AIDS Behav (2012) 16:396–403 treatment via the Internet. This may represent a missed opportunity for education and referral to treatment pro- grams given the large proportion of participants who reported using methamphetamine in the past year and also reported using the Internet to ﬁnd sex partners and/or methamphetamine. In general, relevant online interventions seem to address three broad categories: STD/HIV testing, partner notiﬁca- tion/treatment, and HIV transmission risk behavior modi- ﬁcation [36]. However, validated online interventions are hard to ﬁnd. The Smart Sex Quest Project was an online RCT designed to increase STD prevention among MSM; unfortunately loss to follow-up was so great that outcomes could not be assessed [37]. In a study of 8 US cities, online interventions ranging from banner advertisements for health promotion websites to using chat rooms to enhance partner notiﬁcation are being implemented, though evalu- ation of these interventions is limited [38]. In a small pilot study, two PowerON (The Prevention Organization with Empowerment Resources on the Net) outreach counselors entered chatrooms on gay.com and engaged MSM in instant-message chats about HIV/STD education and pre- vention; the study found that most of the conversations were related to HIV/STD testing, though no outcome measures were recorded [39]. Despite the lack of validation, these types of online health interventions seem to have support from their target audience. An Internet-based survey of men who use the Internet to seek sex with men (MISM) found that a majority of MISM expressed interest in over 20 sexual health inter- ventions, and most MISM endorsed highly explicit lan- guage, visual images, street language and sex stories in any online intervention [40]. Another online survey found that 61% of participants would visit a website, 45% would open an email and 30% would participate in a chat regarding STD/HIV prevention, though MSM or participants with a history of getting tested for an STD/HIV were more likely to endorse all three methods of online interventions [41]. So while further research into the structure and evaluation of online interventions is warranted, there seems to be a willing audience for such interventions. This study had several limitations: the cross-sectional design cannot address causality; the small sample size of women and transgender patients limits the power of the analysis in these subgroups; the results in such a speciﬁc population (HIV-infected patients seeking medical care at two large clinics in San Francisco) may not be generaliz- able to other populations. Social desirability bias may have affected the observed frequency of methamphetamine use and may have had different effects at the two sites. This effect seems to have been limited, given the high frequency of reported methamphetamine use and its comparability to ﬁndings in other studies. Unlike 2004 and 2006, in 2008 we 401 collected information about rates of unprotected sex and income, thereby strengthening the analysis of the associa- tion between HIV transmission risk behavior and meth- amphetamine use since both number of sex partners and rates of unprotected sex could be used as markers of risky sexual behavior. Despite its limitations, this study demonstrates that methamphetamine use among HIV-infected patients in medical care in San Francisco continues across race/eth- nicity and gender/orientation groups, and that the rates of methamphetamine use were steady compared with previous surveys of this same population in 2006 and 2008. The association between methamphetamine use, increased rates of unprotected sex and increased numbers of sex partners highlights the HIV transmission risk associated with meth- amphetamine use and the need for interventions to reduce methamphetamine use and the attendant sexual risk behav- ior. The common use of sexual networking sites on the Internet to ﬁnd sex partners and its association with meth- amphetamine use and HIV transmission risk behavior indi- cates that additional attention should be focused on the role those sites might have in facilitating the continued spread of HIV infection in the U.S., and also the opportunities these sites might present for education and prevention. Acknowledgments This study was supported by the San Francisco Department of Public Health. T.C., C.M., C.B.H., M.D.J., and J.D.K. report no ﬁnancial conﬂicts of interests. 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