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STI’s and the Internet. Risks and Opportunities for Prevention. Kees Rietmeijer, MD, PhD Denver Public Health Department Denver, CO, USA. Discuss STIs and the Internet in 3 Contexts:. Within At-Risk Populations Provider-Population Interaction Among Providers. At-Risk Populations.

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STI’s and the Internet

Risks and Opportunities for Prevention

Kees Rietmeijer, MD, PhD

Denver Public Health Department

Denver, CO, USA

Discuss stis and the internet in 3 contexts
Discuss STIs and the Internet in 3 Contexts:

  • Within At-Risk Populations

    • Provider-Population Interaction

  • Among Providers

  • The story begins
    The Story Begins….

    JAMA July 2000;284

    Internet and std
    Internet and STD

    “Clients who reported seeking sex on the Internet were more likely to have concomitant risk factors for STD/HIV than clients who did not seek sex on the Internet. Thus, seeking sex on the Internet may be a potential risk factor for STD/HIV”

    McFarlane et al. JAMA 2000;284

    Common knowledge
    “Common Knowledge”

    • “Multiple studies have identified Internet use to find sex partners as a risk factor of acquisition of sexually transmitted diseases, particularly among MSM”

      Manuscript recently submitted for journal review



















    Association Internet Sex with Prevalent Gonorrhea and/or Chlamydia


    Sex with Internet


    Odds Ratio

    (95% C.I.)

    Al-Tayyib et al. Poster C-02

    “Sexual encounters with partners met on the

    Internet may not be as risky as previously thought and may even be protective for some. However, a person’s risk for STI may depend on the type of Internet site on which they seek the partner and the explicit purpose of the partnership. Further investigation to elucidate these differences is needed.”

    Al-Tayyib. Poster C-02

    Rietmeijer et al.

    Sex Transm Dis 2007;34:215-219

    Survey among women using online personal ads n 588
    Survey Among Women Using Online Personal Ads (N=588)

    • Extensive e-mail use prior to face-to-face meeting to negotiate safety, boundaries, sexual preferences, STDs, and condom use

    • 30% had sex at first encounter

    • 77% did not use condoms

      “The high frequency and intensity of e-mail communication prior to meeting in person cultivated acceleration of intimacy for the individuals involved and may have affected women’s decisions to engage in risky sexual behaviors.”

    Padgett PM. Sexuality Research and Social Policy 2007;4:27-37.

    Conclusions 1
    Conclusions - 1

    • Online (sex) partnering is no longer restricted to high-risk MSM

    • Using the Internet for sex-seeking purposes may enhance both risk taking and preventive behaviors

    • More research is needed to better understand online interactions between prospective sex partners

    Provider population interactions

    Provider-Population Interactions

    The Internet (and other new media) as a vehicle for prevention

    Hiv sti prevention online typology
    HIV/STI Prevention Online-Typology-

    • Interventions to enhance HIV/STI Testing

    • Efforts to enhance partner notification and treatment

    • Interventions to induce behavior change to prevent STI/HIV acquisition and transmission

    Rietmeijer & Shamos. Sexuality Research and Social Policy 2007;65-73.

    Iwtk evaluation july 2004 january 2005
    IWTK Evaluation(July 2004 – January 2005)

    • 1254 kits placed in the community and 1168 kits requested by e-mail

    • 400 kits returned for testing; 350 (87.5%) requested by email

    • 41/400 (10.25%) were chlamydia positive

    • Of those testing positive, 95.1 received treatment

      Of users:

    • 89.5% prefers collecting own specimen

    • 75.9% prefers self-obtained vaginal swab or urine

    • 86.3% would use Internet again

    Gaydos et al. Sex Transm Dis 2006;33:451-457

    Online partner notification
    Online Partner Notification

    • Use of e-mail as additional modality to PN

    • Partner notification in chat rooms

    • Self-contained online partner notification programs

    Available at and at

    Online pn inspot
    Online PN - InSpot

    Interventions to give information and induce behavior change
    Interventions to Give Information and Induce Behavior Change

    • Interactive Behavioral Interventions

    Interventions to give information and induce behavior change1
    Interventions to Give Information and Induce Behavior Change

    • Interactive Behavioral Interventions

    Conclusions 2
    Conclusions - 2

    • Internet-based and other “new media” interventions are widespread

    • Many are simple online adaptations of offline interventions

    • Some use the advantages for current Internet technology (Web 2.0)

    • Most “new media” interventions have not been evaluated

    The internet and sti hiv prevention providers

    The Internet and STI/HIV Prevention Providers

    Get With The Program!!


    Stdpo users areas of interest n 877
    STDPO Users Areas of Interest (N=877)

    • HIV/AIDS: 71%

    • Chlamydia: 58%

    • Gonorrhea: 58%

    • Syphilis: 57%

    • Behavioral Interventions: 53%

    • Youth/Adolescents: 51%

    • HPV/Genital Warts: 48%

    • HSV/Genital Herpes: 45%

    • Program Improvement: 43%

    Membership by employment n 924
    Membership by Employment N = 924

    Stdpo membership focus of work
    STDPO Membership Focus of Work

    Conclusion 3
    Conclusion – 3

    • Join STDPreventionOnline!!

    A Sneak Preview

    Next Screening

    5:30 PM

    To sign up for a Safe City package, please talk to

    Lee Warner or Kees Rietmeijer