Guys can get STDs all sorts of ways. Even if they’re taking very effective steps to prevent HIV transmission, such as PrEP or HIV meds, they can still get and transmit STDs.

In addition to condoms and testing, there’s another important step that men can take to help reduce STD and HIV transmission in their community: notifying their partners if they think they may have exposed them to an STD.

Many people with STDs never experience any symptoms, so unless they’ve been tested, they often don’t know they have an STD or that they could unknowingly give it to someone else. That’s why notifying partners that they may be infected is so vital to helping break the chain of transmission.

Research has shown that most men believe that notifying partners is the right thing to do, and many of them report wanting to do it themselves. But it can still be awkward, embarrassing, and sometimes even risky to tell a partner that they may have given them an STD. That’s why it’s important to give them easy ways to tell their partners.

Sites and apps can help. Here’s how:

1. Make it easier for men to keep track of their partners.

The more a site or app allows individuals to save messages or partner profiles, the easier it is for someone who’s been diagnosed with an STD to find a former partner. Allowing and encouraging users to save a profile or messages, can help a great deal. Adding capacity for users to save messages for a year would also be a tremendous help, since public health guidelines recommend that people infected with some STDs and HIV contact their partners met in the last year. Additional strategies, such as encouraging men to add people they’ve had sex with to their buddy or “favorite” list, would also help them keep track of their partners.

2. Allow Health Specialists on their sites and apps.

Health Specialists – sometimes called Disease Intervention Specialists, or DIS, – are highly trained in and for decades have played an essential role in stopping the spread of STDs and HIV by helping people get tested and treated. They’re employed by either a health department or a community-based organization. DIS are also using their skills in contact tracing for COVID-19.

Healthcare providers are required by law to report certain STDs to their local health department. Once someone is diagnosed with syphilis or HIV by a healthcare provider, a health specialist will get in touch with them. (Some health departments will also have a health specialist contact a patient with gonorrhea if they have enough staff to do so.) They’ll offer to work with the patient to tell their sex partners that they may have been exposed and encourage them to go to their doctor or a clinic to be tested. Working with health specialists is always completely voluntary.

If a site user is uncomfortable telling their partners directly, they can ask a health specialist to help by reaching out to partners to let them know that they have been exposed to an STD or HIV. The health specialist will NEVER tell a partner who gave them their name. Health specialists are committed to protecting privacy. Furthermore, health specialists will not give any details that would reveal where, or when, the partner may have been exposed.

Creating a standardized profile for a health specialist, with their agency’s logo, is one key step to promoting partner services on a site or app.

Importantly, research has found that site users report welcoming the help of a DIS to notify their partners.

Again, most men want to let their partners know about a potential STD and are glad that their partners are notified and able to get tested and treated. And many men who get notified are grateful that they got the information so that they can take care of themselves. Ultimately, by people notifying each other, either by themselves or with the assistance of their health department, they’re promoting the health of the entire community.

Partner notification has lent itself much more to websites than apps. First, site users have unique identities, which make it easier for a user to find a partner. Second, unless a user has saved a partner’s profile, he may not be able to see him if he’s not in the same geographic area. This also makes it much harder for them to notify partners, as well as for health specialists to find them if they’re trying to help.

BHOC is currently working with researchers at the University of Washington to determine which strategies app users would be most likely to support, including allowing users to anonymously notify partners within an app that they should get tested, and will continue to work with app owners to find ways that work for them.

More information about partner notification.

Introducing Technology into Partner Services: A Toolkit for Programs

The CDC’s Toolkit for technology-based STD and HIV Partner Services (IPS) was written to support health departments, community-based organizations (CBOs) and others authorized to provide HIV/STD partner services (PS). It is designed for use with the Internet and other digital technologies, such as mobile phones, computers, and social networking sites, to trace and contact persons potentially exposed to HIV and other STDs.

If you are an owner, we hope this toolkit will demonstrate the high level of partner services health specialists’ professionalism, dedication to supporting gay and bisexual men’s health, sensitivity when working with site and app users, and commitment to assuring confidentiality at all times.

As a site owner, if you would like to discuss how trained health professionals can support your membership to reduce sexually transmitted infections, or other questions, please reach out to the Using Technology as Prevention (UTASP) Workgroup Technical Assistance Manager, Frank Strona at fhs3@cdc.gov.

For a compilation of articles on partner notification and outreach, go to Literature Review: Partner Notification and Outreach.

toolkitsimulator.org is an online training course to familiarize Disease Intervention Specialists and other partner services staff in how mobile apps work, and how they can be used for partner services. It has interactive practice modules, an overview of common app functions, and provides a way to practice without logging in to app services themselves.

Article: Schroeder, S.; Higgs, P.; Winter, R.; Brown, G.; Pedrana, A.; Hellard, M.; Doyle, J.; Stoove, M. (2019) Hepatitis C risk perceptions and attitudes towards reinfection among HIV-diagnosed gay and bisexual men in Melbourne, Australia. Journal of the International AIDS Society 2019, 22:e25288

  • What they did: Between April and August 2017, 15 gay and bisexual men (GBM) living with diagnosed HIV were recruited from high caseload HIV primary care services in Melbourne following successful hepatitis C treatment. In-depth interviews were conducted exploring understandings of hepatitis C risks, experiences of co-infection and attitudes towards reinfection.
  • Results: Participants’ understandings of their hepatitis C infection and reinfection trajectories were captured in three categories. Hepatitis C and HIV disease dichotomies, Risk environments and avoiding infection, and Hepatitis C care as a catalyst for change. 
  • Takeaways: Hepatitis C/HIV co-infection among GBM cannot be understood in isolation from co-occurring drug use and sex, nor as separate from their HIV infection. Hepatitis C prevention must address subcultural heterogeneity and the intersectionality between multiple stigmatized social identities.
  • Abstract

Article: Goyette-Contesse, M.; Fredericksen, R.; Wohlfeiler, D.; Hecht, J.; Kachur, R.; Strona, F.; Katz, D. (2019) Attitudes about the use of geosocial networking applications for HIV/STD partner notification: A qualitative study. AIDS Education and Prevention, 31(3), 273–285, 2019

  • What they did: Between February and March 2017 via four online focus group discussions consisting of 6-8 participants each, researchers explored how cisgender MSM living in the U.S. meet and communicate with sex partners through geosocial networking (GSN) apps, attitudes towards partner services (PS), and perspectives regarding different strategies for HIV/STD partner notification and health services through the apps.
  • Results: While most participants expressed a preference to notify partners on their own, they were generally more comfortable with HIV/STD partner notification occurring within GSN apps, both by partner services staff using a health department profile and by a hypothetical anonymous messaging system built into the app.
  • Takeaway: 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 notifications. Suggestions included using the health department’s logo as the profile picture and including contact information for health department staff who manage the profile; and having the app verify that the health department profile was real by making it look different from other profiles.
  • Abstract

Article: Gutierrez, M., Quevedo, M., Valle, S., Jacques-Avino, C., David, E., Cayla, J., Garcia de Olalla, P.(2018) Acceptability and effectiveness of using mobile applications to promote HIV and other STI testing among men who have sex with men in Barcelona, Spain. Sexual Transmitted Infections, 0, 1-6.

  • What They Did: Over a three-month period, researchers created online dating app profiles on three different platforms and messaged users in two different locations in Barcelona, Spain, offering them free STI and HIV testing. Once individuals showed up at the centers, they were asked through a survey how they found out about the free testing opportunity. Success was measured by how many people contacted through the apps responded positively to the messaging, and how many people turned up at the testing centers.
  • Results: Out of 2656 messages sent across three different apps (Grindr, PlanetRomeo, Wapo), there were 1019 responses (38.4%). Out of those who responded, 846 (83%) responded favorably, and 108 (12.8%) indicated interested in going to a testing center. Of those that indicated interest, 79 (73.2%) showed up at a testing center. The most common STDs found among those who were tested were gonorrhea and crabs.
  • Takeaway: Users who responded favorably to messaging tended to be 45 or older, online at the time the message was sent out, had a profile picture that was not blank or showed more than their torso, and were on Grindr. Out of the 79 people who sought out testing, 45.4% had not taken an HIV test for more than a year, and 7.8% were getting tested for the first time. This study demonstrates that offering free, confidential HIV and STI testing via dating apps is an effective and proactive method of getting MSM into testing centers. However, this success largely depends on app developers not blocking the researchers’ profiles. Therefore, it is essential that public health organizations establish formal collaborations with online app developers.
  • Abstract

Czarny, H. N., & Broaddus, M. R. (2017). Acceptability of HIV Prevention Information Delivered Through Established Geosocial Networking Mobile Applications to Men Who Have Sex With Men. AIDS and Behavior. 1-7.

  • What they did: Researchers conducted a survey at an LGBT pride festival in Milwaukee, Wisconsin, of 224 gay and bisexual men who use hook-up apps to assess the acceptability of receiving HIV prevention information via these apps.
  • Results: While participants responded that all types of sexual health information were acceptable, some types had higher acceptability than others. Participants were most open to learning about locations for HIV testing and free condoms, PrEP, and partner communication strategies. They were less open to information on HIV home testing, HIV support groups, and HIV risk reduction. They were least open to chatting with a physician online and drug and alcohol information. Regarding preferences for how frequently they received information, participants responded that only when actively seeking it out and through weekly alerts were the most acceptable, but were much less receptive to daily alerts, before starting a new conversation, or every time they open the app were the most unacceptable.
  • Takeaway: Hook-up app users are open to receiving all types of sexual health information through apps and prefer weekly rather than frequent messaging.
  • Abstract

Article: Lampkin, D., Crawley, A., Lopez, T. P., Mejia, C. M., Yuen, W., & Levy, V. (2016). Reaching Suburban Men Who Have Sex With Men for STD and HIV Services Through Online Social Networking Outreach: A Public Health Approach. JAIDS Journal of Acquired Immune Deficiency Syndromes, 72(1), 73-78.

  • What they did: A suburban health department in Northern California had previously performed only street and venue-based outreach for HIV/STD services. In 2011, the department decided to create Grindr accounts for outreach staff. During two trial periods, staff measured 1) how receptive Grindr users were to receiving STD and HIV information from these accounts (October 2012-March 2013) and 2) the number of service activities offered Grindr users (October 2013-March 2014). They compared their results to the same period the year before they began Grindr outreach (October 2011-March 2012).
  • Results: During the first six-month trial period, outreach staff contacted 305 users, which was a 500% total increase in contacts. During the second six-month trial period, they reached 816 contacts through Grindr, which was a more than 1500% increase in all contacts. Of the 68.9% of Grindr users who remained engaged with outreach staff during the second trial period, 35% of these users received one or more of the following services: counseling, referrals, testing, or treatment.
  • Takeaway: Many gay and bisexual men are open to HIV / STD outreach by health department staff through hook up apps, which could lead to many more health education and testing opportunities than traditional in-person strategies.
  • Abstract
  • Click here for more information on outreach efforts on apps and sites.

Article: Pennise, M., Inscho, R., Herpin, K., Owens Jr, J., Bedard, B. A., Weimer, A. C., & Younge, M. (2015). Using smartphone apps in STD interviews to find sexual partners. Public health reports, 130(3), 245-252.

  • What they did: In 2013, a county health department in New York conducted an STD investigation among a sexual network of 97 individuals, nearly all black gay or bisexual men. Disease investigators used smartphones in the field during in-person interviews to access profiles and conversations within Adam4Adam, Jack’d, Facebook, and Black Gay Chat Live. They searched for names and contact information of individuals exposed to HIV or an STD. Staff reached out to these contacts and their corresponding networks through formal county accounts on these sites, in person, or via phone.
  • Results: Disease investigators identified seven new infections within the network, including two new HIV infections. Eight individuals identified during the investigation would not have been found without smartphones in the field. Of the 82 people in this network living in this area, only 15 individuals refused testing or could not be found.
  • Takeaway: Access to contact information within hook up apps can help health department staff identify new HIV and STD infections.
  • Abstract
  • Click here for more information on partner services

Sun, C. J., Stowers, J., Miller, C., Bachmann, L. H., & Rhodes, S. D. (2015). Acceptability and feasibility of using established geosocial and sexual networking mobile applications to promote HIV and STD testing among men who have sex with men. AIDS and Behavior, 19(3), 543-552.

  • What they did: Researchers conducted an anonymous online survey in 2013 of 457 gay and bisexual men in North Carolina to assess the acceptability of receiving sexual health information through hook-up apps. A health educator at an AIDS service organization in Greensboro, NC, also created professional accounts on A4A Radar, Grindr, Jack’d, and Scruff between August 2013 and February 2014 to provide sexual health information and referrals for users. The health educator documented all interactions.
  • Results: Of the 450 participants who responded to the questionnaire, 63.8% wanted to receive sexual health information through a hook-up app. The health educator documented 1,780 profile views from users across A4A Radar, Jack’d, and Scruff and 929 conversations across all four apps. Of the 240 sexual health conversations, 63 (26.3%) led to testing referrals.
  • Takeaways:  Many gay and bisexual men want access to sexual health information through hook-up apps. These apps can also be an effective way for health educators to reach users and to connect them to testing resources.
  • Abstract

Digital Partner Services Literature Takeaways

by Nandini M. Deo

Overall Takeaways:

  • Digital partner services (DPS) tools create opportunities to reach patients and partners who are unreachable through traditional methods. DPS is intended for use alongside, not in place of, traditional partner services
  • The internet and mobile applications are widely utilized for sex-seeking and obtaining sexual health information, most likely due to efficiency.
  • Electronic partner notification cards (“e-cards”) and other technological innovations have low rates of utilization. Development of protocols and procedures would standardize implementation of other technologies and facilitate utilization.
  • Understanding and utilizing online venues for HIV/STD prevention work can reduce barriers to accessing prevention services for several groups disproportionately impacted by HIV and STDs including, but not limited to, young people, men who have sex with men, and people of color.

1) Pellowski, J., Mathews, C., Kalichman, M. O., Dewing, S., Lurie, M. N., & Kalichman, S. C. (2016). Advancing Partner Notification Through Electronic Communication Technology: A Review of Acceptability and Utilization Research. Journal of Health Communication, 21(6), 629-637. doi:10.1080/10810730.2015.1128020

What they did: Reviewed 23 studies on the acceptability and utility of digital partner services

What they found:

  • Though partner notification reduces disease burden and prevents new infections and reinfections, studies show that only a limited number of partners are ever notified (less than 40% of partners). Electronic communication technologies (internet, text messaging, phone calls) have the potential to expand partner services
  • Electronic communications could have their greatest impact in notifying less committed partners who would be otherwise uninformed of their STI exposure
  • Electronic communication technologies have the potential to reduce costs, expand coverage, and increase efficiency of both provider and patient-initiated partner notification services. It is estimated that nearly half of the world’s population has access to the internet and more than 3 out of 4 people in the world have cell phones
  • While website notification systems (such as inspot) are innovative, multiple studies show self-efficacy on these sites is rarely used. It is important to have protocol and utilize other technologies
  • When STI patients notify their partners, time is key. The average median time to notification occurs on the same day as diagnosis. 84% of the patients who do notify their partners do so within 7 days of being diagnosed
  • A crosscutting theme is the discordance between high levels of acceptability and low rates of utilization. The uptake of electronic partner notification has been slow, especially in settings where impact may be the greatest – this could be linked to awareness/campaigns

2) Reed, J.L., Huppert, J.S., Gillespie, G.L., Taylor, R.G., Holland, C.K., Alessandrini, E.A., Kahn, J.A. (2015). Adolescent Patient Preferences Surrounding Partner Notification and Treatment for Sexually Transmitted Infections. Academic Emergency Medicine, 22(1), 61-66. Doi: 10.1111/acem.12557

What they did: Descriptive, qualitative study with a convenience sample of 40 adolescents who presented in Emergency Departments with STI-related complaints.

What they found:

  • Barriers to partner notification among youth include fear of retaliation or loss of relationship, lack of understanding or of concern for the consequences associated with an STI, and social stigma and embarrassment.
  • Participants reported two primary barriers to their partners obtaining STI testing and treatment: lack of transportation to the health care site and the partners’ fear of positive results
  • Most participants preferred to notify their main sexual partners of an STI exposure via face-to-face interaction or a phone call
  • Most participants were agreeable with a health care provider notifying their main sexual partners of STI exposure and preferred phone call

3) Hochberg, C. H., Berringer, K., & Schneider, J. A. (2015). Next-Generation Methods for HIV Partner Services. Sexually Transmitted Diseases, 42(9), 533-539. doi:10.1097/olq.0000000000000335

What they did: A systemic review assessing the utilization and effectiveness of “next generation” HIV partner services technologies

What they found:

  • Although successful notification may be lower overall, use of next generation services provides an avenue to contact those that would previously have been untraceable
  • Despite lower contact rates in internet partner services (iPS), actual notification of HIV risk was higher among those who contacted with iPS vs. TraditionalPS. TextPS has a higher contact rate (77%) and a higher actual notification rate. After the centralization and formalization of iPS with the public-academic partnership in North Carolina, the number of iPS notifications increased from 131 to 455
  • Despite lower than traditional notification rates in the public health department based efforts, next generation techniques were utilized exclusively for partners with no traditional contact information, a previously unreachable group. This may in part explain the lower rates of successful contact as this may be particularly hard to reach population. However, from these data it is not clear that most at risk populations are being reached
  • Taken together, the modest new case-finding ability among a previously unreachable population and increase in total case finding does support including these services as an adjunct to traditional techniques

4) Mimiaga, M. J., Reisner, S. L., Tetu, A. M., Bonafide, K. E., Cranston, K., Bertrand, T., . . . Mayer, K. H. (2009). Partner Notification after STD and HIV Exposures and Infections: Knowledge, Attitudes, and Experiences of Massachusetts Men Who Have Sex with Men. Public Health Reports, 124(1), 111-119. doi:10.1177/003335490912400114

What they did: A one-on-one, open ended, semi-structured qualitative and quantitative study with a convenience sample of STD clinic patients and a respondent-driven sample of men who have sex with men

What they found:

  • Interview findings show that the majority of participants had not previously heard of PN activities prior to this study and only 25% of MSM provided a correct description of PN. Common incorrect definitions included informing current sexual partners of STD/HIV status
  • Nonwhite, HIV-uninfected MSM reported notifying partners of STD exposure least often and were less likely to have been notified by partners of previous STD exposures compared with white MSM .
  • 20% of participants expressed a “not my concern” mentality, articulating a belief that choosing to engage in risky sexual behavior involves an inherent risk of spreading infection, suggesting minimal responsibility or obligation to notify
  • The inability to contact past partners due to anonymous sexual encounters was reported at 89%
  • Direct partner-to-partner notification was the most frequently preferred PN method (53%)
  • One third preferred assistance from a third party, They felt that obtaining assistance from agencies that possessed specialized expertise and knowledge in STD/HIV and PN was indispensable

5) Pennise, M., Inscho, R., Herpin, K., Owens, J., Bedard, B. A., Weimer, A. C., . . . Younge, M. (2015). Using Smartphone Apps in STD Interviews to Find Sexual Partners. Public Health Reports, 130(3), 245-252. doi:10.1177/003335491513000311

What they did: The Monroe County Department of Public Health conducted an STD investigation among men who have sex with men using index case and cluster interviews, and with the use of smartphone applications

What they found:

  • During case interviews, clients are able to use the DIS’s smartphone to long onto their accounts on various websites and apps to find their sexual partners and retrieve inbox messages containing traditional locating information such as phone numbers and addresses. Because notifications cannot happen via GPS apps, the only way for partners to be reached is by accessing profiles during field encounters with the original patient
  • Accessing websites in the field allows staff to confirm partner identities
  • Profile pages on apps and websites can consist of date of birth, age, physical description, nicknames, sexual orientation, HIV status, place of employment, and photographs
  • Allowing patients to log into their social networking or dating site accounts in real time with the DIS improved recall and provided additional locating or contact information for partners
  • These tools are used to identify and locate partners

6) Bauermeister, J. A., Leslie-Santana, M., Johns, M. M., Pingel, E., & Eisenberg, A. (2010). Mr. Right and Mr. Right Now: Romantic and Casual Partner-Seeking Online Among Young Men Who Have Sex with Men. AIDS and Behavior, 15(2), 261-272. doi:10.1007/s10461-010-9834-5

What they did: Examined the relationship between online sexual behaviors and online partner-seeking behaviors for casual and romantic partners of young men who have sex with men

What they found:

  • Researchers have noted that Young Men who have Sex with Men (YMSM) pursuing or participating in romantic relationships may be more likely to forego their concerns about potential infection or unwanted transmission in order to express intimacy, love, and trust. This dynamic may be particularly relevant to online dating because internet-based communications may expedite perceptions of intimacy and security prior to meeting a partner in a face-to-face encounter
  • When sexual behaviors were examined, researchers found that YMSM reported having several sexual partners in the past two months; however, less than half of the sample reported on engaging in Unprotected Anal Intercourse (UAI), both insertive and receptive. These trends are consistent with national data
  • YMSM who seek casual sex partners often may increase their number of sexual opportunities, which may decrease their ability to negotiate condoms successfully regardless of partner type
  • It is possible that YMSM who engage in casual partner seeking frequently may also be more likely to include YMSM who are sexual sensation seekers, who have compulsive sexual behavior symptoms, or who engage in bareback sex

7) Grov, C., Breslow, A. S., Newcomb, M.E., Rosenberger, J.G., Bauermeister, J.A. (2014). Gay and Bisexual Men’s use of the Internet: Research from the 1990’s through 2013. The Journal of Sex Research, 51(4), 390-409. doi:10.1080/00224499.2013.871626

What they did: Reviewed historical and cultural shifts in how gay and bisexual men have used the internet for sexuality between 1990-2013

What they found:

  • Identifying the Internet as a ‘modern bathhouse’, researchers placed increasing attention on gay and bisexual men’s online interaction and their relationships to sexual risk behaviors associated with HIV/STI infection
  • Although seeking partners online may not be directly associated with sexual risk-taking behaviors, the ease and anonymity of online communication facilitated a more efficient communication of needs and desires related to sexual behavior, and this may have increased risk behavior in some groups while decreasing risk for others
  • In 2013, the US consumer spent an average of 2 hours and 28 minutes per day on smartphones and tablets. 80% of that time was spent inside apps and 20% on the web
  • In January 2013 alone, the 20 top dating apps had a combined 17 million users and delivered more than 2.1 billion sessions. Examining app use by sexual orientation, those who identified as heterosexual typically opened their dating apps eight times a week and used them for 71 seconds at a time compared to users of dating apps for gay men which averaged 22 times a week for 96 seconds each time
  • On average, men recruited from Grindr were more likely to be white and reported more sexual partners in the past 2 weeks. A study that examined sexual risk behaviors and HIV prevention practices among MSM using Grindr and found that study participants had high rates of sexual partnering and that among men engaging in unprotected anal intercourse, the majority perceived themselves to be low risk for acquiring HIV
  • Responses included a user friendly content about test site locators, STDs, symptom evaluation, drug and alcohol risk, safe sex, sexuality and relationships, gay friendly health providers, and connection to other gay/HIV positive men

8) Mark, K. E., Wald, A., Drolette, L., & Golden, M. R. (2008). Internet and Email Use Among STD Clinic Patients. Sexually Transmitted Diseases, 35(11), 960-965. doi:10.1097/olq.0b013e3181824f4d

What they did: Conducted an anonymous cross sectional survey of STD clinic patients (adults only), in Seattle, WA

What they found:

  • Of 251 participants, 200 (80%) reported using the internet from a private location at least once a week, 190 (76%) had their own email that they check at least 3 times a week, and 144 (57%) were willing to receive an email reminding them to come back for a follow up appointment if diagnosed with an STD.
  • MSM were more likely than women and heterosexual men to be regular Internet and email users and to have met a sex partner over the internet during the past year (69% vs. 11%)
  • Internet access is present in 62% of US households, access is less common in the households of persons with a high school education or less, Black, Hispanic, and NA/AN households and households with less than $35,000

9) Stahlman, S., Plant, A., Javanbakht, M., Cross, J., Montoya, J. A., Bolan, R., & Kerndt, P. R. (2015). Acceptable Interventions to Reduce Syphilis Transmission Among High-Risk Men Who Have Sex With Men in Los Angeles. American Journal of Public Health, 105(3). doi:10.2105/ajph.2014.302412

What they did: Conducted in-depth interviews with 19 Men who have sex with men in Los Angeles, with repeat primary, secondary, and early non primary non secondary syphilis within the past 5 years

What they found:

  • Several participants expressed preference for community based organizations serving the gay community to do partner notification, stating that they were more comfortable with these types of organizations because staff members were more accustomed to communicating with MSM and because they were more “relatable”, “personal”, “genuine”
  • They were offered a reminder from a public health investigator, which most were okay with, a Public health investigator home visit, which most were not okay with, a website they could reference, which participants were thrilled about, an automated reminder, which there was some uncertainty about, a home test kit, which was mostly very positive, being paid to test, which most people were happy with, and preventative medicine like PrEP, which had mostly positive responses, but with some worries about this type of medicine

10) Landovitz, R. J., Tseng, C., Weissman, M., Haymer, M., Mendenhall, B., Rogers, K., . . . Shoptaw, S. (2012). Epidemiology, Sexual Risk Behavior, and HIV Prevention Practices of Men who Have Sex with Men Using GRINDR in Los Angeles, California. Journal of Urban Health, 90(4), 729-739. doi:10.1007/s11524-012-9766-7

What they did: Conducted a computer-assisted self-interview-based survey of 375 Young men who have sex with men using the GRINDR platform

What they found:

  • 38% of participants (18 years and older, and using the GRINDR platform for sex seeking) reported unprotected anal intercourse (UAI) within the past 3 months
  • White MSM were significantly more likely to report UAI compared to African American and Latino participants
  • 8% did not always ask their sex partners about their HIV status
  • Of those reporting UAI, 70% reported believing that it was “unlikely” or “very unlikely” that they were ever going to acquire an HIV infection

11) Selkie, E. M., Benson, M., & Moreno, M. (2011). Adolescents Views Regarding Uses of Social Networking Websites and Text Messaging for Adolescent Sexual Health Education. American Journal of Health Education, 42(4), 205-212. doi:10.1080/19325037.2011.10599189

What they did: Conducted focus groups of adolescents between 14 and 19

What they found:

  • Adolescents want sexual health education to be easily accessible—they mentioned that when a sex ed question arises, they want an answer immediately. They overwhelmingly responded that they use Internet search engines to find answers to sexual health questions. Despite the excellent accessibility of the internet, accessibility to appropriate sexual health information on the internet was considered poor. An issue raised multiple times was the difficulty with accessing understandable information. There was an emphasis on the use of plain language
  • Adolescents want sexual health resources to be trustworthy—both credible and confidential
  • Adolescents choose resources that offer information in a non-threatening way
  • Providing a safe setting to interact with real people via technology is something that social networking sites and text messaging can readily offer

12) White, J. M., Mimiaga, M. J., Reisner, S. L., & Mayer, K. H. (2012). HIV Sexual Risk Behavior among Black Men Who Meet Other Men on the Internet for Sex. Journal of Urban Health, 90(3), 464-481. doi:10.1007/s11524-012-9701-y

What they did: Conducted interviewer-administered assessments and voluntary HIV counseling and testing for 197 black men who have sex with men in Massachusetts

What they found:

  • Epidemiologic studies have confirmed the moderating relationship between Internet use and disease outcomes as cases of HIV transmission and syphilis outbreaks have been traced to specific chat rooms and sex partners who were met online
  • The results from this study indicate that Black MSM who used the internet to meet sexual partners were at greater risk in male-to-male HIV sexual risk behavior
  • Men who reported using the internet to meet make sexual partners reported a significantly higher number of male partners in the past 12 months
  • The majority (66%) of Black MSM in this study did not identify as gay (i.e. identified as heterosexual or bisexual) and 20% had never come out to anyone

13) Beymer, M. R., Weiss, R. E., Bolan, R. K., Rudy, E. T., Bourque, L. B., Rodriguez, J. P., & Morisky, D. E. (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. Sexually Transmitted Infections, 90(7), 567-572. doi:10.1136/sextrans-2013-051494

What they did: Collect data from all self-identified HIV-negative clients visiting the LA Gay and Lesbian Center for STI screening who identified as a man who has sex with men

What they found:

  • Since 2001, various studies have found that MSM who use the internet to locate sexual partners, compared to those who did not, had a greater odds of engaging in UAI, a higher odds of having anonymous sex, and a higher average number of partners in the span of 6 months
  • Efficiency appears to be the primary risk associated with meeting partners online

14) Sun, C. J., Stowers, J., Miller, C., Bachmann, L. H., & Rhodes, S. D. (2014). Acceptability and Feasibility of Using Established Geosocial and Sexual Networking Mobile Applications to Promote HIV and STD Testing Among Men Who Have Sex with Men. AIDS and Behavior, 19(3), 543-552. doi:10.1007/s10461-014-0942-5

What they did: Evaluated the acceptability and feasibility of providing sexual health information and HIV/STD testing referrals on geosocial and sexual networking apps directed towards men who have sex with men

What they found:

  • About 2/3 of participants reported that they wanted to receive sexual health information via an app.
  • A demonstration that providing sexual health information and HIV and STD testing referrals via geosocial and sexual networking apps designed for MSM is both acceptable and feasible. About two-thirds (63.8%) of surveyed MSM reported that they wanted to receive sexual health information via an app. Additionally, providing referrals to local and geographically specific HIV and STD testing is also feasible; across the four apps, 26.3% of informational chats with the health educator resulted in the user requesting and receiving referrals to a local HIV and STD testing site.

15) Udeagu, C. N., Bocour, A., Shah, S., Ramos, Y., Gutierrez, R., & Shepard, C. W. (2014). Bringing HIV Partner Services Into the Age of Social Media and Mobile Connectivity. Sexually Transmitted Diseases, 41(10), 631-636. doi:10.1097/olq.0000000000000181

What they did: Augmented Partner Services for HIV in New York City using texting and the internet to contact people who did not have traditional information (landline, postal address etc.) available. They compared outcomes of contact attempts, notification, and HIV testing for traditional partner services (traditionalPS), internet based partner services (IPS), and texting partner services (txtPS).

What they found:

  • The myriad of different forms of communication: email, texting, dating or hookup websites, social media, and mobile applications – quickly overwhelm efforts to take a comprehensive approach and leave less-well funded PS operations with the question of how to prioritize efforts given limited resources
  • This study was done by the NYC department of public health, where Internet Partner Services and Texting Partner Services was used with people who didn’t have traditional contact information
  • The contact rate for TextPS was 77%, Traditional PS 69%, and IPS was 41%. People contacted through traditional methods were most likely to follow up with testing (69% vs. 45% vs. 34%)
  • A higher proportion for partners contacted via IPS were 20-29 years old, and although TextPS and TraditionalPS yielded more contacts, IPS activities allowed for contacting many HIV-exposed young men who have sex with men who would have been previously untraceable
  • Health departments that lack funds to equip DIS with smartphones and data plans should consider starting with a more limited, office-based approach to IPS, where no equipment beyond a desktop computer and internet access would be necessary. 1 to 2 staff members, after appropriate training and protocol development, would have sole responsibility for IPS communications.

16) Wohlfeiler, D., Hecht, J., Volk, J., Raymond, H. F., Kennedy, T., & Mcfarland, W. (2012). How Can We Improve Online HIV and STD Prevention for Men Who Have Sex with Men? Perspectives of Hook-Up Website Owners, Website Users, and HIV/STD Directors. AIDS and Behavior, 17(9), 3024-3033. doi:10.1007/s10461-012-0375-y

What they did: Surveyed dating and hookup website users, website owners, and health department HIV/STD directors. Some sites were exclusively for bisexual and gay men, others were for people of all sexual orientations

What they found:

  • Prior studies show that MSM who use the internet to find sexual partners are more likely to report unprotected anal intercourse and more likely to report previous STD diagnoses compared to other MSM
  • Eight interventions were agreed on by the majority of stakeholders: 1) automated HIV/STD testing reminders 2) local STD test site directories 3) links to sex-positive safe sex videos 4) access to sexual health experts 5) profile options to include safer sex preference 6) chat rooms for specific sexual interests 7) filtering partners by their profile information 8) anonymous e-card partner notification for STD exposure

17) Kachur, R., Hall, W., Coor, A., Kinsey, J., Collins, D., & Strona, F. (2018). The Use of Technology for Sexually Transmitted Disease Partner Services in the United States. Sexually Transmitted Diseases, 45(11), 707-712. doi:10.1097/olq.0000000000000864

What they did: A structured literature review of all US studies examining the use of technology to notify persons exposed to reportable STDs

What they found:

  • Between 10% and 97% of partners were successfully notified of exposure through use of technology and between 34% and 81% were screened or tested
  • Five of seven reviewed studies reported 3-19 new infections identified
  • Use of technology for partner services saved programs between $22,795 and $45,362 in direct and indirect medical costs

TellYourPartner.org is a brand-new platform for individuals recently diagnosed with an STI who want to notify their partners anonymously by text.  Users may choose a pre-populated message or write one of their own, and notify up to six partners at a time.

The first documented instance of the Internet being used for the purposes of notifying partners that they may have been exposed to an STD and should get tested was in 1999, and was a response to a syphilis outbreak in San Francisco attributed to sexual encounters that were facilitated through a chat room.23 In the same year, another study was conducted that focused on the Internet as a sex-seeking environment and was identified as a possible STD/HIV risk environment.9

As a result of a significant increase in the number of STD patients reporting sex partners met online through chat rooms, social networking, and hook-up sites, public health programs began incorporating the internet and email into their partner services programs.24-26  These early efforts showed that Internet-based partner services (IPS) held promise as a legitimate tool when partnered with other traditional methods for disease prevention.

The CDC supports using dating websites as a strategy to find partners. By September of 2005, CDC had responded to the promising outcomes shown in several areas with a “Dear Colleague Letter” to public health departments 4  that encouraged program areas to explore the Internet as a disease intervention and prevention tool. A second CDC “Dear Colleague Letter” supporting the use of the internet for partner services was released in 2010.5

Since the release of the first Dear Colleague letter, several studies have been conducted to evaluate IPS outcomes by assessing rates of partner elicitation, notification, and testing and quantifying the number of partners who otherwise would not have been contacted without IPS.

In Texas, Vest et al found that the use of email to reach partners for whom no other contact information was available resulted in 50% of those partners being notified, of which 26% were found to be infected with an STD. Additionally, they found that sending emails did not require additional staff time, and allowed for rapid partner notification (PN) communication.27

Ehlman et al. assessed the effectiveness of Internet partner services in Washington, D.C. and found Internet partner notification (IPN) improved notification and treatment for early syphilis. Using IPN led to a 75% increase in the number of partners investigated, and a 26% increase in number of partners examined and treated, when necessary. At least 285 partners who would not have otherwise been contacted were notified of exposure.28

In addition to emails, social networking sites can also be a venue for PN.  The Milwaukee Health Department in Wisconsin reported on the use of the social networking site, Facebook, to augment partner notification efforts involving a syphilis cluster (n=55). Within the cluster, 17 positive cases of syphilis were found, 10 of which were co-infected with HIV. Among the cluster, two of the positive cases had been named as Facebook contacts, and as a result, were able to be located by Disease Investigation Specialists, or DIS (also known as Health Specialists), when traditional methods failed. Moreover, these two cases were found to be key connectors within the cluster. Facebook was also used to augment traditional partner notification for an additional five individuals. Hunter et al (2014) found that the use of Facebook augmented traditional efforts by allowing DIS to reach partners more quickly, especially among those individuals who may frequently change phone numbers or addresses.29

More recently, texting has also been shown to be a very effective way of reaching partners. In a 2011 Letter to the Editor, Kachur et al. described a case in which text messaging was successfully used for partner notification. In this case, DIS in the New York State Department of Health were able to reach and notify a partner of their syphilis exposure through text messages after traditional efforts had failed.15
In 2012, Mendez et al reported on Multnomah County’s texting PS program, which consisted of sending a text message for partner notification immediately following an attempt to reach cases by phone, but before mailing letters or conducting a field visit. Text messages were sent to 149 clients immediately following an attempted to reach them by phone; 56% of those texted responded to DIS with a phone call, many within 10 to 15 minutes. They also found texting reduced the need for mailing letters and making field visits.30

Hightow-Weidman et al evaluated the use of text messaging for the partner notification of 29 contacts in North Carolina. Text messaging was used only after traditional or IPN attempts did not elicit a response. Of the 29 contacts, 48% (n=14) responded to the text, all within in a median time of 57.5 minutes. Among the 14, two new cases of syphilis and one new case of HIV were identified.31

Udeagu et al. compared traditional, internet and text-based (txtPS) PS delivery methods on contact, notification, and HIV testing rates. They found the contact rates for txtPS (77%) to be significantly higher than traditional PS (69%) or IPS (41%; p<0.0001). IPS (odds ratio (OR), 2.1; 1.2-3.4) and txtPS (OR, 2.4, 1.7-3.2) resulted in a greater likelihood of notifying partners than traditional PS (p<0.0001), but traditional PS yielded the highest proportion of partners testing for HIV (69% versus 34% and 45%, respectively; p<0.0001). They concluded that augmenting their PS program by incorporating the three modes of PS improved their overall PS outcomes, reached partners who were otherwise unreachable, and improved their operational efficiency.32

Lastly, Pennise et al reported on the Monroe County Department of Public Health in New York, which has, since 2012, issued smart phones to the DIS for use during field investigations. They reported on a cluster investigation conducted between February and May 2013 through which partner elicitation, notification, and testing was improved through the use of smart phones. Use of smart phones allowed DIS to search online sites and mobile applications with patients in order to elicit partner information in real time. These efforts resulted in seven new cases of disease being diagnosed, including two new cases of HIV.22

In addition to augmenting traditional partner services, partner notification through an online community is considered an acceptable tool by members of that community. In a national IPS study performed by The Fenway Institute, Fenway Community Health looked at the acceptability of IPS among men who have sex with men (MSM). A total of 1,848 MSM were recruited online via an Internet sex partner-seeking website between October and November 2005. The study concluded that IPS should be considered an acceptable tool for partner services, with more than 92% of participants reporting that they would use IPS in some capacity to inform their sexual partners of possible exposure, if they were to become infected with an STD in the future.33

Additionally, BHOC assessed the levels of support for partner notification by users, website owners, and public health in 2009. Two-thirds of the website users welcomed internet partner services by the government. Currently, BHOC is also working with University of Washington researchers to assess interest in mobile-app based partner notification strategies. Initial analysis suggests that while users believe they themselves should notify their partners, they still welcomed assistance by public health agencies.  Since its inception in 1999, IPS has become a standard practice in many health departments. IPS has been an effective tool for the elicitation, notification, and testing of partners and for reaching those partners, who otherwise would not have been notified of their exposure to an STD or HIV.

Adapted from CDC

The Future

Partner notification has lent itself much more to websites than apps. First, site users have unique identities, which make it easier for a user to find a partner. Second, unless a user has saved a partner’s profile, he may not be able to see him if he’s not in the same geographic area. This also makes it much harder for them to notify partners, as well as for health specialists to find them if they’re trying to help.

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