Web 2.0 and STIs/HIV Risks for Transmission Opportunities for Prevention

1. Web 2.0 and STIs/HIVRisks for TransmissionOpportunities for Prevention Cornelis A. Rietmeijer, MD, PhD 50th ICAAC Conference Boston, MA Wednesday, September 15, 2010

2. “New Media” Other Developments Dwindling Resources Traditional PN  EPT; Online PN Health Care Reform Sexual Disease  Sexual Health Individual Risk Behavior  Sexual Net- works Efficacy  Effectiveness (Scale) Electronic Medical Records and other Practice Innovations Traditional  Non-traditional Prevention Partners Invasive Testing  NAAT Individual  Structural Interventions Program Collaboration and Service Integration (PCSI)

3. Three Perspectives on HIV/STI Prevention and the New Media • Risk Environment • Tool for Prevention Program and Research • Platform for professional collaboration

4. New Media as Risk Environment

5. JAMA July 2000;284 The Story Begins….

6. Klausner et al. JAMA 2000;284:448

7. McFarlane et al. JAMA 2000;284

8. Internet and STD “Clients who reported seeking sex on the Internet were more likely to have concomitant risk factors for STD/HIV than clients who did not seek sex on the Internet.Thus, seeking sex on the Internet may be a potential risk factor for STD/HIV” McFarlane et al. JAMA 2000;284

9. “Common Knowledge” • “Multiple studies have identified Internet use to find sex partners as a risk factor of acquisition of sexually transmitted diseases, particularly among MSM” Recent manuscript submitted for journal review

14. Risk Characteristics Between Offline vs. Online PartnershipsMSM – New York City Jenness et al. AIDS Behav 2010;Epub July 28, 2010

15. Rietmeijer et al. Sex Transm Dis 2007;34:215-219

16. Survey Among Women Using Online Personal Ads (N=588) • Extensive e-mail use prior to face-to-face meeting to negotiate safety, boundaries, sexual preferences, STDs, and condom use • 30% had sex at first encounter • 77% did not use condoms “The high frequency and intensity of e-mail communication prior to meeting in person cultivated acceleration of intimacy for the individuals involved and may have affected women’s decisions to engage in risky sexual behaviors.” Padgett PM. Sexuality Research and Social Policy 2007;4:27-37.

17. MSM MSW Women 1847 6453 4703 N 809 (43.8%) 356 (5.5%) 154 (3.2%) Sex with Internet Partner 0.92 (0.70-1.20) 0.59 (0.42-0.81) 0.57 (0.31-1.01) Odds Ratio (95% C.I.) Association Internet Sex with Prevalent Gonorrhea and/or Chlamydia Al-Tayyib et al. 2008 National STD Prevention Conference

18. You’ve Got Mail (1998)

19. Conclusion 1 • More research is needed to better understand the nature of on-line partnering, including its risks and potential benefits especially among heterosexuals and adolescents

20. New Media as Tool for Prevention and Research

23. Cell Phone & Text Messaging Use Among STD Clinic Patients Clinic Survey Results Presented at ISSTDR, 2007

24. Text Messaging ProjectsDenver Metro Health Clinic • Project 1 Send text message to those testing positive for gonorrhea or chlamydia to call the clinic to receive their results (if they haven’t called back after 7 days)

26. Online Partner Notification

30. ResultsClinic - Level Survey 1 Survey 2 Total Respondents 453 481 N % (95% CI) N % (95% CI) Heard of inSPOT 22 4.9 (3.0 – 7.4) 28 5.8 (3.8 – 8.4) Ever Sent eCard 1 0.2 (0 – 0.7) 10 2.0 (0.9 – 3.7) Ever Received eCard 2 0.4 (0.05-1.4) 5 1.0 (0.3 – 2.3)

31. ResultsClinic - Level • If you were diagnosed with an STI, how would you tell your partners? SURVEY 2 N % 95% CI Face-to-Face 430 89.4 (86.7 – 91.1) Telephone 176 36.6 (32.3 – 40.9) Written note or letter 18 3.7 (2 – 5.4) Text message 53 11.0 (8.2 – 13.8) E-mail / Internet 23 4.8 (2.9 – 5.7) Would not tell 12 2.5 (1.1 – 3.9) Ask someone else to tell them 8 1.7 (0.6 – 2.8)

32. Results – State Level PLoS Publication 2008 2009 eCards Sent

33. ResultsState-Level (1/2008 – 6/2009) STI Identified on eCARD N % (95% confidence interval)

34. Home-Based Testing Through Web-Based Programs

37. I Know Campaign • Social marketing campaign to promote chlamydia and gonorrhea testing among high risk adolescent women of color in LA area – started in 2007 • Website • Bill boards in high-risk areas • Radio PSA • Added online home test kit program, including online results in summer 2009 • Women only • Self-obtained vaginal swabs Rotblatt et al. STD Prevention Conference 2010, Atlanta GA.

38. “I Know” CampaignResults 6/09 – 2/10 • 25,600 site visits • 2,572 kits ordered: 96% online • 1,350 kits returned • 1,286 kits testable • 108 positive results (8.4%) • Chlamydia: 7.9% • Gonorrhea: 0.9% • Chlamydia and Gonorrhea: 0.4% • Received results: 87% • Treatment confirmed: 88% • Total cost project: ~ US 1 million • Cost-effectiveness: $696,000/QUALY Reported chlamydia cases Los Angeles 2008: 55,276 Rotblatt et al. STD Prevention Conference 2010, Atlanta GA.

40. Dutch National Chlamydia Screening Program • 315,000 adolescents/young adults (16-29 years) sent letter to participate, 2008-10 • Amsterdam (sexually active) • Rotterdam (sexually active) • South Limburg (high-risk profile) • Invited to visit website and order kit • Return kit • Obtain results online after 1 week

41. Dutch Chlamydia Screening ProgramPreliminary Results • 57,000 letters sent (April-June, 2008) • Response rate: 21% • Participation rate: 15% (anticipated: 30%) • Chlamydia positivity • Women: 4.3% • Men: 4.2% RIVM Report 210261006, Rijks Instituut voor de Volksgezondheid, 2009

42. Platform for Collaboration

48. Moving Forward • Diffusing the Message: role of new media • Efficacy Effectiveness • Scale/Reach • Cost-effectiveness • The Message: • Shift in discourse: sexual risk  sexual health • The Messenger • Finding new partners in prevention

49. Who is Kicesie?