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One on one sessions Our one on one sessions provide a great opportunity for you to work though sexual issues, concerns or difficulties that you may be encountering. Our one on one sessions are unique and personalised and totally centred around you and what you feel comfortable chatting about. We can meet in person or we can chat on the phone or via a webinar. One thing is that there have been studies shown that gay men in particular, but as well as the bulk of the American population, gets their sexual health information online and reason being, "Well, where else are you going to get your sexual health information?

People are not talking to their physicians. We are not really an open society in talking to our friends about it, and from parent to child, you know, take it away! This has never been the greatest source of sexual health information. As adults, people are turning to the Internet because it takes away the shame and embarrassment. So we are reaching They are reading the news, they are reading Dan Savage s column, you know, whatever it is that they are doing online, looking for a movie timetable, and they are clicking.

So, I do not think we can completely dismiss online prevention but I do think we have to be careful and not assume that everything is going to work.

We were doing one-on-one outreach for a full year and decided that not only was it not cost-effective, but it was really hard to tell whether men were then going in to get tested after they had an interaction with an online outreach worker. Their follow-through, we provided some incentives for men who did get tested at City Clinic.

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Very, very hard to evaluate but the online prevention methods, partially because it is new and partially because you have to translate what happens online into action offline. FS: We have done the same.

We made that choice not to take CDC or federal funds or, in some cases, city funds so that we can do other things. Often because I have been a sexual health educator and am known for some of the same programs that get other folks in trouble: Sex club etiquette, you know, things like that. People have asked, "When are we going to put those on the site, so we have been in the studio about a month now doing video clips, right down from how to give a blow job, how to clean out your butt using a shower shot or an enema system, to relaxation techniques so that you can avoid tearing, to a full gamut of toys to condoms, how to choose different condoms.

So we are mixing them in to create a catalog of sexual health because there is no We need to have more clear visual and written messages that create gay male and gay bi-male sex as a healthy opportunity instead of being limited so often. JK: I think you have to put the prevention into the traditional prevention framework. If you think about primary prevention, we are trying to reduce exposure, awareness, education, risk reduction and certainly awareness on the Internet may not be the best way to do an awareness campaign.

When there is an outbreak of syphilis in San Francisco, it is usually done through the media, through billboards, through other kind of targeted street or venue-based population techniques. But if you want to get more into the knowledge and more in-depth area, I think that the Internet does afford a great way to enable people who are motivated and interested to really learn more, and then the challenge which in primary prevention right now is can the Internet afford a feasible and effective means for risk reduction?

So are there interventions that can be done and to date, there have not been any successful Internet-based risk reduction interventions. It is very difficult to retain people in cohort studies and that is a big challenge. And second part of prevention is what we call secondary prevention or early detection of infection and timely treatment.

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You can bring people into the fold of medical care. MV: I wanted to make sure we talked a little bit about successes GR: Over the past year or so, we have been doing qualitative interviews with staff at AIDS service organizations around the country who were doing online prevention programs and I thought Alberto [Curotto of CAPS] would like to talk just briefly about we found. I can give you my chair.

Alberto Curotto: Well, I would say that the most common form of intervention that has been reported by CBOs is outreach in chat rooms. It is cheap to do; that is the main reason why a lot of CBOs use it.

A lot of times they do not have any funds for this specific type of intervention, so they just use volunteer time or time from existing programs to do it and, in general, they report a lot of success. The successes are very anecdotal, though. It is just people are invited either by email or in physical locations, they are invited to visit the website.

These interventions are generally much more expensive.

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Like everything on the web, there is always a very large cost to initiate something. Then the hope is that if it works, it is there, it is online and live and people will continue to use it, but the initial costs are really, really large and CBOs normally cannot afford it.

So that is what we found. JK: So, Alberto, you talk about help worker outreach, websites and right now the City Clinic website is the second most frequently used website in the City after the jobs website Now without a comparison group, it is difficult to know what other means of outreach would have created.

We have also been involved with what is called "moderated chats" on Gay. K, is one of their more popular sites and then ideally, as Alberto mentioned, you want to do something that is going to be permanent and effective with what you might call a structural intervention. So how can you essentially change the environment and we have been dabbling in this. So I think that there is a lot more that could be done.

But evaluation, as you mentioned, is very difficult and in one comparison group, you do not really know but you can do other types of studies from street-based interviews, from cases and non-cases and find out whether their exposure to the Internet was protective or facilitated their access to health care. AC: I think what we also found from our qualitative interviews that we collected over the past three years is that one big problem in this online hookups is communication.

Communication online is not clear. It seems clear, but it is not. And this somehow has issued into the campaign that was mentioned earlier in the Castro MUNI Station, that is geared toward people, men who hook up online, but it focuses on communication. It is not about condom use, it is not What kind of mini-outcome measures from that type of campaign might be?

GR: We are doing intercept interviews with people to measure regions of the community and get people s reactions but I do not think there is a systematic evaluation.

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AUDIENCE: Has anyone looked at the most frequently used chat sites that actually have profiles and characterize the profile information that is included, like what portion of them actually has HIV status, condom use? Has anyone done anything, any survey like that? PH: We created a Yahoo! PH: Well, yeah.

So we created a Yahoo! A lot of the men tended to be non MSM-identified; a lot of them were married. Anal sex is probably too big of a step, so they look for oral sex. So I think [with sites such as SafeSexCity.

I think you put a line like "I am willing to I do not know. FS: Keeping in mind that there is a cost involved to the company that has to pay the programmer to put that in if it is not already existing.

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DL: You know what? I do not want to answer the question that way. And so, I still have that somewhere and I referred back to it because I think it is really interesting and would be really interesting to do that in a larger way and there may be So it may not even have to be done manually and I do think that would be interesting to say, "This is what is there" rather than "This is what we think you need. I do not necessarily think it is a bad idea. As Alberto said before, is bad communication worse than no communication?

Sometimes yes, sometimes no.

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It is not that hard. These guys are making tons of money; you cannot even imagine! And what we hear from the Internet service providers is, "We don t want to do any of this for you because it may turn away our customers.

You know, it s a turnoff not to turnon. Are they having trouble with their membership? But even the ones that are sex-specific, not Gay.

They changed their community norms to include some information like, "We ll work with the health department if we need to," "This is important to us. We care about your health and if you contact us about sexual health, we will talk to them, we will discuss it. It was not a big deal. There was no defensiveness on the other side. If you did a pre-post evaluation of a site, the content analysis of the chats and then structurally changed the profiles, you could probably measure the impact of that pre and post by doing an after-point content analysis of chats and connections.

DL: Right, and it all comes back to how do you measure behavior change? And this is an issue online or offline. I mean, unless you are sitting in the bedroom with the video camera, you know?

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FS: A lot of major Internet providers are open to conversations. So I think it is important to keep in mind that, you know, we are looking at it from one perspective. We are only one location, who is all trying to hit the same pot of pie for their own individual locations. We, I think, have a little bit different experience level with some of our programs but just to try to keep that in mind, too.

When we started this discussion, we were talking about what the problems were. They were all centered on forums and then when we launched into a discussion about what the interventions were. The first ones that were spontaneous interventions but there also this thing called education. Do we know anything about behavior change models? Norms predict behavior and knowledge predicts behavior, but they are two different predictors. We are wasting our energy.

PH: Right, but that is assuming that all health education efforts have a message, which I do not think ours do. We do not promote a specific message about anything. This finding holds more generally by sex and education level. Economics was also associated with the highest pay among social and behavioural science and law graduates for women as was the case for men. Although the specific fields appearing at the very bottom were not the same for men and women, there was considerable overlap in the fields associated with below-average pay for both sexes.

Another notable difference between the college and university results is the fact that business graduates fared much better at the university level than at the college level. Indeed, university business graduates registered average earnings that were often near the top among all disciplines.