Sexually Transmitted Infections Adopting a Sexual Health Paradigm (2021) / Chapter Skim
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6 Role of Technology and New Media in Preventing and Controlling STIs
6 Role of Technology and New Media in Preventing and Controlling STIs
Pages 283-336
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6 Role of Technology and New Media in Preventing and Controlling STIs Chapter Contents Introduction • Critical Observations to Conceptualize the Role of Technology in the STI Response • Overview of Technology, Media Use, and Trends Technologies • Social Media • Mobile Apps • Dating Apps/Websites • Online Pornography • Virtual Reality/Augmented Reality • Text Messaging • Digital Contact Tracing and Digital Exposure Notification • Wearable Devices/Biosensors • Television, Radio, and Print • Electronic Health Records • Blockchain • Cryptocurrency • "Big Data" and Artificial Intelligence 283
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The role that the COVID-19 pandemic is playing on potential innovations relevant for sexual health. Critical Observations to Conceptualize the Role of Technology in the STI Response The broad key takeaways from this chapter are the following: • A large and growing number of technological innovations are affecting sexual health and STI risk.
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See Chapter 12 for more information on the effects of COVID-19 on STIs and sexual health. • Research on this topic has often been designed for and/or in col laboration with health departments, in order to address potential barriers and improve likelihood of implementation.
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. The technologies discussed are associated with sexual health across all levels identified in the committee's conceptual model (see Chapter 1)
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: mHealth is a component of eHealth and can be defined as "medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs) , and other wireless devices" (WHO Global Observatory for eHealth, 2011)
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Additionally, some people who traditionally experience the digital divide (e.g., lower-income, racial and ethnic minorities) are also populations that tend to suffer inequities related to sexual health (see Chapter 3 for a discussion on priority populations)
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Survey conducted January 8–February 7, 2019. SOURCE: Pew Research Center, 2019a.
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adults continues to increase, with 72 percent on at least one platform by 2019 (Pew Research Center, 2019a)
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. A systematic review of 57 studies found that studies about health misinformation were mainly related to vaccination and infectious diseases and that misinformation was prevalent on social media (Wang et al., 2019)
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(2017) sought to examine the influence of sexual health information sources on their subsequent sexual risk reduction behaviors among Black and Latino/a youth.
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. Mobile apps can also include social media, dating, and other technologies listed in this chapter but are primarily described here to include those that are focused on sexual health and/or research.
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Examples: Potential of Technology to Decrease STI Risk Mobile apps may be used to address sexual health in a variety of ways. While apps that address sexual health education may exist, a review of 2,693 apps found in a search with keywords related to sexual health found that only 25 percent (n = 697)
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, which can be applied to STI prevention and control efforts. For example, researchers have studied games to improve sexual health and HIV-related outcomes, with preliminary evidence of positive effects.
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. People may use dating apps for a variety of reasons, from finding a long-term partner to a casual "hookup" (Hobbs et al., 2017)
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(2015) used four different dating apps targeting the MSM community to determine their acceptability and feasibility in providing sexual health messages: 63.8 percent of participants were receptive to health information presented in dating apps and 26 percent of initiated
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found that, of 60 dating apps reviewed, only 9 included sexual health content; 7 of those apps were targeted toward MSM. See Chapter 3 for a discussion of MSM as a priority population and Chapter 2 for a discussion of disassortative mixing and social networks (an important consideration for STI prevention and control)
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(2016) conclude that while online pornography is "extremely common," its impact on outcomes such as sexual health and well-being are uncertain.
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Young, provided to National Academies staff on December 8, 2020, for the Committee on Prevention and Control of Sexually Transmitted Infections in the United States. Available by request from the National Academies Public Access Records Office via email at PARO@nas.edu.
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. VR games might be developed to help increase self-efficacy in discussing STI testing with sexual partners or a health care provider.
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Examples: Potential of Technology to Decrease STI Risk A variety of text message–based interventions exists for sexual health promotion (Lim et al., 2008; Willoughby and Muldrow, 2017)
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A newer meta-analysis again focused on text messages to change health behavior more generally, which included four studies on text messaging for sexual health promotion, found an overall effect of d = .24 (Armanasco et al., 2017)
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Current studies evaluating the success of digital contact tracing for COVID-19 will help to inform future needs and the potential role of these technologies in STI prevention and control. Wearable Devices/Biosensors Sensors are increasingly being incorporated into public health research and practice, as well as daily life for health monitoring.
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. Such innovative design, if successful in increasing pleasure, might increase frequency of condom use and thereby decrease STI transmission.
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As later sections address, advertising on mobile devices has already exceeded other types of communication tools. This trend is expected to increase, making it important for public health departments to invest in digital approaches.
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. These findings highlight the applicability of mass media campaigns to sexual health, more broadly.
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. Although campaigns may positively affect sexual health, they can be expensive to create and distribute.
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. Examples: Potential of Technology to Increase STI Risk There are not clear examples of how EHRs may be related to increased STI risk.
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Apervita, AllianceChicago, and the Public Health Informatics Institute. Report from CDC, provided to National Academies staff on November 6, 2020, by Raul Romaguera for the Committee on Prevention and Control of Sexually Transmitted Infections in the United States.
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To decrease STI transmission and improve transparency about current infection status with a potential sexual partner, Hopper suggested merging blockchain technology with a dating app. For example, before using the dating app, there could be a two-step verification process whereby a user would (1)
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. Through Gingr, sex workers might be able to reduce their STI risk and improve sexual health (oreofekari, 2019)
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. This includes a large amount of "social data," such as from social media, wearable devices, and Internet search, which can provide information about people's attitudes, behaviors, locations, mobile apps and websites used, searches for health information, and other digital behavioral outcomes (Evans and Chi, 2008; Olshannikova et al., 2017; Olteanu et al., 2019)
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. In the next 10 years, they may become a mainstream part of public health outreach and engagement, including for sexual health.
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Young, provided to National Acad emies staff on February 2, 2021, for the Committee on Prevention and Control of Sexually Transmitted Infections in the United States. Available by request from the National Academies Public Access Records Office via email at PARO@nas.edu.
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, and can contain confidential patient information, decreasing the likelihood that all local health departments would have the resources to use them frequently. In contrast, technology data are often available in near or perfect real time, free, publicly available, and, of course, massive compared to traditional surveillance data, helping to address limitations in current surveillance methods and enabling these data to be used as an additional surveillance tool.
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. Similarly, directors of state and local health departments have worked with researchers to develop visualization and mapping tools that leverage AI to identify, map the location, and detect trends in social media posts related to HIV, including perceptions of stigma and views about pre-exposure prophylaxis (Benbow et al., 2020)
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Many questions first need to be addressed, including the following: • Do companies, individuals, and/or public health departments and researchers bear the ethical responsibility of using technolo gies in STI prevention and care? • What role, if any, should public health and safety organizations, including law enforcement, play in using these technologies and gaining access to their data?
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. The large amount of location-based data collected from devices might allow for much more granular understanding and use, not only by corporations to serve advertisements but also by public health departments to identify and retain individuals and populations who have been the most difficult to reach for STI and sexual health interventions and engagement and provide them with digital health outreach.
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However, these tech nologies are merely platforms for engaging people in behavior change. The same tools originally feared to increase STI transmission also hold promise for altering individual and group behaviors and promoting sexual health.
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3. CDC should partner with state and local health departments to develop and implement highly targeted AI-based digital mass communication outreach strategies to identify and intervene to address inequities among populations heavily impacted by STIs.
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The primary costs include purchasing advertisements. The second action under Recommendation 6-1 would likely incur the greatest financial costs of the three suggested actions, as it involves changes to the surveillance software infrastructure and additional reporting activities from local health departments.
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FIGURE 6-5 Digital health funding, 2013–2020. NOTE: Only includes U.S.
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Box 6-3 provides examples of specific research needs in this space. BOX 6-3 Future Research Needs • What are the best practices for using social media, mobile apps, virtual reality/augmented reality, and other technologies to reduce sexually trans mitted infection (STI)
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2014. Sex on demand: Geosocial networking phone apps and risk of sexually transmitted infections among a cross-sectional sample of men who have sex with men in Los Angeles County.
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2017. SHIHbot: A Facebook chatbot for sexual health information on HIV/AIDS.
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2017. A computerized sexual health survey improves testing for sexually transmitted infection in a pediatric emergency department.
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2019. A blockchain solution to sexually transmitted infections in online dating.
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2020. Patient perception of mobile phone apps for the care and prevention of sexually transmitted diseases: Cross-section al study.
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2008. SMS STI: A review of the uses of mobile phone text messaging in sexual health.
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2019. PowerPoint presentation to the Committee on Prevention and Control of Sexually Transmitted Infections in the United States.
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adults using social media, including Facebook, is mostly unchanged since 2018. https://www.pewresearch.org/fact-tank/2019/04/10/ share-of-u-s-adults-using-social-media-including-facebook-is-mostly-unchanged since-2018 (accessed November 18, 2020)
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2018. Examining the efficacy of an mHealth media literacy education program for sexual health promotion in older ado lescents attending community college.
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PowerPoint presentation to the Committee on Prevention and Control of Sexually Transmitted Infections in the United States. Washington, DC.
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The local health department perspective. PowerPoint presentation to the Committee on Pre vention and Control of Sexually Transmitted Infections in the United States.
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2019. Mining Twitter to assess the determinants of health behavior toward hu man papillomavirus vaccination in the United States.
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