Mary McFarlane

Relationships of Stigma and Shame to Gonorrhea and HIV Screening

OBJECTIVES The purpose of this study was to assess the relationships between stigma and shame associated with seeking treatment for sexually transmitted diseases (STDs) and undergoing testing for gonorrhea and HIV. METHODS Participants were 847 males and 1126 females (mean age: 24.9 years) in 7 cities. Two scales assessed STD-related stigma and STD-related shame. RESULTS Rates of stigma and shame were higher among participants without a gonorrhea test in the past year and among those without an HIV test. Sex, age, health service use, previous suspicion of gonorrhea, and low levels of stigma were independently associated with gonorrhea testing. Age, enrollment site, use of health services, gonorrhea testing, and low levels of stigma were independently associated with HIV testing. CONCLUSIONS Shame is part of the experience of seeking STD-related care, but stigma may be a more powerful barrier to obtaining such care.

Soliciting sex on the Internet: what are the risks for sexually transmitted diseases and HIV?

BACKGROUND Strategies to meet sex partners have been augmented by the Internet. This medium is an environment of potential risk for acquiring or transmitting sexually transmitted disease (STD). GOAL To document how the Internet is used to find sex partners and what risks such activity poses for STD infection. STUDY DESIGN Participant observations of 175 chat rooms targeting men who have sex with men (MSM), heterosexuals, and couples seeking sex partners. RESULTS Findings indicate evidence of past meetings (9% of MSM-room observations, 15% of couple-room observations) and solicitation of sex (9% of heterosexual-room observations, 17% of MSM-room observations, 36% of couple-room observations) by members of these groups. Safer sex or risk-reduction behaviors were not frequently mentioned, but were sometimes acknowledged through solicitation of drug-free and disease-free partners. CONCLUSIONS Because people can use the Internet to solicit sex partners, it is a risk environment for sexually transmitted diseases. The Internet offers fast and efficient encounters resulting in sexual contact, which may translate into more efficient disease transmission. However, the Internet also offers many possibilities for innovative technologic approaches to promote STD and HIV prevention.

Young adults on the internet: Risk behaviors for sexually transmitted diseases and HIV

PURPOSE To examine the sexual behaviors and related risk factors for sexually transmitted diseases and HIV among young adults who seek sex partners on the Internet. METHODS Study staff recruited participants in online chat rooms, bulletin boards, and other online venues. A total of 4507 participants responded to a 68-item, self-administered, online survey of Internet sex-seeking practices. The survey solicited information on sexual behavior with partners found on the Internet; in addition, a parallel set of questions addressed sexual behaviors with partners found off the Internet. Of the respondents, 1234 (27.4%) were 18-24 years old. Of the young adults, 61% were male and 75% were white. Responses from young adults were compared to those received from older adults. In addition, responses from young adults who seek sex partners online were compared to responses from young adults who do not seek sex partners online. Analyses, including logistic regression, Chi-square tests, Students t-tests, and analyses of variance, focused on the difference between young and older adults, as well as the differences in sexual behavior with partners located online and offline. RESULTS Young adults who seek sex on the Internet report substantially different sexual behavior patterns than young adults who do not seek sex on the Internet. Young adults with online partners reported sexual behaviors similar to older respondents who used the Internet to find sex partners; however, older respondents were more likely than young adults to have been tested for sexually transmitted diseases and HIV. CONCLUSIONS Young adults who seek sex partners online may be at significantly greater risk for sexually transmitted diseases than their peers who do not seek sex partners online. These data point to an urgent need for online sexual health promotion.

Recruitment and retention of an online sample for an HIV prevention intervention targeting men who have sex with men: the Smart Sex Quest Project.

There is an increasing interest in developing interventions for HIV and STD prevention that can be delivered on the Internet. However, we know little about what it takes to identify, recruit and retain participants in interventions so that we can test their efficacy and effectiveness. Objectives for this investigation were to evaluate rates of recruitment and retention in an Internet-based randomized controlled trial (RCT) to increase sexually transmitted disease (STD) prevention among men who have sex with men (MSM). The Smart Sex Quest study was a RCT conducted online. Eligible participants were MSM, at least 18 years old and US residents. After completing a baseline risk assessment, participants were exposed to tailored or control messages and asked to return to the site at three months for a follow-up interview. From January 2002 through June 2003, 3,625 persons logged on as potential study participants; of these, 563 were not eligible, while 1,286 left the site without filling out a baseline survey. Complete baseline data were available for 1,776 participants, all of whom were eligible to complete a follow-up. Complete follow-up data were available for 270 (15.2%) participants. While the Internet is a valuable tool for conducting research, conducting this longitudinal research online was severely affected by a loss to follow-up, and analyzing outcome data was hampered by significant differences between those who did and did not complete the study. Alternate ways to recruit for and evaluate online trials must be considered.

Characteristics of persons with syphilis in areas of persisting syphilis in the United States: sustained transmission associated with concurrent partnerships.

Background and Goal In areas with persistent syphilis, to characterize persons at higher risk for transmitting syphilis. Study Design Cohort study. Structured interviews of persons with early syphilis from four research centers were linked to outcomes of partner tracing. Results Of 743 persons with syphilis, 229 (31%) reported two or more partners in the previous month, and 57 (8%) received money or drugs for sex in the previous three months. Persons with at least one partner at an earlier stage of syphilis than themselves were defined as transmitters; 63 (8.5%) of persons with early syphilis met this definition. Having concurrent partners (two or more in one week in the last month) was independently associated with being a transmitter. Conclusion Sexual network/behavioral characteristics of syphilis patients and their partners, such as concurrency, can help identify persons at higher risk for transmitting syphilis who should receive emphasis in disease prevention activities.

Risks and benefits of the internet for populations at risk for sexually transmitted infections (STIs): results of an STI clinic survey.

Background The Internet is increasingly used for the recruitment of sex partners, potentially leading to increased risks for sexually transmitted infections (STIs). Less is known about the use of the Internet as a resource for STI education and prevention. Goal To evaluate the use of the Internet for sex-seeking and STI information purposes by clients of a large STI clinic. Study Design A 10-item survey was conducted among clients of the Denver Metro Health (STI) Clinic who visited the clinic for a new problem between September 2000 and May 2001. Results Among 4741 clients surveyed, 2159 (45.5%) had Internet access. Of these, 138 (6.4%) reported to have gone on-line with the specific purpose of finding a sex partner and 146 (6.8%) reported having sex with a partner they found over the Internet. Internet sex-seeking was more common among men who have sex with men (MSM; 77/269, or 28.6%) than among men who have sex with women (MSW; 52/1176, or 4.4%;P < 0.0001) and higher among MSW than among women (9/714, or 1.3%;P < 0.001). The Internet was accessed by 604 persons (28.0%) to find information on STIs. Of these, 65.1% did so for general STI information, 36.3% for information on HIV, 25.7% for information on genital herpes, 22.4% for information on chlamydia, 21.7% for information on HPV, 19.9% for information on gonorrhea, 16.1% for information on syphilis, and 9.3% for other information. Of persons seeking sex, 54.4% accessed the Internet for STI information, compared to 26.2% of persons not seeking sex (P < 0.0001). Conclusions Among STI clinic clients in Denver, nearly half have access to the Internet. Sex-seeking appears to be most prevalent among MSM. Internet use for STI information is common among those with Internet access and even more widespread among those who access the Internet to seek sex. Research is needed to develop and evaluate Internet-based STI-prevention interventions.

Internet-based health promotion and disease control in the 8 cities: successes, barriers, and future plans.

Objectives: The objective of this paper is to provide a detailed description of Internet-based sexually transmitted disease/human immunodeficiency virus prevention in the 8 US cities most affected by syphilis in men who have sex with men. Goal: By reviewing the efforts under way in these 8 cities, we will understand the barriers and facilitators associated with Internet-based prevention efforts. Study: This is a review of Internet activities taking place in 8 major US cities. Results: Efforts in the 8 cities vary, with some cities reporting little or no Internet-based prevention activities. Other cities have attempted banner advertising, online outreach, online partner notification, online laboratory slips for syphilis testing, and auditorium-style chat sessions. Conclusion: Though a number of policy-related barriers prevent some cities from engaging in Internet-based prevention, these activities are clearly important to the overall prevention effort. In order to surmount local policy barriers, it is essential to obtain evaluation data from the programs initiated.

CDC consultation on methamphetamine use and sexual risk behavior for HIV/STD infection: summary and suggestions.

In January 2005, the U.S. Centers for Disease Control and Prevention hosted a national consultation of scientists, public health officials, and community service providers to address growing concerns about the association of methamphetamine use and sexual risk behavior for HIV/STD infection, which is well documented among men who have sex with men. The purpose of the consultation was to review a representation of the current state of the science and practice on the topic in order to reduce the situational link of methamphetamine use and sexual risk. A set of suggestions for future research and programs were developed by the participants. This article provides a summary of content and recommendations from the consultation, and not an exhaustive review of the literature.

The process of seeking sex partners online and implications for STD/HIV prevention.

Research has shown that online sex-seeking among men who have sex with men (MSM) is related to elevated risk for sexually transmitted diseases (STDs), including HIV infection; however, the process of seeking sex online is not well understood. It is important to understand the process of seeking sex partners in order to determine the best method for reaching MSM at high risk for infection. We report on baseline data from the Smart Sex Quest, an Internet-based STD prevention intervention targeting MSM (n=1,776, 79% white, mean age=33 years). Results indicate that older, white, college-educated men solicited sex partners on AOL, whereas Gay.com was a more frequent choice among younger men. Yahoo was named as a solicitation site more frequently by those with no college education, as were ‘bareback’ websites devoted to facilitating anal sex without the use of condoms. Following online solicitation, men tended to meet in public restrooms (86%), partners’ homes (74%) and their own home (57%). Though results are limited by the self-selected nature of the sample, the data have important implications for online outreach, study recruitment and intervention.

Sex and the internet.

Since the media serve as means of facilitating interpersonal contacts the Internet is considered as medium for the burgeoning sex-seeking environment. The use of Internet for sex-seeking purposes is enhanced due to the anonymity of instant interaction with like-minded people. In addition its immediacy allows for a virtual encounter to be followed by physical encounter and with more partners to choose from subsequently enhancing the sex- seeking efficiency. According to several studies on-line sex- seekers had greater number of sex partners and had showed risky sexual behaviors. Transmission of sexually transmitted infections has also been linked to Internet use. In another study it revealed that Internet sex-seeking is part of risk behavioral repertoire and it is common among men who have sex with men (MSM). Hence research regarding Internet-related sexual behavior is largely focused on MSM. On the contrary the Internet could play an important in the prevention of sexually transmitted disease/HIV as a medium of prevention messages.