1. STI’s and the Internet Kees Rietmeijer, MD, PhD Denver Public Health Department Denver, CO, USA Risks and Opportunities for Prevention

2. Discuss STIs and the Internet in 3 Contexts: Within At-Risk Populations Provider-Population Interaction Among Providers

3. At-Risk Populations

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

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

6. 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

7. “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” Manuscript recently submitted for journal review

8. N Sex with Internet Partner Odds Ratio (95% C.I.) MSM 1847 809 (43.8%) 0.92 (0.70-1.20) Association Internet Sex with Prevalent Gonorrhea and/or Chlamydia MSW 6453 356 (5.5%) 0.59 (0.42-0.81) Women 4703 154 (3.2%) 0.57 (0.31-1.01) Al-Tayyib et al. Poster C-02

9. “Sexual encounters with partners met on the Internet may not be as risky as previously thought and may even be protective for some. However, a person’s risk for STI may depend on the type of Internet site on which they seek the partner and the explicit purpose of the partnership. Further investigation to elucidate these differences is needed.” Al-Tayyib. Poster C-02

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. You’ve Got Mail

18. Conclusions - 1 Online (sex) partnering is no longer restricted to high-risk MSM Using the Internet for sex-seeking purposes may enhance both risk taking and preventive behaviors More research is needed to better understand online interactions between prospective sex partners

19. Provider-Population Interactions The Internet (and other new media) as a vehicle for prevention

20. HIV/STI Prevention Online -Typology- Interventions to enhance HIV/STI Testing Efforts to enhance partner notification and treatment Interventions to induce behavior change to prevent STI/HIV acquisition and transmission Rietmeijer & Shamos. Sexuality Research and Social Policy 2007;65-73.

21. HIV/STI Testing

22. IWTK Evaluation (July 2004 – January 2005) 1254 kits placed in the community and 1168 kits requested by e-mail 400 kits returned for testing; 350 (87.5%) requested by email 41/400 (10.25%) were chlamydia positive Of those testing positive, 95.1 received treatment Of users: 89.5% prefers collecting own specimen 75.9% prefers self-obtained vaginal swab or urine 86.3% would use Internet again Gaydos et al. Sex Transm Dis 2006;33:451-457

23. Online Partner Notification Use of e-mail as additional modality to PN Partner notification in chat rooms Self-contained online partner notification programs

24. Available at www.ncsddc.org and at www.stdpreventiononline.org

25. Online PN - InSpot

27. Interventions to Give Information and Induce Behavior Change Interactive Behavioral Interventions

28. Interventions to Give Information and Induce Behavior Change Interactive Behavioral Interventions

29. Conclusions - 2 Internet-based and other “new media” interventions are widespread Many are simple online adaptations of offline interventions Some use the advantages for current Internet technology (Web 2.0) Most “new media” interventions have not been evaluated

30. The Internet and STI/HIV Prevention Providers Get With The Program!!

33. STDPreventionOnline

34. STDPO Users Areas of Interest (N=877) HIV/AIDS: 71% Chlamydia: 58% Gonorrhea: 58% Syphilis: 57% Behavioral Interventions: 53% Youth/Adolescents: 51% HPV/Genital Warts: 48% HSV/Genital Herpes: 45% Program Improvement: 43%

35. Membership by Employment N = 924

36. STDPO Membership Focus of Work

37. Conclusion – 3 Join STDPreventionOnline!!

38. A Sneak Preview Next Screening 5:30 PM To sign up for a Safe City package, please talk to Lee Warner or Kees Rietmeijer