
Ask HN: Does anyone care about STD prevention? - soelost
	According to the CDC, half of all adults have never been tested for an STD, and that’s probably because most people with an STD don’t have symptoms. What this leads to is a lot of people unknowingly infecting others. Every year there are an estimated 20 million new cases of infection. Year after year the problem is only getting worse. I&#x27;ve been working on a solution but I want to know if theres any interest.
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lucozade
Assuming you mean the US, I'm not sure the evidence leads one to conclude that
this is a particularly serious issue for the general population.

It is true that for the last decade the prevalence of STDs has steadily
increased. But that's from an historic low. Also, there are a few high risk
groups (<25s, MSMs) that account for the vast majority of cases.

So, I'm not sure a stat like 0.5 of all adults haven't been tested is that
persuasive. What is the equivalent rate for the high risk groups? If they have
low testing/awareness levels then you may be onto something but I'm not sure
that that's true (and it may vary considerably between regions in the US).

BTW this isn't intended to denigrate what you're doing as I have no idea what
that is. If you do have an effective way to prevent STDs then that could be
very valuable.

~~~
soelost
I am only talking about the US so I agree with you about the general
population.

However, the problem is serious relative to the size of one of the high risk
groups that you mentioned since they account for roughly half of all the
infections. Though that risk decreases through age 40 we are still talking
about millions of people in either age group.

As for MSMs, they do have a higher rate of incidence, especially when it comes
to Syphilis and HIV, the 2 STDs with lowest overall infection numbers.
Overall, MSM would be a subcategory within the larger age group.

I would also like to know what the test rate is for the <25 group, but Im not
sure the rate for the MSM group matters anymore than the white group or the
obese group. I am also curious about the bisexual rate and their affect if
any, being that they are the go between.

My sample size was just over 30 people(laughable), most of which believed that
no symptom meant no infection. It seems as though government and NGO's alike
focus on awareness, of which testing happens to be a component. Not sure how
successful they are.

The other side is that even if testing is high, the process is tedious, which
I can personally attest to. A person gets tested, then waits 3-5 business days
to get their results. If positive, they then contact their partners. Assuming
they still have their information, neither have blocked each other, and they
make it over the hurdle that is stigma or shame. At which point their partner
goes through the same process, and so on. All the while, all those who have
yet to be notified are out in the world infecting others. The time it takes to
test and treat someone is considerably slower than the time it takes to infect
others. This is all conjecture, but the facts are limited and the stats we
have are high.

Due to the stigma associated with the topic its been tough getting people to
talk so I honestly appreciate your response. After this I get the feeling that
you'll be a critic of my idea, but hopefully a constructive one.

My idea is to improve partner notification by taking a network approach which
looks at partners to the 4th degree, and alerts those that may have been
exposed. My hope is this will get more people tested.

I understand the problems with my new partner receiving an alert that was set
in motion by my ex, but if my new partner insists on condom use then we won't
get alerts.

------
dev_north_east
Avoid sleeping around, find a partner to have a monogamous relationship with.
Sorted.

Interested to hear about your solution?

~~~
soelost
This also addresses InGodsName.

My solution is an app where we log all new partners and periodically log our
on-going partners, and then update when we're tested, whether positive or
negative. If positive, the app alerts all partners to the 4th degree. The 4th
degree, in the event your partner cheats on you and that person ends up
testing positive. The app could alert you and your partner at the same time.
Its not about blame or shame but getting people tested and treated so they
stop infecting others. If negative, then the app won't send you alerts from
partners prior to your test date.

~~~
jrowley
Just speaking for myself, but there is no way I'd ever give any app (except
possibly a personal journal/writing app) that kind of data. In my opinion, who
I bone is my business, and it is my responsibility to get tested regularly if
I'm having unprotected sex with lots of partners.

~~~
soelost
Do you mind telling me your age? I can definitely say you're not the first
person to say that. Early on I got that from a handful of people, along with a
few others asking what kind of information they'd have to share, and from
there I decided to anonymize it based on HIPAA's Methods for De-
identification.

It is your business and responsibility. I agree with you, but I just wish
everyone else felt the same way and acted as though they did. But the number's
tell a different story.

With that said, you can drive down the highway at 65 with your seatbelt on
following all the rules. But if everyone else feels like driving against
traffic then you're still at risk. And Im not saying to act reckless because
everyone else is. Im saying to turn on your radio to listen to the traffic
alerts.

My question for you is, are you dead set on your stance or is there something
that could change your mind? Some of the people that were opposed at first
didn't want to share their identities while others felt they owed it to their
partners to call them. The reason I ask is because you gave an exception.

~~~
jrowley
I'm ~25.5 years old, and had a pretty healthcare oriented upbringing (I grew
up in family of clinicians).

So I guess I'm not 100% dead set, but pretty close. If this tool was used in a
healthcare context, by healthcare professionals I might consent to it. For
example, if as part of my annual check up I filled out a list of the people I
had intercourse with (and their location, DOB, some more identifiers) and the
last time I did so, etc. and it got entered into the EHR, and then EHR did
some linking (Epic EHR already has Care Everywhere which links records across
health systems), then at least the data would be in the system. From there it
could automatically send alerts out, or perhaps better, it would alert your
physician/clinician that you might be of higher risk. I don't think the
clinician (or any human user, besides the user them self) should be able to
see who their self reported partners are.

So the above system makes the assumption that people have regular access to
physicians, which is not a safe assumption. People who already have regular
access should be getting screened by their clinician to see if they are at
risk, and then tested. So I'm not sure it really has that much of a value add,
and it certainly adds some complexity.

I'm all for reducing the burden of STDs/STIs, but I'm not sure that a registry
is the best approach, but I'm not a health policy person.

~~~
soelost
When you said personal journal my thought was, this isn't a journal but it is
a personal log. It's not like me or any other users can see it.

I definitely want to move in the direction of users logging partners on their
own, and clinicians sending out the alerts but don't know how to tackle that
part so Im starting with user inputs since thats fairly straightforward.

Why are you so accepting of it in the context of a healthcare system but not
so much when its outside of that? Isn't a registry a registry no matter how
slice it? And what features or safeguards would make you more comfortable with
it outside of a healthcare system?

BTW I really appreciate you letting me pick your brain.

~~~
jrowley
Hey - I don’t have time to reply to this atm with holidays and idk when the
thread will die but feel free to email me. It’s in my profile

------
subroutine
Dr. He Jiankui cares.

~~~
soelost
Thanks!

~~~
subroutine
I take it you've heard of him by now?

~~~
soelost
Nothing about STDs though...

~~~
subroutine
Do you consider HIV and STD?

~~~
soelost
Of course. I looked him up again but this I included HIV in the search. Can't
believe I missed it the first time.

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meiraleal
No, the same way most of all adults didn't test for Diabetes, which is a lot
worse than most STD.

~~~
soelost
Good point. But why do you think that is?

~~~
meiraleal
Most of people don't have (at time) Diabetes or STD. If you would test for
everything you have a slight chance to have, we would have an even more
hypochondriac society (for the happiness and profit of the drugs business).

I do think that more people should do diabetes test, though.

------
quickthrower2
Yep got tested a few years back but not since being in long term is
relationship. Test was free

~~~
soelost
Appreciate the comment and Im glad to hear you were tested. But if you don't
mind, how often were you getting tested when you were single, do you know if
your partner was also tested prior to entering the relationship? Did you get
tested together or even consider it?

~~~
quickthrower2
We both got tested at roughly the same time. Different clinics.

Didn’t get tested before.

~~~
soelost
Im glad to hear that. You're only the second person who's told me they got
tested together or roughly the same time. Im often guilty of not doing it
myself.

