Using Technology for Outreach, HealthCommunication and Partner Services Stephan S. Adelson National Coalition of STD Directors Rachel Kachur Centers for Disease Control
Two Lives:Responsibilities, Opportunities,and Challenges in Both Worlds
Integrating Social Everywhere
Virtualizing, Augmenting, Mirroring ...
Changing Culture, Venues, Challenges“Gay communities undergoing structural decline” with many identifying the Internet as theunderlying cause”. “These changes in the gay community were noted as increasing the complexity of sexual decision making and HIV risk, while decreasing effective prevention”. Pacific Islander 1% Middle Eastern 1% More than 2.5 million active profiles, over 26 American Indian 1% million monthly visits1, and 120,000 men Other Ethnicity 3% online nightly, Asian 4% Mix 8% Latino 15% Black 23% White 45% More than 750 million active users, 50% login 2/2/11 daily – 250 million access through mobile devices Rosser Simon B.R., West William and Weinmeyer Richard Are gay communities dying or just in transition?, Minneapolis : AIDS CARE, May 05, 2008. - 5 : Vol. 20. - pp. 588-595. Most Popular Websites in Lifestyle - Dating (ranked by visits); Experian Hitwise US, July, 2011
Facebook for Hookup Community Research, Inc. LGBT Consumer Index, 2009-10
Yesterdays approach was “Push”Today’s Reality: ‘Opt In’ and ‘On Demand’
Do You Have a Website?
The Debate is OVERYour Diet Needs to ChangeGraphic provided by: Lee Aase, Director, Mayo Clinic Center for Social Media, email@example.com
Friends / ContentIts nice to have friends BUT quantity does notequal quality. Social NETWORKING = connections “We” are the content, community and the conversation of the community is where the potential for impact resides
Levels of BelongingCommunity happens organically, but effort is required. Lurkers >60% of users Attracted not connected Friends Connected with acquaintances No deep sense of belonging Core <20% of users Deeply connected, source of information, advocates Valdis Krebs, @ Valdiskrebs http://orgnet.com/community.html
Social Media Policy: You Need it!
Create a foundation• Start at home! Define what staff may and may not post – agency pages (to like / comment or not to like…) – personal pages regarding work, clients, co-workers, etc.• Social Media Strategy – Review and reference agency mission / how can SM enhance overall strategy – Define goals for the use of Social Media (enhance FIRST) – Define what types of content – Describe how you will build community / encourage engagement – Plan for sustainability (resources) – Freedom of speech, how far (moderation) – Evaluation Content, community, engagement (its not just numbers of friends and likes!)• Develop an overarching Social Media Policy: – Reference / link to existing Policies – Individual policies will be needed for each tool (as needed) • Different networks have different features and implications for departments and employees
Men OnlineThe Marketing of ‘Self’ as a desirable sex object
Risk Online!?• “online sex seeking among MSM has been reliably associated with greater numbers of partners, higher likelihood of meeting HIV- positive (HIV+) partners, more receptive anal sex, and greater methamphetamine use”• “men meeting online are no more likely to engage in unprotected anal intercourse than they are with partners met off-line• “MSM who met sexual partners exclusively offline reported the fewest partners but the greatest proportion of partnerships involving unprotected anal intercourse.” and more studies since….Hello?! – Sex happens face to face talk is cheap…. Chiasson Mary Ann [et al.] A comparison of On-line and Off-line Sexual Risk in Men Who Have Sex With Men; An Event-Based On-Line Survey, Journal of Acquired Immune Deficiency Syndromes, 2007. Control Centers for Disease Methamphetamine Use and Risk for HIV/AIDS. - Atlanta, 2007. Horvath Keith J., Rosser Simon and Remafedi Gary Sexual Risk Taking Among Young Internet-Using Men Who Have Sex With Men, American Journal of Public Health, 2008. - 6 : Vol. 98.
Sex Seeking Online & MSM• Adult communities make meeting people for sexual encounters easier by increasing ‘supply’ and advanced filtering options• Breaks down once ‘closed’ sexual networks• Potentially increases the number of partners• Possibly facilitates impulsive behaviors (exposure/availability)• Potentially increases exposure to drugs• Possibly increases internalized homophobia through the reinforcement of stereotypical, detrimental social behavior, potentially contributes to prejudice and judgmental attitudes• Potentially increases changes in social norms and behaviors through; fantasy portrayed as reality, exposure of once hidden fetishes, changes in social venue, perceived anonymity
MSM Men Seeking Sex on an Intergenerational Gay Internet Website: An Exploratory Study 28.5% self-reported as married 68.5% of the married group willing to be anal receptive 15.2% receptive AI was their primary desire Craigslist (7days) 8/15/11 Atlanta Married: 1000+ Discrete: 784Sowell, R., Phillips, K., Men Seeking Sex on an Intergenerational Gay Internet Website: An Exploratory Study, Public Health Reports, 2010 Supplement 1, Volume 125
Understanding Sexual Behavior ~ Behavior is NOT Orientation These strategies helped the participants maintain their heterosexual identity despite behaviors that were conventionally consistent with a bisexual identity. Some protected their heterosexual identity by explaining their sexual behavior as infrequent (Tony: ‘‘I’m not having sex every day, or every other day, with a man’’) accidental (Donnell: ‘‘Something just happens’’) recreational (Talon: ‘‘We all play games to relieve stress’’) unnecessary (Jason: ‘‘Don’t need to do that’’) necessity (Mark: ‘‘I needed the money at the time’’)Reback, C., Larkins, S., “Maintaining a Heterosexual Identity: Sexual Meanings Among a Sample of Heterosexually Identified Men Who Have Sex with Men” Arch Sex Behav (2010) 39:766–773
Mashup Social Porn Hookups
Health Communication“Communication strategies to inform and influenceindividual and community decisions that enhancehealth.” National Guidelines for Internet-based STD and HIV Prevention – Health Communication, National Coalition of STD Directors, October 2009
Blogging as Education (both ways!) • Launched: December 1, 2011 (World AIDS day) • Between 6,000 and 10,000 readers daily • Promoted through links from within the site • Active readers (comments ranges from 2 – 172) • Health posts receive the most comments
HIV Status in Profiles, What’s Yours? “I think the safest thing to do is always assume everybody is positive and never have unsafe sex.” “Personally I’m not going to advertise such personal and confidential information on a public website …” “It’s disappointing how frequently people lie… It seems some people will be honest enough to list themselves as positive.. then at some point63 FB “likes”, 172 comments they say “screw it” and magically become negative…”
Weekly visits: rough estimates Internet Outreach Communities of MSM• Manhunt – ‘lessening need for 1:1 interactions with outreach profiles’ (outreach now defined as ‘agency promotion’ w/costs = to advertising rates: $900 annually)• Adam4Adam: New agreements – An agency specific protocol and/or guidelines that addresses specific topics ~ focus on cultural competency and evaluation• BareBackRT 52 Outreach Profiles 31 Partner Services in 18 Jurisdictions – No change
Men Helping Men Real, personal, a true ‘peer’. Integration is key to long term success ‘I am…’ Multiple pictures
Internet-Based Partner Services Do you? Must you? Should you? Will you? Duty to warn: Certain states have laws requiring practitioners (directly or with the assistance of public health authorities) to warn persons they know to be at risk for infection with a communicable disease, an STD, or HIV by their patients. Privilege to warn: Many other states have laws permitting but not requiring practitioners to warn persons that they are at risk. Centers for Disease Control and Prevention. Recommendations for Partner Services Programs for HIV Infection, Syphilis, Gonorrhea, and Chlamydial Infection. MMWR October 31, 2008 / Vol. 57 / No. RR-9 / page 75
Why IPS • A response to changes in the way the world communicates • Changes in the way people meet sex partners (1 in 6 couples married in the last 3 years met on an online dating site, 1 out of 5 single people have dated someone they met on an online ) • Lack of traditional information (use of virtual identifiers) • Increases in infection rates among populations that are ‘early adopters’ of technology (e.g. MSM) (**7 out of 10 gay men use a smart phone regularly, ***Adam4Adam #3 dating site in US) • Increase the effectiveness of all PS – Internet search and new information on patients and partners – IPS training and PS program review and required revisions to data collection, dispositions, and other current tools adjusted to incorporate IPS • Client-centered approach: reaching partners through popular / convenient communication tools of preference (* 92% of study participants (n=1848 MSM) would use IPN in some capacity to inform partners if infected with an STI in the future) • Economics and time management – Expediency of email, online communication* Match.com and Chadwick Martin Bailey 2009 - 2010 Studies: Recent Trends: Online Dating Marriage Survey: 7000 US adults age 18+, married within the past 5 years, Online Dating Survey:3000 US adults age 18+, who used online dating in the past 5 years** The Online Gay Male 2010: Fabulis, March 2010***Experian HitWise, January 2011HIV and STD Status Among MSM and Attitudes About Internet Partner Notification for STD Exposure, Mimiaga, M., et al. Sexually Transmitted Diseases, February 2008 Vol. 35, No. 2, p.111–116
Evaluation of IPS for Syphilis, Washington, DC 1/07 6/08361 early syphilis patients, for whom 888 sex partners were investigated, 381 (43%) via theInternet • 83% more sex partners being notified of their STD exposure • 26% more sex partners being medically examined and treated if needed • 8% increase in the overall number of syphilis patients with at least one treated sex partner “…without IPN these 381 partners would not have been investigated.” Evaluation of an Innovative Internet-Based Partner Notification Program for Early Syphilis Case Management, Washington, D.C., January 2007-June 2008
Thoughts on ‘Partner Services’ and HIV“All persons with newly diagnosed or reported HIV infectionshould be offered HIV partner services at least once, typicallyat diagnosis or as soon as possible after diagnosis.”People do not stop having sex (nor should they be asked to!)Increases in rates of co-infection, (‘priority cases’)Viral Load and transmissionSexual Behaviors / History Recommendations for Partner Services Programs for HIV Infection, Syphilis, Gonorrhea, and Chlamydial Infection, National Center forHIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, MMWR Recommendations and Reports October 31, 2008 / Vol. 57 / No. RR-9
Text Message for Partner Notification (txtPN)• The goal of text messaging by DIS is to motivate the recipient to communicate via voice.• To used text message for partner services you must be issued a local health department wireless phone and you must adhere to the templates provided in the guidance.• DIS are never permitted to exchange disease specific information through text messaging.• Text messages can be received at any time of day or night and you should be aware that you may receive a reply to your text message at any time of day or night.