Those of us who ran AIDS agencies conducted outreach in chat rooms because it was something we had all done on the streets and in bars and clubs for years.

Sixteen years later, although chat rooms still exist, most men are seeking partners using dating and hook-up sites and apps. And many of our programs are still trying hard to demonstrate through their actions and attitudes that “we’re not the sex police.”

As more and more men with syphilis reported meeting partners online, STD programs joined their HIV colleagues and ventured into sites to broadcast messages, conduct outreach, and offer partner services. Sites and apps can make finding new partners much more efficient, which presents challenges for our prevention efforts. They also present wonderful opportunities for preventing HIV and STDs.

As Ed Laumann, one of the nation’s most foremost researchers on sexuality, said to me, “Remember – the internet is a network.” As a network itself, it can have a profound impact on transmission and prevention. While our risk of contracting an STD is partially due to individual and psychological factors (“I was in love,” “I was drunk,” “I was lonely”), our risk is also affected dramatically by our partner’s—and their partners’—risk.

Dating sites can get messages out to their networks of users quickly and less expensively than print or broadcast media. They can also go beyond using networks to help shape them in such a way that they can reduce transmission. They can provide the tools to allow individuals to make informed decisions about their partners, and reduce the likelihood that they have sex with individuals with a much different risk profile than they do without knowing it. Scruff, for example, now allows its users to specify one or more prevention options on their profile screen (“PrEP,”  “Condoms,” and “Treatment as Prevention”). BarebackRT, by its very name, attracts men who prefer having sex without condoms. Hornet reminds individuals to update their profile options related to sexual health. These strategies all give individuals valuable information to make choices, while supporting their freedom to choose the partners they want.

For many years, owners and managers of sites have complained that they got numerous and often conflicting requests from public health programs. Conversely, public health programs had little consensus about what would work best. Furthermore, no one took the time to ask users which strategies they would actually prefer, and those that they wouldn’t (which, notably, included some that we in public health had implemented for years).

To try to put some order to this chaos, we worked with Jen Hecht at the San Francisco AIDS Foundation to create Building Healthy Online Communities. We sought to develop a consensus and find out what all three of these stakeholder groups wanted. In 2010, we conducted a survey of site owners, STD and HIV program directors, and 3,000 site users. We found eight areas of agreement, as well as some areas of disagreement. In 2014, we brought a number of site owners together with public health leaders from around the country to help prioritize our strategies.

After the meeting, the Elizabeth Taylor AIDS Foundation and Gilead Sciences funded us to advance many of the strategies that emerged from the survey and the meeting, including: helping coordinate communication between public health and sites and apps, messaging and advertising regarding prevention options including PrEP, reducing stigma, and developing best practices for some of the built-in strategies on website and apps, such as giving users profile options regarding sexual behaviors and prevention strategies. NCSD is housing and providing invaluable support for this project.

Since then, we’ve been working one-on-one with owners to advance STD prevention. The app Scruff is donating ad space for us to promote STD testing around the country through its Benevolads program for STD awareness month. We’re also working with Daddyhunt to incorporate a storyline about PrEP into their next webseries, which follows the characters in their successful first episodes.

We also recently conducted a survey of HIV and STD programs around the country to find out how they are currently working with sites and apps. About a quarter of those programs we surveyed are conducting partner notification and outreach on those sites that currently allow it. Many are also placing ads, with budgets ranging from $200 to $300,000. We were happy to find that many programs were willing to share their campaign materials with others, which suggests that by working together we can all save resources. The survey also gave us valuable data regarding new and old barriers that many health departments face, including prohibitions on accessing sites at work.

In the immediate future, we’ll be working hard to streamline communication with owners. In addition, we are developing a site that will include outbreak alerts and up-to-date information that’s both gay-friendly and scientifically accurate. We’ll be providing links to the campaigns whose creators are willing to share them on our site. We’ll also be looking for ways to involve users and grassroots media in prevention messaging. And, we’ll be working closely with researchers to evaluate these programs.

Partner notification on apps continues to be a challenge. We will continue to hold conversations with app owners to see how we can work together to adapt partner services in ways that are both technologically feasible and meet the needs of users and owners.  We found in our own survey that a majority of users were receptive to getting an email telling them they may have been exposed to an STD —a finding that several studies have corroborated. However, there is still a need for marketing materials that make the benefits of partner services clear.

Since PrEP has been launched, prevention programs around the country have developed different messages for users regarding their choices to use PrEP and condoms to protect themselves from STDs. State and local programs have recognized the need to better understand how best to communicate this complex message. A meeting of communication experts and prevention experts would be an excellent first step.

These are exciting times for prevention online. For more information—or to suggest an idea for success —please get in touch!