Social Media and Its Impact on Sexually Transmitted Infections
Social media and its impact on sexually transmitted infections
Dr Gary Whitlock, Consultant Physician, 56 Dean Street
ESCMID eLibrary © by author Background
ESCMID eLibrary © by author ESCMID eLibrary
Chelsea and Westminster Hospital © by author NHS Foundation Trust Context
• 56DS • Opened 6 y ago • Soho, central London
Sexual health • 60% MSM • 12,500 clinic attendances per month
• Focus on reducing undiagnosed HIV ESCMID eLibrary © by author Context
HIV • 4200 HIV+ cohort • >90% MSM
• High HIV+ incidence • 1 in 2 of MSM diagnosed in London • 50% RITA+ (predicted PHI) ESCMID eLibrary © by author Dean Street Express: a new service design for asymptomatic STI screening
ESCMID eLibrary © by author Time to result notification for chlamydia/gonorrhoea NAAT tests
8 days faster
ESCMID eLibrary Whitlock G et al. IJSA (2018) © by author Definitions
ESCMID eLibrary © by author Social media (OED definition)
Websites and applications that enable users to create and share content or to participate in social networking
Social networking The use of dedicated websites and applications to interact with other users, or to find people with similar interests to one’s own. ESCMID eLibrary © by author Geosocial networking applications
= GSN apps
A smartphone application Allowing registered users to use their smart phone’s GPS To locate and network with other users who are physically nearby
ESCMID eLibraryBeymer MR et al STI 2014 © by author History
ESCMID eLibrary © by author ESCMID eLibrary © by author ESCMID eLibrary © by author Cottaging Internet sites for meeting sex partners: Cruising areas Bathhouses/saunas Gaydar Manhunt Personal Ads Adam4Adam
1980 1990 2000 2010
Internet sites: GSN apps
Grindr Gay.com Scruff Craigslist Recon ESCMID eLibraryiPhone launched 2007 © by author Aug 2015: downloads Apple ioS + Google play
ESCMID eLibrary © by author Abodo 3500 college students who use dating apps
ESCMID eLibrary © by author What’s all the fuss about?
ESCMID eLibrary © by author ESCMID eLibrary © by author Social media
ESCMID eLibrary © by author ESCMID eLibrary © by author ESCMID eLibrary © by author Gonorrhoea in MSM in USA
ESCMID eLibrary © by author Hypotheses (Liau et al. 2006)
Self-selection hypothesis Those more likely to engage in risky sex are more likely to use social media to meet sex partners
Accentuation hypothesis Social media accentuates risk behaviours and STI transmission. Expanding access to sex partners increases sexual actitvity and likelihood of risky behaviour ESCMID eLibrary © by author What do we know?
ESCMID eLibrary © by author MSM: meeting via internet
Ng et al Am J Public Health (2013) California MSM with primary/secondary syphilis
Review of EPR (case management reports) 2004 - 2008
N=5925 HIV+ 59%
36% used internet to meet sexual partners (>bars/clubs>saunas…) Internet ESCMIDmeet: significantly more sexeLibrary partners in last 6/12 (9.8 v 5) © by author MSM: meeting via internet
Liau et al STD (2006) Meta-analysis
Literature search: ‘MSM’ + ‘Internet’/ ‘online’ /… 1988 – 2000
40% had used internet for sex partners
Internet meet greater odds of condomless AI (OR 1.68), irrespective of HIV status ESCMID eLibrary © by author MSM: meeting via internet
Rosser et al AIDS Behav (2009) Internet survey of sex behaviour (MINTS-II Survey)
US MSM using Gay.com June-September 2005
N = 2716 Condomless AI 2x more likely when partners met online, irrespective of HIV status
Proportion of partners they engage in condomless AI with was similar
?Internet ESCMID facilitates efficiency in meetingeLibrary men for sex rather than increasing rates of unsafe sex © by author MSM: Internet
• Common (even 20 y. ago) • More sex partners • More condomless AI ?through more sex partners
ESCMID eLibrary © by author MSM: USA, meeting via GSN app
Beymer et al STI (2014) Case note review
MSM visiting the Los Angeles Gay & Lesbian Centre for STI screening HIV-negative at baseline August 2011 – January 2013
N = 7184
34% in-person meet only 30% internet only or with in-person
36% GSNESCMID or with other eLibrary © by author USA: MSM: meeting via GSN app
Beymer et al STI (2014) GSN app users more likely to be: <40 y.o. White/Asian/other (cf. African-American/Latino) College graduates
GSN app (cf in-person or internet meet) Higher rate of NG
GSN app (cf in-person) Higher rate of CT
No associationESCMID with syphilis or HIV eLibrary © by author Australia: MSM: meeting via GSN app
Chow et al AIDS patient care STDs (2016); Chow et al IJSA (2018) Anonymous questionnaire
MSM attending Melbourne Sexual Health Centre July 2014 – June 2015
N = 1902
Meeting partners: 71% mobile app 46% through friends 41% internet 37% garESCMID bar eLibrary 35% sexual on premises venue (SOPV) © by author Australia: MSM: meeting via GSN app
Chow et al AIDS patient care STDs (2016); Chow et al IJSA (2018) Significant assoc between age and meeting method: Younger (mobile app) > older (SOPV)
Mobile app meet: more likely to have more sexual partners BUT no significant assoc between meeting method & condomless AI
87% had sexual intercourse in last 3/12
Mobile app meet: more ESCMID likely to engage in receptive eLibrary rimming & using partner’s saliva as lubricant for AI © by author MSM: GSN app
• Common • More sex partners • More NG & CT Not HIV or syphilis • ?Due to ‘efficiency of GSN’/spontaneity ESCMID eLibrary © by author Use dating apps: heterosexual
• Anonymous survey • n=539 • Two sexual health clinics • 70% women, 30% men • London, UK • August 2015
F M Total
Ever used dating app (87) 54% (45) 12% 24% ESCMID eLibrary Mohabeer Hart et al. STI 2016; 92 (suppl 1): A1 © by author Dating app use: heterosexual
70
60
50
40
30
20
10
0 A long-term A casual A casual or A casual Sex only All of the Blank relationship relationship long term rel. relationship or above sex only ESCMID eLibraryMen Women Mohabeer Hart et al. STI 2016; 92 (suppl 1): A1 © by author Dating app use: heterosexual
Frequency app use (%) Female Male Every month 10 15 Every few months 23 31 Yearly 28 27 Less than once a year 38 27
ESCMID eLibrary Mohabeer Hart et al. STI 2016; 92 (suppl 1): A1 © by author Dating app use: heterosexual: sex partners in last 12 months
Group who have never used SM Group who have used SM to find a 50 partner
45 30
40 25 35
30 20
25 15 20
15 10
10 5 5
0 0 0 1 2 3 4 5 6 7 8 9 10 to 16 to >20 >30 Blank 0% 1 2 3 4 5 6 7 8 9 10 to 16 to >20 >30 Blank 15 20 15 20 ESCMIDMale (n=109) Female (n=287) eLibraryMen (n=45) Women (n=87) © by author Dating app use: heterosexual
%
Would request STI testing kit via app 62
Would value sexual health info via app 57
ESCMID eLibrary Mohabeer Hart et al. STI 2016; 92 (suppl 1): A1 © by author ESCMID eLibrary © by author ESCMID eLibrary © by author Dating app use: MSM
Method of meeting sex partners %
In person only 34
Internet only or with in-person 30
GSN phone app only or with other methods 36
ESCMID eLibrary Beymer MR et al STI 2014;0 1-6 © by author iPhone Grindr
Dating app use: MSMMore GSN apps…
Method of meeting sex partners %
In person only 34
Internet only or with in-person 30
GSN phone app only or with other methods 36
ESCMID eLibrary Beymer MR et al STI 2014;0 1-6 © by author Swiss statement HPTN-052 PARTNER U=U Dating app use: MSM
Method of meeting sex partners %
In person only 34
Internet only or with in-person 30
GSN phone app only or with other methods 36
ESCMID eLibrary Beymer MR et al STI 2014;0 1-6 © by author PrEP US FDA Online generic Dating app use: MSM 56DS
Method of meeting sex partners %
In person only 34
Internet only or with in-person 30
GSN phone app only or with other methods 36
ESCMID eLibrary Beymer MR et al STI 2014;0 1-6 © by author Dating app use: MSM
Method of meeting sex partners %
In person only 34
Internet only or with in-person 30
GSN phone app only or with other methods 36
ESCMID eLibrary Beymer MR et al STI 2014;0 1-6 © by author What can we do?
ESCMID eLibrary © by author ESCMID eLibrary © by author Engage existing/new GSN apps
• Sexual health promotion • Advertise health services In January 2015 • Education Only 15% (9/60) dating apps contained sexual health content • Safer sex messages • Promote testing for STIs and HIV Huang et al (2016)
• Sharing info with potential sex partners • Increasing partner notification • Sharing results of STI screens ESCMID eLibrary © by author Hornet/ECDC PrEP survey
• Hornet/ECDC survey on PrEP
ESCMID eLibrary © by author ESCMID eLibrary © by author Who are MSM at high-risk?
• PEPSE, Jan-Jun 2013 1 • 530 MSM • HIV incidence: 7.6 per 100 pyfu
• MSM with early syphilis, Jan – Jun 2014 2 • 206 MSM (110 HIV-; 96 HIV+) • HIV: 8.3 per 100pyfu
1. Whitlock et al STI 2016 ESCMID eLibrary2. Girometti et al STI 2016 © by author Dean Street Prime
ESCMID eLibrary © by author Dean Street Prime
ESCMID eLibrary © by author Dean Street Prime
ESCMID eLibrary © by author Dean Street Prime
ESCMID eLibrary © by author ESCMID eLibrary © by author Temporal evolution of PEP and PrEP with time at 56 DS
450 1800
400 Generic PrEP 1600
350 IMPACT 1400
300 PEP 1200
250 1000 prescriptions
200 800 PrEP
150 600 PEPprescriptions 100 400
50 200 Cumulative Cumulative
0 0
ESCMIDDate (MontheLibrary – Year) Suchak et al P80 BASHH/BHIVA conference (2018) © by author HIV Testing and New Diagnoses, 56 Dean Street, 2015-2017
80 8000
70 7000
60 6000
50 5000
40 4000 HIV HIV tests/month
30 3000 HIV+ diagnoses/month HIV+
20 HIV tests performed 2000
10 New HIV diagnoses 1000
0 0
Jul-15 Jul-16 Jul-17
Jan-15 Jan-16 Jan-17
Jun-15 Jun-16 Jun-17
Oct-15 Oct-16
Apr-15 Apr-16 Apr-17
Feb-15 Sep-15 Feb-16 Sep-16 Feb-17 Sep-17
Dec-15 Dec-16
Aug-15 Aug-16 Aug-17
Nov-15 Nov-16
Mar-15 Mar-16 Mar-17
May-15 May-16 May-17 Month ESCMID eLibraryNwokolo N Lancet HIV (2017) © by author Thanks
ESCMID eLibrary © by author