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BACKGROUND Shigellosis, an acute diarrheal disease, is the third most common bacterial infection in the United States. Shigellosis most commonly affects children under the age of 5; however, clusters and outbreaks of shigellosis have been reported among gay, bisexual, and other men who have sex with men (MSM). Evidence suggests that knowledge of shigellosis among MSM is low, indicating health promotion outreach is needed for this population. METHODS To inform the development of shigellosis-related health communication materials and strategies, six focus groups were conducted in 2017, in Atlanta, Georgia among 24 self-identified gay and bisexual men. Participants were asked about their preferences and recommendations for health communication materials. RESULTS Participants indicated they would prefer a range of physical and virtual materials placed in diverse locations where the community would see them. Respondents recommended health messages be simple, quick to read, and concise and have limited word counts. Participants also advised the use of diverse images that were inclusive of couples of varying sexual orientations to reduce stigma. Participants advocated for the use of humor and provocative images to increase user engagement. CONCLUSIONS The results emphasize the potential benefits of conducting formative research when designing health communication materials. Incorporating messaging preferences of MSM in the development of shigellosis-related health communication materials could enhance their relevance for the target population, while also avoiding unintended consequences associated with stigmatizing MSM.

BACKGROUND: Associations between online sex seeking and increased risk for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) among men who have sex with men (MSM) typically rely on convenience samples. We examined Internet and mobile app use for finding sex partners among a nationally representative sample of MSM. METHODS: We analyzed 2011 to 2017 data from the National Survey of Family Growth, a nationally representative sample of the civilian, non-institutionalized US population (15–44 years). The analytic sample was comprised of men who reported 1 or more same-sex partners in the past year. We also assessed associations between online sex-seeking and STI risk, sexual health care behaviors, and condom use. RESULTS: Of 13,320 male respondents, 442 (3.0%) reported sex with a man in the past year, of whom 215 (46.3%) had met a partner online. Between MSM who met partners online and those who did not, we found no differences by age, education, race/ethnicity or socioeconomic status. Men who have sex with men with online partners were more likely to identify as gay (68.4% vs 49.5%, P = 0.0124). They also reported more sex partners overall (M = 3.04 vs 1.60, P < 0.0001), and multiple insertive (46.3% vs 8.5%, P < 0.0001) and receptive (33.2% vs 15.4%, P = 0.0055) anal sex partners, in the past year. They were also more likely to receive sexual risk assessments (56.0% vs 40.4%, P = 0.0129), STI testing (57.4% vs 35.3%, P = 0.0002), and STI treatment (17.8% vs 8.7%, P = 0.0152) in the past year. We found no differences in condom use. CONCLUSIONS: Men who have sex with men who report using online sources to find sex partners are more likely than other MSM to report behaviors that increase risk for STI/HIV but are also more likely to engage in behaviors that may mitigate further transmission, such as STI testing.

Preventing unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection, among adolescents is a public health priority. This report presents prevalence estimates for condom and contraceptive use among sexually active U.S. high school students from the 2019 Youth Risk Behavior Survey. Behaviors examined included any condom use, primary contraceptive method use, and condom use with a more effective contraceptive method, all reported at last sexual intercourse. Analyses were limited to sexually active students (i.e., those who had sexual intercourse with one or more persons during the 3 months before the survey). Except for any condom use, students reporting only same-sex sexual contact were excluded from analyses. Weighted prevalence estimates were calculated, and bivariate differences in prevalence were examined by demographic characteristics (sex, race/ethnicity, and grade) and other sexual risk behaviors (age of sexual initiation, previous 3-month and lifetime number of sex partners, and substance use before last sexual intercourse). Nationwide, 27.4% of high school students reported being sexually active (n = 3,226). Among sexually active students who reported having had sexual contact with someone of the opposite sex (n = 2,698), most students (89.7%) had used a condom or a primary contraceptive method at last sexual intercourse. Prevalence of any condom use at last sexual intercourse was 54.3%, and condoms were the most prevalent primary contraceptive method (43.9% versus 23.3% for birth control pills; 4.8% for intrauterine device [IUD] or implant; and 3.3% for shot, patch, or ring). Approximately 9% had used condoms with an IUD, implant, shot, patch, ring, or birth control pills. Using no pregnancy prevention method was more common among non-Hispanic black (23.2%) and Hispanic (12.8%) students compared with non-Hispanic white students (6.8%); compared with Hispanic students, using no pregnancy prevention method was more common among non-Hispanic black students. Prevalence of condom use was consistently lower among students with other sexual risk behaviors. Results underscore the need for public health professionals to provide quality sexual and reproductive health education and clinical services for preventing unintended pregnancy and STDs/HIV and decreasing disparities among sexually active youths.

A qualitative study among gay and bisexual men examining shigellosis-related knowledge, attitudes, and practices revealed low knowledge levels, limited concern about shigellosis, and mixed intention to engage in prevention behaviors., Background Shigellosis is a highly contagious enteric bacterial disease transmitted through the fecal-oral route. It is primarily transmitted through person-to-person contact and via contaminated food and water. Outbreaks of shigellosis among men who have sex with men (MSM) attributed to sexual person-to-person contact have been reported. These outbreaks are of concern because they are often caused by multidrug-resistant strains of Shigella. Little is known about shigellosis-related knowledge, attitudes, and practices among gay, bisexual, and other MSM. Methods Six focus groups were conducted among self-identified gay or bisexual men in Atlanta, GA, in Fall 2017. Participants were asked about shigellosis-related knowledge, attitudes, and practices. Focus groups were audio recorded, and the transcribed audio was analyzed using inductive and deductive thematic coding. Results Among the 24 focus group participants, most perceived that diarrheal illness was caused by contaminated food. Knowledge of shigellosis and Shigella was low, with most never having heard of the disease or bacteria. Participants did not perceive shigellosis to be a serious health concern, especially when compared with HIV; however, they did perceive gay and bisexual men to be at risk of Shigella infection. Participants reported mixed intentions to change sexual behaviors to prevent shigellosis or talk with sexual partners about diarrhea. Conclusions Health communication and education efforts could be used to increase knowledge about shigellosis and shift perceptions about the severity of shigellosis among gay, bisexual, and other MSM. Additional work is needed to identify effective ways to promote shigellosis-related prevention behaviors among gay, bisexual, and other MSM.

To determine whether sexual-risk and STI-testing behaviors differ by college student status.Sexually experienced 17- to 25-year-olds from a 2013 nationally representative panel survey that evaluated the "Get Yourself Tested" campaign. Non-students (n = 628), 2-yr (n = 319), and 4-yr college students (n = 587) were surveyed.Bivariate analyses and multiple logistic regression were used.Students were less likely than non-students to have had an early sexual debut and to have not used condoms in their most recent relationship. 4-yr students were less likely than non-students to have had multiple sexual partners. 2-yr students were less likely than non-students to have not used contraception in their most recent relationship.2-yr and 4-yr college students were less likely than non-students to engage in sexual-risk behaviors. Given potentially greater risk for STI acquisition among non-students, identification and implementation of strategies to increase sexual health education and services among this population is needed.

Background Geosocial networking (GSN) app use among men who have sex with men (MSM) has presented new opportunities for increasing the reach and efficiency of sexual health interventions but also poses challenges to HIV/sexually transmitted disease partner notification. Understanding MSM's attitudes toward app-based preventive sexual health services can help inform their development and delivery. Methods We recruited US MSM who had met a sex partner on GSN apps in the last year to participate in an online survey assessing acceptability and preferences regarding app-based partner notification, health department presence, and sexual health services. Three app-based notification strategies were presented: sending notification messages through participant's/partner's app profile, health department app profile, or in-app anonymous messaging. Results Of 791 respondents, a majority (70%) preferred to be notified by their partner directly; however, most would get tested if notified by health department profile (95%) or anonymous in-app message (85%). Given the options provided, 50% preferred notifying a partner using their own profile, 26% with health department assistance, and 24% via in-app anonymous message. A majority (71%) were comfortable notifying a partner through a health department profile, and 74% were comfortable using in-app anonymous messaging. Most participants (82%) were comfortable with health departments having app profiles to provide sexual health services. Conclusions Our results suggest that GSN app-based partner notification and sexual health services would be used by and are acceptable to US MSM. Partnering with app companies to integrate these services and increase access to public health programs has potential to improve MSM sexual health.

Background This study aimed to explore gaps between Centers for Disease Control and Prevention's clinical guidelines for obtaining a sexual history and regular clinical practice. We examine how patient, provider, and setting characteristics may influence the likelihood of obtaining comprehensive sexual histories and examine patient outcomes linked to sexual history taking. Methods We performed a narrative review to identify studies that examined clinical practice and sexual history taking via 8 databases. A 2-level inclusion protocol was followed, wherein the abstract and full text of the article were reviewed, respectively. Data were abstracted using a standardized tool developed for this study. Results The search yielded 2700 unique studies, of which 2193 were excluded in level 1, and 497 were excluded in level 2, leaving 10 studies for data abstraction. None of the studies reported comprehensive sexual history taking, and 8 studies reported differences in how providers obtain a sexual history when patient and provider demographics are considered. Three studies found a positive link between providers who discuss sexual history and provider sexually transmitted disease testing. Conclusions When sexual histories are obtained, they are not comprehensive, and providers may discuss sexual history differentially based on patients' demographic characteristics. Providers who discuss patients' sexual history may be more likely to also provide sexual health preventive care.

As increased attention and proposed funding are being directed toward community colleges, it is important to consider the sexual and reproductive health care needs of this growing population. Existing data suggest there are significant sexual health needs among this population and often insufficient provision of services. Some community college students are more likely than students at 4-year colleges to test positive for sexually transmitted diseases (STDs). Given resource constraints, creative solutions are required. These may include campus-wide policies addressing STD/HIV (human immunodeficiency virus) prevention, referral systems to connect students to care in the community, and partnerships with local health departments, Federally Qualified Health Centers, or community-based organizations to assist with the provision of services. Colleges have the unique opportunity to provide students with valuable information about sexual health and services. Community colleges, in particular, are uniquely positioned to reach at-risk community members for STD testing and sexual health care who might otherwise be lost to care. More research is needed on the sexual health needs of community college students, especially on factors such as geographic location, how embedded the school is into the community, social norms around sexual health on college campuses, and health services offered. New and innovative ways to promote linkage to care for testing and counseling could offer potential health benefits to this growing at-risk population.

We examined 2016 United States market research to understand the demographics and sexual health testing behaviors of dating app users. Internet/app users were more likely to be young adults, male, nonwhite, of Hispanic ethnicity, and unmarried. Users also reported greater testing for sexually transmitted disease, human immunodeficiency virus, and pregnancy.

Background Rates of reported early syphilis in Alaska increased over 300% between 2015 and 2018, with cases concentrated in men who have sex with men (MSM) that reside in the Anchorage/Mat-Su region. To better understand the epidemic, we surveyed at-risk Alaskan MSM about their syphilis knowledge, attitudes, and practices using a paper- and web-based survey. MSM were recruited through several avenues, including advertisements on two, popular geosocial-networking apps for gay, bisexual, and other MSM. We report on the relative efficiency in recruiting men through two different geosocial-networking apps. Methods The geosocial-networking apps (App A and App B) were selected based on key-informant interviews. Identical ad text and imagery promoting the survey ran on each app for two weeks. The total number of times the ads were displayed (impressions), number of times users clicked on an ad (clicks), mean clickthrough rate (CTR; clicks/impressions), and costs for advertising on the two apps were estimated and compared. Results App A had a total of 28,642 impressions, and 904 clicks (daily range: 5–191). The mean CTR for App A was 5.45, at a cost of $0.32/click. App B had a total of 681 impressions, and 57 clicks. The mean CTR for App B was 8.37, at a cost of $12.28/click. Of 119 survey responses, 59 (50%) were online surveys, of which 32 (54%) reported hearing about the survey through the geosocial-networking apps ad. Conclusion Recruiting MSM for surveys and prevention interventions through mobile apps is productive and may be cost-efficient. However, not all apps produce the same results. In our survey, App B was over 38 times more costly per click than App A. Programs should routinely explore the effectiveness and associated costs with utilization of app-based advertising. Disclosure No significant relationships.

Meeting sex partners through geosocial networking (GSN) apps is common among men who have sex with men (MSM). MSM may choose not to exchange contact information with partners met through GSN apps, limiting their own and health departments' ability to notify partners of HIV/STD exposure through standard notification methods. Using online focus groups (four groups; N = 28), we explored the perspectives of U.S. MSM regarding offer of partner notification features through GSN apps. Most participants were comfortable with HIV/STD partner notification delivered via GSN apps, either by partner services staff using a health department profile or through an in-app anonymous messaging system. While most participants expressed a responsibility to notify partners on their own, app-based partner notification methods may be preferred for casual or hard-to-reach partners. However, participants indicated that health departments will need to build trust with MSM app users to ensure acceptable and effective app-based delivery of partner notification.

Homelessness affects an estimated 1.6 million US youth annually. Compared with housed youth, homeless youth are more likely to engage in high-risk behaviors, including inconsistent condom use, multiple sex partners, survival sex, and alcohol/drug use, putting them at increased sexually transmitted disease (STD) risk. However, there is no national estimate of STD prevalence among this population.We identified 10 peer-reviewed articles (9 unique studies) reporting STD prevalence among homeless US youth (2000-2015). Descriptive and qualitative analyses identified STD prevalence ranges and risk factors among youth.Eight studies reported specific STD prevalence estimates, mainly chlamydia, gonorrhea, and syphilis. Overall STD prevalence among homeless youth ranged from 6% to 32%. STD rates for girls varied from 16.7% to 46%, and from 9% to 13.1% in boys. Most studies were conducted in the Western United States, with no studies from the Southeast or Northeast. Youths who experienced longer periods of homelessness were more likely to engage in high-risk sexual behaviors. Girls had lower rates of condom use and higher rates of STDs; boys were more likely to engage in anal and anonymous sex. Additionally, peer social networks contributed to protective effects on individual sexual risk behavior.Sexually transmitted disease prevalence estimates among homeless youth fluctuated greatly by study. Sexually transmitted disease risk behaviors are associated with unmet survival needs, length of homelessness, and influence of social networks. To promote sexual health and reduce STD rates, we need better estimates of STD prevalence, more geographic diversity of studies, and interventions addressing the behavioral associations identified in our review.

Introduction Homelessness is a societal problem with public health implications. The U.S rate of homelessness is 17.7/10,000. Nightly, 5 50 000 persons experience homelessness, 6.5% under the age of 18 years. Homelessness is associated with greater engagement in high-risk sexual behaviour. Less is known about sexually transmitted infections (STI) among the homeless. Methods We systematically identified peer-reviewed articles, published 2000–2016, which reported STI bio-specimen testing and rates among homeless persons in the US. Articles (n=9) were grouped by age (e.g. youth=5; adults=4); STI rates and correlate factors were described by gender. Results Across STIs, rates varied from 0.4%–17% among homeless youth (n=5), and 0.9%–52.5% among homeless adults (n=4). Rates for chlamydia (CT) were similar for youth (4.2%–11.6%)%) and adults (4.6%–10.8). For gonorrhoea, the highest rates for youth (0.4%–9.9%) were double those for adults (0.9%–4.1%)%). STI rates also varied by age and gender. CT was highest among young females (6.45%–11.0%%); followed by adult females (6.7%); then young males (4.73%–4.8%). Rates of HSV-2 (5.52%–11.85%%), HBV (1.42%–17%) and trichomoniasis (2.3%) were reported only in studies on youth. HCV varied among youth (3.77%–12%)%) and adults (9.8%–52.5%%), with rates highest among homeless adult men. Composite STI rates were most often reported for adults (16.4%–40.7%%), with highest rates among adult women who experienced intimate partner violence (IPV) (25.9%–40.7%)%).For youth, longer periods of homelessness were associated with high-risk sexual behaviours. Peer social networks had protective and risk effects on sexual behaviour. For adults, frequency and length of homelessness, incarceration history, substance use, injection drug use (IDU), and IPV were associated with having an STI. Conclusion STI rates among homeless persons varied by age and gender. There is a need for more complete STI data on homeless youth and adults. Such data can aid in understanding STI risk while homeless and how best to develop tailored prevention strategies.

Youth in the United States bear a disproportionate burden of sexually transmitted diseases (STDs). Stigma, misconceptions, and access challenges keep many from getting tested or treated. The GYT: Get Yourself Tested campaign was launched in 2009 to reduce stigma and promote STD communication and testing. This evaluation sought to assess the first 2 years of campaign engagement and associations with STD testing among youth.Campaign engagement with select GYT on-the-ground events, social media sites, and STD testing locator tools was measured through process/media tracking metrics. Sexually transmitted disease testing patterns were assessed using data from Planned Parenthood affiliates (2008-2010) and national trend data from clinics participating in national infertility prevention activities (2003-2010).On-the-ground events reached an estimated 20,000 youth in 2009 and 52,000 youth in 2010. Across 2009 to 2010, GYT's Facebook page gained 4477 fans, Twitter feed gained 1994 followers, and more than 140,000 referrals were made to the STD testing locator. From April 2008 to 2010, there was a 71% increase in STD testing and a 41% increase in chlamydia testing at reporting Planned Parenthood affiliates (representing ∼118 health centers). Chlamydia case positivity rates during this period were stable at 6.6% (2008) and 7.3% (2010). Trend data indicate that testing was higher in spring 2009 and 2010 compared with other periods during those years; this pattern is commensurate with STD Awareness Month/GYT activities.Data quality is limited in a manner similar to many STD prevention efforts. Within these limitations, evidence suggests that GYT reaches youth and is associated with increased STD testing.

In the United States, young people (ages 15-24 years) are disproportionately affected by human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs), due at least in part to inadequate or incorrect HIV/STD-related knowledge, attitudes, beliefs, and behavioral intentions (KABI). Comic book narratives are a proven method of HIV/STD prevention communication to strengthen KABI for HIV/STD prevention. Motion comics, a new type of comic media, are an engaging and low-cost means of narrative storytelling. The objective of this study was to quantitatively evaluate the effectiveness of a pilot six-episode HIV/STD-focused motion comic series to improve HIV/STD-related KABI among young people. We assessed change in HIV/STD knowledge, HIV stigma, condom attitudes, HIV/STD testing attitudes, and behavioral intentions among 138 participants in 15 focus groups immediately before and after viewing the motion comic series. We used paired t-tests and indicators of overall improvement to assess differences between surveys. We found a significant decrease in HIV stigma (p .001) and increases in both HIV knowledge (p = .002) and behavioral intentions to engage in safe sex (p .001). In summary, this motion comic intervention improved HIV/STD-related KABI of young adult viewers by reducing HIV stigma and increasing behavioral intentions to engage in safer sex. Our results demonstrate the promise of this novel intervention and support its use to deliver health messages to young people.

Young people (15-24 years) in the United States are disproportionately affected by infection with human immunodeficiency virus (HIV) and sexually transmitted diseases (STD). Shortfalls in HIV/STD-related knowledge, attitudes, beliefs, and behavioral intentions (KABI) likely contribute to this discrepancy. In this report we describe our experience developing a novel means of health communication combining entertainment-education theory and recent technological advances to create a HIV/STD-focused "motion comic." We also report the audience satisfaction and acceptance of the intervention. We used the Health Belief Model (HBM), entertainment-education (EE) principles, and the Sabido Method (SM) and conducted three rounds of focus groups to develop a 38-minute HIV/STD focused motion comic for young people between the ages 15 and 24 years. Participants indicated that motion comics were an acceptable method of delivering HIV/STD prevention messages. They also expressed satisfaction with motion comics plot, story settings, the tone of humor, and drama. Our results suggest that motion comics are a viable new method of delivering health communication messages about HIV/STD and other public health issues, and warrant further development and broader evaluation.

Zika virus has been identified as a cause of congenital microcephaly and other serious brain defects (1). CDC issued interim guidance for the prevention of sexual transmission of Zika virus on February 5, 2016, with an initial update on April 1, 2016 (2). The following recommendations apply to all men and women who have traveled to or reside in areas with active Zika virus transmission* and their sex partners. The recommendations in this report replace those previously issued and are now updated to reduce the risk for sexual transmission of Zika virus from both men and women to their sex partners. This guidance defines potential sexual exposure to Zika virus as having had sex with a person who has traveled to or lives in an area with active Zika virus transmission when the sexual contact did not include a barrier to protect against infection. Such barriers include male or female condoms for vaginal or anal sex and other barriers for oral sex.(†) Sexual exposure includes vaginal sex, anal sex, oral sex, or other activities that might expose a sex partner to genital secretions.(§) This guidance will be updated as more information becomes available.

CDC issued interim guidance for the prevention of sexual transmission of Zika virus on February 5, 2016. The following recommendations apply to men who have traveled to or reside in areas with active Zika virus transmission and their female or male sex partners. These recommendations replace the previously issued recommendations and are updated to include time intervals after travel to areas with active Zika virus transmission or after Zika virus infection for taking precautions to reduce the risk for sexual transmission. This guidance defines potential sexual exposure to Zika virus as any person who has had sex (i.e., vaginal intercourse, anal intercourse, or fellatio) without a condom with a man who has traveled to or resides in an area with active Zika virus transmission. This guidance will be updated as more information becomes available.

This paper describes a flexible, multi-stage, nonprobability sampling process used in a study of persons recently diagnosed as HIV-positive (PRDH). From July 2007 to June 2008, we used venue and chain-referral sampling strategies to recruit PRDH in the US. We sought equal distributions (n = 20) of eligible PRDH from four self-identified subgroups: gay or bisexual men (GBM), heterosexual men (HM), heterosexual women (HW), and male-tofemale transgender women (TGW). We categorized 30 sampling venues as websites, health clinics, or other networks. For 359 volunteer respondents, website venues proved more productive compared to health clinics and other sources. Website venues were most efficient for sampling recently diagnosed GBM and HW. Passive sampling methods were less effective in recruiting HM and TGW. Sampling approaches should be flexible and tailored to reach sub-categories within hidden populations. The sampling process itself produced valuable knowledge about social networks of hidden HIV populations.

Background: Although the Internet is one of the most commonly accessed resources for health information, finding information on local sexual health services, such as sexually transmitted disease (STD) testing, can be challenging. Recognizing that most quests for online health information begin with search engines, the purpose of this exploratory study was to examine the extent to which online information about local STD/HIV testing services can be found using Google. Methods: Queries on STD and HIV testing services were executed in Google for 6 geographically unique locations across the United States. The first 3 websites that resulted from each query were coded for the following characteristics: (1) relevancy to the search topic, (2) domain and purpose, (3) rank in Google results, and (4) content. Results: Websites hosted at .com (57.3%), .org (25.7%), and .gov (10.5%) domains were retrieved most frequently. Roughly half of all websites (n = 376) provided information relevant to the query, and about three-quarters (77.0%) of all queries yielded at least 1 relevant website within the first 3 results. Searches for larger cities were more likely to yield relevant results compared with smaller cities (odds ratio [OR] = 10.0, 95% confidence interval [CI] = 5.6, 17.9). On comparison with .com domains, .gov (OR = 2.9, 95% CI = 1.4, 5.6) and .org domains (OR = 2.9, 95% CI = 1.7, 4.8) were more likely to provide information of the location to get tested. Discussion: Ease of online access to information about sexual health services varies by search topic and locale. Sexual health service providers must optimize their website placement so as to reach a greater proportion of the sexually active population who use web search engines.

Data were collected via the Internet on sexual behaviors of Indian men who have sex with men (MSM; n = 171); these data were compared to online American MSM (n = 682). Among Indian MSM, 51% had never been tested for HIV, 100% believed themselves to be HIV-uninfected, and 22% (secondary Internet male partners) to 43% (primary male partners) reported not using condoms during last anal intercourse. While U.S. MSM were more likely to not use condoms (42% for secondary Internet partners to 67% for primary male partners), most (88%) had been tested for HIV (.0001 ≤ p ≤ .002, all comparisons). Low rates of HIV testing, beliefs about being HIV-uninfected, and significant levels of unsafe anal intercourse could fuel the spread of infection among Indian MSM.

Background The Internet has become a common venue for meeting sex partners and planning participation in risky sexual behavior. In this article, we evaluate the first 18 months of the Washington, DC, Department of Health Internet-based Partner Notification (IPN) program for early syphilis infections, using the standard Centers for Disease Control and Prevention (CDC) Disease Investigation Specialist (DIS) disposition codes, as well as Washington, DC, Department of Health's IPN-specific outcomes for pseudonymous partners. Methods We analyzed DIS disposition codes and IPN-specific outcomes from all early syphilis investigations initiated January 2007-June 2008. Internet partners were defined as sex partners for whom syphilis exposure notification was initiated by e-mail because no other locating information existed. If the e-mails resulted in additional locating information, we used the standard CDC disposition codes. Alternatively, the following IPN-specific outcomes were used: Informed of Syphilis Exposure, Informed of General STD Exposure, Not Informed or Unable to Confirm Receipt of General STD Exposure. Results From the 361 early syphilis patients, a total of 888 sex partners were investigated, of which 381 (43%) were via IPN. IPN led to an 8% increase in the overall number of syphilis patients with at least one treated sex partner, 26% more sex partners being medically examined and treated if necessary, and 83% more sex partners notified of their STD exposure. Conclusions IPN augmented traditional syphilis case management and aided in the location, notification, testing, and treatment of partners. Conversely, without IPN, these 381 partners would not have been investigated.

The Internet is a major source of HIV-related information and resources for persons recently diagnosed with HIV/AIDS (PRDHA). This study examined the types of HIV-related websites that appear as a result of HIV-related keyword searches and the extent to which website information targets PRDHA. The first page of HIV-related webpages from 18 keyword searches was coded. Among 137 webpages meeting inclusion criteria, 63% represented HIV-informational websites, 31% targeted HIV-positive individuals, and over half contained or provided access to HIV prevention, treatment, and transmission information. Thirty-three percent of webpages contained or provided access to PRDHA-targeted information, with a greater percentage of those webpages having mobile, non-English, and "Ask the Expert" features compared with non-PRDHA targeted webpages. Implications for PRDHA include the following: (1) they should explore HIV-related websites to gain insight into the credibility of the information contained on those sites; (2) PRDHA must be aware that HIV-related websites have the potential to elicit dated, emotionally distressing, or irrelevant information; and (3) to obtain information that relates to their demographic and situational profile, they may wish to use specific key terms (e.g., "HIV women") rather than attempting to navigate webpages that arise from general search terms (e.g., "HIV"). Recommendations for future development of online resources for PRDHA include providing HIV-relevant information in a stepwise fashion, providing demographically targeted HIV information, and greater utilization of mobile technology.

Many HIV-positive persons use the Internet to address at least some of their needs for HIV-specific information and support. The aim of this multimethod study was to understand how a diverse sample of persons who were recently diagnosed with HIV (PRDH) used the Internet after an HIV diagnosis and their perceptions of online HIV-related information and resources. HIV-positive persons (N = 63) who had been diagnosed since the year 2000 were recruited primarily through HIV-related websites and HIV medical clinics. One third of participants (33%, n = 21) were gay or bisexual men, 25% (n = 16) were heterosexual men, 32% (n = 20) were heterosexual women, and 10% (n = 6) were transgender women (male to female). Semistructured interviews and brief postinterview surveys were used to collect qualitative and quantitative data. Qualitative findings suggested that the most appealing websites to PRDH included those that: (1) provided usable information on topics of immediate concern; (2) used accessible formats that were easy to navigate; (3) were perceived as trustworthy, and (4) provided access to diverse perspectives of persons living with HIV/AIDS. Topics that PRDH found most useful included various medical treatment-related issues, tools for coping with depression and fear, and learning how others cope with HIV. Incorporating the perspectives of HIV-positive persons into the design and content of HIV-related websites is important to enhance their appeal for this diverse and growing population.

There are no published reports on ways in which caregivers use the Internet to support people living with HIV/AIDS (PLWHA). Five hundred caregivers were recruited in a 5-week period to complete an online survey of demographic characteristics, Internet use, online health-seeking self-efficacy, and ways they used the Internet to support PLWHA. Caregivers were on average 39 years old, white, heterosexual, highly educated, and Internet-savvy. Most provided informal care only (e.g., as a friend; 78%), with the remainder divided among those who provided care exclusively as part of their job (11%) or in both informally and professionally (11%). Most (72%) respondents visited a general medical website for HIV information, and 44% shared information from the Internet with PLWHA. Compared to informal caregivers, caregivers whose roles were both informal and professional had greater odds of recently sharing information from the Internet with PLWHA (odds ratio [OR] = 2.03) and ever printing off information from a website to give to PLWHA (odds ratio [OR] = 3.87). Professional caregivers had higher odds of ever printing off information from a website to give to PLWHA (OR = 1.87), but lower odds of sending an e-mail with a website link (OR = 0.32) than informal caregivers. These findings suggest that websites providing HIV-related resources should consider the various ways in which caregivers use their content, and how utilization differs by role. More research is needed to understand how people providing care for PLWHA share information and support each other and the impact that doing so has on caregiver burden and treatment outcomes for PLWHA.

Background The GYT: Get Yourself Tested campaign promotes sexually transmitted disease (STD) and HIV testing and communication with partners and providers among youth. We evaluated these behaviors in relation to campaign awareness among youth through a national survey. Methods We collected data from 4017 respondents aged 15 to 25 years through an online panel survey designed to be representative of the US population. The GYT campaign targeted 4 key behaviors: STD testing, HIV testing, talking to partners about testing, and talking to providers about testing. Results Respondents who were aware of the GYT campaign (24.4%) were more likely to report engaging in each of the 4 target behaviors. Associations remained significant when stratified by race and sex and when taking into account sexuality, sexual activity, age, insurance status, and use of campaign partner-provided services. Conclusions Awareness of the GYT campaign is related to the 4 target behaviors promoted by the campaign, suggesting that health promotions campaigns oriented toward youth can be successful in increasing STD-related, health-seeking behavior, including among populations disproportionately affected by STD.

Objectives: The objective of this paper is to provide a detailed description of Internet-based sexually transmitted disease/human immunodeficiency virus prevention in the 8 US cities most affected by syphilis in men who have sex with men. Goal: By reviewing the efforts under way in these 8 cities, we will understand the barriers and facilitators associated with Internet-based prevention efforts. Study: This is a review of Internet activities taking place in 8 major US cities. Results: Efforts in the 8 cities vary, with some cities reporting little or no Internet-based prevention activities. Other cities have attempted banner advertising, online outreach, online partner notification, online laboratory slips for syphilis testing, and auditorium-style chat sessions. Conclusion: Though a number of policy-related barriers prevent some cities from engaging in Internet-based prevention, these activities are clearly important to the overall prevention effort. In order to surmount local policy barriers, it is essential to obtain evaluation data from the programs initiated. BULL AND MCFARLANE 1 FOUND that the Internet “has a greater, more instantaneous reach than any other medium to facilitate encounters that result in sexual activity.” Using the Internet to meet sex partners has been shown to be associated with an increased number of partners, including an increased number of partners known to be human immunodeficiency virus (HIV)-positive and increases in reported anal sex when compared with sex with partners met via other venues. 2 In some cities in the United States and Europe, increases in the incidence of syphilis among men who have sex with men (MSM) are associated with increases in the use of the Internet to meet new sex partners. 3,4 In addition, outbreaks of syphilis have been traced to Internet-based “chat rooms” in a number of cities, 5,6 with a large proportion of contacts who are anonymous or known only by their chat-room nicknames. As the Internet becomes ever faster, cheaper, and more accessible, it is likely that Internet-initiated sexual activity will continue to be a factor in outbreaks of sexually transmitted diseases. The public-health response to the issues raised by the Internet has been varied. In outbreak situations, the primary concerns of health officials are partner notification, testing of contacts, and treatment of cases. Partner notification on the Internet is made complicated by a baffling array of online security and anonymity protections, though some of the cities included in this report have

To assess the relationship between Internet use and sexual risk behavior among women.A cross-sectional survey, with 64 items, seeking sex partners online was posted on the Internet. Respondents were targeted through e-mail list serves and bulletin board postings. However, the majority of responses were gathered after national media coverage of the survey.Of the 4444 eligible participants, age18, from North America who completed the online survey, 29% (n = 1276) were women. Of the 1276 women, 544 (43%) reported having sex with a person they first met on the Internet. These women were more frequently white, older, and more experienced with testing for sexually transmitted infections (STI) than women who never had a sex partner they first met online. They also had a higher number of total lifetime partners and more frequently used condoms. However, these women also reported high rates of STI, are not regularly using condoms, and are engaging in anal, oral, and vaginal sex with Internet partners. Many of the women say they would appreciate receiving STI prevention information via e-mail, and those with Internet partners more frequently stated they would participate in chat room discussions about prevention (p0.02).The Internet is a flourishing sex venue, and women too are using this new vehicle to seek out sex partners. The wide pool of potential sex partners found online coupled with ease of travel and an increase in partners has the potential to spread an STI or HIV with greater efficiency than ever before imagined. Although women with Internet partners may engage in protective behavior more frequently than women with no Internet partners, they also engage in higher risk behaviors. This population, therefore, needs to be recognized and targeted with STI and HIV education and prevention efforts.

Zika virus is a mosquito-borne flavivirus primarily transmitted by Aedes aegypti mosquitoes (1,2). Infection with Zika virus is asymptomatic in an estimated 80% of cases (2,3), and when Zika virus does cause illness, symptoms are generally mild and self-limited. Recent evidence suggests a possible association between maternal Zika virus infection and adverse fetal outcomes, such as congenital microcephaly (4,5), as well as a possible association with Guillain-Barré syndrome. Currently, no vaccine or medication exists to prevent or treat Zika virus infection. Persons residing in or traveling to areas of active Zika virus transmission should take steps to prevent Zika virus infection through prevention of mosquito bites (http://www.cdc.gov/zika/prevention/).

BACKGROUND: Few studies have examined the association between sexual health risks and online sex-seeking among teenagers. The purpose of this study was to assess the associations between meeting sex partners online and a range of sexual risk behaviors and outcomes among adolescents. METHODS: Participants aged 13 to 19 years were recruited from a publicly funded teen clinic in Florida. After obtaining informed consent/assent, 273 participants completed an audio computer-assisted self-interview that included questions on demographics, sexual behavior, sexually transmitted disease (STD) history, and online sex-seeking behaviors and experiences. Participants also provided urine samples for chlamydia and gonorrhea testing. Data were analyzed using logistic regression to identify the association between having an online sex partner and sexual behaviors/outcomes. RESULTS: After adjusting for significant bivariate correlates, teens reporting online sex partners were more likely to be male, be multiracial, have a history of same-sex sexual activity, report a higher number of vaginal sex partners, and report a lower age at first vaginal sex. However, teens with online sex partners were no more likely to have ever had an STD or a current biological STD. CONCLUSIONS: This study is one of the first to correlate biological STD results to online sexual partnering data in a youth population. Although meeting a sex partner online was not associated with past or current STDs, it was associated with other sexual risk behaviors. Future research is needed to examine the complex nature of online sexual partnering among adolescents and to develop intervention approaches.

Internet-based programs for sexually transmitted infections (STI)/HIV partner notification have generated considerable interest as public health interventions; yet data are lacking to support widespread dissemination. We report on a clinic-based and web-based evaluation of the Colorado inSPOT online partner notification program.Clinic-based surveys were conducted at a large urban STI clinic before and after the implementation of feasible clinic interventions as well as nonclinic campaigns to promote the use of inSPOT Colorado. Questions assessed recognition and use of the site. Website statistics were provided by the inSPOT service, including the number of site hits, e-cards sent, and specific STI exposures identified on the card.Recognition and use of the service among STI clinic patients remained low (6%) despite the interventions. Site statistics demonstrated an immediate but quickly diminishing response after placement of a banner ad on a popular gay website. Newspaper advertisements and radio public service announcements showed small increases in website use. Analysis of STIs specified on the e-cards, showed scabies and pediculosis as the most-identified STIs, accounting for nearly 30% of all e-cards sent. Clinic survey data indicated that when respondents were faced with the hypothetical situation of being diagnosed with an STI, more than 90% would notify partners in person; only 5% would use e-mail or the Internet.Our data did not support the effectiveness of the inSPOT intervention among a predominantly heterosexual population in a large urban STI clinic.

Background: Notifying patients of gonorrhea and chlamydia test results using online services may improve clinic efficiency and increase receipt of test results. This study evaluated the implementation of an online results system in an urban sexually transmitted infections clinic. Methods: Using the clinic's electronic medical records system to assess if and how gonorrhea and chlamydia test results were obtained, 3 time periods were examined between December 2007 and April 2009: Period 1, six months before initiation of the online results system; Period 2, six months when patients could opt in for online results by creating their own access codes; and Period 3, four months when access codes were assigned. In addition, a survey was conducted to assess reasons for accepting or declining the online results system. Results: A total of 9056 new patient visits were evaluated. During Periods 1, 2, and 3, respectively 67%, 67%, and 70% patients received results either online or by telephone (NS). The proportion of patients calling the clinic for results decreased from 67% in Period 1, to 51% in Period 2, and 36% in Period 3 (P < 0.0001). Survey results indicated that patients accepted online results primarily because of the ability to check results anytime of day. Reasons for not accepting results online included lack of Internet access or a preference to receive results via the telephone. Conclusions: The online results system decreased the number of phone calls to the clinic pertaining to STI test results, but had no effect on the overall proportion of patients receiving results.

Background With the rapid expansion of social media, public health organizations have been quick to adopt these new channels to reach target populations. Typically, however, these efforts are accompanied by minimal evaluation and results are not routinely used to inform and improve programs. The GYT: Get Yourself Tested campaign, a national, US campaign to increase STD testing and decrease stigma is a case study that illustrates the challenges and the importance of evaluating social media. Methods Between 1 April 2009 and 30 September 2010, metrics data for the GYT: Get Yourself Tested campaign were collected and evaluated from such social media venues as Facebook, Twitter, the GYTnow SMS code, and the GYTnow campaign website. Facebook and Twitter usage were indicators of user engagement with the campaign, and behavioural intentions were measured through use of a STD testing center locator from the GYT website and use of the GYT Short Message Service (SMS) code. A mobile phone user can send a zip code to the SMS service to receive information about local testing centers. Results Evaluation of the GYT social media efforts allowed campaign organisers to measure campaign reach and engagement, customer sentiment, and intentions to get tested for STDs. The campaign reached over one million people in five national, social media venues. The Facebook site recruited 4177 fans, and the Twitter account had 1719 followers. The testing center locator was used by 64 000 people; 51,000 people used the SMS code to locate services. Qualitative data provided additional information about campaign sentiment as well as barriers to participation in the campaign. Analysis of the various metrics also uncovered unexpected issues such as a significant dip in participation in April as a result of a lack of participation by one of the major phone carriers. Conclusions Evaluating social media metrics can provide an in-depth understanding of how well target audiences are being reached, how information and messages resonate with them and how efforts can be improved or changed. Findings from this analysis help illustrate the need to adequately evaluate social media efforts, guide future social media evaluations, and understand audience behaviours when engaging in social media activities. Additional web analytic studies are needed to better understand the impact of social media use for STD prevention.

Background The National Get Yourself Tested (GYT) Campaign was launched in 2009 to promote STD communication and testing among youth (≤ 25 years) through multimedia platforms, on-the-ground outreach, and linking youth to free/low-cost STD testing. It is a public-private partnership effort between the U.S. Centers for Disease Control and Prevention (CDC), MTV Networks (MTV), the Henry J. Kaiser Family Foundation, and Planned Parenthood Federation of America, among other partners. This effort sought to evaluate campaign exposure and associations with STD testing and communication among youth during the first two years of implementation. Methods Media metrics tracked campaign-related television, web and social-media programmes in 2009–10; a national mail-panel consumer survey of youth assessed campaign recall and self-reported changes in STD testing and discussions in 2010; and STD patient data from partner health centres (n = 9 affiliate health centres) tracked STD testing in April 2008 (pre-campaign), 2009 and 2010. Results In its first two years, GYT received > 18 hours of airtime on MTV; its website received > 1.5 million views, and its testing locator made nearly 145,000 clinic referrals. Awareness of GYT among teenage respondents (n = 766) on a national survey was 18.3%, among whom roughly 1/5 reported having talked about STDs/testing with a family member (17.5%) or friend (21.2%). Among participating affiliates, there was a 71.0% increase in patients receiving STD testing in April 2010, compared to April 2008 (at a period when chlamydia testing rates nationally rose by Conclusion This data offers encouraging evidence that GYT is reaching and mobilising youth most in need of testing. Reported testing increases in GYT-partner health centres were greater than national-level trends which varied minimally from 2008–2010. Efforts are underway to conduct a national evaluation of the campaign.

Background The 2010 STD Treatment Guidelines advise physicians and other health-care providers on the most effective diagnostic evaluation, treatment regimens, prevention and vaccination strategies for STDs. CDC revises the Guidelines approximately every 4 years, using a scientific, evidence-based process. Previous communication efforts around the Guidelines have lacked structured promotion and evaluation strategies. 2010 communication efforts strove to improve dissemination of this important resource in the public and private sector using traditional and novel communication technologies. Methods The Guidelines were released online in the MMWR on 16 December 2010. A communication plan was devised involving an email distribution campaign, development of interactive elements such as webinars, podcasts, social media (Twitter), and mobile promotional efforts through a partnership with Epocrates. Click-through rates and web metrics were tracked using SiteCatalyst and tracking codes. Results 45 days post-launch, the 2010 Treatment Guidelines web page was viewed 107 174 times and downloaded 47,715 times making it the second most popular download on CDC9s website. An email campaign targeting more than 54,000 individuals resulted in click-through rates well above worldwide government industry standard (3.3%); ranging from 10% to 878% suggesting that emails were forwarded or the site was bookmarked. A January 13 live webinar resulted in 3200 registrations, 827 CMEs, and 742 evaluations. A podcast featured on Medscape was viewed 12 296 times within 30 days; traffic was 3 times that of a June Chlamydia podcast. Preliminary Twitter data show that tweets were clicked on or retweeted at least 50 times during a 4-day period. A Dec 21 Epocrates DocAlert was delivered to 80 795 devices in the first 10 days, 272 857 devices by week 6, and targeted to primary care, OB/Gyn, ID, ER, urologists, etc.; 22% of responders requested detailed information and links via email or via iPhone/Android on device. Conclusions Data suggest (see Abstract P2-S8.03 Figure 1) that promotion efforts were highly successful as page view spikes coincided with email and mobile campaign pushes. Campaign tracking codes and web metrics are a simple way to evaluate health communication efforts and can offer insight on how well target audiences are being reached. Likewise, public health communicators should consider mutually beneficial partnerships with organizations that can reach providers in the private sector.

Background About 19 million new STDs occur each year in the USA, almost half of which are among youth. Lack of information, misconceptions and stigma prevent many from getting tested. To normalise conversations around sexual health and destigmatize testing, the GYT Campaign was launched in April 2009, with the goal of promoting STD testing among youth ages 15–25 years. Methods GYT was developed as part of It9s Your (Sex) Life, a public information partnership of MTV and the Kaiser Family Foundation, together with the Centers for Disease Control and Prevention and Planned Parenthood Federation of America (PPFA). The campaign uses on-air, online, on-the-ground, and mobile components to increase STD testing and spark an empowering youth movement. It has expanded each year, reaching over 4,000 health centers nationwide, including school- and college-based health centers. Efforts to evaluate the campaign9s reach and impact include media/materials tracking, national surveys, patient intake surveys at partnering clinics and schools, and the monitoring of STD test/positivity rates. Results At campaign launch, GYT was among the most-searched terms on Google, the most-tweeted terms on Twitter, and the most discussed videos on YouTube. As of January 2010, GYT had produced >60 public service ads and original programs, airing 3200 times on MTV stations (18 h of airtime), and had 1.5 million visitors to www.itsyoursexlife.com. A national survey suggests that campaign awareness among teens (13–19 years; n=766) reached 18% in 2010, with 10–20% reporting that they talked to a friend (21%), family member (18%), partner (11%) or provider (17%) about STDs/testing; and 10% reporting having visited a doctor as a result of the campaign. Available data from participating PPFA clinics revealed a 71% increase in patients presenting for STI testing from April 2008 (pre-campaign) to April 2010, with a 25% increase from April 2009–2010. Chlamydia positivity was 6% among women and 9% among men during campaign promotion periods, indicating that GYT did not simply motivate the worried well. Conclusions Research suggests that GYT is effectively reaching youth and impacting sexual-health discussions and STD-testing behaviours. The public-private partnership may serve as a model for other sexual health promotion programs. Creative ways for mobilising youth and lessons learnt about campaign branding, celebrity recruitment, and evaluation will be shared.

Background Launched in 2005, CDC-INFO is the Center for Disease Control and Prevention9s (CDC) national contact center, which responds to health related enquiries from the general public and healthcare providers and partners 24 h a day, 7 days a week. STD-related topics have consistently been among the top ten most frequently asked questions. In order to better understand what information is being sought, telephone calls and emails to CDC-INFO were analysed for STD specific topics and topic frequencies. Methods STD-related calls and emails made to CDC-INFO between October 2009 and September 2010 (FY2010) were analysed for topic content and frequency. Results In FY2010, there were 44339 STD-related calls and 2123 STD-related emails to CDC-INFO. Enquiries fell into 11 main categories. The top 3 telephone enquiries were about Herpes (26%), Testing and Counselling (25%) and Human Papillomavirus (HPV) (18%). The top 3 email enquiries were about Herpes (34%), HPV (21%) and Other Sexually Transmitted Diseases (12%). The most common STD question to CDC-INFO was Can you help me locate a STD testing site in my area?", although the largest percentage of questions were about Herpes, followed by HPV, Testing and Counselling and Chlamydia. Findings from CDC-INFO correlate with findings from traffic to the Division of STD Prevention (DSTDP) website (http://www.cdc.gov/std/) which also finds that Genital Herpes and HPV are the most frequently visited pages on the website. A CDC-INFO satisfaction survey conducted between October 2009—and March 2010 found that among STD related telephone callers, 63% were female, over 65% were 34 years old or younger, 34% were White and 35% were Black/African American. Of those qualitatively interviewed, 91% (n=199) reported learning new information as a result of the call to CDC-INO and 68% indicated a desire to change a behaviour based on the new information. Reducing risky sexual behaviour was the most common type of behaviour change indicated. Conclusions Information about Genital Herpes, HPV, and STD testing locations are the most frequently sought after topics by those accessing CDC-INFO. Regularly analysing enquiries to CDC-INFO can help the DSTDP identify topics of most concern to the general public, possibly detect emerging trends and tailor communications accordingly. Further research should be done to determine how DSTDP communication and prevention priorities correspond to general public enquiries and concerns.