Breakout Innovations: Social Media vs. Social Disease

With 19 million new sexually transmitted infections (STIs) each year in the U.S., notifying partners is a crucial public health responsibility. But financially strapped local health departments often lack the resources to personally notify partners of an infected person.

Can tech pick up the slack?

Charlotte Gaydos, DrPH '93, MPH, MS, and Jessica Ladd, MPH '11, decided to find out. They developed a survey, targeted at teens and young adults, to learn whether anonymous emails, e-cards, text messages or letters would be an acceptable tool for sending and receiving partner notifications regarding a possible STI.

The survey was posted as a Facebook Event for two weeks in early September, successfully recruiting more than 500 individuals. Of these, 343 met the criteria for the study.

While their preliminary analysis is ongoing, Ladd says that the vast majority of survey participants preferred a phone call from a health department disease intervention specialist (DIS) as the means of partner notification. If calls were not an option, participants rated emails as the next best option. Only a minority of participants favored sending or receiving partner notification via anonymous text messages, e-cards or letters.

But the survey response doesn't negate the value of social media, says Gaydos, a professor in the Division of Infectious Diseases at the Johns Hopkins School of Medicine, with joint appointments in Epidemiology and in Population, Family and Reproductive Health at the Bloomberg School.

"Some people said texting was okay,"she notes. "It could be that some people know their partners well enough to say that, 'Yeah, he's on his cell phone all the time, so he will be most receptive to a text message.' Because everyone's experiences are different, building flexibility into the system is good."

"It shows that a social network such as Facebook could be used to enroll large numbers of participants at little or no cost."—Jessica Ladd

Ladd, a PhD student in Epidemiology at the School, notes another positive outcome of the survey: "[It] shows that a social network such as Facebook could be used to enroll large numbers of participants at little or no cost." Furthermore, she believes the results confer 'a high potential' for using email as a means of anonymous notification.

The survey results will help inform the design of a user-friendly website, tentatively scheduled to launch next summer through a nonprofit called Sexual Health Innovations, which Ladd just founded. Pending funding, the site will allow individuals to anonymously tell their partners that they have been exposed to an STI and should see their doctor or health department for testing. The site will be designed to maximize privacy and minimize false reporting.

Gaydos is optimistic that the website will be effective, a confidence based on the success of an increasingly popular website she and her team developed in 2004: I Want The Kit (IWTK), at iwantthekit.org.

"People can go online to request collection kits to test for STIs," Gaydos says. "This is a form of social media where we allow individuals to collect samples in the privacy of their own homes and mail them in. Such an approach is especially useful for, say, a 15-year-old girl who doesn't want her parents to know she's having sex, but who knows she might have been exposed to an STI."

Individuals can receive notice of their test results however they request; texting is popular with many. "That 15-year old girl, for example, is not going to want a call to her house," Gaydos says. "The message is coded, so we are not giving out any private information, nor do we text any positive results."

There are limits, of course, to the use of technology and social networking for certain purposes. As Gaydos points out, human contact, even via the phone, is still more important for many people. Because their recent Facebook survey was small and participants were mostly college-educated white women, Gaydos and Ladd are conducting a similar survey with Baltimore Health Department patients, who are primarily inner-city African-Americans.

But according to Gaydos, the survey results have "definitely" helped public health researchers better target future efforts on this and other health issues. "Social media is a great way to reach adolescents and young people," she says, "and that is exactly where most STIs are—in men and women under the age of 25."