The world wide epidemic of HIV/AIDS, genital herpes, and other incurable viral STDs is largely a result of there being an insufficient incentive for individuals to be tested. Centers for Disease Control and Prevention (“CDC”) have found increased testing to be the most effective means of prevention. However, currently, an individual’s fear of receiving positive test results is not adequately counterbalanced by an incentive to receive negative results.
The receipt of positive test results adversely impact everything from one’s dating and sex life to one’s credit rating and insurability. This fear makes not knowing and not being tested the preference of the majority. Left unchecked, and absent mandates for global testing, people will continue to avoid testing and continue to insidiously both, knowingly and unknowingly infect their partners. Without a cure or improved treatments for viral STDs, an individual’s fear of receiving positive results will be difficult to overcome.
Therefore, the focus of the new prevention strategy should be to develop incentives for individuals to be tested that also appeal to selfish motivations, rather than global calls for social responsibility, which have proven insufficient. The most economical and powerful solution is to leverage the tools of social networking, which CDC have found to be effective. This requires an efficient means by which prospective sexual partners can mutually communicate their negative HIV/STD test results, prior to sexual activity.
Problem - No Incentive for Testing
The principal problem of HIV and other viral STDs is that both the carriers and their partners are not aware of their infection. CDC estimates that in the United States 25% of those infected with HIV are unaware that they are infected. They have also found that the best means of preventing new transmissions is to ensure that those infected are aware of their condition, because when people know they are positive they tend to reduce their level of sexually risky behavior.
CDC and World Health Organization (“WHO”) now call for annual HIV for all between the ages of 18 to 64. However, these recommendations are still incomplete models to effectively isolate the disease. They do not provide a self-interested motivation for individuals to be tested and they remain biased toward a philosophy of treatment over prevention.
Current Partner Notification Systems
There are examples of online partner notification systems that have proved successful; however they are also retroactive measures of disease isolation, rather than proactive prevention. Inspot.org is a non-profit website that allows people who have been infected with HIV to anonymously notify past sexual partners that they are at risk and should seek testing.
Statistical data on the effectiveness of this system is not available, but one may surmise that it would at least help to encourage high risk people to seek testing. This is a beneficial system for those already infected, but does little to help individuals prevent contraction. Its anonymous system, although practical, does little to encourage open discussion about HIV/STDs before sexual activity takes place.
Sites for Positive Carriers
Interestingly, there are a number of successes systems that “sero-sort” positive carriers from the larger population. For example, in Africa, there is a popular Internet dating site called HIVSingles.com, which encourages HIV positive people to date other HIV carriers. It is successful because it allows people to mutually identify themselves as carriers, thereby removing the moral and ethical dilemmas, awkwardness, guilt and legal liability associated with dating someone who may not be infected.
There are other such sites like HerpesSingles.com, which have become popular in the United States and similarly encourage people infected with genital herpes to date others also infected with the disease. These sites do however instill a false sense of security because there are many strains of these viruses, which may cause more or less severe symptoms depending on the individual.
Also, there is a risk that new, more dangerous and more easily communicable viruses may be born out of increased cross-contamination in individuals who are exposed to multiple strains. However, at least these sites isolate those infected with certain sexually transmitted infections, from those who may not be infected. The popularity of these sites begs the question of why similar systems are not available for people who have tested negative for sexually transmitted diseases and who wish to remain healthy.
New Approach
An online health service could provide a practical means for couples to identify each other as having received negative test results. If popularized, this will make routine testing and disclosure a social imperative. The site leverages social networking to foster a socially driven incentive for individuals to be tested for HIV, herpes and others STDs. By making it easy to identify one-self to others as having been recently tested, with negative results, it will make one more attractive to a prospective partner.
This creates a self-interested incentive for people to engage in testing and to disclose it openly to their partners. It also provides the tools for members to require that their partner be tested and to disclose negative results in kind. The networking effect will become increasingly powerful as the membership grows, for failure to produce such information will make one less attractive and result in fewer occasions to engage in sexual activity with other members.
The risk of contracting HIV and others STDs is now the single greatest fear for daters with new partners, which has created interference to the normal course of sexual relations. This signal of a CheckTonight membership will reduce the fear in others and demonstrate one’s social responsibility. Membership will reduce the interference and add an additional layer of protection in addition to the use of condoms.
Condom Use Insufficient
The rising rates of new STD infections shows that the condom alone is an insufficient measure of prevention. The condom has been clinically demonstrated to be a highly effective tool in preventing HIV and some other STDs, however, the increasing rates of new STD infections show that the condom in practice is insufficient. The porosity of condoms, the slippage and breakage rates and the limited area of coverage all compromise its strength of prevention; however its primary failure is its practical requirement.
The condom is required immediately prior to sexual activity taking place, when clear reasoning and normal risk aversion are often clouded by passion and or alcohol. The reality is that most who claim to “use condoms” do not use them properly in every single instance of sexual activity. In fact, 70% of Americans with multiple sex partners do not use condoms for every act of sexual intercourse.
For example, condoms are often applied after several minutes of sexual activity, rather than from start to finish. It is time to reevaluate the effectiveness of the condom, based not on its ability to prevent the transmission of viruses in a laboratory, but based on its effectiveness in reducing the number of new sexually transmitted viral infections.
Cultural Shift A new web service should will provide a trusted and reliable means of communicating health information between partners, at their choosing and will provide an incentive for people to be tested more frequently. Over time, routine testing and partner disclosure will become a social imperative and greatly slow the spread of disease.
By introducing a means of easily communicating fundamental indicators of personal health and social responsibility, it allows critical information to be used to assist in partner selection. This process may occur long before sexual activity takes place. Such a service will also improve safer sex practices among members and help to promote and educate people on the risks of STDs and the importance of proactive measures for prevention.
Additionally, rather than creating a false sense of security or encouraging greater promiscuity, it will assist in fostering risk aversion. Members will be more likely to engage in safer sex practices and to select their partners more carefully in order to sustain their status as members, who must test negative every 6 months. We need incentives for people to be tested often and to discuss matters of sexual health on an informed basis. This system is required to advance public health and for people to be accountable and proactive about disease prevention.
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