National Guidelines for Internetbased STDHIV Prevention

1
National Guidelines for Internet-based STD/HIV
Prevention

• Rachel Kachur, MPH
• Stephan Adelson
• November 14, 2007
• New York City

2
Overview

• My background
• Whats going on in NY?
• Needs Assessment
• Content of the Guidelines
• The views in this presentation dont necessarily
  represent those of the CDC.

3
My Life
4
So I went online and what did I see?

• Viewer Warning

5
Swingers convention in Niagara Falls, October
10-14
6
Lesbian Sex Mafia Event
7
Party at David Barton Gym
8
(No Transcript)
9
(No Transcript)
10
African American MSM event
11
(No Transcript)
12
(No Transcript)
13
All this to say, people are online looking for
and finding sex partners
14
What we know

• The Internet is a means for both STD transmission
  AND prevention
• Ad hoc nature of online efforts
• Programs are looking to NCSD CDC for guidance

15
Dear Colleague Letter

• Adapting current disease-control and
  health-promotion activities to the Internet
  environment is a critical step for public health
  agencies.
• Given the continued high rates of multiple STD
  among MSM, it is particularly important to focus
  online disease-prevention and health-promotion
  efforts on this population.

16
NCSD/CDC Internet Needs Assessment
17
Methods

• 13 item questionnaire
• Closed open-ended questions
• Knowledge, attitudes, access/barriers, current
  Internet-related STD activities,
  training/technical assistance needs
• Emailed to 63 program areas ( 181 full
  associate members of NCSD)

18
Results

• After much begging pleading, 53 surveys were
  returned
• 7 were duplicates, which were removed from
  analysis
• Resulting in a response rate of 75 or 47 program
  areas

19
Use of internet for risky sex
20
Results Asking about online partners
21
Awareness, Use Protocols
22
Access to technologies

• 94 of programs - everyone within the
  organization has a computer and access to email
• 76 have restricted access to the Internet
• 33 critical to job duties
• 53 important to most or a few job duties
• 30 have unrestricted access to the Internet
• 26 critical to job duties
• 68 important to most or a few job duties
• No definition was provided for restricted vs.
  unrestricted access

23
Barriers

• Main barriers were internal restrictions (30),
  lack of personnel dedicated to the task (27),
  lack of financial means (20) a lack of
  knowledge (19).
• Additional barriers include a lack of commitment
  (8), local laws (6), and/or state/federal laws
  (5).

24
DIS competencies
25
Training Needs
26
Training Needs continued
27
Training Needs continued
28
Training Venue Preferences
29
ISP/Website Collaboration

• Most program areas have never tried to
  collaborate with an ISP or website
• Most successful collaborator is Manhunt

30
Online chalk talk

• Everyone, except one program area, said yes they
  would like to see an online compendium and they
  would use an online compendium
• One exception was contacted and after a
  description, they too said they would like to see
  and would use an online compendium

31
Summary of Needs Assessment

• Knowledge and awareness (among respondents) are
  high need to increase the incorporation of the
  internet (use) into everyday STD prevention
  efforts
• Need to establish written protocols
• Address existing barriers by
• raising awareness
• increase funding
• provide training
• Promote public health ISP/website partnerships

32
Development

• 3 tiers of experience
• Experts/most experienced
• Those who recognized the need but hadnt tried
  anything
• Those who hadnt even thought about it
• Input from researchers, MDs, CBOs, Health
  Departments, CDC, NCSD, and the private sector
• Reviewed by Health Departments Community Based
  Organizations

33
(No Transcript)
34
A foundation to build upon

• Non-prescriptive
• Applicable for both STD and HIV prevention
• Written for a broad audience
• Provide best practices from those that have the
  most experience
• Create a baseline for the production of local
  guidelines

35
Contents

• Tips from the field
• Examples from CBOs
• Tools from existing programs

Tip from the field Aggressive outreach can cause
chat room members to leave the chat room or
website and go elsewhere
36
Internet Partner Notification

• Chapters include
• Introduction
• Background
• Before you begin
• Evaluation of IPN
• Getting started
• Implementing IPN
• The Future of IPN

The Internet is a powerful tool for communication
and, as such, is a valuable tool for facilitating
STD/HIV PN. Research has shown the Internet to be
a venue for STD transmission11-13 as well as a
venue for disease control and health
promotion14-16.
37
Internet Partner NotificationAddressing Concerns
IPN can be likened to leaving a letter at
someones door. Those new to IPN or who are
considering IPN often have concerns about
confidentiality and the possibility of breaching
confidentiality. The primary concern is that
sending an email, often from an email such as
DCSTD, will unwittingly breach confidentiality.
Sending an email carries the same risks as
leaving a letter on a doorstep. ..but the public
health benefit of notifying someone of their
possible exposure and infection outweighs the
small possibility that confidentiality will be
breached.
Tip from the field   Amend confidentiality
agreements to include e-mail addresses, screen
names other potentially identifying information
38
Internet Partner NotificationGiving examples and
tools
HIV and STD
Tip from the Field   In addition to documenting
IPN efforts some program areas have created
additional forms to monitor IPN. See Appendix F
for an example.
39
Internet Partner NotificationProviding practical
advice
For example, on www.bgclive.com  (Black Gay
Chat), after creating a profile, it is necessary
to chose "My Account Options" and then chose
"Turn Who I Recently Visited Off."  Otherwise
when an internet partner's profile is viewed, it
will document the HD's visit on that particular
profile.
Tip from the field   IPN should be conducted from
designated department email accounts and
profiles, and never from personal email accounts
or profiles.
Programs need to be aware that different websites
have different options that may help maintain or
potentially breach confidentiality. 
40
Internet Outreach

• Chapters
• Introduction
• Background
• Principles of Outreach
• Getting started
• Program implementation
• Limitations of Internet Outreach
• Summary
• Glossary

There are several approaches Internet outreach
workers can take when attempting to engage a
community or encourage individuals into a
one-on-one chat session. There are two approaches
that are currently in practice an active and a
passive approach.
41
Internet OutreachAddressing Concerns
It is important to note that, for agencies with
limited resources other forms of Internet work
such as partner notification and health
communication (as outlined in the other sections
of these guidelines), might be considered more
cost effective over Internet outreach.
TIP from the field When considering costs,
remember that choosing where and when to perform
outreach affects the cost effectiveness of the
program.
The most significant portion of the cost involved
with Internet outreach is related to staff
salaries and time.
42
Internet OutreachGiving examples and tools
HIV and STD
Tip from the Field   Some IM programs have a log
feature that can automatically save chats and
allow you to print them as needed. You can
typically find this feature under preferences,
setting, or options.
43
Internet Outreach Providing practical advice
Tip from the field Most programs that conduct
online outreach have, at one time or another,
been removed, blocked, or had their profile
deleted or their account revoked from a website.
Some Internet outreach workers may choose to
actively contact online clients they suspect,
from reading profiles or chat room conversations,
are practicing high-risk behaviors.
Being too aggressive during outreach can threaten
trust and rapport-building and will often be met
with negative feedback from the online community.
44
Next steps
Final Draft of Internet Partner Notification and
Outreach sections are available now in print and
online as a PDF at the NCSD website
http//www.ncsddc.org The guidelines will be
finalized, including the health communications
section, and available by years end and
available online or possible as a CD-Rom Efforts
will be made to provide the means for continued
communication and updating of the document
thorough a listserv or other electronic means of
communication Technical Assistance Trainings
45
The Future of the Guidelines
This is the first iteration of many to come.
We hope these guidelines will be living
documents, that is, documents that are constantly
changing and continuously being updated based on
research and program experience, so that they
remain relevant and useful. You have a say
please provide us with feedback
46
Thanks to
Health Outreach
Partner Notification
Contributors
David Novak Jemima Talbot Bruce Furness Dan
Elhman Beau Gratzer Jill Gatwood
Eric Roland Frank Strona Stephan Adelson David
Novak
Thomas Bertrand Don Clark Stewart Coulter Sam
Dooley Kevin Farrell Larry Foster Suzanne
Haecker Tracey Hardy Rachel Kachur Todd
Logan Mary McFarlane Jorge Montoya
Pam Pitts Amy Pulver Jan Scott David
Sullivan Drew Thomits Karen Thompson Lyn
Trotter Duane Wilmot Dan Wohlfeiler Andrew
Woodruff Kim Seechuk
Special thanks to the reviewers and the medical
editor...
47
Rachel Kachurrkachur_at_cdc.gov(404) 639-2387 or
through STDPreventiononline.org