AIDS Behav (2012) 16:396–403 that the Internet plays in methamphetamine use and transmission risk behavior may lead to new opportunities for methamphetamine use and risky sexual behavior screening, counseling and referral to treatment. The Inter- net may be a powerful means to increase the availability of those and new interventions. Our study examined methamphetamine use, sexual behavior and Internet use among HIV-infected patients seeking care in two San Francisco clinics. In prior surveys in 2004 and 2006 we demonstrated that methamphetamine use was associated with an increased number of sex part- ners and decreased adherence to antiretroviral therapy [9, 24]. We repeated the survey in 2008 to reassess the prev- alence of methamphetamine use among different demo- graphic groups, its association with sexual risk behavior, and also to expand our understanding of the potential role of the Internet in the HIV-infected population which had not been speciﬁcally addressed in previous studies. We expected that the use of the Internet to ﬁnd sex partners would be common among this population, and that this practice would be associated with both methamphetamine use and risky sexual behavior. Methods Survey Methods Between May and July 2008 we systematically distributed a brief self-administered anonymous survey to patients seek- ing care at two University of California, San Francisco (UCSF) outpatient HIV clinics: one at San Francisco General Hospital, a county hospital serving a largely low-income, publicly insured population (County), and one at Mofﬁtt Hospital, a university-based clinic that serves a larger pro- portion of patients with private insurance (University). At the County clinic, a staff person from the San Francisco Department of Public Health offered the survey to patients in the waiting room and kept a tally of the number of patients who declined to complete the survey and reasons why; at the University clinic, a nurse offered the survey to patients as she conducted patient intake, and kept a similar tally. Duplicate surveys were excluded. The response rate at the County was 71% and the response rate at the University was 72%. We collected information on demographics (age, race, gender, gender of sex partners, and monthly income), sexual activity (number of sex partners in last 4 weeks and 6 months, use of Internet sites to ﬁnd sex partners, frequency of unprotected sex), frequency of methamphetamine use (prior 12 months, prior 4 weeks, and if the patient used in the prior 4 weeks they were asked if their use was less than weekly or more than weekly), route of use, patient-provider communication about methamphetamine use (e.g. ‘‘Has 397 your doctor asked if you use Meth?’’), utilization of and referral to methamphetamine treatment programs, and uti- lization of the Internet to obtain methamphetamine. Respondents who used methamphetamine in the last 12 months were asked to complete ﬁve additional metham- phetamine dependency screening questions [25, 26]. In addition questions on monthly income (‘‘Monthly Income: Less than $2,000; More than $2,000’’) and the use of the Internet—both for ﬁnding sex partners and obtaining meth- amphetamine—were included. Lastly, we asked about unprotected sex (‘‘Preventing the spread of HIV is hard. In the past 6 months, how often did you have anal or vaginal sex without a condom with someone who was HIV-negative or whose HIV status you did not know?’’), and about treatment for methamphetamine use and referral to treatment pro- grams. On average it took the participants less than 5 min to complete the survey, and they received a snack bar in exchange for their time. Data Analysis Using STATA SE 7.0 [27], we compared two or more categorical variables using a percent prevalence and P-value using the Chi-square test, with P \ 0.05 as the criterion for statistical signiﬁcance. The Student’s t-test was used to compare means for parametric data and the Wilcoxon Rank Sum Test was used to compare medians for non-parametric data. For the analyses, four gender/orientation groups were constructed based on each respondent’s gender and the gender of their sex partners: MSM (including bisexual men), heterosexual men, transgender (male-to-female and female-to-male), and women. Women who had sex with women (N = 15) and heterosexual women were combined given the small sample sizes. We did not measure associ- ations between methamphetamine and other factors for non-MSM given small sample sizes. Human Subjects Review The survey was reviewed by the Centers for Disease Control and Prevention (Human Subjects Review numbers 2004- 00133 and 2004-00195) and designated as non-research public health practice in accordance with the Code of Federal Regulations, Title 45, Part 46: The Public Service Act. Results Participation Of the 893 returned surveys, 236 (26%) were excluded because those were duplicate (107), incomplete (48) or 123