The Epidemiology of Internet Sex Partnering and Intervention Use, California

Transcription

1 The Epidemiology of Internet Sex Partnering and Intervention Use, California 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 2006 ISIS, Inc. All rights reserved. 1

2 Disclosure Dr. Klausner is an employee of the City & County of San Francisco In the past 12 months Health Communication Strategies, a health marketing company supported by King Pharmaceuticals the manufacturer of penicillin G benzathine, has supported City & County education, research and training programs Dr. Klausner has received consulting fees from MedReviews to speak with financial analysts from Rodman & Renshaw an Investment Bank Dr. Klausner has received medical research grant funding from Gen Probe, Inc ISIS, Inc. All rights reserved. 2

3 Tracing a syphilis outbreak through cyberspace Klausner et al JAMA 2000; 284: Report of 7 cases of syphilis associated with the Internet use in Summer 1999 Use of the Internet for disease control Combining traditional/ cyber notification 40% of named partners interviewed 6 cases per index patient evaluated

4 Sexual network of syphilis cases associated with Internet use, San Francisco, /14/99 A 6/18/99 D 7/26/99 E * 3/11/99 B * 7/7/99 C G * 8/5/99 8/2/99 F * A = tested positive (case) = tested negative = not tested Bold = index case * = new case 2006 ISIS, Inc. All rights reserved. 4

5

6 Cruising on the Internet highway Kim AA, Kent C, McFarland W, Klausner JD. J Acquir Immune Defic Syndr 2001; 1: 28(1): Survey of men attending STD clinic 32% of gay men used Internet to meet partners Men with Internet partners had more partners, less condom use, more substance use 2006 ISIS, Inc. All rights reserved. 6

7 Correlates of Internet use in MSM with Syphilis in Los Angeles Taylor M, Aynalem A, Smith L et al.. Sex Trans Dis 2004; 31(9): Review of 1219 syphilis cases Increase in Internet 18% 26% Internet users more likely to be white, have anal sex, anonymous sex, any drug use ISIS, Inc. All rights reserved. 7

8 Percent of Interviewed Men who Have Sex with Men Primary & Secondary Syphilis Cases Reporting Meeting Partners by Venue, California, Percent of MSM Cases Internet Bars/Clubs Bathhouses Sex Clubs Note: The difference between bathhouses and sex clubs is the presence of private rooms; sex clubs do not have private rooms ISIS, Inc. All rights reserved. 8 7/2006 Provisional Data CA DHS STD Control Branch

9 Percent of Interviewed Gay Male Cases Reporting Meeting Internet Partners by Area, California, % Internet Users Internet Use among MSM, Interviewed P&S Syphilis Cases, CA * (excluding Northern CA and Central CA due to small numbers) Internet Bars/Clubs Bathhouses California Total Bay Area, No SF (Area 3) Sex Clubs Long Beach (Area 7) & East San Diego (Area 8) & East SF (Area 9) LA (Area 10) Note: The difference between bathhouses and sex clubs is the presence of private rooms; sex clubs do Year not have private rooms ISIS, Inc. All rights reserved. 9 7/2006 Provisional Data CA DHS STD Control Branch

11 Internet site mentions, syphilis cases, California * # Cases Use of Specific Sites among P&S Syphilis Cases Reporting Internet Use, CA * (NOTE: reported usage of individual sites is NOT mutually exclusiv e) Manhunt.com Adam4Adam Craiglist AOL Gay.com M4M Men4Men Year *First half, ISIS, Inc. All rights reserved. 11

12 Internet site mentions, new HIV cases San Francisco City Clinic * * m4m Men4now Manhunt Other M4Msexnow.com M4M4sex.com Craigslist Gay.Com AOL *First half 2006 includes SFGH/COPC cases 2006 ISIS, Inc. All rights reserved. 12

13 Sex and the Internet Davis M, Hart G, Bolding G et al. Cult Health Sex 2006; 8(2): Interviewed 128 gay men in London; 25% HIV+ Identity management Anonymity Harm avoidance (abuse, discrimination, rejection) Potential for risk mitigation filtering, predetermination 2006 ISIS, Inc. All rights reserved. 13

15 The Internet for STD/HIV Prevention & Sexual Health Promotion Deb Levine, M.A., Executive Director Internet Sexuality Information Services, Inc. November 15th, 2006

16 ISIS, Inc. 501(c)3 organization founded in 2001 Creating new & effective tools to reach people with critical sexual health information Developing high tech solutions for sexual education and HIV/STD prevention 2006 ISIS, Inc. All rights reserved. 16

17 Best Practices for Interventions Needs assessment focus groups, chat/im interviews, community advisory boards Include community in all aspects of program development Extensive usability testing with target audience Good on and offline social marketing Evaluation plan 2006 ISIS, Inc. All rights reserved. 17

18 Model ISIS Programs All program developed in partnership with SF DPH inspot: an anonymous peer to peer online STD partner notification program SexINFO: a sexual health cell phone text messaging program for youth STDTest.org: download lap slips & get test results online via unique ID 2006 ISIS, Inc. All rights reserved. 18

20 inspot: STD e cards Developed in response to the rise in syphilis among men who have sex with men in San Francisco Focus groups of target population found: 1) Pre AIDS vs. post AIDS mentality towards STDs 2) Always tell partners about STDs, but not always hookups, f* buddies, etc. 3) Would tell casual sex partners if there were an easy, anonymous way 2006 ISIS, Inc. All rights reserved. 20

21 inspot Launched in October, 2004 to national media acclaim Simple mechanics and design: Tell Them Get Checked Cards can be sent anonymously or from an address to up to 6 people Drop down menu of STDs Personal message optional No back end database Quickly gained community trust & support 2006 ISIS, Inc. All rights reserved. 21

23 Current Site Available in 6 cities, 4 states, one country Being translated into Spanish Content updated for all sexual orientations E prescriptions available in SF for gonorrhea and chlamydia treatment 2006 ISIS, Inc. All rights reserved. 23

24 Usage statistics 750+ people visit the site each day 30,000 ecards have been sent to 49,500 recipients from SF site Every month, from ecards are sent from each site in the portal (50= Indiana; 250 = San Francisco; 700 = Los Angeles) 80% of ecards are sent anonymously 80% of ecards include a personal message >49% of people receiving ecards click through for more info about STDs and testing sites 2006 ISIS, Inc. All rights reserved. 24

25 Impact? HIV High Estimate (Feb Apr Avg.) Low Estimate (May Jun Avg.) Annual e cards sent* (projected) New LAC HIV Cases, ** Est. Annual Clickthroughs* HIV partner contacts, 2005 (113 CBO based DHS PCRS)*** inspotla contacts as % of Current Contacts 1,776 1,598 1, % 879 1,598 1, % *Projected, based on May June 2006 ** Reported cases. Source: HIV/AIDS Semi Annual Surveillance Summary, Jan General est cases per year. *** 2006 ISIS, Inc. All rights 25 From 1,347 identified index patients. Source: LAC STDP, 2006 reserved.

26 Impact? Syphilis Annual e cards sent (projected)* 2005 Early Syphilis Cases** Est. Annual Clickthroughs* Number of 2005 Field partner contacts (sy)*** High Estimate (Feb Apr Avg.) 1,400 1, Low Estimate (May Jun Avg.) 764 1, inspotla contacts as % of Current Contacts 128% *Projected, based on May June ISIS, Inc. All rights ** Provisional. Source: LAC STDP, 2006 reserved. *** From 793 case interviews. Source: LAC STDP, % 26

27 Online Surveys Two week survey in April 2006 Convenience sample Links posted on inspot portal, City Clinic website, HookingUpOnline.org, and Yahoo! Health Banner ads on Gay.com SF only 2006 ISIS, Inc. All rights reserved. 27

28 Street Intercept Surveys Convenience sample of 833 gay and bisexual men interviewed between March and December % knew what inspot was 2% had received an e card 4% had sent an e card 73% said, if diagnosed with an STD, would consider sending an anonymous e card 2006 ISIS, Inc. All rights reserved. 28

29 Online survey respondents N=317 Mean age= 31 years, (18 55+) 64% female; 36% male 48% Caucasian; 26% African American; 11% Latino; 15% other 33% spend hours/wk online 14% spend more than 30 hours/wk 2006 ISIS, Inc. All rights reserved. 29

30 Online surveys 13% knew what inspot was 3% had sent an ecard 3% had received an ecard 65% of total respondents said they would consider sending an anonymous ecard if they were diagnosed with an STD in the future 2006 ISIS, Inc. All rights reserved. 30

31 Provider Surveys 150 surveys mailed to HIV medical providers in San Francisco; 46 (31%) returned surveys 26% had heard of inspot 9% had referred patients to site 84% would do so in the future 74% agreed that palm sized cards were best way to give patients the information 2006 ISIS, Inc. All rights reserved. 31

32 SexINFO SexText.org Sexual health text messaging project for youth age in San Francisco Developed in response to rise in gonorrhea and chlamydia among young African American women Technology driven thru the web, delivered via cell phones Focus groups of youth found that they consider text messages to be accessible, affordable and private 2006 ISIS, Inc. All rights reserved. 32

34 Usage Stats Developed with Advisory Board of youth workers, clergy members, adolescent medicine professionals, & young people 4500 unique inquiries in the first 25 weeks Top 3 Inquiries 1. What 2 do if condom broke 2. 2 find out about STDs 3. What 2 do if u think ur pregnant 2006 ISIS, Inc. All rights reserved. 34

35 Awareness of Service 322 surveys collected at 3 SF clinics 11% of clinic patients knew of SexINFO Patients from target audience MOST likely to know about service African American, aged Low income, live in target areas Least expensive cell phone provider 2006 ISIS, Inc. All rights reserved. 35

37 Technical Side Personal identifying info is downloaded every 24 hours to local medical record system Results are faxed from lab to DPH and input manually by data entry person into web database via unique ID Identifying information is never associated on the Web with test results 2006 ISIS, Inc. All rights reserved. 37

38 Statistics Average 2000 visitors per month 620 blood draws to date All reactive tests have been followed up by Health Department Future: Private server, adding chlamydia and gonorrhea testing, adding interactive feature to determine necessary tests 2006 ISIS, Inc. All rights reserved. 38

40 Acknowledgements Dr. Jeffrey Klausner, San Francisco Department of Public Health, Director of STD Prevention and Control Gilbert Herdt, PhD, Director of NSRC and SFSU Human Sexuality Program Mary McFarlane, PhD, Research Behavioral Scientist CDC Division of STD Prevention Eric Whitney, Associate Director, ISIS Richard Foxall, Board Member, ISIS 2006 ISIS, Inc. All rights reserved. 40