Best Practices in Integrating New Technologies into HIV STD Prevention

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					Best Practices in Integrating
  New Technologies into
   HIV/STD Prevention

  Prevention Intensive Workshop
 17th Annual HIV/STD Conference
     Springfield, IL 10/29/2008
        Why New Technologies?
Effective interventions & services meet clients where they are

And where is everybody these days?

Surfing the web, or using their mobile phone, or both
      What new technologies?
Explosion of new wired or wireless electronic
  technologies over last 10 years -

WWW revolution
Social networking sites
Pod-casting to mobile phones
Text messaging
Virtual reality

For short, we’ll call all this stuff “E-Tech”
 Internet…everybody’s doin’ it!
• 220 Million Internet users in U.S.
• 72.5% of U.S. population uses the internet
  on a daily basis at home or at work
• 80% of adult internet users have searched
  for health topics online
• 11% sought sexual health information
• 21 million teenage internet users online
• 87% of them in age range 12-17
• Teens average 20 hours a week online
 (sources: Fox, Health info online;, June 2008.)
               Go Mobile!
• 262.7 million wireless subscribers in U.S.
• 84% of U.S. population
• 79% of all teens (17 million) have a mobile
• 15% of teens own a “smart phone”
• Monthly SMS or text messages sent in the
  U.S. jumped from 12.2 million in June 2000,
  to 7.2 billion in Jun 2005 to 75 billion in
  June 2008.
                         (Source:, Oct 2008)
       People using these new
         E-technologies to:
do pretty much everything that people do…
Shop, search for information, communicate
  with friends & family, seek health &
  lifestyle information, share pix, listen to
  music, catch a new video, chat, meet new
AND connect for sex
           Internet and Sex
• Internet & mobile-based technology are
  ideal mediums for sexual pursuits as result
  of the three As:
• Accessibility
• Affordability
• Anonymity
          Internet and Sex
• Soliciting sexual partners on-line is
  becoming more prevalent, particularly
  among groups who are already at
  increased risk for STIs
• The increased use of technologies to meet
  people gives us new opportunities to reach
  people where they are with prevention
  interventions using the same technologies.
            Best Practices
we’ll overview some current “best practices”
  using E-Technologies in 3 contexts:
• Within at risk populations
• Provider – population interactions
• Provider to provider
3 Primary types of interventions
• Interventions to increase HIV/STI
  screening and testing
• Interventions to enhance partner
  notification and treatment
• Education & health promotion to provide
  information, encourage behavior change
  and prevent STI/HIV acquisition and
• Asks users to answer simple questions about their
  behaviors & symptoms they may have
• Program analyzes 3000 logic factors comparing
  responses to CDC STD Treatment Guidelines,
• Based on user responses, provides a
  personalized list of recommended tests and/or
  vaccines and links to relevant STI fact sheets
• A list with the questions, user responses and
  resulting recommendations can be printed and
  taken to medical provider for follow up
    Advantages of
•   Free screening for user and providers
•   Easy access – can be set up in kiosks
•   Perceived as a credible source
•   Attractive simple format
•   Customized education/notes for users
•   Personalized risk assessment
•   Promotion of STI screening & follow up
• Online wizard for STI screening & lab order
• For San Francisco residents
• Site provides fact sheets on STI, symptoms,
• Option to select which tests you want or use
  a “quiz wizard” for recommended tests
• 7 lab sites where users can take lab orders
  for specimen collection & testing – how it works
• Users take a brief “screening quiz”
• Answer questions to create an online lab
• Take slip to SF area labs for specimen
  collection and free testing
• Get their lab results online in 3-5 days
  using a nine digit code number
• If any lab result positive, follow up with SF
  City Clinic or private MD for treatment
       Benefits of
• Increases number of people getting tested
  for STIs
• Increases percentage of tested people
  who learn their test results
• Increases user knowledge about STI
  transmission, symptoms, treatments
Free online access to male & female chlamydia
test kits for residents of Denver, CO, Maryland, W.
Virginia, most of central Illinois
Part of a John Hopkins research study
Can call for a test kit, or have it mailed to you
• Residents of Illinois
  counties in blue can
  receive a free test kit
  and participate in the
  study by going to:
          I Want the
• Research study, so there is a
  questionnaire mailed with the kit
• Kit uses self-administered sample swab
• Sample tested for chlamydia, gonorrhea
  and trichomonas at John Hopkins
  University lab in Baltimore
• Participants with positive lab results are
  referred for free treatment in their area
• To let partners know that you have an STD
  and that they may have been exposed too.
• Online service only for selected cities and
  states (includes Chicago but not all of IL)
• Sends e-card/email to one or more people
• Your own email address is optional
• Site includes city-specific testing sites, local
  resources, and general info on most STIs
            Some notes from the site…
• In Chicago, there's an easy way to tell your sex
  partners you have an STD. Send them a free inSPOT
  e-card, ANONYMOUSLY or from your email address,
  right here.
• No information will be reported to any government or
  private agency. Please respect the community and
  don't use these cards to spam.
• We appreciate your desire to inform your partners
  about their possible contact with an STD. We
  recommend, if at all possible, that you contact your
  partners directly.
• If you choose to notify them through inSPOT and
  they have a spam blocker, the card you send them
  may go into their spam file.
          STI “options” in their drop down
             list don’t include HIV….
•Crabs & Scabies
•Hepatitis A
•Molluscum Contagiosum
•Non-Gonococcal Urethritis (NGU)

 B.   I left with Crabs and Scabies. You might have, too.
      Get checked out soon.
      This is a test from me to me to see how this works.
 C.   Was sent anonymously thru

• A=the card chosen. B=the STD msg. C=your
  personal note you type in.
Some e-card choices…
2 e-card choices in Spanish
• The internet's first, confidential online sexual history log.
• The site gives the user the ability to easily maintain a
  sexual history, and keep track of who he or she has been
  with. Very useful if you need to find someone again!
• 1 out of 3 people, both male and female, have some kind of
  "sex log". The problem with that is that they have no place
  to keep it from prying eyes - or they don't keep it up to date
  because it is too hard to maintain.
• MyBlackBook® solves both those problems - and more,
  giving everyone a place to store their sexual history and
  details about the event - without fear of somebody finding it
  - or judging them on their lifestyle.
What tools and features does MyBlackBook offer:

•Statistics: Show hard, raw numbers - about your sexual
lifestyle and what it will take to make a difference in your life.
•Risk Assessment: Based on your sexual history, we give
you the ability to see how your habits can increase your
health risk
•Recent Partners: Charts allow you to see who you've been
sexually active with, if they overlap time-frames, and if there
are any possible links between them.
•Create Reports: View recent activity, view pictures of
entries, search sessions and display information for each
session and entry contained in your MyBlackBook.
Includes VDNote - a tool that analyzes and gives you the probability (in
percentage) on your risks of contracting specific STDs.
Risk percentages provided are based on national sexually transmitted
disease rates and your probability for a specific STD reflects your sexual
habits as logged in your MyBlackBook account.
Track your STD Test results, and receive notifications
on the site when test results are outdated and you
should schedule to be tested again.
• Designed by health educators at I.S.I.S., Inc. with
  funding from the San Francisco Department of Public
  Health, STD Prevention and Control, and programmed
  by Hip Cricket.
• Provides info and advice via mobile phone text
  messages (SMS) for urban youth about:
   – STDs
   – HIV
   – Birth Control
   – Sexual Health Services, and more.
How does “SEXINFO” work?
Send the text message
“sexinfo” to the number
A recording tells callers to
select a number, based on
their reason(s) for calling
The number selected
generates a text message
back to the phone with
information related to the
question selected
Next slide shows the type of
info given to callers
Txt "1" if ur condom broke : “U may be at risk 4 STDs + prgnancy S.E. Clinic,
Keith at ArmstrongSt, 415-671-7000 M-F8-5, W8-12, City Clinic 356 7th St 415-
487-5500 MWF 8-4 TuTh 1-4”

Txt "3" if s/he's cheating on u: “If u think s/he's cheating on u, get a checkup
2day STDs can go backnforth most times there's no symptoms drop-in City
Clinic 356 7th St 415-387-5500”

Txt "5" for STD info: “If u have sex, u can get an STD + not know it. Dropin get
checked FREE 356 7th St. 8-4 MWF, 1-4 TuTh free RAPID HIV tests HipHop
415-337-4719 MTh 1-5.
Txt "6" if ur not sure u want 2 have sex: “It's ur choice 2 have sex or not get info
B4U decide Balboa/1000 Cayuga 415-469-4512; 9-4 M-F; Cole St. Clinic 555
Cole St dropin Th 2-6; 415-751-8181”.
    Strength in Numbers (SIN)
• Social networking site for HIV+ gay men
• Local chapters in 27 U.S. cities, 7 statewide
  chapters, several other cities around the globe.
• SIN chapters use Yahoo Groups to help
  members network online in a free and easy to
  use environment. Also use Facebook &
• Users need a Yahoo profile to join Yahoo
  Groups to reach SIN chapter web pages
             SIN – Activities
• interactive WWW communications system
• develop local programs to increase self-esteem
  and social interaction skills
• organize & guide local activities to increase
  physical abilities
• promote volunteer opportunities for members in
  HIV-related efforts including fundraising for
  treatment services and research
• - Sex Education by
       Teens, for Teens!
Sex, etc. is an award-winning national
 magazine and Web site on sexual health
 that is written by teens, for teens.
Major topic areas on the site include:
•   Girls' Health      Guys' Health
•   Sex                Love & Relationships
•   GLBTQ              Deciding about Sex
•   Birth Control & Condoms
•   Sexually Transmitted Diseases
•   Pregnancy...Am I/Is she?
•   Teen Parenting     Abortion Adoption
•   Emotional Health Abuse & Violence
•   Body Image
  National Guidelines for Internet-based STD and
   HIV Prevention: Accessing the Power of the
    Internet for Public Health (Final, March 2008)

•Guidelines for Internet-based Partner Notification

•Guidelines for Internet Outreach

•Guidelines for Health Communications or
• Puts reproductive health professionals in touch
  with the people and resources they need
• Join STDPO and receive FREE full access to
  STI journal!
• is a project of The
  Internet & STD Center of Excellence, a research
  effort to explore, identify, implement and
  evaluate innovative technologies and
  applications that show promise in addressing
  sexually transmitted disease prevention.
                 Major site sections on:
•   Resources for review and/or download
•   Events, including major and regional
    conferences and trainings
•   Discussion (blogs; q/a with other professionals)
•   Groups (regional & specialty focus areas)
•   STD info
•   Daily digest of top STD and other health-related
• The leader in developing technology for
  promotion of sexual health and healthy
  relationships, and to prevent disease
• ISIS mission is to provide leadership,
  innovation, educational resources and
  research in online sexual health promotion.
        ISIS recent notable projects include
•   A sponsor of the 1st Annual SEX:Tech
    Conference, SFO, Feb 2008
                          ISIS services include:
•   Professional trainings and workshops for community and health workers re:
    Internet interventions;
•   Custom websites designed to reach target populations with interactive
    prevention messages;
•   Liaison services between non-profit or government groups and corporate
    Internet entities;
•   Design of online social marketing campaigns and offline campaigns to reach
    online populations;
•   Consulting services re: development of Internet prevention and outreach
    strategic plans;
•   Moderation services for facilitated chats and message board forums related to
    sexual health;
•   New sexual health promotion tools via cell phones, Internet, and PDAs;
•   Computerized behavioral risk assessment for sexual health and disease
    prevention; and
•   Email listserv set up and maintenance for community members and/or