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Twelve percent of HIV-negative men and 20 percent of HIV-positive men said they had used methamphetamines, and 37 percent of HIV-negative men and 53 percent of HIV-positive men said they had used amyl nitrate (commonly known as "poppers").

Rietmeijer noted that these trends coincided with the availability of effective new HIV/AIDS treatments, which may be causing some MSM to become complacent about safe sex practices. Handsfield's analysis shows that 68 MSM in King County were reported with infectious syphilis in 1999, compared to only five MSM in 1997.

MSM also represented a growing share of all syphilis cases in the county, increasing from 28 percent (five out of 18 cases) in 1997 to 84 percent (32 out of 38 cases) by the first half of 2000.

In the summer of 1999, for example, health officials in San Francisco identified an outbreak of syphilis among gay men who had met their sexual partners in an Internet chat room. D., of the San Francisco Department of Health reported on successful efforts to provide STD prevention information through the Internet following this syphilis outbreak.

Website staff worked with health workers to post information about syphilis on a popular gay Internet home page, which was linked to the Department of Health STD clinic website, and also visited chat rooms to educate participants about syphilis and to encourage people who had met partners in the chat room to seek medical evaluation.

He said the changes have significant implications for HIV transmission among MSM and for the Nation's initiative to eliminate syphilis transmission in the United States. From August 1999 through May 2000, the researchers surveyed 904 gay and bisexual men at a variety of clinical settings about their sex and drug use practices.

Valdiserri also noted that CDC is studying ways to expand access to effective prevention programs for gay and bisexual men. The men were also offered testing for gonorrhea, chlamydia and syphilis.

In the month following the awareness campaign, there was an 18 percent increase in the number of gay men evaluated at the city's STD clinic, and there are plans to expand the campaign with the Internet service providers. D., of the AMC Cancer Research Center collaborated with the Denver Public Health Department to conduct a survey to determine whether sexual partners who meet over the Internet are more likely to practice risky sexual behaviors.

Bull and her colleagues analyzed surveys from 4,601 respondents, aged 18 years or older, who were living in North America.

This upward trend contrasts with gonorrhea rates seen in heterosexual men visiting the clinic, which fell from 8.2 percent in 1995 to 5.7 percent in 1999.

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