E-STD Prevention and Control Jeffrey D. Klausner, MD, MPH Director, STD Prevention and Control Services San Francisco Department of Public Health Associate Clinical Professor of Medicine University of California, San Francisco

Internet-based disease control interventions Surveillance Education and health promotion Screening and test results Partner notification and treatment Prevention

Internet-based disease control interventions Surveillance Education and health promotion Screening and test results Partner notification and treatment Prevention

CA DPH STD Control Branch (rev 3/2008)

CA DPH STD Control Branch (rev 3/2008)

Internet-based disease control interventions Surveillance Education and health promotion Screening and test results Partner notification and treatment Prevention

SF City Clinic website Klausner JD. Sex Transm Dis. 1999 Oct;26(9):548.

hookinguponline.org

Brief sexual health videos www.taumed.com

Health department profiles on sex partnering sites

Internet-based disease control interventions Surveillance Education and health promotion Screening and test results Partner notification and treatment Structural changes

Online access to chlamydia test kits Forty-one of 400 (10.3%) women were chlamydia positive; 95.1% treated Gaydos CA, et al., Sex Transm Dis. 2006 Jul;33(7):451-7

STDTest.org Levine D et al., Sex Transm Dis. 2005

Frequency of online syphilis testing by quarter, 2003-2007 = Reactive tests (6.0%)

Online STD clinic test results Kohn R et al, CDC NSTD Conference, 2006

Online access increases persons learning STD test results Month Kohn R et al, CDC NSTD Conference, 2006

Internet-based disease control interventions Surveillance Education and health promotion Screening and test results Partner notification and treatment Structural changes

Internet guidelines for health departments Messages sent from Internet service provider less likely to be discarded; use same e-mail provider as case. Health departments may need multiple e-mail accounts. Include reference to “Serious health matter” in message header; include verifiable information No group messages; use same principles of confidentiality as with postal service or telephone Upon e-mail response, collect information to develop more personal contact

InSpot: online peer-to-peer partner notification for STDs/HIV

InSpot partner prescription About 120 CT prescriptions; 100 GC prescriptions in 2007

Internet-based disease control interventions Surveillance Education and health promotion Screening and test results Partner notification and treatment Prevention

Sex partnering sites facilitating safer hook-ups

Site modifications promote safer sex  Requires persistence, voluntary cooperation from business owner Increasing public health and community advocacy; no regulatory authority Potentially very effective and low cost

Site modifications promote safer sex   Requires persistence, voluntary cooperation from business owner Increasing public health and community advocacy; no regulatory authority Potentially very effective and low cost

E-STD prevention and control Primary prevention Education, health promotion, structural changes to modify networks Secondary prevention Screening, test results, partner notification and treatment

Conclusions Internet sex partnering is common among persons at high risk for STD/HIV Web offers opportunity for STD prevention and control interventions

Acknowledgments SFDPH STD Services—Jacque McCright, Robert Kohn, Rachael Perez, Florence Yu, SF City Clinic, 1360 Staff SFDPH Business Enterprise Systems—Donna Childers SF Partners in STD/HIV Prevention STOP AIDS Full Circle Fund CDC—Wendy Wolf, Dayne Collins Gay.Com, Craigslist, Manhunt.net ISIS-Inc—Deb Levine Scarlet Letter Services—Frank Strona CA DPH STD Branch—Dan Wohlfeiler