Why Texting Public Health Messages Is a Brilliant Idea. Except When It’s Not…

A new service has partnered with a Los Angeles school district – the second largest in the country – to not only deliver STD results by text message, but also to promote the idea children share their “status” as easily as they share the highlight of their day on Facebook. But when it comes to children having sex, it’s never quite that simple now is it?

Qpid.me is the brainchild of Ramin Bastani and operates from the following premise: “We believe that sharing is a good thing and that it can lead to better sexual health decisions, more (safe) sex and fewer STDs.” Bastani went on to tell CNN in an interview: “If it’s cool for a beauty queen to share her STD status [Qpid.me’s celebrity sponsor is Tamie Farrell, Miss California 2009], then maybe kids will start to think it’s cool to share their own results. We want to normalize the idea of sharing your status.”

The process is fairly straightforward. Qpid.me requests patient test results from health clinics (with patient permission, of course) then transmits those results via text, email, and provides access to their online site. The concept of delivering STD results electronically is not necessarily new, or controversial. The danger lies in convincing children there are no concerns about sharing such private information among peers who may not respect their privacy, or, worse may shame them for contracting curable diseases.

Since 2004 sexual health clinics in the United Kingdom have experimented with delivering text messages to patients for both negative and positive test results. The feedback from both patients and clinical staff was noticeably positive. Previously staff would spend up to 120 hours a month contacting patients to deliver mostly negative results that required no follow-up. For those patients who had positive results the delay in contact (prior to the text message-based system) also delayed treatment and increased both the likelihood of complications and that the infection would spread.

Roughly half of the Los Angeles Unified District’s 660,000 students –some as young as age 13 — have been taught in sex education classes how to retrieve their STD status, share it with a partner, and request it prior to engaging in sexual activity. Unfortunately children in Los Angeles County are in a hurry to have a lot of sex, and apparently they’re not making time to use protection either.  CNN notes that in 2011 children between ages 13 and 19 accounted for a quarter of the chlamydia cases and 16% of the gonorrhea cases, according to the Los Angeles County Health Department.

It’s clear there is an epidemic among our youth, and it’s conceivable that delivering STD results via text, e-mail, and mobile apps could stem this tide. But at what cost socially and emotionally? This may promote a false sense of security, leading children to believe a negative STD test taken weeks ago means that a person is still negative. (Though accurate detection depends on a host of variables including the STD testing window).

Thus Qpid.me could create the very problem they are trying to prevent: a rise in unprotected sex. And what if minors trust their partners with test results even when said results are positive?

Can you imagine the rampant embarrassment and “slut shaming” if the information were to leak out (whether purposefully or by accident)? The STD epidemic among children is real, however this solution is definitely not the right one.

John S. Wilson is a health policy analyst focused on long term care and digital health. His work frequently appears in Forbes, CNN, Black Enterprise and the Huffington Post. He is also a Digital Health advisor to the NewMe Accelerator, a start-up tech incubator for minority entrepreneurs. John may be reached on Twitter: @johnwilson.

8 replies »

  1. Lucky that pre-Qpid.me there was neither sex nor slut shaming/bullying nor for that matter sharing of information about who was thought to have what STD anywhere in the LAUSD or among any other group of teenagers…. oh, no wait….

  2. David,

    Thanks for the comment. While I agree that the status quo isn’t working and that text messages or other digital communication will resonate with young people and can be used to positively change behavior, I don’t think teenagers are mature enough to avoid sharing sensitive information with this technology in the wrong way. I steadfastly believe more effective conversations with teenagers regarding sex need to happen. I only question the particular method and whether it takes into account the limitations of this younger audience.

    I don’t think Qpid.me intends to promote sex, however putting this information in the hands of teenagers could certainly lead to a false sense of security that would not necessarily be possible with standard test results that people are not in the habit of sharing currently. After all, a big part of Qpid.me’s push is to make it far more popular to share these test results, so f course there could be unintended consequences.

    I think “slut-shaming,” while crude, is a correct term to use because it’s already occurring in high schools and colleges. A negative test result shared with someone a woman thought she could trust could end up making her a laughingstock among her peers.

    Ramin shared with me that piece you referenced and I found it interesting. But at the end of the day I think there are still some concerns to have here.

  3. I am an advisor to Qpid.me and I am writing to set the record straight on a few points. Because of the sensitive nature of the information and situations the company deals with, it is important to get this right.

    The status quo isn’t working. According to the CDC, 20 million people got an STD in the US last year — and half of those infections were among youth.

    The post gives the impression that Qpid.me is promoting sex to youth. This is just not the case. Qpid.me is promoting testing. Again, per the CDC, only 13% of high school students get tested for HIV while 47% have had sex (CDC’s Youth Risk Behavior Survey from 2011 – http://www.cdc.gov/healthyyouth/sexualbehaviors/pdf/hivtesting_adolescents.pdf). If we increase the number of students getting tested, there is an opportunity for them to get educated about their sexual health that will help them make better choices.

    The LA Unified School District program is all about education. The post is surprisingly reminiscent of the abstinence-only position taken by some educators. Qpid.me — together with many public health departments and school districts around the country — believes that it is unrealistic to shy away from these conversations in a population that, however young, is already largely sexually active.

    The post suggests that Qpid.me give a false sense of security because status changes. The same could be said of any program that involves testing, where individuals rely on out-of-date test results.
    Every single time someone’s status is shared using Qpid.me a message is included that says, “Disclaimer/Be smart: This person may have had sex since being tested. Always use condoms / be safe.” That is part of the educational program at the LAUSD as well.

    The post states that “slut-shaming” may happen if positive results get out there. I think that the writer may have misunderstood the way Qpid.me works. Results are only shared by an individual, not by the service without explicit authorization. Most test results shared via Qpid.me are negative results. If individuals’ results are positive, then they are encouraged to seek appropriate medical care. Qpid.me makes sharing positive STD results very difficult. Additionally, the company encourages people to share results on their own phone, to reduce the opportunity for screenshots.

    For further information about the LAUSD program, check out this piece by the person spearheading it, Tim Kordic, Program Manager, HIV/AIDS Prevention Unit, Health Education Programs Department of the LAUSD:

  4. Thanks for reading.

    Yes, the delivery failure is also something to think about. Although the ability to log in online is probably the catch-all there.

  5. Thanks for reading.

    Right, I noticed that as well. There’s nothing wrong with having a particular agenda but most consumers aren’t going to view it through that lens. Instead, it’ll be more about consumers’ actual concerns, not the organization’s.

    I also agree that the district should look to other types of sexual health promotion before diving fully into this. Although, to be honest, I’m not sure what alternatives they’ve looked into or implemented.

    I’ll check that article out.

  6. Oh, and a second somewhat related point

    People aren’t thinking about this nearly enough as far as I can tell – as completely ludicrous as it sounds – proper mobile device hygiene.

    How many people do you know who use appropriate measures to disinfect their mobile devices regularly? I’ve seen usage policies, but not many.

    There are products on the market, but I’m not clear on how well they’re catching on. Let’s do a study that randomly tests a thousand patient and or physician devices and see what we come up with ..

    I’m willing to bet the results will be shocking ..

  7. Interesting points John. I’ve wondered about this myself – although I hadn’t really given much thought to the sex ed/side of the story. The false security issue is clearly something that needs to be thought about ..

    Another thing we need to consider: delivery failure / delay is a big deal. I’m going to stay away from what this means for teens on the verge of getting down to business (“no news is good news”, I’m guessing) – but in other public health scenarios – texts not getting through or coming through late could cause serious headaches

  8. Fair, fair points.

    1-Is a service like this really promoting a culture of trust?
    2-Are we back to square one with the delayed notifications?

    And while similar sentiments have been expressed by those at the National Abstinence Education, let’s be real: they are probably more annoyed that a service like Qpid.me promotes promiscuity.

    It’s sort of unrealistic to think that one text messaging system can solve all.

    Why not make the sharing a gradual thing, especially when partnering with such a large school district? What about support groups first, maybe broken down by gender?

    A wonderful program for adolescents, unfortunately in a much more privileged charter school in Philly, was profiled a couple of years ago in the NYT…


    Hope someone at Qpid.me/LA County School District read it…