5 ms·

Ask HN: Does anyone care about STD prevention?

9 points by soelost 8y ago

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've been working on a solution but I want to know if theres any interest.

subroutine 8y ago
Dr. He Jiankui cares.
- soelost 8y ago
  Thanks!
  - subroutine 8y ago
    I take it you've heard of him by now?
    - soelost 8y ago
      I looked him up as soon as you sent it but fell asleep while reading.
    - soelost 8y ago
      Nothing about STDs though...
      - subroutine 8y ago
        Do you consider HIV and STD?
        soelost 8y ago
        Of course. I looked him up again but this I included HIV in the search. Can't believe I missed it the first time.
quickthrower2 8y ago
Yep got tested a few years back but not since being in long term is relationship. Test was free
- soelost 8y ago
  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 8y ago
    We both got tested at roughly the same time. Different clinics. Didn’t get tested before.
    - soelost 8y ago
      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.
dev_north_east 8y ago
Avoid sleeping around, find a partner to have a monogamous relationship with. Sorted. Interested to hear about your solution?
- soelost 8y ago
  You are absolutely right! Just like, eat healthy and exercise. We both know its easier said than done. I doubt people that come out of long relationships in their 20's or at any age actually think about getting tested. Imagine you are now in a relationship with my ex. Before getting with my ex I unknowingly contracted Chlamydia. Over the course of our 3 year relationship I infected her, and now she may or may not have given it to you. My solution would make it so the person who infected me would be able to alert me, my ex, and possibly you if you haven't been tested or using condoms.
- 1000units 8y ago
  The HIV/AIDS problem in the third world could easily be solved the same way. Instead we waste billions of dollars every year on research and aid.
  - thijsvandien 8y ago
    Getting raped is not exactly sleeping around.
    - 1000units 8y ago
      Please elaborate. What do you think the breakdown is, people who contracted HIV during a rape versus otherwise?
      - soelost 8y ago
        In certain African countries its estimated that HIV transmission between heterosexuals occurs .0009 and most rape would probably fall under that number so I doubt it would be a primary reason. The primary reasons would still comes down to not using protection and not knowing one's status(i.e. testing). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2978669/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2978669/
lucozade 8y ago
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 8y ago
  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.
meiraleal 8y ago
No, the same way most of all adults didn't test for Diabetes, which is a lot worse than most STD.
- soelost 8y ago
  Good point. But why do you think that is?
  - meiraleal 8y ago
    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.

soelost 8y ago

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 8y ago
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 8y ago
  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 8y ago
    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 8y ago
      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 8y ago
        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
yesenadam 8y ago
My first reaction is - that's crazy, no-one's gonna want to be a part of that. Some thoughts: How do you ID people? (Name isn't enough) Does everyone have to be on the system? People sleep with people overseas sometimes, so..would have to be international. At times people sleep with people and don't know their (full) name. And maybe the risk is higher in precisely those cases.
- soelost 8y ago
  No-one? Those are strong words. You add them using their phone number. You can give them a name just so you know who's on your list but the system won't actually have their name. As of now, if me and you have a mutual partner, that partner doesn't have to be a member, but the two of us would have to add the person to our lists. International is important: Im sometimes one of those people. Luckily we end up connecting on Facebook or IG. For now I'll be starting with the US to get my feet wet. If theres interest then I will proceed. People sleep with strangers, some people are poly, regardless of the reason, its a way to keep track of who and when, and if needed, to also alert them. Whats your second reaction? LOL
  - yesenadam 8y ago
    Strong words? Isn't it what most people would say? (Or at least think - I doubt they'd say or write it to you - that would be rude maybe. That's why I thought my honest first reaction might be useful.) My second reaction was thinking about it and asking you some questions. Hmm yeah, I guess you don't need 100% coverage of people for it to be some use. (Personally I don't have a phone number, but I guess that's unusual!)
    - soelost 8y ago
      It made me laugh because it caught me off guard. But never say no-one because people do weird things then go online and form groups around those weird things. LOL 100% coverage isn't needed. As long as alerts and testing aren't taking months and the infections aren't being recycled then I am happy to help a few. But I would much rather help the masses. But as you've shown it definitely won't be easy. Btw, if you just want email alerts let me know ;)