Online STD Risk Assessments

[Lascivious L&L]

Making risk assessments requires assumptions. Assumptions always reflect the bias within the person making the assumptions. The reason for assumptions is because we don't know what actual risks are, because we don't know all the mechanics of infection. And each infection is different.

You haven't even mentioned what STD this risk assessment is for. Each STD requires a very different risk assessment. As someone mentioned, herpes and HPV are not as effectively prevented by condoms as is HIV. Herpes and HPV are much more common than HIV, by orders of magnitude.

What is the infection rate of HIV? Well it depends on the population you are studying. It depends on IV drug use. It depends on the frequency of anal sex. It depends on the number of partners. Assumptions for each of these factors have to be made to make a risk assessment. Once you've made more than one or two assumptions, the accuracy becomes nill because assumptions aren't knowledge.

[Trojan Defense]

Okay, maybe I didn't explain it well enough the first time. So here is a rough idea of how the process might go:

1.) Purpose and Disclaimers Acknowledged. "You understand that this is an educational tool to help sexually active people better manage std risks. Furthermore, you understand that the most reliable way to prevent stds is to abstain from sex, and that by your refusal to do so, you may be putting yourself at risk; all it takes to become infected is just one person - just one bad choice."

2.) Prevention Goals Defined. You indicate which stds are of concern to you (and, if you wish you may read up on some stds you didn't know about). Maybe you are not concerned about the most treatable of stds; maybe you're concerned about the viral stds, but not the bacterial stds. Maybe you're concerned about all stds. Maybe you're concerned about all stds except herpes, because you already have have herpes, and therefore are not concerned about the risk of catching something you already have. Whatever the case may be, your answer helps fine tune the risk analysis and make sure the results that are displayed back to you, are relevant to your particular situation.

3.) Questions Presented. An extensive list of questions is systematically presented in the order of greatest significance to least significance. You answer as many questions as you are so inclined to, with the understanding the more questions you answer, the more accurate the assessment will be, and that at least some questions will be mandatory for a meaningful assessment. (Questions for which you skipped, or did not get to, the system would assume a worst case scenario as your answer, resulting in a more conservative risk assessment. The reason for that would be to err on the side of caution.)

4.) Probability of Infection Calculated. After answering the questions, you might get this kind of feedback: "Based on the number of questions you answered, and the answers you gave, if you become infected, it is estimated that it would be somewhere between your 1st, and 1,000th partner, and we are 90% confident that our assessment is correct in your particular case." (Obviously, the higher the second number, which we'll call your partner limit, and the third number, the confidence interval, the better.)

5.) Educated Guess of Outcome Made. Furthermore, we can make an educated guess as to what your outcome will be using the probability of infection, your life expectancy, and the rate at which you take on partners. Based on that, you might get feedback such as: "It is our educated guess, that at the rate you are going, you will eventually become infected if nothing changes."

6.) What-If Scenarios Ran. Here you can see how your choices impact your ability to swing safely, and if you wish, how making one set of changes over the the other affects your probability of infection, and ultimately, your expected outcome. This can help give you a better idea of what is possible, and explain how the system reached the conclusion that it did.

7.) Strategy Defined. If you are interested in risk reduction, you are presented with essentially three options. If you want to have sex with many people, it is to be more selective. If you don't want to be more selective, then it is to have fewer partners. And if the first two options do not offer enough risk reduction by themselves, then do both: have fewer partners AND be more selective.

What this suggests, is that there is a relationship between your quantitative risk factors (number of partners), and your qualitative risk factors (partner selection, etc.) Assuming all qualitative risk factors are held constant, and the only variable risk factor is number of partners, then the risk assessment is dynamic in that it changes when you do. If the probability of infection for you was 1 in 1,000 when you took the assessment, and since then, you had sex with 5 more people, all you have to do is add 5 to 1. Now your probability of infection is 6 in 1,000.

The end result of this process is that you have defined a personal strategy for safer sex, and you have the means to dynamically assess your own risk, as you take on more partners.

Now is it perfect? No, but that's not to say that I don't think the flaws in it can't be worked out to the point that it becomes good enough.

[Trojan Defense]

Originally Posted by Lascivious L&L

You haven't even mentioned what STD this risk assessment is for.

The risk assessment would be for all stds, but as you can see in step two of the process, you select which ones are of concern to you. So if you select stds x, y, and z, and the probability of infection for each of these was calculated as follows:

STD X 1 in 1,000
STD Y 1 in 500
STD Z 1 in 250

Then for all practical purposes we'd go with the probability of infection for STD Z.

[LikeMinds321]

I would not use an Online STD Risk Assessment for the reasons others have stated.

Originally Posted by Trojan Defense

4.) Probability of Infection Calculated. After answering the questions, you might get this kind of feedback: "... it is estimated that it would be somewhere between your 1st, and 1,000th partner....

This sounds so funny to me because 1,000 partners is unfathomable to me, personally. I think it is for most swingers. We aren't as busy having sex with as many people as you must think.

7.) Strategy Defined. If you are interested in risk reduction, you are presented with essentially three options. If you want to have sex with many people, it is to be more selective. If you don't want to be more selective, then it is to have fewer partners. And if the first two options do not offer enough risk reduction by themselves, then do both: have fewer partners AND be more selective.

But I already know this. It's common sense. I think most people understand this.



Where else are you asking for opinions? Dating sites, health sites? I'm curious what other feedback you've received from the public.

LM

[Trojan Defense]

Originally Posted by LikeMinds321

This sounds so funny to me because 1,000 partners is unfathomable to me..."

Having 1,000 partners is unfathomable to me too, but that's not the point. The point is...

If your probability of infection was 1 in 1,000, that is not to suggest you should have that many partners. It is to suggest a reasonable limit based on your risk tolerance. If you wouldn't want the probability of infection to exceed 5% (or 50 in 1,000) then you'd limit the number of partners you could be with to 50 (under the conditions from which the probability was based off off). Remember, the stated goal would be to quantify risk as to better manage it, and this would be one way of doing that.

Originally Posted by LikeMinds321

But I already know this. It's common sense. I think most people understand this."

Unfortunately, common sense reaches its limit when the knowledge you seek is anything but common. Knowing how to reduce your risks is simple. Knowing by how much is not. Without having some sort of special tool to do so, that depth of knowledge is reserved to those who study such things.

Originally Posted by LikeMinds321

Where else are you asking for opinions? Dating sites, health sites? I'm curious what other feedback you've received from the public.

I've had many ideas for helping people better manage risk, some of which could maybe work together, and this is just one of them. Feedback that I've received has been mixed across the board. As for swingers, some, like those here, have been critical/dismissive of such ideas, but some from elsewhere have been encouraging. A few AIDs activists expressed optimism. A public health official told me that some of my ideas had been mentioned in one of his focus groups, and were already being considered. An epidemiologist that I contacted, thought my ideas sounded good in theory, even though we did not get to discussing them in depth. Some people that had become recently infected also expressed some support, as they wished they there was a better way to manage risk (than using what I guess you'd call common sense). And others have been dismissive as I lack formal research to backup my ideas. So like I said, feedback has been mixed.

Though that's not to say my critics don't make some valid points. It is true, with this particular idea, probabilities can not conclusively tell you if you will become infected, but they can tell you if you're likely to become infected. Furthermore, probabilities of infection that use 'number of partners' as a predictor variable do have their limitations. Such a probability can not really tell you how many people you can be with, but it can suggest how many you shouldn't be with according to your risk profile. So I don't think its entirely useless as some have said, particularly if it is taken into consideration within the context of other ideas that I have.

And I don't think Lascivious is completely wrong to suggest that with this particular idea, we just don't know enough about the mechanics of std infection, that the data is insufficient, but at the same time that's not to say that I don't think std data collection could be improved as to make it sufficient.

[Lascivious L&L]

We already have the data to suggest that most, more than 50%, of sexually active adults are infected with herpes and HPV. So all swingers and most adults should assume they are or will be infected with those STD's.

HIV is the big one. If none of your partners are not infected, then you cannont become infected through sex no matter how many partners you have. What you are really measuring is the risk of meeting an infected partner. That depends more on what group of people you fuck than the number. Do you have sex with IV drug users? Then your risk goes up. Is unprotected anal sex big in your group? Then your risk goes up.

What is the risk if you fuck an HIV infected partner? There are studies on this, and the ones I've seen suggest it takes far more than one fuck on average to infect. Studies suggest that it takes more than 10 fucks, and perhaps even a hundred, on average.

[slevin]

Originally Posted by Lascivious L&L

We already have the data to suggest that most, more than 50%, of sexually active adults are infected with herpes and HPV. So all swingers and most adults should assume they are or will be infected with those STD's.

Do we really have the data to suggest that? The popular data says 1 in 4 are infected with Herpes, but this is questionable. It's not commonly tested for unless specifically asked for. It's also not guaranteed to be detected accurately; in a blood test they test for whether you've been exposed to the virus, rather than if you have it. Unless they have a new blood test for it...

As for HPV, the stats there are difficult to be accurate since there is no test for HPV in men. Additionally, HPV will work its way out of your system, so someone with HPV today may not have it in a few years and shouldn't continue to be counted in statistics.

I think the high herpes and HPV rates are used as STD marketing to make sure people take wearing condoms and practicing safe sex seriously. Personal opinion there though.

[Trojan Defense]

Originally Posted by Lascivious L&L

We already have the data to suggest that most, more than 50%, of sexually active adults are infected with herpes and HPV. So all swingers and most adults should assume they are or will be infected with those STD's.

That is unfortunate, but perhaps such a tool could be of educational value in showing that if you choose to swing, and not screen your partners (of which last I checked there isn't really a good way to do that with HPV, and HSV), then that risk is just the price of admission you pay to get into the swinging lifestyle.

Originally Posted by Lascivious L&L

HIV is the big one. If none of your partners are not infected, then you can not become infected through sex no matter how many partners you have.

I do not disagree with this, though what you're saying applies to any std really. Obviously, you can't catch what's not there, but the trick is figuring out whether or not its there in the first place. Anything outside of getting tested is an educated guess at best, and even then we are still dealing with probabilities as a result of false positives, and false negatives.

Originally Posted by Lascivious L&L

What you are really measuring is the risk of meeting an infected partner.

That is correct. The primary risk factor is in whether or not the person you are having sex with is infected, (and secondary to that is how you are having sex with them.)

Originally Posted by Lascivious L&L

That depends more on what group of people you fuck than the number.

That is true, but how else are you to measure risk in a meaningful way than to use 'number of partners' as the metric? People don't think in terms of percentages when they have sex, which is how most statistics are presented, but in terms of whole numbers.

Originally Posted by Lascivious L&L

Do you have sex with IV drug users? Then your risk goes up. Is unprotected anal sex big in your group? Then your risk goes up.

Yes, that is true too, but the question here isn't really whether or not any one of those makes your risk go up. The question here is by how much does those things make your risk go up? What difference does any combination of those, and other risk factors make? I'd venture to say most people don't know the answer to that.

Originally Posted by Lascivious L&L

What is the risk if you fuck an HIV infected partner? There are studies on this, and the ones I've seen suggest it takes far more than one fuck on average to infect. Studies suggest that it takes more than 10 fucks, and perhaps even a hundred, on average.

I would agree with this as well, and have seen studies on this as well among serodiscordant couples (meaning couples where one partner is infected, and the other is not). Just because you have sex with someone that is infected, it does not necessarily mean that you will become infected (although the risk certainly is there). What it then comes down to is how infectious is the partner that is infected, and how susceptible is the partner that is not infected, which is why how you have sex then matters.

Since most people don't know about these things in great depth, having a special tool from which to effectively educate them about it might be a good idea. A number of folks that have gotten infected have told me that just had no idea about this stuff.

[Lascivious L&L]

Trojan, the point you're not getting is that the answer to your questions is that we don't know. The number of partners you've had is by itself not an accurate measure of your risk. Much more goes into actual risk than that. Giving risk as a number per partner is not accurate and is misleading.

Trying to offer people a simple means to assess risk is a nice concept. But it doesn't work with our state of knowledge today. What you've proposed does not assess risk any more accurately than to say increasing partners increases risk.

[Lascivious L&L]

Slevin, the data is on the CDC site. The last general population test for herpes found 58% of adults infected with HSV-1, and close to 20% with HSV-2. Both are herpes and both can infect either orally or genitally. Most quoted figures include only HSV-2, as if it is the only herpes. As I understand, herpes is a viral infection for life, like chickenpox/shingles, though for most the immune system holds the virus completely in check.

HPV, because there has been no test for males, is not assessable in the general population. The general consensus is that most sexually active adults are or have been infected. Some feel the body can get rid of the virus. Some feel it is like herpes, a lifetime infection that for most can be completely controlled by the immune system. The accurate answer is that we don't know. When we have an efficient test for men, we may learn more.

Condoms are not nearly as effective at preventing infection with herpes or HPV as they are with HIV. Some go so far as to say don't consider condoms as a preventative measure for herpes or HPV.

[Trojan Defense]

Originally Posted by Lascivious L&L

Trojan, the point you're not getting is that the answer to your questions is that we don't know.

That is why I'd suggest our collection of std data could be improved.

A part of my idea would entail creating a feedback loop between the system, and those served by it. When a person used the system they'd get a risk assessment, but in the process of getting that assessment, they'd be submitting data to the system. Whenever they returned, they would again be submitting data to the system, that would either support or go against the system's original assessment. So to whatever degree the system was originally off, it could self-correct and become progressively more accurate over time as more data became available, correlating risk factors with outcomes.

Originally Posted by Lascivious L&L

Giving risk as a number per partner is not accurate...

In many cases, I think you may be right. As I'd see it, this wouldn't be just a black and white issue, but one involving many shades of gray. For those of us who are at extremely high, or extremely low risk, I think we could have some confidence in the accuracy of such an assessment. Whereas those falling somewhere between those two extremes would be in a gray area, for which our level of confidence in such an assessment would be at it's weakest.

Originally Posted by Lascivious L&L

Giving risk as a number per partner is misleading...

I think whether or not an assessment is misleading depends on how it is presented. If the probability of infection is 1 in 50, and we tell people, that based on this, they can go out and have sex with 50 people, that would be misleading. However, if we instead say most people of a given risk profile do not make it beyond 50 partners, and use that as a basis for risk reduction, then I'm not sure it's quite as misleading then. In fact, that might be rather educational.

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Despite all of this, I think one of the reasons a person might use this, is for the same reason that they may use the weather forecast to plan a trip - and that is because they rather have some sort of idea, than no idea at all, and they believe in the goals of the system, (which stated in somewhat different terms would be to take the collective knowledge of many as to empower the individual with greater decision-making capabilities).

[highlander]

Originally Posted by VegasLee

I do though.


Edit: Useful information about using stats for sex. 15 year old girl. She died of AIDS. Now in reviewing AIDS stats she did not fit the profile in any form or manner. The guy that infected her did not fit the stats either. According to the stats she should not have caught a STD or Aids and she diffidently should not have died.

Actually, this is NOT true. HIV infection rates are higher for young people than old-even when you adjust for things like frequency of sexual activity. You need to look carefully at the statistics to understand some of this. HIV tends to piggyback on other STD's like HPV, HSV, gonorrhea and chlamydia. In the case of HSV and HPV, folks are much more likely to get and transmit HIV the first year or two after they have gotten those diseases than 2-4 years later. Having sex with someone that has gotten HSV in the last 2 years is 5-20 times more risky that having sex with someone that has had that infection for over 2 years(for both getting HIV or HSV itself).

That makes these diseases especially risky for the young folks starting their sexual careers. They have a whole different risk profile and immune system than someone that has already gotten HSV and/or HPV and has already gotten through their period of highest risk.

I saw one figure that was looking a rate of HIV infection for young gay men in parts of California of 5% for every 6 months--and this after all the various educational efforts and what not. That rate went _Way_ down for the same demographic 3-5 years later _even if we adjust for frequency of sexual activity_.

Also, younger guys are more likely to be having their first experiences with IV drugs--and 50% of all women that get HIV get it from a man whose risk was not promiscuity or bisexuality-but IV drug use-and some middle class communities are having a real upsurge of IV drug use in recent years.

Also, younger men are more likely to have not established a clearly heterosexual or homosexual identity. For example, in Robin Baker's Sperm Wars he points out that bisexual men are actually more likely to father children as teenagers than heterosexual men--but that changes dramatically as these men age.


Young folks REALLY do have extraordinary risks here-and tend to lack knowledge of their own mortality.

[highlander]

Originally Posted by Lascivious L&L

What is the risk if you fuck an HIV infected partner? There are studies on this, and the ones I've seen suggest it takes far more than one fuck on average to infect. Studies suggest that it takes more than 10 fucks, and perhaps even a hundred, on average.

Actually, there is only one really good heterosexual study I have seen on this-and it was done in Africa by a guy from Johns Hopkins. You are right HIV appears to be generally hard to get. However, it VARIES a LOT by several factors
a) time after infection
b) presence of other STD's like HSV, HPV, gonnorhea and chlamydia-and
how recently those diseases were acquired.


One reason why so many MPH types are nervous about using testing as a means to prevent HIV spread:
when the AIDS epidemic first hit the tests that were available had a large window-they weren't very accurate for 6 months. We now have PCR test that are accurate 6-9 days after infection-but they aren't universally used.

Also, when you look at AIM's use of testing with porn actors, they were doing _monthly_ testing of a _variety_ of STD's
This has taken the rate of STD's among porn actors to something below that of the general population. The thing is, when they do get an HIV infection, sometimes they will get 2-3 at once because HIV is more infectious right after initial infection.

I think we _could_ do something similar in the swinging community-and wouldn't take monthly testing(I think quarterly testing might help a lot).

[VegasLee]

Originally Posted by highlander

Actually, this is NOT true. HIV infection rates are higher for young people than old-even when you adjust for things like frequency of sexual activity. You need to look carefully at the statistics to understand some of this. H

I am very good at stats and research.

HIV AGE STATS

Your argument does not hold up with CDC facts and stats.

[Lascivious L&L]

Unfortunately the CDC information does not contain the rate of infection per population category. Thus we don't know from those stats whether younger people have a higher or lower rate of infection, only the absolute number of cases. We need to know the population of each age group in order to figure the rate of infection per age group.

The cumulative number of infections is going to be greater in the age groups who were sexually active since the virus came to humans, which is somewhere in the fifties. That's my age group. So my age group and the next decade lower will have the highest cumulative numbers because we've been exposed to it longest.

One of the reasons I find Trojan's idea of risk assessment not beneficial is because we don't know well the mechanics of STD infections. Once you put a number on it, people will look to the number rather than the words used to put those numbers in perspective. The numbers become absolute without the finer points of perspective being remembered by most people.