Abstract
US men who have sex with men (n=1848) completed an online questionnaire about their willingness to use Internet-based partner notification. Eighty-one percent reported that it would be important to them to receive a partner notification e-mail if they had been exposed to a sexually transmitted infection. Seventy percent reported that if infected, they would use a public health specialist to inform partners of possible exposure through Internet notification. There was broad acceptance of Internet partner notification by at-risk US men who have sex with men, including a willingness to receive or initiate a notification e-mail.
The consistent increases in sexually transmitted infections (STIs) among men who have sex with men (MSM)1–4 and the increased potential of HIV transmission in this population5 underscore the need to develop culturally appropriate and innovative STI and HIV prevention strategies for MSM.6
Partner notification is a core component of STI prevention and control programs in the United States7–12 and may help to prevent the spread of STIs and HIV among MSM who engage in risky sexual behavior. Traditional partner notification uses 3 strategies for notifying the sexual partners of infected patients: provider referral, partner referral, and contract referral (patients agree to notify their sexual partners on their own by a specific date).
Previous studies have reported the high prevalence of risky sexual behaviors among MSM who use the Internet, including the higher frequency of anonymous and unprotected sexual intercourse.13–16 Anonymous sexual intercourse poses challenges in the context of partner notification programs because individuals may not be able to identify their sexual partners and provide locator information. As online health information on STIs and HIV has become more pervasive, several initiatives and studies17–19 have introduced Inter-net partner notification systems that permit notification of sexual partners who may not be otherwise identified by an infected patient.
We assessed the acceptability and perceived utility of Internet partner notification systems for MSM through one of the largest MSM-specific sexual partner–seeking Web sites. This study goes beyond previously reported studies,17,19 because it was made available to all US users of this Web site and thus examines a national sample.
METHODS
This study was conducted online with full cooperation and participation from the MSM-specific sexual partner–seeking Web site’s administrators. All study measures and procedures were approved by the institutional review board at the Fenway Institute.20–21
The questionnaire was administered to participants (restricted to individuals aged ≥ 18 years) through the online survey service provided by Survey Monkey (http://www.surveymonkey.com) for 1 month beginning in October 2005. The questionnaire asked about demographic information (age, education level, race, residential zip code, sexual identity, and STI and HIV history) and reactions to and preferences regarding e-mail notification of exposure to an STI. Respondents were asked to rate their likelihood of using a variety of services included in a sample partner notification e-mail. Questions about participants’ intent to use different strategies for partner notification if they became infected with an STI were developed according to the theory of planned behavior.22
We calculated descriptive statistics for both demographic variables and content-related questions. In addition, we used the χ2 global test of independence to test independent associations between variables and used the t test and 1-way analysis of variance (ANOVA) for mean comparisons. Regions were defined according to a regional map of the United States obtained from the Centers for Disease Control and Prevention.25
RESULTS
Descriptive statistics are reported in Table 1 ▶. At least 1 zip code from each of the 50 states and the District of Columbia was reported, with the exception of South Dakota and Idaho. The mean number of participants in each of the 9 US regions was 203 (SD=133.5). There were no statistically significant regional differences in demographics or survey responses.
TABLE 1—
Demographic Characteristics of Users of a MSM-Specific Sexual Partner–Seeking Web Site: Internet Survey, United States, 2005
| No. (%) | |
| Race/Ethnicity | |
| White | 1482 (80.2) |
| Black | 77 (4.2) |
| Hispanic | 150 (8.1) |
| Multiracial | 29 (1.6) |
| Asian/Pacific Islander or other | 110 (5.9) |
| Education | |
| High school/GED or less | 200 (10.8) |
| Some college/associate degree/technical school | 580 (31.4) |
| College degree | 663 (35.9) |
| Graduate/professional degree | 405 (21.9) |
| Self-reported sexual orientation | |
| Homosexual/gay | 1608 (87.0) |
| Bisexual | 222 (12.0) |
| Heterosexual/straight/other | 18 (1.0) |
| Self-reported HIV status | |
| HIV uninfected | 1294 (70.0) |
| HIV infected | 370 (20.0) |
| HIV status unknown | 184 (10.0) |
| Self-reported STI history | |
| Previous STI diagnosis (syphilis, gonorrhea, chlamydia, or any combination) | 702 (38.0) |
| Syphilis | 222 (12.0) |
| Gonorrhea | 481 (26.0) |
| Chlamydia | 277 (15.0) |
Note. GED = general equivalency diploma; MSM = men who have sex with men; STI = sexually transmitted infection. Total sample = 1848; age range = 18–70 years; mean = 36, SD = 10.3.
More than 80% of the participants reported that it was important to receive a partner notification message if they were exposed by someone on the Web site. The majority of participants (77.7%) reported that it was important for a partner notification message to link them to Web sites where they could learn about specific STIs they had been exposed to, and 82.1% of participants indicated that a partner notification e-mail should include information about specific health centers where they could be screened and treated. More than 75% of the participants indicated that it was important for the message to include a phone number to contact a public health specialist familiar with the possible infection. Overall, 78.8% of participants indicated that it was important to have a phone number or link to contact a customer service person from the MSM-specific sexual partner–seeking Web site to verify the e-mail’s authenticity.
The majority of the respondents reported they would be very or somewhat likely to use (1) a direct phone number to the public health specialist who initiated the e-mail and could provide the recipient with more information if desired (61.0%); (2) a link to a Web site that provides information on where to get tested (82.6%); (3) a link to a Web site that provides information about the STI the recipient was exposed to, including information on modes of transmission, symptoms, and treatment (86.2%); and (4) a phone number or e-mail address for the MSM-specific sexual partner–seeking Web site’s customer support center to confirm that the partner notification e-mail is from a valid source (70.5%).
Overall, 70% of study participants would use a public health specialist in some capacity to inform their partners through a partner notification e-mail of possible exposure to an STI. Participants chose 1 response to indicate their intentions to use a partner notification system in the future: 32.2% reported that they would use a public health specialist to notify their sexual partners anonymously through a partner notification e-mail, 37.9% would tell or e-mail their regular partner(s) themselves and have a public health specialist notify their other sexual partners through a notification e-mail, and 22.3% would notify their sexual partners themselves. Only 4.5% of participants reported that they would do nothing at all, and 3.2% reported that they would do something other than the options listed.
DISCUSSION
The broad support shown in this national sample of MSM for an Internet partner notification system suggests that it would be reasonable to use online partner-seeking Web sites to develop such a system. The feasibility of Internet partner notification was demonstrated by Klausner et al,17 who found that sending e-mails to members of a chat room frequented by MSM that was tied to a syphilis outbreak in San Francisco led to an average of 5.9 partners per infected individual being motivated to undergo testing for syphilis. Although online partner notification may directly benefit only MSM who use the Internet to find sexual partners, this population has an elevated STI and HIV risk,13–16 so an Internet approach has the potential to significantly reduce STI and HIV incidence among MSM.
Acknowledgments
This work was supported by the Massachusetts Department of Public Health.
Human Participant Protection The institutional review board at the Fenway Institute reviewed and approved all study protocols and procedures.
Peer Reviewed
Contributors M. J. Mimiaga led the writing and data analysis, interpreted the findings, and collaborated on the study design. A. D. Fair, A. M. Tetu, and R. VanDerwarker reviewed and edited drafts and interpreted the results. D. S. Novak, T. Bertrand, and S. Adelson collaborated on the study design and reviewed and edited drafts. K. H. Mayer collaborated on the study design, reviewed and edited drafts, and supervised the work of the entire protocol team.
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