AIDS Behav (2012) 16:396–403 DOI 10.1007/s10461-010-9869-7 O R I G I N A L P A P E R Methamphetamine Use, Transmission Risk Behavior and Internet Use Among HIV-Infected Patients in Medical Care, San Francisco, 2008 Taylor Clark • Carina Marquez • C. Bradley Hare • Malcolm D. John • Jeffrey D. Klausner Published online: 30 December 2010 The Author(s) 2010. This article is published with open access at Springerlink.com Abstract Methamphetamine use is associated with adverse health outcomes and HIV incidence. Few studies have assessed methamphetamine use, sexual behavior and Internet use among HIV-infected patients. Surveys were administered to a sample of HIV-infected patients seeking medical care in a San Francisco county hospital and uni- versity-based clinic. In 2008, 35% of homosexual partici- pants, 26% of heterosexual participants and 11% of female participants reported methamphetamine use in the past year. Of participants, 29% reported using the Internet to ﬁnd sex partners; Internet-users versus non-Internet-users reported a higher median number of sex partners in 6 months (4 vs. 1), were more likely to report unprotected sex (32 vs. 10%), and higher rates of methamphetamine use in the past 12 months (48 vs. 24%). Given the association among methamphetamine use, increased sex partners and Internet use, the Internet may present a new and effective T. Clark (&) School of Medicine, University of California San Francisco, 1224 Willard Street, San Francisco, CA 94117, USA e-mail: taylor.clark@ucsf.edu C. Marquez (&) Department of Medicine, University of California San Francisco, 505 Parnassus Avenue, Room 987, Box 0119, San Francisco, CA 94143-0119, USA e-mail: carina.marquez@ucsf.edu C. B. Hare M. D. John Department of Medicine, University of California San Francisco, San Francisco, CA 94117, USA J. D. Klausner Division of AIDS and Infectious Diseases, Department of Medicine, University of California San Francisco, San Francisco, CA, USA 123 medium for interventions to reduce methamphetamine- associated sexual risk behavior. Keywords Methamphetamine HIV MSM Internet Introduction Methamphetamine is an addictive stimulant whose use in the United States has increased greatly over the past decade [1]. Methamphetamine is associated with medical compli- cations and sexually transmitted disease (STD) and human immunodeﬁciency virus (HIV) transmission risk behavior in all users [2–5], but presents special problems in HIV- infected users. Methamphetamine use is more common among HIV-infected men who have sex with men (MSM) [6] and is associated with increased HIV transmission risk behavior, progression to AIDS [7] and decreased adherence to antiretroviral (ARV) therapy [8, 9]. Many of the successful efforts to decrease the use of methamphetamine and its associated sexual risk behavior have focused primarily on screening and counseling in the clinical setting. Routine screening and counseling about risky sexual behaviors has been shown to decrease risky behavior [10–13]. Behavioral interventions, contingency management programs and referral to outpatient treatment programs have shown promise in decreasing metham- phetamine use and reducing risk behaviors associated with the spread of HIV infection [12, 14–17]. While interven- tions in the clinical setting have been shown to be effective, there are fewer studies on the role the Internet plays in methamphetamine use and risky sexual behaviors. The use of the Internet to ﬁnd sex partners on sexual networking sites has been associated with methamphetamine use and sexual risk behavior [18–23]. Better characterizing the role