How To Intervene on Sexual Networks..and Why Dan Wohlfeiler Transforming Care Conference Oct. 21, 2016

Transcription

1 How To Intervene on Sexual Networks..and Why Dan Wohlfeiler Transforming Care Conference Oct. 21, 2016

2 What I ll cover: Why? What? Now What? Challenges of behavior change Why networks are important BHOC efforts to reduce transmission online Research Collaboration Next Directions What can you do?

3 Intervention Counseling Information Qualitative Assessment of Findings Project Respect (Kamb, 1998) 7.3% 10.4% Project Aware (Metsch, 2013) 12.3% 11.1% MSM in Project Aware 18.7% 12.5%

4 Individual behavior vs. Individual risk Imagine two blue people, each has one partner Their partner was HIV- when they got together And they have the same condom use and sexual behavior repertoire Are they both equally protected against HIV? Your HIV exposure is not just determined by your behavior It is determined by your partner s behavior Which is determined by their partner s behavior Which is determined by their partner s behavior... 10/11/2016 Morris and Tsellegellasie, Seattle WA 4

5 Recommended Standards for the Safe Operation of Sex Clubs in San Francisco (1991) Owners and AIDS educators Clean, well-lighted place for sex Rules made explicit at door No private spaces Condoms, educational materials, etc.

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8 BHOC Goals Build self-sustaining features into sites that promote health and informed choices, and reduce stigma Coordinate and improve advertising and messaging Coordinate interactions with sites and apps

9 The problem: Men who get STDs (including HIV) report meeting partners online We had: no knowledge of which interventions MSM would use little knowledge of what website owners preferred no consensus about impact spent funds without coordinating as well as we could Website owners get multiple, conflicting requests We aren t doing a good job of leveraging many online/app features.

10 Our vision for the study To find strategies to reduce HIV and STD transmission that will be supported by and low cost to website owners and public health, and likely to be used by website users.

11 We surveyed three stakeholder groups about the same set of interventions 18 Website owners/ Managers 82 HIV/STD Directors 3,050 MSM website users How likely would you be to implement each idea? Which ideas are most likely to reduce HIV and/or STD transmission? Which interventions would you be most likely to use? BUILDING HEALTHY ONLINE COMMUNITIES 11

12 % of Users Light Use Moderate Use Frequent Use Heavy Use "In a Typical Week, How Many Hours Do You Spend Online Looking for Guys?" < 3 hrs 3-5 hrs 6-13 hrs >13 hrs No Response 0.7

13 % of Users How Often Do You Get What You re Looking For Online?" Rarely Sometimes Often No Response

14 The win, win, wins: Eight strategies were favored by a majority of owners, users, and directors: 1. Filtering partners by profile information 2. Online STD testing directory searchable by zipcode 3. Subsection of sites for specific sexual interests 4. Including safe sex preference as a profile option 5. Access to sexual health experts 6. Access to sex-positive videos 7. Automatic HIV/STD testing reminders at users choice of intervals 8. Online partner notification re HIV/STD exposure with e-cards

15 Health Dept. Budgets for Advertising Online (n=92) 2015 Min = $200 Max = $100,000 Total = $687, HDs 2016 Min = $200 Max = $500,000 Total = $1,750, HDs

16 2015 and 2016 Online Advertising Budgets $600,000 $500,000 $400,000 $300,000 $200,000 $100,000 $

17 Successes Total responses = 75 Finding and notifying partners (partner notification & contract tracing) Bringing people in for testing Targeted advertising Increase in web traffic Ability to reach otherwise hard to reach populations (non-gay identified MSM, bisexual, young gay black men, transient populations) Promoting services, programs, and activities One on one conversations Education

18 Challenges Total responses = 76 Getting permission to work with sites/apps Bureaucratic issues working with sites/apps Trouble getting responses from people after contacting them Budget - Money, funding, and staffing Outreach is best done after typical work hours Fee based memberships & fees to send messages Not familiar with sites/apps, lack technical expertise Being flagged as spam, not allowing public health profiles Geo-location based apps can make contract tracing difficult Managing public perception buzz kill, being policed

19 Profile Option Challenges: What do they mean? Self or Partner? Status or Strategy? Safe sex PrEP or I m on PrEP Undetectable or Taking Treatment as Prevention Condoms Positive Positive/Undetectable Negative Negative on PrEP Don t know

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21 Stigma

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23 National repository of over 1200 medical providers who prescribe PrEP Features Searchable by coverage for uninsured and PrEP navigation services Add more providers Correct info for existing providers Add the widget with a single line of code Developed by researchers at Emory University, funded by MAC AIDS Fund Preplocator.org Open source widget: preplocator.org/publicly-available-tools/

24 Technology & Internet Resources Support Introducing Technology into Partner Services: A Toolkit for Programs: The toolkit provides information and resources on various pieces that go into an IPS program and can help provide direction & support when planning, developing, implementing, and/or evaluating a jurisdictionspecific IPS program National Internet Partner Services Quarterly Call listserve; Frank Strona at FHS3@cdc.gov for access to the listserve National Prevention Information Network (NPIN) Site: IPS Community Group Provides for supplemental information on IPS & other technology based tools within the NPIN membership Shareable Tools, TA requests Peer to Peer Support, Resources & FAQs New Members use Use code 5722STD16 for access to the group or FHS3@cdc.gov for more info Frank Strona fhs3@cdc.gov Rachel Kachur rlk4@cdc.gov

25 Improving Messaging Online Coordinate placement and messaging where possible Pretest through snowball sample Exclusion criteria Place on bhocpartners.org with contact info and data Info on how to place ads (both Benevolads and Paid)

26 Bhocpartners.org (coming soon) Sexual health info for gay/bi men Best practices for site design Profile options Literature review Advertising campaigns How to place ads Ad samples and contact info Links and widgets

27 We get an alert from a health department and it says, 10% increase in cases! And then we open it and it says the number of cases went up from 9 to 10 Number of cases? Increase? Severity of disease? Other factors?

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29 Charity or social responsibility? There should be funds at the ready... so that public health and others aren t dependent on the charity of private companies such as apps and websites. When there is a Zika outbreak CDC isn t hoping that major magazines will give them ad space...

30 Hookup App: Pay Up or Drop Dead Jim Key, The Advocate, August 26, 2016 I suggest you choose which app to use as carefully as you choose the men you meet, taking into consideration which of them is really into you.

31 So, what do you do when a company makes millions off of your community, but won t lift a finger to protect and promote your health.. Sounds like it's time to ACT UP on these folks. Gregg Gonsalves

32 Health : Disease Intervention Specialists Like0 Here at Adam4Adam, we are committed to your health. We want you to have fun AND stay healthy. That s why we partner with health specialists, who can help link you to information and services. On A4A, we have two kinds of specialists. You can find out which services they provide in their profiles.

33 Health : Doing The Right Thing When You Get Crabs DAVE on September 10, 2016 at 11:52 am Share 29 Tweet51 Like46 A while ago, a good buddy told me a story that made me flinch, close my eyes, and say to myself I hope this never happens to me.

34 Daddyhunt s The Serial and PSAs

35 What you can do: Encourage men to reveal as much as they can on profiles Encourage men to keep contact information (save messages, contact info, star favorites ) Add PrEP providers are in preplocator.org Add test locations to gettested.cdc.gov Submit blogs to marketing@adam4adam.com Designate partner services lead and contact Frank Strona at fhs3@cdc.gov to join partner services workgroup If willing to share campaigns, or willing to help build online review panel, send to dan.wohlfeiler@ucsf.edu

36 Public Health: Bringing you structural interventions for 165 years.

37 Stay safe for Baby Noah. Your actions today can help determine whether Baby Noah faces risk of HIV infection - or not - in the future. And don t forget to buckle him into a car seat, swaddle him in fireproof pajamas, give him a good education, dating sites that support his health, a real healthcare system, and a fairer world.

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39 THANK YOU Jen Hecht, San Francisco AIDS Foundation Stephen Hicks and Jessica Frasure-Williams National Coalition of STD Directors All the website owners, public health colleagues, and LGBT community

40 For more info, to submit a blog to A4A, or suggestions: Dan Wohlfeiler Dan.wohlfeiler@ucsf.edu Reports: And coming to the web soon: bhocpartners.org