約會應用程式的新用途：追逐性病
資料來源：Darius Tahir / 2022 年 11 月 30 日 / Kaiser Health News / 財團法人台灣紅絲帶基金會編譯
（ERIC HARKLEROAD / KHN 插圖；蓋蒂圖片社）
Heather Meador 和 Anna Herber-Downey 在工作中使用約會應用程式——他們的老闆知道這一點。
這個故事也在 CBS 新聞上播出。 它可以免費重新發布。
兩人都是愛荷華州東部 Linn County Public Health 僱傭的公共衛生護士。 他們了解到，約會應用程式是告知用戶他們之前在網站上認識的人可能已將他們暴露於性傳播感染的最有效方式。
根據疾病控制和預防中心的數據，從 2019 年到 2020 年，通報的淋病和梅毒病例分別增加了 10% 和 7%，性傳播感染（也稱為 STD）在全國範圍內激增，愛荷華州也未能倖免。 兩人發現電話這種傳統的接觸者追踪方法不再有效。
「當我 12 年前開始工作時，我們給每個人都打了電話」，縣衛生部門臨床分部主管米多爾說。「打電話給某人越來越難了」。他們說，即使發短信也無濟於事。人們不一定會在 Facebook 上回復消息。約會應用程式就在那裡。
由於許多人在網上與性伴侶會面——通過 Grindr 或 Snapchat 等網站，它們的總部分別位於西好萊塢和加利福尼亞州的聖莫尼卡——聯繫追踪者通常沒有太多信息可以繼續，只有一個網名或一張圖片。
因此，大約一年前，Meador 和她的同事獲得了當地老闆的批准，可以在該應用程式上建立個人資料，透過該資料他們可以聯繫感染者的性伴侶。
傳統上，接觸者追踪人員會採訪感染 STI 的人，了解他們最近的遭遇，然後聯繫這些合作夥伴，告訴他們潛在的接觸情況。
林恩縣接觸者追踪人員在整個工作日都使用這些應用程序。 Grindr 特別依賴於地理定位，向附近的用戶顯示匹配項。 因此，追踪者在外出時會使用這些應用程序，希望能與被診斷患有性傳播感染的人在同一街區閒逛。 有時，用戶會「點擊」合同追踪器以查看他們是否對約會感興趣。
當公共衛生官員發現他們正在尋找的人時，他們會發送一條消息要求打電話。 這是一個成功的方法：Herber-Downey 估計他們有 75% 的時間會進行初次接觸。
Linn County 決定轉向於線上是因為全國 STI 率上升，對抗 STI 的資金下降，人們採用新技術來結識新朋友並尋求樂趣。「性傳播感染的增長速度遠遠超過我們所擁有的資金」，全國性傳播疾病主任聯盟預防計畫主任利奧·帕克說，與此同時，所有公共衛生部門——許多資金不足——正在努力應對新的行為。
「社交媒體公司擁有數十億美元； 我們卻有數萬人需服務」，南加州大學公共衛生教授 Jeffrey Klausner 博士說，他曾擔任舊金山 STD 預防和控制服務主任。 這種資金差距意味著很少有公共衛生部門的工作人員可以上網。 克勞斯納說：「只有在大城市才有人負責這件事」。
即使部門有足夠的員工來迎接挑戰，也可能缺乏制度支持。 一些公共衛生官員詢問登錄應用程式的員工。 克勞斯納曾代表加利福尼亞州文圖拉縣的接觸者追踪人員作證，該追踪者因使用色情網站工作而被解僱。
但是隨著人們遷移到網上與合作伴侶會面，在那裡關注他們是有道理的。「我們現在處於數位時代」，帕克說。 個人可能不會外出，或者可能會質疑他們的身份，使得線上場所變得舒適、匿名的浪漫空間——這反過來意味著人們更難面對面接觸，至少一開始是這樣。
此外，像 Grindr 這樣的線上空間是超越接觸者追踪的有效公共衛生工具。 它們可以成為宣傳公共衛生問題的有用方法。
帕克和林恩縣官員表示，關於約會應用程式的公共服務公告——提倡使用保險套或共享性健康診所的營業時間——似乎確實能引導人們獲得服務。 「我們確實有人進來說」，『我看到你們進行了免費檢測。 我在 Grindr 上看到了它』」，Parker 說。
Grindr 是最大的專注於 LGBTQ+ 人群的約會應用程式，它向其成員推送消息和信息，Grindr for Equality 的主管 Jack Harrison-Quintana 說。 例如，在 2015 年芝加哥 LGBTQ+ 社區爆發腦膜炎期間，這種參與得到加強。
在那次疫情爆發期間，該應用程式在全市範圍內發送了有關疫苗接種的信息。 然後 Harrison-Quintana 利用該服務的設計：Grindr 工作人員使用該站點的地理定位功能將消息定向到特定的社區。 他說：「我們可以進去，真正地一個街區一個街區地問，『這是出現病例的地方嗎？』」， 如果是這樣，他們會向該地區發送更多消息。
該活動鼓勵該應用程式進一步努力，該應用程式定期向該平台每月約 1,100 萬用戶群發送有關從 covid-19 到猴痘的一切公共衛生信息。 Grindr 還允許用戶顯示他們的 HIV 狀態，並顯示他們是否接種了 covid、猴痘和腦膜炎疫苗。
然而，有幾件事 Grindr 不會做。 該公司不允許公共衛生部門創建機構賬戶。 而且它不允許將有關 STI 暴露的自動通知發送給用戶。
該公司表示，這是出於隱私考慮，儘管公共衛生倡導者呼籲部署更好的消息傳遞功能。 Grindr 認為，政府在該應用程式中的存在過於具有侵擾性，即使是匿名通知也會讓用戶追踪感染源。 （當被問及自行加入該網站的公共衛生官員時，公司發言人帕特里克·萊尼漢說：「個人可以在他們的個人資料中自由地說『我是一名公共衛生專業人員——問問我的工作！』， 以他們認為合適的方式自由討論性和公共衛生問題」。）
Grindr 的立場——無論對公共衛生界的一些人來說多麼令人失望——反映了私營部門長期以來試圖採取的平衡行動，旨在平衡政府對用戶隱私利益的擔憂。
克勞斯納指出，1999 年舊金山爆發的梅毒疫情是他第一次看到這些利益如何不一致。 此次爆發可追溯到 AOL 聊天室。 克勞斯納表示，根據他的研究，人們似乎可以上網並「比披薩外賣更快地找到性伴侶」。
但說服總部位於紐約的時代華納（最終成為 AOL 的公司母公司）進行合作既費時又棘手——進入聊天室需要紐約總檢察長辦公室的幫助。
克勞斯納說，自那時以來，在線行業取得了進步。 他幫助一項服務開發了一個系統，可以將數位明信片發送給可能暴露的人。「恭喜你得了梅毒」，明信片上寫著。「它們是前衛的明信片」，他說，儘管有些選項較不那麼「狡詐」。
然而，總的來說，約會應用程式的世界仍然是「分叉的」，他說。 對於公共衛生工作，吸引 LGBTQ+ 用戶的應用程式通常比那些主要迎合異性戀客戶的應用程式更有幫助。
這是由於該社區在性健康方面的歷史，與約會應用程式合作的公共衛生組織 Building Healthy Online Communities 的負責人 Jen Hecht 解釋說。「酷兒群體中的人們對 HIV 有——什麼——30、40 年的思考？」 她說。
她說，儘管性傳播感染會影響每個人，但對於專注於直接約會的應用程式來說，「規範和期望並不存在」。 事實上，無論是 Match Group 還是 Bumble——擁有最大的異性戀約會應用程式的公司，都位於德克薩斯州——都沒有回應 KHN (Kaiser Health News) 的多次置評請求。
但至少到目前為止，使用者似乎很欣賞基於應用程式的介入措施。 Harrison-Quintana 表示，Grindr 已採用實事求是的方法來傳達健康信息。 他從未受到任何強烈反對，「這非常好」。
達流士.塔希爾：DariusT@kff.org，@dariustahir
A New Use for Dating Apps: Chasing STDs
By Darius Tahir / NOVEMBER 30, 2022 / Kaiser Health News
(ERIC HARKLEROAD / KHN ILLUSTRATION; GETTY IMAGES)
Heather Meador and Anna Herber-Downey use dating apps on the job — and their boss knows it.
This story also ran on CBS News. It can be republished for free.
Both are public health nurses employed by Linn County Public Health in eastern Iowa. They’ve learned that dating apps are the most efficient way to inform users that people they previously met on the sites may have exposed them to sexually transmitted infections.
A nationwide surge in STIs, also known as STDs — with reported cases of gonorrhea and syphilis increasing 10% and 7%, respectively, from 2019 to 2020, according to the Centers for Disease Control and Prevention — isn’t sparing Iowa. The duo has found that the telephone call, a traditional method of contact tracing, no longer works well.
“When I started 12 years ago, we called everyone,” said Meador, the county health department’s clinical branch supervisor. “It’s getting harder and harder to just call someone on the phone.”
Even texting is ineffective, they said. And people aren’t necessarily answering messages on Facebook. The dating apps are where they’re at.
Because many people are meeting sex partners online — via sites like Grindr or Snapchat, which are headquartered in West Hollywood and Santa Monica, California, respectively — contact tracers often don’t have much information to go on, just a screen name or a picture.
So, about a year ago, Meador and her colleagues got approval from their bosses at the local level to build profiles on the app, through which they can contact the sex partners of infected people.
Traditionally, contact tracers interview people infected with an STI about their recent encounters and then reach out to those partners to tell them about the potential exposure.
Linn County contact tracers use the apps throughout their workday. Grindr, in particular, relies on geolocation, showing users matches who are close by. So the tracers use the apps when they’re out and about, hoping to wander into the same neighborhoods as the person diagnosed with an STI. Sometimes users “tap” the contract tracers to see whether they’re interested — in dating, that is.
When the public health officials spot someone they’re looking for, they send a message asking for a call. It’s a successful method: Herber-Downey estimated they make an initial contact 75% of the time.
Linn County’s decision to move online comes as STI rates rise nationally, funding to fight them falls, and people adopt new technologies to meet people and seek fun. “STIs are increasing way faster than the funding we have,” said Leo Parker, director of prevention programs for the National Coalition of STD Directors, all while public health departments — many underfunded — are grappling with new behaviors.
“Social media companies have billions; we have tens of thousands,” said Dr. Jeffrey Klausner, a University of Southern California public health professor, who previously served as San Francisco’s director of STD prevention and control services. That funding disparity means few public health departments have staff members who can go online. “It’s only really in major cities that they have anyone who’s tasked for that,” Klausner said.
Even when departments have enough employees to take on the challenge, institutional support can be lacking. Some public health officials question employees who log into the apps. Klausner once testified on behalf of a Ventura County, California, contact tracer who was fired for using sex sites for work.
But with people migrating online to meet partners, following them there makes sense. “We’re now in a digital age,” Parker said. Individuals might not be out, or might be questioning their identity, making online venues comfortable, anonymous spaces for romance — which, in turn, means people are harder to reach face-to-face, at least at first.
What’s more, online spaces like Grindr are effective public health tools beyond contact tracing. They can be useful ways to get the word out about public health concerns.
Parker and the Linn County officials said public service announcements on dating apps — advocating for condom use or sharing the business hours for sexual health clinics — do seem to lead people to services. “We do have individuals coming in, saying, ‘I saw you had free testing. I saw it on Grindr,’” Parker said.
Grindr, which touts itself as the biggest dating app focused on LGBTQ+ people, pushes out messages and information to its members, said Jack Harrison-Quintana, director of Grindr for Equality. That engagement intensified during a 2015 meningitis outbreak among LGBTQ+ communities in Chicago, for example.
During that outbreak, the app sent citywide messages about vaccination. Then Harrison-Quintana took advantage of the service’s design: Using the site’s geolocating capabilities, Grindr workers targeted messages to specific neighborhoods. “We could go in and really go block to block and say, ‘Is this where the cases are showing up?’” he said. If so, they sent more messages to that area.
That campaign encouraged further efforts from the app, which regularly sends public health messages about everything from covid-19 to monkeypox to the platform’s base of roughly 11 million monthly users. Grindr also allows users to display their HIV status and indicate whether they’re vaccinated against covid, monkeypox, and meningitis.
There are a couple of things Grindr won’t do, however. The company won’t allow public health departments to create institutional accounts. And it won’t allow automated notifications about STI exposures to be sent to users.
That’s due to privacy concerns, the company said, despite calls from public health advocates to deploy better messaging features. Grindr believes that a government presence on the app would be too intrusive and that even anonymous notifications would allow users to trace infections back to their source. (When asked about public health officials who join the site on their own, company spokesperson Patrick Lenihan said: “Individuals are free to say something like ‘I’m a public health professional — ask me about my work!’ in their profile and are free to discuss sexual and public health matters however they see fit.”)
Grindr’s position — however disappointing to some in the public health world — reflects a longtime balancing act attempted by the private sector, which aims to square government concerns with users’ privacy interests.
Klausner pointed to a 1999 syphilis outbreak in San Francisco as one of the first times he saw how those interests could be at odds. The outbreak was traced to an AOL chatroom. Based on his research, Klausner said it seemed as though people could go online and “get a sex partner faster than you can get a pizza delivered.”
But persuading New York-based Time Warner, eventually AOL’s corporate parent, to cooperate was time-intensive and tricky — gaining entrée into the chatroom required help from the New York attorney general’s office.
The online industry has advanced since then, Klausner said. He helped one service develop a system to send digital postcards to potentially exposed people. “Congratulations, you got syphilis,” the postcards read. “They were edgy postcards,” he said, although some options were less “snarky.”
Overall, however, the dating app world is still “bifurcated,” he said. For public health efforts, apps that appeal to LGBTQ+ users are generally more helpful than those that predominantly cater to heterosexual clients.
That’s due to the community’s history with sexual health, explained Jen Hecht, a leader of Building Healthy Online Communities, a public health group partnering with dating apps. “Folks in the queer community have — what — 30, 40 years of thinking about HIV?” she said.
Even though STIs affect everyone, “the norm and the expectation is not there” for straight-focused dating apps, she said. Indeed, neither Match Group nor Bumble — the corporations with the biggest apps focused on heterosexual dating, both based in Texas — responded to multiple requests for comment from KHN.
But users, at least so far, seem to appreciate the app-based interventions. Harrison-Quintana said Grindr has landed on a just-the-facts approach to conveying health information. He has never received any backlash, “which has been very nice.”
Darius Tahir: DariusT@kff.org, @dariustahir