April! We've passed the vernal equinox and spring is springing, flowers are blooming, we're shedding our sweaters and jackets and all will be warm once again. We can put our winter blues to rest and bask in the knowledge that summer will soon be upon us.
To my delight, I recently discovered that this month, aside from its status as the month of change and renewal, is also STD Awareness Month! I don't know who comes up with these things (Margarita Day? Jelly Bean Day? Deviled Egg Day?) but I'm charmed by this juxtaposition of the season of fertility and rebirth with the reminder that all that fertilizing and reproducing comes with its own set of venereal side effects.
Thus, with an eye towards awareness and education, I want to explore the recent phenomenon of STD outbreaks that have been tied to social media. Technology has undergone a meteoric change and evolution over the past decade and never before have we had at our disposal, in our pockets and never far from our hands, such powerful devices for accessing such quantities of information and to communicate with such wide audiences. I'm, of course, talking about smartphones here. Many of us now have mini computers at hand 24/7 that allow us to do … well, almost anything we can think of. Need to check the weather, book movie tickets, and watch a video of goats screaming like humans? That takes just ten minutes for a person with a smartphone, fifteen minutes if you rewatch that goat video. (And you will.)
The proliferation of high-tech, pocket-sized devices has increased our interaction with social networking applications and websites such as Twitter, Facebook and Craigslist. These networks not only keep us in constant contact with our families, friends, colleagues, and the creepy mouth-breather who sat next to us in tenth grade social studies, but also allow us to form new relationships anytime, anywhere, as the mood strikes us. There are, in other words, a wide variety of emotional itches that our smartphones and access to social media allow us to scratch. It is worth remembering, however, that when it comes to sex, that itch may be especially transmissible.
In an article published this month looking at how Craigslist facilitates internet hook-ups and sexual transactions, the authors note that our advancements in technology are intricately tied to our sexual health:
Mass printing facilitated the dissemination of newsworthy information and pornographic publications. The widespread use of telephone services facilitated verbal communication, including phone-sex services. Relatively easy to use and affordable instant cameras and video cameras permitted amateurs to produce their own photographic content, including sexual media, and to post it on internet amateur sites. Finally, the internet has enabled sites, such as Craigslist, to facilitate exchanges in which heterosexual and homosexual consumers can advertise themselves and seek others as products in personal ads. (1)
In case you were not already aware.
Craigslist. OKCupid. Adam4Adam. Grindr. Manhunt. Match.com. Gaydar. These are a few of the dating and sex-seeking networks that you may have heard of, networks that casual sex encounters distinct from the commercial sex market. Not only do these pruriently focused websites and apps allow for quick and discrete opportunities between strangers, or "Internet-generated contacts," they're also the perfect vehicle for buttressing a network capable of trading in STDs (2).
Easily accessible sexual encounters can engender risky sexual behaviors that in turn increase the likelihood of STD transmission (3)(4). And when sex becomes a sort of "impulse purchase" through sex networking sites, people do engage in behaviors that compromise their health (1). A 2006 study found that the rates of indulging in high-risk sexual behaviors - reporting anonymous sex, multiple sex partners, previous STD infections and having sex without condom protection - with a "casual partner were elevated among those who used the Internet to look for sex compared with those who did not" (5). Another 2006 study of 270 men who have sex with men (MSM) found that 48% reported having sex with a partner they found online with only 53% reporting consistent condom usage (6).
What happens when you have groups of people who frequently using the internet to locate sexual partners and who engage in risky behaviors? We know how the cookie crumbles, yes? Last year, New Zealand health officials identified an outbreak of syphilis among gay and bisexual men that was clustered around social media and iPhone applications such as Grindr, Boy Ahoy and NZ Dating. The city of Christchurch alone suffered a four-fold increase in cases from 2011 to 2012. One physician involved in treating patients within the outbreak reported of a few cases of men using these applications to have sex with more than 50 partners in three months (7). Busy bees!
Last month, the Canadian city of Halifax saw a similar increase in syphilis with half of the cases reporting their sexual hookups through Grindr and sex networking sites (8). And just ten years ago, Craigslist was the scapegoat during the syphilis outbreak that struck San Francisco from 1998 to 2002, where a 1000% increase in cases among MSM was strongly associated with sex seeking encounters mediated by the site (6)(9). Syphilis, it appears, is riding the tech boom to the top.
The internet has radically changed the landscape of our social networks, and for some people it has ushered in a "spring" of sexual gratification that has never been as freely available or accessible as it is now. This may seem like a "pedantic inquiry into the screamingly obvious" but these forums, applications and networks are changing the social ecology and epidemiology of STDs in ways that public health researchers are still trying to grasp (10). In 1854, the physician John Snow identified a water pump handle as the origin of the cholera epidemic plaguing the Soho district of London. These online meeting spots and hookup sites are the new "pump handle:" facilitating disease transmission while allowing us to expand and elaborate upon the range and accessibility of our sexual behaviors, of how and with whom we have sex with. It's springtime.
This is by no means the first time that new technologies have had a marked effect on this kind of human behavior. Notable examples include the increased access to penicillin that cured gonorrhea and syphilis following WWII and the emergence of the birth control pill in the 1960s. I wrote about the former phenomena here, respectively.
A fascinating story by Frontline on an outbreak of syphilis among teenagers in a suburb of Atlanta in the mid '90s. It's riveting!
From the Pew Research Foundation, the Powerpoint presentation "Social Media & Young Adults: Challenges & Opportunities for STD Prevention." It has some eye-opening statistics on how our style of life has changed since the introduction of computers and cell phones.
1. MS Rosenbaum et al. (2013) Craigslist Exposed: The Internet- Mediated Hookup. Journal of Homosexuality. 60(4): 505-531
2. P Etkind et al. (2003) International Travel and Sexually Transmitted Disease. EID Journal. 9(12): 1654–1656.
3. SS Bull and M McFarlane. (2000) Soliciting Sex on the Internet: What Are the Risks for Sexually Transmitted Diseases and HIV? Sexually Transmitted Diseases.27(9): 545-550
4. J Chan and A Ghose. (2012) Internet’s Dirty Secret: Assessing the Impact of Technology Shocks on the Outbreaks of Sexually Transmitted Diseases. Social Science Research Network [Online]. Accessed April 22, 2013 here.
5. G Bolding et al. (2006) Heterosexual men and women who seek sex through the Internet. International Journal of STD & AIDS.17(8): 530–534
6. R Garofalo et al. (2007) Tip of the Iceberg: Young Men Who Have Sex With Men, the Internet, and HIV Risk. American Journal of Public Health.97(6): 1113-1117
7. O Carville (March 9, 2013) "Syphilis 'back with a vengeance" Stuff.co.nz [Online]. Accessed April 22, 2013 here.
8. CBC News (Mar 18, 2013) "Syphilis outbreak in Halifax continues to thrive." CBC News [Online]. Accessed April 22, 2013 here.
9. Centers for Disease Control and Prevention (CDC) (2003) Internet Use and Early Syphilis Infection Among Men Who Have Sex with Men - San Francisco, California, 1999-2003. MMWR Morb Mortal Wkly Rep.52(50): 1229-32.
10. A Ross. "Love on the March." The New Yorker [Online]. Conde Nast Digital, November 12 2012. Accessed April 22 2013 here.