Online Dating and STIs: On the Line

By now, everyone has realized that online dating is, in the parlance of today’s youth, a thing. A big thing. As of 2013, at least 11% of all American adults, 20% of those aged 25-34, had used an online dating site or mobile app. A full 5% of Americans that are married or in a committed relationship met their partner online4. But while people go online looking for love, that may not be the only thing they find. With intimacy comes risk, including sexually transmitted infections (STIs), and online dating is no exception. In this post, I’ll delve into the relationship between online dating and STIs. It turns out, it’s complicated.

Crossing the line

While little research has explored the connection, it looks like online dating can increase the likelihood of getting a sexually transmitted infection. In a study of men who have sex with other men, those that used geosocial networking applications, like Grindr, had a greater risk of contracting gonorrhea and chlamydia compared to those who met partners at in-person venues2. Another study, this one on Singaporean men, found that those who used online sex forums were more likely to have oral and anal sex and sexually transmitted diseases than those who frequented brothels. This seems cut and dry, but it may not be so simple. The men who went online were also more likely to engage in risky behaviors (such as not using condoms), making them more prone to STI, and knotting up these conclusions in a web of correlation. It’s unclear if online dating increased the risk of STI on its own, or if the relationship simply reflects the overlap between people that date online and those who practice unsafe sex5.

Online dating isn’t just the province of men or the young. American adults aged 45-54 are about as likely to use online dating as those aged 18-244, and that number is sure to rise, with many older people interested in re-partnering after divorce or the death of their partner. The uptick in online dating in this age group may partially explain the increase in STI prevalence in some demographics, including older Australian women. But again, this conclusion is complicated by risky behavior. While Australian women over 40 who that date online are more likely to discuss STIs with a new partner before sex, they are less likely to refuse sex without a condom compared to younger women1.

online dating
The Internet: it’s not just for cats anymore.

Putting it all on the line

It’s not all bad news. Although the Internet may be contributing to the rise in STI incidence globally, it may also offer some solace for afflicted. The number of STI cases worldwide is staggering: there are about 20 million new STI cases a year in the US alone, and around 110 million new cases per year internationally. Although nearly every sexually active person will contract an STI at some point in his or her life (usually HPV), diagnosis with an STI can still come with severe stigma. Many STI positive people fear that disclosing their status to a potential partner will inevitably lead to rejection. In the face of these concerns, the Internet offers a space for solidarity; a suite of niche dating sites has emerged, specifically for people with incurable STIs3.

Although they are considered specialty sites, there are a lot of them, and they are popular. PositiveSingles, which includes people positive for any incurable STI, has 30,0000 members in the UK alone, and gained 100,000 new members globally in the last year. There are also sites for specific conditions, like H-YPE and H-Date, which cater to people positive for the two most common STIs, herpes and HPV. These sites offer more than a chance to meet your match; some sites provide support networks, and many have online counselors. Unfortunately, while the intention of these sites is an admirable thumbing of the nose to stigma, they may actually be circuitously reinforcing it, by insinuating that people positive for STI should only date other positive people. They may also inadvertently encourage unprotected sex between people with a positive diagnosis, who (for whatever reason) don’t appreciate the risk of multiple or superinfections3.

At its best, online dating, like everything else on the Internet, is a tool. It can help or harm depending on how it’s used. And while it can offer a good way to meet people, not everything is best done online. When it comes down to brass tacks, avoiding STI relies on prevention through safe sex, and that can only happen face-to-face. The conversation might be challenging, but it’s worth it. After all, your health is on the line.

References

  1. Bateson, DJ, E Weisburg, KJ McCaffery, and GM Luscombe. (2012). When online becomes offline: attitudes to safer sex practices in older and younger women using an Australian internet dating service. Sexual Health, 9: 152-159.
  2. Beymer, MR, RE Weiss, RK Bolan, ET Rudy, LB Bourque, JP Rodriguez, DE Morisky. (2014). Sex on demand: geosocial networking phone apps and risk of sexually transmitted infections among a cross-sectional sample of men who have sex with men in Los Angeles county. Sexually Transmitted Infections, 0: 1-6.
  3. Heyden, Tom. “Online dating for people with sexually transmitted infections”. BBC News Online. 28 March 2013. Web. 23 February 2015.
  4. Smith, Aaron. “5 facts about online dating”. Pew Research Center. 13 February 2014. Web. 2 March 2015.
  1. Wong, ML, TT Koh, S Tjahjadi, M Govender. (2014). Men seeking sex online practice riskier sexual behaviours than men frequenting brothels: survey findings from Singapore. Sexually Transmitted Infections, 90: 401-407.

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The Cost of Mental Illness: Side Effects

In developed countries, mental illness causes more disability than any other disease group, including cancer. In 2004, 25% of adult Americans reported having a mental illness in the previous year2. As a consequence, the cost of mental illness is astronomical; it was approximately $300 billion in 2002 in the US alone2, accounting for 6.2% of US healthcare spending. That amounts to about $1,000 a year for every American5. However, if that price is the prescription for mental illness, it’s got plenty of side effects, because the sum, while staggering, only represents a fraction of the actual cost of mental illness. The true tally is much higher and harder to calculate, and includes the toll of mental illness on society, the ill and their families.

Social side effects

Mental illness and resulting discrimination impair the abilities of the ill to participate in society, and rob communities of their contributions. The cost of the work hours and wages lost due to the absence of the ill is referred to as productivity loss. In the UK, depression results in productivity losses that are 23 times as great as the associated healthcare costs, and is the most important cause of absenteeism from the workplace4. Mental illness can also relegate the suffering to the outskirts of society, with severe consequences. In the US, 22% of the incarcerated and 1/3 of the adult homeless population are mentally ill5, and it is estimated that for every £1 of healthcare spending on those referred for addiction treatment in the UK, £3 is spent on them by the criminal justice system, and £10 by the victims of crime4. The mentally ill are also less likely to be hired or be rented to, and more likely to be falsely charged with a violent crime3.

mental illness
For reference: this is what $1 billion in $100 bills looks like.

This social segregation has insidious effects. Working is not just a means to an economic end; it also imparts self-esteem to the employee, and expands their social network4. The benefits of social inclusion are sorely needed by the mentally ill, and could aid in their treatment and recovery. Being ostracized may actually prolong illness or contribute to relapse by lowering self-worth, perpetuating the cause of unemployment and exclusion, and creating a terrible feedback loop.

Personal side effects

While the cost of mental illness to society is very dear, it pales in comparison to the price paid by the afflicted and their families. The mentally ill shoulder physical, emotional, and social burdens as a result of their illness. Serious mental illnesses, such as schizophrenia, cause poor personal care and lifestyle choices (e.g. a high fat diet), which can negatively affect overall health and self-esteem, and act as barrier to social acceptance. The seriously mentally ill smoke 44% of cigarettes used in the US5, and are more likely to be overweight; 40-60% of people with schizophrenia are overweight or obese, which in turn makes them more likely to suffer from diabetes and cardiovascular disease7.

Unfortunately, seeking help isn’t without its own consequences. The treatment for mental illness often includes medication that can have serious side effects. Antidepressants can cause gastrointestinal (e.g. nausea, vomiting) and neuropsychiatric (e.g. drowsiness and dizziness) issues, and negatively interact with other drugs8. Antipsychotics can contribute to weight gain, and those that do put the patient at a greater risk for type II diabetes. Some antipsychotics may also increase the risk of movement disorders, cataracts, and cardiac dysfunction, such as arrhythmias7. Depression and schizophrenia, as well as their respective treatments, are also associated with negative sexual effects, meaning they impair sexual function and satisfaction1.

Stigma and its corollaries, prejudice and discrimination, are pervasive issues for the mentally ill, and mental illnesses have become increasingly stigmatized over the past few decades. These interactions depend on an ‘us’ and ‘them’ mentality perpetuated by stereotypes, and a social, economic, or political power imbalance between the groups. With that dynamic in place, the mentally ill are subjected to both everyday and structural discrimination. Stigma can also be internalized by the ill, a phenomena called self-stigmatization. Stigma strains familial ties; 20% of respondents to a family survey reported lower self-esteem and tenser relationships with other family members as a result of stigma3. The impact of stigma is profound, and can cause the ill to shun treatment, in order to avoid the label of mental illness and its resulting social repercussions6.

The social backlash against mental illness is contingent in part on the idea that it is rare. It isn’t; it’s incredibly common. And while the burden of its symptoms and their treatment is unavoidable, the sting of stigma is not. Acceptance and understanding of mental illness can lighten the load. Mental illness will never be painless, but we might be able to make it a little less expensive.

References

1. Baldwin, D, & A Mayers. (2003). Sexual side-effects of antidepressant and anti-psychotic drugs. Advances in Psychiatric Treatment, 9:202-210.

2. CDC Mental Illness Surveillance. Centers for Disease Control and Prevention. 2 December 2013. Web. 27 April 2014. http://www.cdc.gov/mentalhealthsurveillance/faqs.html

3. Corrigan, PW. (1998). The impact of stigma on severe mental illness. Cognitive and Behavioral Practice, 5:201-222.

4. Knapp, M. (2003). Hidden costs of mental illness. British Journal of Psychiatry, 183:477-478.

5. Insel, TR. (2008). Assessing the economic costs of serious mental illness. American Journal of Psychiatry, 165(6):663-665.

6. Rüsch, N, MC Angermeyer, & PW Corrigan. (2005). Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. European Psychiatry, 20:529-539.

7. Üçok, A, & W Gaebel. (2008). Side effects of atypical antispychotics: a brief overview. World Psychiatry, 7(1):58-62.

8. Wilson, K, & P Mottram. (2004). A comparison of side effects of selective serotonin reuptake inhibitors and tricyclic antidepressants in older depressed patients: a meta-analysis. International Journal of Geriatric Psychiatry, 19:754-762.

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