Sheana Bull

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.

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.

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.

Practice patterns for the elicitation of sexual history, education, and counseling among providers of STD services : Results from the gonorrhea community action project (GCAP)

BACKGROUND The frequently asymptomatic nature and high incidence of severe complications of sexually transmitted diseases (STD) calls for targeted efforts to identify those at greatest risk. Earlier studies have shown inconsistencies regarding STD evaluation by primary care clinicians and physicians. However, the literature regarding the consistency of practice patterns regarding elicitation of sexual history is limited. We examined practice patterns for the elicitation of sexual history among providers across seven sites nationwide. METHODS As part of a multisite study to encourage health seeking for populations specifically at risk for gonorrhea (GC) and other STDs, semistructured interviews that included questions regarding sexual history elicitation were conducted with 208 service providers in a total of 121 publicly and privately funded clinics, managed care organizations (MCOs), hospital clinics, community- and school-based clinics in Denver, New York, Los Angeles, Birmingham, St. Louis, Indianapolis, and Prince Georges County, MD. RESULTS Among the providers interviewed, practice patterns for the elicitation of sexual history were inconsistent. Sexual histories were described as routine (i.e., solicited from every client regardless of reason for visit) in 57% of sites. Providers most frequently asked clients their number of sex partners (57%), their contraceptive history (55%), and STD history (34%). Client discomfort among 46% and provider discomfort among 13% was cited as barriers to the elicitation of sexual history. A quarter (26%) of providers agreed that the elicitation of sexual history can be fostered by improved provider communication skills and 16% agreed increasing training and experience for providers is needed. CONCLUSIONS These findings suggest that interventions with providers to standardize sexual history elicitation can help to reduce barriers to prevention, diagnosis, and treatment of STD.

Patterns of general health care and STD services use among high-risk youth in Denver participating in community-based urine chlamydia screening.

Background: In the United States, youth are at highest risk for STDs, and innovative programs have been called for to increase their access to essential STD‐related services. To guide the development of such programs, locally relevant information is needed on current use of general health care and STD services in this population. Goal: To study access to and use of general health care and STD services in a purposive sample of high‐risk youth in innercity Denver. Study Design: An interview‐based survey conducted as part of a community program for urine chlamydia screening targeting black and Hispanic youth 13 years to 25 years. Results: Of 221 sexually experienced youth in the survey, 72% had accessed general health services in the past year and 39% reported an STD evaluation at any time in the past. Community and school clinics were reported by 50% as a source for general health care and by 62% as a source for STD services. STD clinics were reported by only 14% as a source for STD services. Routine checkups were the most important reasons to seek general health care, yet of those who went for a routine checkup, only 34% reported an STD evaluation. Although few barriers appeared to exist in accessing general health care, anticipated anxiety about procedures and results formed the major barrier to accessing STD services. Conclusions: Use of general health services was common in this population of high‐risk adolescents; however, the provision of STD services as part of general health care visits appeared to be low. On the basis of these findings, a comprehensive STD prevention strategy may be envisioned, which would include provider interventions to increase the provision of STD prevention services in general health care settings; community interventions to enhance access to general health care and STD services; and community‐based screening programs for those not able or willing to seek clinic‐based services.

Technology-Based Health Promotion

SECTION ONE: ORIENTATION TO TECHNOLOGY BASED HEALTH PROMOTION 1. A Primer on Technology Based Health Promotion 2. Ethical Issues in Technology Based Health Promotion SECTION TWO: UNIQUE ASPECTS OF TECHNOLOGY BASED PROGRAM DEVELOPMENT, IMPLEMENTATION AND EVALUATION 3. Technology Based Health Program Development 4. Technology Based Program Implementation 5. Program Evaluation for Technology Based Health Promotion 6. Case Studies in Computer-Based Health Promotion 7. Case Studies in Internet-Based Health Promotion 8. Case Studies in Mobile Phone-Based Health Promotion Epilogue

What Do Young Adults Expect When They Go Online? Lessons for Development of an STD/HIV and Pregnancy Prevention Website

We used participatory research to develop a theoretically based online STD/HIV and pregnancy prevention intervention that would be entertaining and captivating for 15–25 year olds while delivering key messages about condom use. We conducted six focus groups with 15–25 year olds attending reproductive health clinics and completed a content analysis with focus group data. Youth had expectations that websites contain features such as graphics and flash technology. They would participate in research online if their confidentiality was assured and if they could receive an instant incentive. Limited access to high-end bandwidth capability requires use of compressed graphics and music to reach diverse audiences. Youth suggested approaches to frame role-model delivered messages about HIV/STD and pregnancy risk, condom attitudes, norms and self-efficacy for negotiation. These data allowed for development of a dynamic, interactive and relatively low bandwidth site that retains fidelity to key theoretical constructs in STD/HIV and pregnancy prevention.

LUCHAR: Using Computer Technology to Battle Heart Disease Among Latinos

Many promising technology-based programs designed to promote healthy behaviors such as physical activity and healthy eating have not been adapted for use with diverse communities, including Latino communities. We designed a community-based health kiosk program for English- and Spanish-speaking Latinos. Users receive personalized feedback on nutrition, physical activity, and smoking behaviors from computerized role models that guide them in establishing goals in 1 or more of these 3 areas. We found significant improvements in nutrition and physical activity among 245 Latino program users; however, no changes were observed with respect to smoking behaviors. The program shows promise for extending the reach of chronic disease prevention and self-management programs.