresponded to individual preference and mutual agreement not to use condoms. When meeting offline, men were more likely to cite reasons related to context and relationships. In developing HIV-prevention interventions for this population, researchers should address both venues separately, as reasons why men engage in non-use of condoms appear to differ.

To inform health information targeting, we used cross-sectional data from 2577 HIV-negative MSM to identify groups of men who access similar sources. Offline, more men reported talking to a physician about HIV than about having sex with men; fewer than half attended a safer sex workshop. Online, men sought information primarily through Internet search engines, GLBT websites, or health websites. A latent class analysis identified four groups of health seekers: minimal health seekers, those who accessed online sources only, those who sought information mostly from health professionals, and those who sought information from diverse sources. Minimal health seekers, 9% of the sample, were the group of greatest concern. They engaged in unprotected anal sex with multiple partners but infrequently testing for HIV or sought sexual health information. By encouraging health seeking from diverse sources, opportunities exist to increase men's knowledge of HIV/STI prevention and, when necessary, access to medical care.

The aims of this study were to understand strategies and consistency of strategy used by HIV-negative and HIV-positive men who have sex with men (MSM) to ascertain the HIV status of their male sexual partners and their associations with unprotected anal intercourse (UAI) and serodiscordant UAI (SDUAI) in the past 3 months. Participants (n = 640) completed an online survey in December 2007. The most commonly reported strategy was checking online profiles (85%), followed by talking before sex (82%), talking after sex (42%), and guessing (29%). Adjusting for demographic and behavioral factors, guessing the HIV status of sex partners was associated with greater UAI and SDUAI partners, as was using an inconsistent strategy. Ascertaining HIV status before having sex was associated with fewer SDUAI partners. Prevention should target MSM who guess the HIV status of their sex partners and emphasize explicit safer sex agreements.

The present study explored the relationship between compulsive sexual behavior (CSB) and unprotected anal intercourse (UAI) for men who have sex with men (MSM) across a number of ethnic/racial groups and who used the Internet to seek sexual partners. A sample of 2,716 MSM (512 Asian, 445 Black, 683 Latino, 348 Other, 728 White) completed on online survey that collected information about their sexual behaviors with partners met online and offline. The survey also included the Compulsive Sexual Behavior Inventory (CSBI). Consistent with the notion that CSB is a stable trait, higher scores on the CSBI were associated with greater odds for engaging in UAI, regardless of the context in which sex partners were met (online or offline). Differences in median CSB scores were generally similar across racial and ethnic groups. The median CSB score was significantly higher for HIV-positive participants than for HIV-negative participants. HIV-prevention interventions are needed among MSM, but should take into account that some may be resistant to risk reduction strategies because of CSB.

Objective: The primary objective of this study was to develop and test a highly interactive Internet-based HIV prevention intervention for men who have sex with men (MSM). MSM remain the group at highest risk for HIV/AIDS in the United States and similar countries. As the Internet becomes popular for seeking sex, online interventions to reduce sexual risk are critical. Given previous studies, a secondary objective was to demonstrate that good retention is possible in online trials., Design: A randomized controlled trial with 3-month, 6-month, 9-month, and 12-month follow-up design was employed., Methods: In 2008, 650 participants were randomized to an online, interactive sexual risk reduction intervention or to a waitlist null control., Results: Retention was 76-89% over 12 months. At 3-month follow-up, results showed a 16% reduction in reported unprotected anal intercourse risk among those in the treatment condition versus control [95% confidence interval (95% CI) of rate ratio: 0.70-1.01]. No meaningful differences were observed at 12-month follow-up., Conclusion: Internet-based, persuasive computing programs hold promise as an effective new approach to HIV prevention for MSM, at least in the short term. Further, online trials can be conducted with acceptable retention provided strong retention protocols are employed. Four directions for future research are identified.

The Internet is a major source of HIV-related information and resources for persons recently diagnosed with HIV/AIDS (PRDHA). This study examined the types of HIV-related websites that appear as a result of HIV-related keyword searches and the extent to which website information targets PRDHA. The first page of HIV-related webpages from 18 keyword searches was coded. Among 137 webpages meeting inclusion criteria, 63% represented HIV-informational websites, 31% targeted HIV-positive individuals, and over half contained or provided access to HIV prevention, treatment, and transmission information. Thirty-three percent of webpages contained or provided access to PRDHA-targeted information, with a greater percentage of those webpages having mobile, non-English, and "Ask the Expert" features compared with non-PRDHA targeted webpages. Implications for PRDHA include the following: (1) they should explore HIV-related websites to gain insight into the credibility of the information contained on those sites; (2) PRDHA must be aware that HIV-related websites have the potential to elicit dated, emotionally distressing, or irrelevant information; and (3) to obtain information that relates to their demographic and situational profile, they may wish to use specific key terms (e.g., "HIV women") rather than attempting to navigate webpages that arise from general search terms (e.g., "HIV"). Recommendations for future development of online resources for PRDHA include providing HIV-relevant information in a stepwise fashion, providing demographically targeted HIV information, and greater utilization of mobile technology.

Many HIV-positive persons use the Internet to address at least some of their needs for HIV-specific information and support. The aim of this multimethod study was to understand how a diverse sample of persons who were recently diagnosed with HIV (PRDH) used the Internet after an HIV diagnosis and their perceptions of online HIV-related information and resources. HIV-positive persons (N = 63) who had been diagnosed since the year 2000 were recruited primarily through HIV-related websites and HIV medical clinics. One third of participants (33%, n = 21) were gay or bisexual men, 25% (n = 16) were heterosexual men, 32% (n = 20) were heterosexual women, and 10% (n = 6) were transgender women (male to female). Semistructured interviews and brief postinterview surveys were used to collect qualitative and quantitative data. Qualitative findings suggested that the most appealing websites to PRDH included those that: (1) provided usable information on topics of immediate concern; (2) used accessible formats that were easy to navigate; (3) were perceived as trustworthy, and (4) provided access to diverse perspectives of persons living with HIV/AIDS. Topics that PRDH found most useful included various medical treatment-related issues, tools for coping with depression and fear, and learning how others cope with HIV. Incorporating the perspectives of HIV-positive persons into the design and content of HIV-related websites is important to enhance their appeal for this diverse and growing population.

There are no published reports on ways in which caregivers use the Internet to support people living with HIV/AIDS (PLWHA). Five hundred caregivers were recruited in a 5-week period to complete an online survey of demographic characteristics, Internet use, online health-seeking self-efficacy, and ways they used the Internet to support PLWHA. Caregivers were on average 39 years old, white, heterosexual, highly educated, and Internet-savvy. Most provided informal care only (e.g., as a friend; 78%), with the remainder divided among those who provided care exclusively as part of their job (11%) or in both informally and professionally (11%). Most (72%) respondents visited a general medical website for HIV information, and 44% shared information from the Internet with PLWHA. Compared to informal caregivers, caregivers whose roles were both informal and professional had greater odds of recently sharing information from the Internet with PLWHA (odds ratio [OR] = 2.03) and ever printing off information from a website to give to PLWHA (odds ratio [OR] = 3.87). Professional caregivers had higher odds of ever printing off information from a website to give to PLWHA (OR = 1.87), but lower odds of sending an e-mail with a website link (OR = 0.32) than informal caregivers. These findings suggest that websites providing HIV-related resources should consider the various ways in which caregivers use their content, and how utilization differs by role. More research is needed to understand how people providing care for PLWHA share information and support each other and the impact that doing so has on caregiver burden and treatment outcomes for PLWHA.

This study assessed the feasibility of online recruitment of high-risk Latino men who have sex with men (MSM) for HIV prevention survey research and investigated the relationship between Internet use and unsafe sex. Participants (N = 1,026) were Internet-using Latino MSM living in the U.S. recruited using online banner advertisements. Respondents completed a cross-sectional, online survey in English or Spanish. Sample characteristics reflected national statistics within 5%. Nearly all (99%) reported having used the Internet to seek sex with another man. Two-thirds of respondents reported having unprotected anal sex with > or =1 man in the last year, 57% of these with multiple partners. Participants reported engaging in anal sex and unprotected anal sex with nearly twice as many men first met online versus offline, but risk proportions did not differ. Internet-based HIV prevention research is possible even with geographically-dispersed minority populations. Efficiency appears the primary risk associated with meeting partners online.

This study sought to identify the magnitude of HIV risk in a diverse sample of Men who use the Internet to seek Sex with Men (MISM), and test if specific subpopulations are at sufficiently increased risk to warrant tailored interventions. A sample of 2,716 American MISM, stratified by race/ethnicity, completed an Internet survey of online and offline sex seeking behavior during the last 3 months. Across most demographics, a minority of MISM reported unprotected anal intercourse with male partners (UAIMP). Across all demographics, risk of UAIMP substantially increased with partners met online. Other predictors of increased online partner risk include being 30-39 years old, having children, not living in the Northeast, and low income. HIV-positive men and African Americans reported increased online and offline partner risk. To address higher risk of UAIMP, online HIV interventions should prioritize the needs of MISM, especially HIV-positive men, with content focused on online-mediated liaisons.

As part of a study to develop effective Internet-based HIV prevention interventions for Men who use the Internet to seek Sex with Men (MISM), we sought information from the target population on; (a) acceptability of sexually explicit media; (b) interest in specific content areas; and (c) identification of credible sources of information. A cross-sectional stratified Internet-based survey design was employed. Between September and November 2005, we recruited 2,716 MISM through Gay.com stratified across race/ethnicity to ensure adequate racial/ethnic diversity. Sixteen Likert-type items assessed acceptability of sexual explicitness, 24 items identified topics for inclusion, and two assessed sources of information. There was near universal acceptability for highly sexually explicit education. Over 75% reported high interest in 10 sexual health topics. HIV positive MISM and MISM engaged in unprotected anal sex with multiple male partners reported significantly less interest in HIV prevention specific content. Differences across age, race/ethnicity and education were identified. Idiosyncratic searches and gay sites were frequently cited sources of information; however blogs, government, and media sites were not. It is acceptable for web-based HIV prevention for MISM to be highly sexually explicit and to provide detailed content relevant to men's sexual health. Since demographic differences in acceptability and content were minor, it is appropriate for interventions to target across demographics. Interventions to re-engage men engaging in high risk and HIV + MISM should be considered. Leading health agencies should review whether their web information is retrievable, credible and useful to those most at risk.

The aim of this study was to examine online profile and in-person communication patterns and their associations with unprotected anal intercourse (UAI) in online and offline partnerships between men who have sex with men (MSM) who have never tested for HIV ("Never Tested"), had been tested at least once for HIV ("Tested"), and had tested positive for HIV. Between September and November 2005, 2,716 MSM participated in a one-time online survey. Although 75% and 72% of the Tested and Never Tested groups disclosed a HIV-negative status in all of their online profiles, 17% of HIV-positive participants did so. Exchanging HIV status information was highest among the Tested group, while HIV-positive men were most likely to negotiate UAI. Serodisclosure was not an independent predictor of UAI, although making an explicit agreement to engage in UAI was. Sexual communication and risk-taking patterns differed by testing status. Explicit agreements to avoid UAI were associated with reduced sexual risk-taking. Misrepresentation of HIV status is an identified challenge for HIV prevention.

Objectives: We examined the characteristics of young Internet-using men who have sex with men (MSM) and risks associated with seeking sex online, offline, or through both strategies., Methods: Data were obtained from MSM aged 18 to 24 years who completed a 45-minute online survey regarding sex and Internet use in the preceding 3 months., Results: Significantly more Internet-using MSM who had met sexual partners both online and offline (43%) reported unprotected anal intercourse than did those who had met sexual partners exclusively online (29%) or offline (34%). MSM who met sexual partners exclusively offline reported the fewest partners but the greatest proportion of partnerships involving unprotected anal intercourse (49%). Meeting sexual partners both online and offline (odds ratio [OR]=3.38-58.42) and being drunk (OR=1.57) or high (OR=2.24) increased the odds of having more sexual partners. The same factors increased the odds of having unprotected anal intercourse (online and offline sexual partners, OR=1.60; being drunk, OR=1.43; being high, OR=1.61)., Conclusions: Risky sexual behavior was prevalent among all of the study subgroups. Our findings suggest that online sex seeking is associated with greater numbers of sexual partners but neither promotes nor discourages unprotected anal intercourse. Regardless of where sexual partners met, being drunk and high were significant risks for unprotected anal intercourse.

The aim of this paper is to advance rigorous Internet-based HIV/STD Prevention quantitative research by providing guidance to fellow researchers, faculty supervising graduates, human subjects' committees, and review groups about some of the most common and challenging questions about Internet-based HIV prevention quantitative research. The authors represent several research groups who have gained experience conducting some of the first Internet-based HIV/STD prevention quantitative surveys in the US and elsewhere. Sixteen questions specific to Internet-based HIV prevention survey research are identified. To aid rigorous development and review of applications, these questions are organized around six common criteria used in federal review groups in the US: significance, innovation, approach (broken down further by research design, formative development, procedures, sampling considerations, and data collection); investigator, environment and human subjects' issues. Strategies promoting minority participant recruitment, minimizing attrition, validating participants, and compensating participants are discussed. Throughout, the implications on budget and realistic timetabling are identified.

The Internet has developed as a major site for sexual activity, both cybersex and for making contacts for sex in real life (IRL). As part of a major study of HIV-risk behavior on the Internet and IRL , we obtained on-line responses from 1,017 Latino men who have sex with men (MSM) in the U.S. Open-ended questions solicited responses regarding whether respondents preferred to meet sexual partners first IRL (48.4%), on the Internet (31.6%), or "it depends" (20%), and "why?". Data were analyzed by theme, with themes grouped into overarching domains. Data indicate that for those preferring the Internet, themes represented were ease of Internet use, its advantages for people who were shy, and its anonymity, safety, the excitement and opportunity for experimentation of Internet contact, ability to avoid interpersonal contact, and control of visuals and the environment. Reasons for preferring meeting IRL included some of the same themes, but emphasizing the importance of a "real presence" and the possibility to build a relationship. Where "it depends", key themes were contextual: mood, time, setting, alcohol and drug use, sexual needs and urgency, and relationship intentions. Antagonistic advantages were often noted for cybersex and IRL. These data suggest that motivations for making Internet sexual contact in MSM are complex, depend on the context and nature of the relationship sought, and that the Internet has allowed the development of a class of sexual contacts located between IRL and fantasy.

As part of a wider study of Internet-using Latino men who have sex with men (MSM), we studied the likelihood that HIV-negative (n=200) and HIV-positive (n=50) Latino MSM would engage in sexual negotiations and disclosure of their HIV status prior to their first sexual encounters with men met over the Internet. We also analyzed the sexual behaviors that followed online encounters. Our results showed that both HIV-negative and positive men were significantly more likely to engage in sexual negotiation and serostatus disclosure on the Internet than in person. Those who engaged in sexual negotiations were also more likely to use condoms for anal intercourse. Compared to HIV-negative MSM, HIV-positive MSM were significantly less likely to disclose their serostatus, and 41% of them acknowledged having misrepresented their serostatus to a prospective sexual partner met over the Internet. Although similar proportions of HIV-positive and negative men had condomless anal intercourse, HIV-positive MSM were more likely to report lack of intention to use condoms. Pleasure was the reason most frequently cited for lack of condom use. Cybersex was reported by only one-fifth of the sample. We conclude that the Internet, an understudied milieu of sexual networking, may present new possibilities for the implementation of risk reduction strategies, such as the promotion of sexual negotiation prior to first in-person encounter and serostatus disclosure.

Experiences of men who have internet sex with men were studied to determine the level of misrepresentation in real life and on the Internet of physical, relationship, sexual interests, and HIV status. An internet-based questionnaire in English and Spanish ($20 compensation) recruited 1,026 Latino MISM over 3 weeks. Four 'fib' scales were created to measure misrepresentation by the respondent and to the respondent on the Internet and IRL. Overall, respondents rated being misrepresented to on the Internet significantly highest, followed by being misrepresented to IRL and misrepresenting themselves to others on the Internet, and misrepresenting themselves to others IRL lowest. For HIV status there were no differences between Internet and IRL misrepresentation by others and Internet and IRL misrepresentation by self, but a significant difference between HIV status misrepresentation by self and others. Misrepresenters were more likely to have had cybersex before meeting their last partner and to prefer cybersex, to be more sexually compulsive, and to speak and think more in Spanish. Social desirability considerations account for the higher misrepresentation on physical characteristics and sexual interests by others, and higher misrepresentation on the Internet. However, misrepresentation of HIV status was the lowest category and while it was misrepresented more often by others than self, there were no internet/IRL differences. Data suggest that HIV misrepresentation occurred for 20% of men and was lower than other forms of misrepresentation. Implications for HIV prevention are discussed, along with the concept of levels of accuracy in internet communications.

To identify biases and threats to validity of Internet survey data collection on HIV-related risk behaviors, we studied 1,546 Latino men who have sex with men on the Internet recruited through banner impressions on a leading national gay Internet site. The study could be completed in English or Spanish. Of those commencing, 33.6% dropped out before completing the 450-field questionnaire. None of the linguistic variables (level of use of Spanish or English) predicted dropout. However, dropouts were more likely to identify as Puerto Rican or Black, to reject the $20 compensation or offer it to a charity, to not have met men for sex on the Internet, to identify as bisexual or heterosexual, and to use Web sites or personal ads for contact and to use the Internet less at home than those who completed the study. Men in seroconcordant monogamous relationships and those who had not met a man for sex on the Internet were also more likely to drop out. These data suggest that there are no linguistic and few demographic and Internet use variables that are associated with dropout. Issues of compensation and respondent characteristics that make it likely that there will be a large number of inapplicable data fields in the questionnaire appear to be significant predictors of dropout. Although there were many data missing, the dropouts did not appear to be at greater HIV-associated risk than the completers. The fact that there appear to be few systematic demographic or Internet use biases in dropouts suggests that the completers do not represent a seriously skewed sample of those Latinos who commence the Internet survey.

Cybersex (engaging in sexual self-stimulation while online with another person) and meeting partners for sex are commonly reported among men who have Internet sex with men (MISM). We studied 1,026 Latino MISM in the US and constructed a scale to measure beliefs about cybersex. Respondents were recruited to an online Internet study and compensated for their effort. Factor analysis indicated that there were three dimensions: (1) liking cybersex: perceived anonymity and safety of cybersex; (2) potential for greater IRL interaction in seeking partners on the Internet; and (3) a dimension of negative beliefs about Internet contacts which was not psychometrically stable. Safety referred to physical and HIV-related safety. We formed two scales to describe the first two dimensions. Respondents who were high on the 'liking cybersex: perceived anonymity and safety' scale were more likely than low scorers to use chat-rooms and webcams. They were also more likely than low scorers to have had cybersex and phone sex before meeting. Those who were high on the 'IRL interaction' scale were more likely than low scorers to use e-mail, bulletin boards and paid websites. However, there was significantly less disclosure about HIV status and discussion about safer sex by those higher on the 'IRL interaction scale', and when sex in real life did occur, those higher on the 'IRL interaction' scale were more likely to have receptive oral or anal sex, whereas those high on the 'liking cybersex: perceived anonymity/safety' scale were less likely to have insertive sex or be drunk/high. MISM scoring high on the 'IRL interaction' scale were significantly more likely than low scorers to prefer to meet partners on the Internet. We discuss the implications of the Internet for MSM and for sexual IRL interactions in the Internet age.

Indian men who have sex with men are disproportionately impacted by HIV. While prevention efforts to date have focused on men who visit drop-in centers or physical cruising sites, little is known about men who are meeting sexual partners on virtual platforms. This paper explores issues related to sexual identity and sexual behaviors in an online sample of men who identified as gay (n = 279) or bisexual (n = 123). There were significant differences in outedness between the two groups, with 48% of bisexually identified men reporting that they were out to "no one" and 82% stating that they present themselves as heterosexual to family and friends. Corresponding rates for gay-identified men were 15% and 41%, respectively (both p