2. Cornelis A. Rietmeijer, MD, PhD
HIV/STI Prevention and the (not so) New Media Moving Beyond the Proof of Concept
Cornelis A. Rietmeijer, MD, PhD
HIV/STD Prevention in Rural Communities
Sharing Successful Strategies
Thursday April 7, 2011

3. GYT 2011 STD Awareness Month www.gytnow.org

4. Traditional PN
 EPT;
Online PN
Dwindling
Resources
Health Care
Reform
Sexual Disease 
Sexual Health
“New Media”
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)
Other
Developments

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

6. New Media as Risk Environment

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

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

9. McFarlane et al. JAMA 2000;284

10. 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

11. “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

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

17. Survey Among Women Using Online Personal Ads (N=588)
Extensive 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 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.

18. Rietmeijer et al.
Sex Transm Dis 2007;34:

19. You’ve Got Mail (1998)

20. Conclusion 1
More research is needed to better understand the nature of on-line partnering, including its risks and potential benefits especially among
Heterosexuals
Adolescents
Older adults who are divorced or widowed

23. New Media as Tool for Prevention and Research

24. Cell Phone & Text Messaging Use Among STD Clinic Patients Clinic Survey Results
Do you use a cell phone?
84.7%
Do you use text messaging on your cell phone?
90.2%
Is it OK to contact you via text message?
93.5%
Presented at ISSTDR, 2007

25. Text Messaging Projects Denver Metro Health Clinic
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)

27. Online Partner Notification

31. Results Clinic - Level Survey 1 Survey 2 Total Respondents 453 481
N % (95% CI) N % (95% CI)
Heard of inSPOT (3.0 – 7.4) (3.8 – 8.4)
Ever Sent eCard (0 – 0.7) (0.9 – 3.7)
Ever Received eCard ( ) (0.3 – 2.3)
Rietmeijer et al. Sex Transm Dis 2011; Epub.

32. Results Clinic - Level
If you were diagnosed with an STI, how would you tell your partners?
SURVEY 2
N % % CI
Face-to-Face (86.7 – 91.1)
Telephone (32.3 – 40.9)
Written note or letter (2 – 5.4)
Text message (8.2 – 13.8)
/ Internet (2.9 – 5.7)
Would not tell (1.1 – 3.9)
Ask someone else to tell them (0.6 – 2.8)

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

34. Results State-Level (1/2008 – 6/2009)
STI Identified on eCARD N % (95% confidence interval)
Chlamydia (14.2 – 17.4)
Gonorrhea (14.7 – 17.9)
Syphilis (10.4 – 13.4)
Crabs/Scabies (26.5 – 30.5)
Hepatitis A (3.1 – 4.7)
Molluscum Contagiosum (3.6 – 5.4)
Non-gonococcal urethritis (15.5 – 2.9)
Shigella ( )
Other STD (14.1 – 16.3)
Total Cards

35. Home-Based Testing Through Web-Based Programs

38. 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
Billboards 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.

39. “I Know” Campaign Results 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.

41. Dutch National Chlamydia Screening Program
315,000 adolescents/young adults (16-29 years) sent letter to participate,
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

42. Dutch Chlamydia Screening Program Preliminary 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 , Rijks Instituut voor de Volksgezondheid, 2009

43. The Internet and Clinic Operations

44. Stockholm, September 3 1967: 5:00 AM

45. Transfer to Electronic Medical Record System
Denver, March , 8:00 AM

49. Providing Test Results Online Lessons Learned
Proportion of patients receiving results online
Opt-in Phase: 25%
Opt-out Phase: 50%
No net increase or decrease of patients receiving results
Substantial savings in clerical time spent on answering phone calls
Ling et al. Sex Transm Dis 2010;37:

51. Platform for Collaboration

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

57. Who is Kicesie?

59. Non-Traditional
Prevention
Partner
New Media
Scale
Sexual Health

61. Can Your Hear Me Now?

62. Slide Set Available at: www.stdpreventiononline.org