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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

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
stdpo users areas of interest n 877
STDPOUsers 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%
conclusion 3
Conclusion – 3
  • Join STDPreventionOnline!!

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