Recent research shows that using the social media platform Reddit can help investigators gain insights into sexual risk behaviors and symptoms of sexually transmitted infections (STIs) in real time. Anonymous Reddit posts were leveraged by investigators to better understand people’s sexual behaviors and experiences with STIs before and during COVID-19.1
“This research stems from my group’s interest in using big data-available sources to predict outbreaks and patterns in STIs and to respond to STI rates,” says Amy K. Johnson, PhD, lead study author and research associate professor at Potocsnak family division of adolescent and young adult medicine at the Ann & Robert H. Lurie Children’s Hospital of Chicago. “We hope to translate it from the research lens into public health practices and surveillance of STIs,” Johnson says.
Using anonymous social media databases can provide information that more formal surveillance efforts lack. For instance, during the initial public health response to COVID-19 surges and crises, many health departments shifted their STI staff to work on the COVID-19 response. This made it less likely that STI case reports during 2020 and 2021 accurately reflected STI rates nationwide. Plus, many people who may have experienced symptoms of an STI were deterred from seeking testing and treatment during the nationwide shutdown.
“In combination with the move to telehealth and the lack of STI screenings, we knew we may see declines in cases,” Johnson says. “We were thinking about where people were communicating online, and we looked at Reddit.”
Reddit has a couple of advantages that lend itself to research into stigmatized subjects. For one, it can be anonymous. Secondly, it offers subreddit categories where people who are concerned about a topic can virtually congregate and discuss their concerns.
Some subreddits are related to sexual health, so researchers studied these to identify any patterns in how people talked about potential STIs. “Our suspicions were there would be a lot of talk on subreddits,” Johnson explains. “Because it’s user-generated and in a discussion form and it’s anonymous, it a good venue for STI research, specifically.”
Anonymity is the antidote to stigma around sexual activity and STIs. “Often times, people turn to the internet for health information — specifically, information that may be related to health behaviors, including behavior that may make them more likely to get an STI,” Johnson says. “We pulled data from Reddit and used data processing techniques to really aggregate the data and use natural language processing to identify clusters of text. We had a pre-COVID period, and we identified a COVID-19 pre-vaccination period.”
During the first wave of the pandemic, much of the country was shut down, and there were restrictions regarding social distancing and lack of access to in-person healthcare. In the post-vaccination period, some restrictions were lifted, and public gathering reopenings varied from state to state. With March 2020 as an inflection point, Johnson and colleagues did not gather data from that month. But they also looked at a third period — the COVID-19 post-vaccination period from January 2021 to July 2021. They cut it off in July 2021 to conduct analysis.
“Our study really demonstrated there was an overall increase in volume of STD-related posts in the COVID-19 time periods,” Johnson says. “From the pre-COVID time period to the two COVID time periods, there were changes in what was being talked about.”
The changes related to behavior changes due to lockdowns, restrictions on in-person gatherings, and the closing of STI services. “Regardless of guidance in locking down and social distancing, people still engaged in sexual behavior, including condomless sex,” Johnson says. “There was a reduction in STI testing as well as treatment, so the cases are not accurately reflected in our surveillance numbers.”
During the pandemic periods, public health officials were not capturing the entire burden of STIs. “When you reduce STI testing and equipment, you eventually will reduce STI cases,” Johnson says. “By not testing people, you don’t find positives.”
This explains drops in STI case reports. “Cases declined and then quickly rebounded when services were restored and public health workers went back to STI surveillance,” Johnson explains. “We think that was an artifact to reduced STI testing.”
Reddit posts included conversations about HPV and warts during the two COVID-19 periods. In the pre-COVID-19 period, posts were more general about STI risks and behavior. “We think that was related to efforts of self-diagnosis,” Johnson says. “We didn’t survey Reddit users — we used their posts and did an analysis on topic clustering, and these are our hypotheses about those clustering.”
Johnson and colleagues’ findings suggest that Reddit might be a good platform for sexual health workers to leverage for distributing accurate health information about STIs, testing, and treatment, Johnson says. An estimated four in five internet users reported seeking health information online.1 Asking public health and medical experts to post accurate health information could be a way to mitigate any harm from incorrect diagnoses and faulty recommendations by non-medical Reddit users, she adds.
The results also point to a way to enhance STI surveillance systems and public health response, using data that already exist and using methods that people access. “If we know that people who have STIs are seeking support online, public health should use those sources,” Johnson adds. “Think about how they process information and how that could help support and monitor STI outbreaks, predicting them, and responding to them, with educational information and treatment resources.”
REFERENCE
- Johnson AK, Bhaumik R, Nandi D, et al. Sexually transmitted disease-related Reddit posts during the COVID-19 pandemic: Latent Dirichlet allocation analysis. J Med Internet Res 2022 Sep 20. doi: 10.2196/37258. [Online ahead of print].
Recent research shows that using the social media platform Reddit can help investigators gain insights into sexual risk behaviors and symptoms of STIs in real time. Anonymous Reddit posts were leveraged by investigators to better understand people’s sexual behaviors and experiences with STIs before and during COVID-19.
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