Background:
HIV/STD prevention providers have been increasingly implementing Internet-based outreach to access MSM who use the Internet to seek sex partners. In 2004, Montrose Clinic developed Project CORE (Cyber OutReach Education) to provide education and risk-reduction information to MSM in Houston.

Objective:
To understand the effectiveness of Internet outreach to MSM.

Method:
CORE uses chat rooms and websites to address HIV/STD prevention needs of sexually active MSM. Activities include prevention education and risk reduction counseling, referrals to online health information and local service providers, and recruitment for HIV/STD testing. Upholding strict standards of confidentiality, Cyber Health Educators (CHEs) also promote positive health-seeking behaviors, including STD testing, hepatitis vaccination, and emotional support.

Result:
Using content and discourse analysis, 100 one-on-one Instant Messaging transcripts from a 1-year period in 2004-2005 were analyzed. Topics of discourse included sex with serodiscordant partners, barebacking, substance use (especially crystal meth), and more. Analysis indicated potential high rates of depression, sexual addiction, and unprotected sex. Roles that emerged for CHEs were risk assessor, information and referral source, recruiter for testing/treatment services, and emotional supporter. Results determined quality assurance measures and core competencies for CHEs, including online active listening, non-invasive, non-judgmental risk assessment, skills building, crisis intervention and motivational interviewing.

Conclusion:
To effectively reach high-risk MSM who use the Internet, skilled CHEs must be indigenous to the population served and must instill an emotionally supportive online atmosphere. Many men reported isolation and loneliness and were seeking "virtual" fraternity with other gay/bisexual men. Therefore, this activity reaches sexually active men who may not be reached thru traditional prevention services, providing a pseudo-anonymous environment in which to discuss sexual behaviors. CORE was also successful at recruiting for HIV and syphilis testing.

Implications:
Prevention programs working in this innovative area need to utilize best practices and core competencies for reaching high-risk individuals who use the Internet.