Online STD Risk Assessments

[highlander]

Originally Posted by VegasLee

I am very good at stats and research.

HIV AGE STATS

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

Wrong Lee. Your understanding of statistics is limited at best. Better stick with making money-which you are obviously good at-but don't let it go to your head.


First off, your data is for AIDS diagnosis, NOT infection.

A better figure would be HIV diagnosis.

That is _still_ a problem-because it doesn't control for things like frequency of testing among different groups-and the frequency of use of condoms and the actual rate of sexual activity. We'd also have to do more to really look at things like just how susceptible someone is per exposure at various ages.
(though it s clear that 18-34 year old folks are disproportionately unlikely to have health insurance in the US and are thus less likely to get annual checkups)


If we look at worldwide figures, we get something rather different.

World wide, most people that get HIV, do so by age 25.
Around half of the people who acquire HIV become infected before they turn 25, and AIDS is the second most common cause of death among 20-24 year olds.

Figures in the US are complicated because AIDS in the US is largely either
a) IV drug users
b) regular partners of IV drug users
c) men having sex with men

If we look at AIDS as a classical heterosexual STD, we might get a rather different picture in the US.

What also complicates this is the relative availability of public health/std services in various parts of the country--AIDS has been increasing greatly in parts of south with poor public health services and limited sex education. I'd also suggest that in many parts of the country a sexually active 13-15 year old might have limited effective access to STD diagnosis and treatment simply because they can't drive themselves to a STD clinic-and only the more enlightened family docs would really handle this issue well.

Early sexual debut is clearly established as a major risk factor in a variety of locales- including(the 15 year old you are talking about would be classed as clearly an early bloomer).

Africa

China

Europe


The article I saw that looked at a 6% rate of infection over 6 months among young(23-29) gay men.

I'd be REAL interested in seeing any citation that describes a higher infection rate among any identifiable group of folks.

The rates of Gonorrhea and Chlamydia are also both heavily concentrated in 15-24 year olds even in the US.

I haven't found a good breakdown on age of IV drug users that get AIDS. However, clearly IV drug use is initiated later than sexual activity. Also IV drug habits tend to last and worsen over time-so is a pretty good bet that HIV infections at a later age include more related to IV drug use.

The other thing I haven't seen a good breakdown on is how the difference between going HIV+ and getting full blown aids varies by age at infection.

[highlander]

The thing that I Think might make risk assessment useful:
if it relied purely on factors that folks can assess unequivocally. Factors like age, ethnicity, tested drug use, STD test results. Where I can see it useful is in telling folks stuff like just how often they need to test to be doing anything useful--and how testing for more than just HIV can help improve their odds.

Some of this is an open research problem. We clearly know that presence of recent HSV infection, Chlamydia or gonorrhea increase HIV transmission. This has been one reason suggested on why HIV spreads so much more heterosexually in Africa-because those diseases are common there(and often public health resources are minimal). Some African countries have had substantial results in decreasing rate of HIV infection by just getting serious about treating those STD's that can be treated.

[Lascivious L&L]

On the International AIDs site there is a study of the studies done on the relationship of age to infection. Of the six North American studies used, four found HIV infection more prevalent in youth, two did not.

Studies I looked at there talk about infection being related to age of first intercourse. The question is whether the infection is a result of the young age or the risky behaviors the younger people engaged in. For example when the number of partners was controlled for, the age relationship faded. So perhaps those infection rates reflect the more partners one would likely have because they have been sexually active longer.

There was a relationship between smoking and early sex, both risky behaviors. It may be that risk takers start younger and engage in more risky behaviors. Thus it may be the behaviors not the age that is the factor.

The bottom line is there is much not known about HIV infection, rates, and which behaviors affect those rates by how much. Since lying is such a factor in sexual history taking, how accurate are the risky behavior analyses? I've never been convinced that such behavior self reporting is anything but a rough guess.

[highlander]

Well, we know that young folks are at higher risk for Chlamydia-and women with Chlamydia are 5 times as likely to get HIV as the general population.

Gonnorhea is also linked to spread of HIV. When I did the math a while back, I calculated that 40% of the HIV cases are related to presence of some other STD(i.e. HPV, HSV,Chlamydia, gonorrhea or syphilis). That is especially important because 35% are either directly related to IV drug use or health care related. That suggests that if we could eradicate all STD's, the rate of sexual infection from HIV would be down 61%. (one statistician friend of mine told me that is why Gardisil got fast tracked BTW)

One big question is why doesn't HIV mimic the distribution of other STD's in terms of geography and age? One simple reason is that HIV is largely a blood born disease that is spread especially well by sharing needles or specific sex acts like anal intercourse.

Anyhow, just the concentration of Chlamydia and Gonorrhea among the young is enough to suggest a special risk for sexual HIV infection among them. The thing about those diseases, they are both highly contagious, can cause sterility-and their symptoms aren't always real obvious.

[Trojan Defense]

Originally Posted by highlander

The thing that I Think might make risk assessment useful:
if it relied purely on factors that folks can assess unequivocally. Factors like age, ethnicity, tested drug use, STD test results. Where I can see it useful is in telling folks stuff like just how often they need to test to be doing anything useful--and how testing for more than just HIV can help improve their odds.

I would agree with that, and had planned on getting to the topic of testing.

Originally Posted by highlander

Some of this is an open research problem. We clearly know that presence of recent HSV infection, Chlamydia or gonorrhea increase HIV transmission. This has been one reason suggested on why HIV spreads so much more heterosexually in Africa-because those diseases are common there(and often public health resources are minimal). Some African countries have had substantial results in decreasing rate of HIV infection by just getting serious about treating those STD's that can be treated.

I would agree with that as well. Aside from providing a public health service, this would be something intended to aid epidemiological research.

[Trojan Defense]

Originally Posted by Lascivious L&L

The bottom line is there is much not known about HIV infection, rates, and which behaviors affect those rates by how much. Since lying is such a factor in sexual history taking, how accurate are the risky behavior analyses? I've never been convinced that such behavior self reporting is anything but a rough guess.

What I believe this comes down to is who are you asking, what are you asking, and how are you asking. If great care was taken in designing the system, I think we could get some useful data from it. As for lying, aside from some psychological profiling, measures could be put in place for data validation.

Compulsive liars often slip up sooner or later as it eventually becomes difficult to keep all of their stories straight. The system could take advantage of this fact, by periodically sneaking in questions to which it already knows the answers to. Upon finding any inconsistencies in the truth, the system could then discredit a dataset. Furthermore, if one thing a person says is not plausible, (ex: a person claims to have been with a million partners), then that would put into question the validity of the remaining data they contributed, of which we would have to throw out.

[Trojan Defense]

I think Lascivious most succinctly sums up the opposing side's argument on this topic with...

Originally Posted by Lascivious L&L

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.

However, I do not believe these problems are beyond fixing.

The problem with data collection could be resolved by following Highlander's suggestion to use risk factors that can be assessed unequivocally. And even the risk factors that we can not unequivocally assess, are not necessarily useless. We may have to leave such factors out of the risk assessments, but collecting such data may help epidemiologists better understand stds by showing correlations between how a large number of people answer a question, and what their outcomes are.

As for people forgetting the finer points of perspective, and taking the numbers as being absolute, that is not necessarily a bad thing if we can leverage that to our advantage. Instead of telling people how many partners we think they could have before infection was statistically inevitable, we could tell them how many they could have before they should get tested, and never get close to the danger zone. For example, we may have a guideline that says a person in a particular situation should retest no later than 4 months a part, or 10 partners a part (which ever comes first). So in the event they hit their partner limit first, it puts them on an accelerated testing schedule. The benefit of this would then be that a person's level of risk reduction then becomes proportionate to their level of sexual activity.

[highlander]

I will attest that Trojan defense is right such a system could in fact be developed. I have worked on commercial systems in the financial arena that do things very similar to what he's asking(i.e. if you use credit cards, your transactions run through I system I did some of the early work on).

When public health folks say stuff like:
have fewer partners
know your partners serostatus
be monogamous


They are essentially constructing a "rules based system".

The thing is:
if you do a closer examination:
a fairly small portion of the population are really at high risk. There are genetic, lifestyle and health history factors that tend to predispose certain people towards specific diseases at specific times in their lives.

This kind of system hasn't been created yet-but I'm convinced it could be created.

[slevin]

Originally Posted by highlander

I will attest that Trojan defense is right such a system could in fact be developed. I have worked on commercial systems in the financial arena that do things very similar to what he's asking(i.e. if you use credit cards, your transactions run through I system I did some of the early work on).

When public health folks say stuff like:
have fewer partners
know your partners serostatus
be monogamous


They are essentially constructing a "rules based system".

The thing is:
if you do a closer examination:
a fairly small portion of the population are really at high risk. There are genetic, lifestyle and health history factors that tend to predispose certain people towards specific diseases at specific times in their lives.

This kind of system hasn't been created yet-but I'm convinced it could be created.

I think the point many are trying to make is that even though such a system could be developed the viability of the system itself is in question. For things like assessing credit, predicting market trends and things of the nature you described the downfall of being wrong in some cases isn't such a big deal. So you extend a few thousand in credit to someone who defaults. It sucks, but it isn't the end of the world; especially if you're able to reduce that number quite a bit. For something like this with STDs the impetus of being wrong is far greater (to the individual). Additionally, the financial systems are being used by people with a fair bit of expertise in that area. They have experience, knowledge and it is their job to keep up with the details of what they are working on. People using this STD tool will generally be uneducated, uninterested in learning more and looking for a quick shortcut to putting much thought into risk analysis.

I don't think anyone is challenging that it could be developed, just how useful it would end up being. I still haven't seen much detail on how it would work. Anyone who poses questions doesn't seem to get actual answers.

[highlander]

The thing to keep in mind here:
with an STD risk assessment, having a recent, clean bill of health overrides a lot of the past--but perhaps not all of the past.

For most folks, a collection of higher risk factors would mean they would have to test more frequently to overcome their increase risk. For some, it might mean some time out(i.e. someone that just got diagnosed with HSV2 is rather infectious for 1-2 year years and vulnerable to HIV infection during that period). I can also imaging folks that have recently been out of country(i.e. on a vacation to Bangkok) might find themselves at a high risk until they go their next valid test. Now, there are going to be some folks that need to go in for treatment. Others may find they have incurable diseases like HSV2-but a lot of folks are in that boat-and it really isn't the end of the world. The only life threatening STD's out there are HIV and HepC(which is barely an STD)

I think if such a system were created, and a few people started using it as an aid to selecting partners, in time it would snowball. Right now, it is hard to make the case that what swingers do is any worse than what the rest of the public does from a public health standpoint. It looks like it is plausible that a subset of swingers might be able to make a case that what they do is safer than what the general public does(even with celibates thrown into the mix on the side of the general public!).

[slevin]

Originally Posted by highlander

The thing to keep in mind here:
with an STD risk assessment, having a recent, clean bill of health overrides a lot of the past--but perhaps not all of the past.

For most folks, a collection of higher risk factors would mean they would have to test more frequently to overcome their increase risk. For some, it might mean some time out(i.e. someone that just got diagnosed with HSV2 is rather infectious for 1-2 year years and vulnerable to HIV infection during that period). I can also imaging folks that have recently been out of country(i.e. on a vacation to Bangkok) might find themselves at a high risk until they go their next valid test. Now, there are going to be some folks that need to go in for treatment. Others may find they have incurable diseases like HSV2-but a lot of folks are in that boat-and it really isn't the end of the world. The only life threatening STD's out there are HIV and HepC(which is barely an STD)

I think if such a system were created, and a few people started using it as an aid to selecting partners, in time it would snowball. Right now, it is hard to make the case that what swingers do is any worse than what the rest of the public does from a public health standpoint. It looks like it is plausible that a subset of swingers might be able to make a case that what they do is safer than what the general public does(even with celibates thrown into the mix on the side of the general public!).

I have yet to hear how any of those important factors would be able to be captured by the system in a reliable fashion. Relying on people to tell the truth just isn't feasible. Unlike credit scores there is no automated way for things like my travel details or recent test results to be posted to my online STD risk profile unless I volunteer them. That just won't happen.

[highlander]

STFree.com has worked out a way to get clinics to report confidential results without disclosing identity. basically you ask your results to be sent to that service using their forms. AIM Healthcare foundation records your photoid number on your test results-which are hosted on their site. Neither are completely automated-but they both provide reasonable authentication for anyone that doesn't have an identical twin. Stuff like travel records are on your passport(although there are people with multiple passports).

You are right-these are the sorts of things that can't be used as part of an assessment unless you want them be. The point is if you want an accurate, 3rd party validated assessment of your risk that didn't disclose your identity, that is a solvable problem.

who might want that? Well, someone that may have superficial trappings of being risky, but really isn't(and wants partners to understand just how low risk they really are).

Now once a few folks start doing this sort of thing, having an accurate assessment of low risk becomes a competitive advantage for some folks-and others start to look at what they might do to become competitive.

[Trojan Defense]

Originally Posted by slevin

I think the point many are trying to make is that even though such a system could be developed the viability of the system itself is in question.

What this is building up to is an advanced form of serosorting that is facilitated through information technology. When viewed in the right context, the viability of such ideas starts to become more clear, as the success of such ideas is not necessarily dependent on how well they work by themselves, but how well do they work as part of a greater system.

[Trojan Defense]

Originally Posted by highlander

You are right-these are the sorts of things that can't be used as part of an assessment unless you want them be. The point is if you want an accurate, 3rd party validated assessment of your risk that didn't disclose your identity, that is a solvable problem.

Highlander is right. What I propose is not a mandate, but a tool. If you don't want it, you don't have to use it, but if you do, its there.

Originally Posted by highlander

who might want that? Well, someone that may have superficial trappings of being risky, but really isn't(and wants partners to understand just how low risk they really are).

Now once a few folks start doing this sort of thing, having an accurate assessment of low risk becomes a competitive advantage for some folks-and others start to look at what they might do to become competitive

Highlander makes another valid point. Many of the people who choose not to swing do so because they are afraid of stds. If such a system adequately addressed their concerns, then that may lead to a large influx of new swingers that are being very careful. So what I suspect successful implementation of these ideas would lead to over time is an exponential increase of new swingers, and a less dramatic, but steady increase of veteran swingers into the system as momentum picked up.

[highlander]

I'm not sure how big the niche for swinging would be even if STD's were absolutely zero concern. I suspect that even STD's were gone tomorrow, lots of people would find other reasons not to swing. That said, I think there _would_ be an influx into swinging broadly defined if there was an aspect of swinging that was clearly much safer than today.


I think the bigger aspect of the whole serosorting thing is it takes folks into a more intential mindset on relationships in general-as opposed to a "spontaenous" mindset. There are a lot of folks that are real up tight about doing anything that smack of looking for a relationship or sex.