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For public health advocates, the Internet, and its ability to spread disease through anonymous sex hookups, is the new tobacco. Just as the "right to smoke" as an important civil liberty has been largely discredited, the "right" of sex Web site owners to profit unfettered from the spread of diseases such as syphilis and AIDS should also go by the wayside.
Consider the parallels. Nicotine stimulates the brain's pleasure centers and temporarily eases stress. Cigarettes, lighters, ashtrays, and smoking porches serve as social props, making it easier for some people to connect with each other.
On the Internet, sites such as Adam4Adam encourage browsers to fill out questionnaires stating their body type, sexual preference, and physical location. They are immediately directed to pages with photos of dozens of men with hard abs and penises who are ready to have sex at a moment's notice.
If you're willing to click on a photo, send a quick proposition, and walk a couple of blocks, it's a snap to pile into an anonymous barebacking threesome and thus, presumably, enjoy some pleasure and temporarily ease stress.
Tobacco offers a clear trajectory toward illness, incapacity, and death. If you become a heavy smoker as a teenager, you have a 50-50 chance of it killing you.
Unlimited, anonymous, multipartnered sex of the sort encouraged and facilitated by Adam4Adam is also a route to serious illness. After nearly being eradicated in the late 1990s, syphilis — which if left untreated can cause brain and heart damage — bounced back with a vengeance in San Francisco from 1998 to 2002, increasing 1000 percent. It's now surging nationwide. A state health study released last month showed that new syphilis patients were most likely to have met new sex partners on the Internet. In San Francisco, more than two-thirds of patients surveyed by the Department of Public Health said they met new partners online — and at least half of those met on Adam4Adam.
Big Tobacco escaped significant regulation for 50 years by creating a multi-billion-dollar apparatus to influence politicians, create public sympathy, and conduct phony science.
Web sites such as Adam4Adam, AOL, and Craigslist have even more powerful weapons to use against public health regulators. They include the First Amendment, the secrecy-friendly structure of the Internet, and civil-liberties advocates suspicious of any threat to unfettered private activity online.
It's "protect public health versus make money vs. assure civil liberties," says Jeff Klausner, San Francisco's director of STD prevention and control. Over the past few weeks, Klausner has been working with the city attorney, the National Institutes of Health, the California Department of Public Health, and the Department of Public Health in New York, whose large gay community also uses social networking sites for sex, in an effort to track down Adam4Adam's thus-far-anonymous and secretive owners. His aim: To get the site to slap the equivalent of a surgeon general's warning on its hookup forums and at least make users aware of the dangers of the anonymous, multiple-partner unsafe sex that is its stock-in-trade.
Adam4Adam purposefully obscures its ownership with a private-registration service called Domains by Proxy. The company has not responded to messages Klausner sent to a fax number and e-mail address on the site.
In response to my inquiry, someone identifying himself as Marc replied to say Adam4Adam had been running a banner ad for the Department of Public Health HIV vaccine trial, and directed me to a "health resources" page that listed five Web sites for groups combating AIDS and other STDs. "I can't even remember when we started that banner, it's been so long," he said.
"That's an HIV vaccine campaign," Klausner retorts. "It has nothing to do with sexual health, safe sex practices, or anything that I've been trying to talk to them about. Maybe they could also inform members how common STDs are, that they're asymptomatic, and inform them where they could get a checkup." Klausner has considered the possibility of a public nuisance lawsuit against Adam4Adam, although it might be legally impractical, considering that the company apparently isn't located in the city.
In his efforts to crack down on sites like Adam4Adam, Klausner gets no sympathy from civil-liberties advocates. "We've been through this before when people try to shut down newspapers as public nuisances," says Lee Tien, an attorney with the Electronic Frontier Foundation, a nonprofit dedicated to protecting individuals' rights online. "The First Amendment protects the press, it protects online speakers, it protects AOL, and it protects sex Web sites."
To me, however, this seems one of those instances where the residents of America's civil-liberties capital need to step back. Let's think of the real stakes: the risk of rampant disease, disability, and death versus infringement of the right of Web site owners to remain anonymous as they make money off customers' tastes for reckless, anonymous sex.
During the 1980s, San Francisco quite reasonably shut down its bathhouses. Los Angeles County has passed laws requiring commercial sex venues to provide counseling and testing for social diseases; there are similar policies in San Francisco. Sex in bars is outlawed throughout California. In 2005, Klausner attempted to pressure AOL to warn users of its vast network of chatrooms about the outbreak of social diseases. S.F. Health Department studies found AOL was a primary venue for the spread of such diseases. Klausner threatened lawsuits and announced plans to recruit lawyers to push the cause nationally.
In the end, AOL successfully blew him off, Klausner says. A lot of the men seeking hookups drifted to specialized sites such as Manhunt.com and Adam4Adam.com. "AOL ultimately failed to take any action, failed to notify its members, and failed to engage in sexual health promotion," Klausner says. An AOL spokesman says the company declined to participate in the campaign targeting private chatrooms "due to privacy concerns for our users."
For Stephan Adelson, a consultant who used to be vice president of the for-profit gay-hookup site Manhunt.com, Klausner's methods are unnecessarily confrontational. Adelson believes Web-based sex entrepreneurs and public health officials should learn to coexist.
"I would suggest maybe the approach that San Francisco uses when they engage Web site owners may be a hindrance," he says. "It's a policy-based approach rather than a partnership-based approach."
Adelson says he is going to Canada later this month to meet with the owner of Adam4Adam — whose name he refused to reveal — to discuss increasing safe-sex awareness through the site. But Adelson also is quick to defend his erstwhile competitor, saying Adam4Adam is misrepresented and already provides ample information. He says that it's unfair to single it out, given the variety of sex sites available. "A few years ago, it was Manhunt," he says. "In other cities, the main one is Craigslist. In others, it's GayBlackChat.com."
In Adelson's view, it's unclear whether these sites pose a public-health threat. In fact, he's downright skeptical of the studies linking syphilis and the Internet. "It's a tenuous connection," he says. "There's no absolute evidence. Research and studies are valuable tools that, with careful crafting, can prove all kinds of misnomers. One thing the Internet does is it provides rapid communications. You can talk to hundreds of people in a very short period of time. When it comes to facilitating sexual encounters, it's an excellent facilitator."
Klausner says Adelson's perspective can be traced to the profit motive that guided Manhunt. "As a former Web site manager and now a private consultant trying to obtain government business as an intermediary between government and these types of businesses, he clearly has a self-interest" in promoting his style of sexual health awareness, Klausner says. "Unfortunately, the results of his work can be seen currently on the site [Manhunt] — health Web pages that are buried and hard to reach, absence of routine sexual health messaging, and the absence of readily available contact information for the owner."
I don't know what to make of self-appointed industry spokesman Adelson's pooh-poohing of scientific research. But I can attest to the fact that his assertions about Adam4Adam's supposed proactive stance are overblown. The route from homepage to registration to a gallery of live, nude, local available men is a straight path unobstructed by safe-sex messages. To find that information, you must either hunt for it or know where to look. In other words, Adam4Adam is not what you'd call a good corporate citizen.
For that matter, much-ballyhooed do-gooder Craigslist seems to take pains to argue that it warns cruisers about unsafe sex practices, while similarly designing its message to be as unobtrusive as possible. Even AOL, whose Time Warner parent would seem to have ample reason to burnish its corporate image by cooperating with public health officials, seems to have determined that being cruiser-friendly is more important than limiting the spread of disease.
This means health advocates like Klausner need enforcement tools. A place to start might be for state attorneys general to cooperate and to bring public nuisance cases where local officials can't.
Sex in bars has been wisely deemed in California as a type of free expression that the public has a health interest in regulating. We should also be able to make Adam4Adam at least warn users that when they engage in serial anonymous threesomes, they're playing with fire.