April is STD Awareness month. This article is one in a series published by RH Reality Check in partnership with the National Coalition of STD Directors, focused on aspects of STD prevention, treatment and funding and the public health implications of neglecting STDs.
The Internet has truly changed the way we communicate, socialize and, yes, find love and sex. Actually, there are few areas of our lives that have not been dramatically changed by the Internet.
These changes are evidenced in many facets of our daily life, but no change is more poignant than the evolution of our social and sexual lives from person to person interactions in real world venues to virtual communications through online forums and social sites. For example in the world of dating; according to a recent study conducted by Match.com and Chadwick Martin Bailey, 17 percent of couples married in the last three years met each other on an online dating site. When we look specifically at sex seeking online, even social networking sites such as Facebook are used to facilitate sexual encounters. When we look at men who have sex with men (MSM) online in the United States, we see that the second most popular free dating and sixth most popular site overall is Adam4Adam, a MSM website focused on facilitating sexual encounters between men. When we consider the percentages of MSM in the general population and the fact that this MSM site is number two, it is obvious that MSM have adopted online hookups as a primary tool to facilitate sexual encounters.
In the context of sexual health and sexually transmitted infections, this shift in the way men meet men for sex has had a major impact on disease intervention efforts.
This shift was first noted in 1999 when there was an outbreak of syphilis among users of an Internet chat room that challenged traditional methods of notifying partners of an infected person that they may have been exposed and to seek testing and possible treatment. Since 1999, Internet-Based Partner Services (IPS) has been incorporated into disease intervention activities across the nation and when incorporated well, IPS has increased the number of partners notified of their exposure dramatically. For example, between January 2007 and June 2008, the Washington, DC area notified an additional 381 persons of their possible exposure to Syphilis as a result of the incorporation of Internet-Based Partner Notification (IPN) into their partner services program.
As experience in IPS, IPN, and use of the Internet for ‘record’ searching on patients and partners grows; it appears that more cases are investigated and that outcomes are improved. For example, preliminary data in New York State show that there was an increase in Internet-based investigations of 64 percent between 2009 and 2010 with 23 percent of those interviewed being either infected and brought to treatment or treated preventively. Based on this data from NY state it can also be assumed that as IPS experience increases, Disease Intervention Specialists (DIS), the front-line of the STD prevention workforce across the country, become better at using virtual identifiers, such as a screen name or email address. When these types of identifiers are accessible, in 56 percent of IPS cases, real-world information was able to be obtained and these cases were converted to traditional partner services cases in 2010 — an increase of 18 percent over 2009.
The use of technology for sex-seeking can complicate disease intervention activities, but responding to changes as they occur through the use of the same technologies by incorporating these same technologies into intervention programs can effectively reduce the spread of disease. We as public health must be flexible enough to respond to the ways Americans communicate and use technology for sex-seeking by using the same technologies for our disease intervention activities.