A Blockchain Solution to Sexually Transmitted Infections in Online Dating
In Alaska, my home state, we’re known as the state for sexually transmitted diseases and infections. In 2016, Chlamydia rates in Alaska at 771.6 per 100,000 were significantly higher than rates in the U.S. at 497.3 per 100,000. This is particularly the case among young people. Unfortunately, infections don’t differentiate between the young and inexperienced from the older and experienced.
Instead, they often go unfounded and, more troublingly, untreated. The result is that many individuals acquire an STD or STI at some point during their connect lives. What’s more, access to instant dating is now easier than ever. Tinder, Bumble, and others allow anyone with a smart-phone to connect with another person at any moment, all the time.
While wonderful for many people in a lot of ways, there stands a problem. If it is easier with another person for a short-term (possibly) relationship, then (a) individuals are more likely to engage in casual sex and (b) those that engage in a lot of casual sex can decrease the amount of time between partners.
Just the other day there was a Tinder user explaining that:
I matched with like a hundred people on Tinder last week.
There was a number of troubling aspects to this statement. The first, of course, is the statistical reality of having a large number of potentially untrustworthy partners. While engaging in safe-sex is a generally accepted behavior, its application, in reality, is a little more troubling. According to the CDC, only 30% of men used condoms in their last sexual encounter. What’s worse is that 50% of new STI’s occur in young people.
The Riskiness Math for STD/STI acquisition is as follows:
Higher Modern Probability of STI/STD Acquisition = (A large number of partners )+ (spotty condom use) + (users that can, and often do, completely disregard the sexual safety of others of their own enjoyment) + (unrestricted, anonymous access to users regardless of sexual health status)
To many, this is a petrifying reality in which every person anyone has sex with will definitely have some sort of infection! (Which of course isn’t true, but that doesn’t stop it from feeling that way)
The question that emerges to me is the following:
With such ease of access and the semi-anonymous structure of many dating applications, how is it possible to trust another person’s word on their sexual health status? Is it possible to confidently know their status if the relationship is destined to be short lived?
In other words, if we want to engage in short-term, casual-sex relationships with a number of “less-than-trustworthy” partners, how can we possibly be confident in our sexual status beyond going to get tested periodically and trusting what they tell us? That is, assuming it comes up in conversation at all and the counter-party users know their status to begin with.
Introducing a Blockchain Solution to STIs in Dating Applications
This solution, which I call Hardly, aims to create verifiable STD and STI status (hereby called Status or sexual health status) for participants in the casual sex community looking to engage in safe sexual encounters with short-term partners. Currently, sexual Status is only verifiable through testing clinics and is not securely verified on current dating applications. The result is that sexually transmitted infections are common for those engaging in casual sex and otherwise, especially in young individuals and gay communities. Because of the brevity of the many such relationships, there is an incentive to lie if an individual is STI/STD positive. Which, we will call the trust problem. Additionally, because many STI’s are asymptomatic in individuals, it’s difficult for one individual to safely validate if another individual is free of infection prior to engaging in intercourse with a new partner beyond the judgment of character. Thus, traditionally preventable STI’s such as Chlamydia and Gonorrhea are prevalent — with 25% of individuals catching some sort of sexually transmitted infection at some point in their lives.
By creating a verifiable network that allows users to validate their status and engage in sex with untrusted parties it is entirely possible to decrease the prevalence of STD/STI’s, save medical expenses of treatment, and allow people to have more, safer sex, even in semi-anonymous online dating culture.
The Fundamental Idea of Using a Blockchain
The idea behind having a blockchain solves two problems: the verification of status problem and the honeypot problem. With technology and record-keeping as it stands today, it difficult to convert medical records into a verifiable check on dating applications.
Currently, however, there is a solution that allows individuals to verify their sexual health status. It’s called SafeApp. And they do a good job in the United States. The user interface is simple and attractive. And if it delivers on its promise, then the fundamental problem of distrust is solved.
Yet there are a number of questions that are unanswered:
How safe is the information provided on their servers? Any centralized server, by its design, tends to be hackable. In the United States, there are unfortunately still social stigmas underlying various sexually transmitted infections — this TED talk delves into this. If their servers are to be hacked, then their users could have potentially sensitive information exposed to malcious users.
Is this solution scalable? Their application is HIPAA compliant, but what about international regulations? What if the application user is traveling abroad and wants to use the application?
How does this application contribute back to the medical community? With the currently inconsistent reporting standards of STDs and STIs, it’s difficult to track the transmission of different infections. Now what if there was an anonymous, but auditable, record of the spread of sexually transmitted infections?
This where the blockchain comes in.
The purpose of the blockchain, as opposed to the traditional database management systems, is three-fold: (1) it allows users to own their own sexual health medical information in a secure, verifiable way, (2) it allows counter-party users to verify the sexual status of the person they are considering swiping without having to endure the awkward conversations and the problem that emerges from the trust problem, and (3) it would create a secure way for researchers to create blindable audit trails to stop the continuous spread of STDs and STIs.
The blockchain will be used for participants to independently own their own Status and will allow be used for others to validate the status of another user. This solution could be built upon the Ethereum using smart contracts and validation nodes. Due to the nature of medical data, the only reliable actors to confirm STD/STI status are medical clinics and surrounding primary care doctors found within the medical clinics. To ensure reliability, and to keep false-negatives low (which is notorious among self-testing devices), medical data should only be validated only by a certain number of users. The clinics, in other words, would act as the validation nodes for the system that verify the status of an individual and therefore enable the smart-contract to allow the user to join the network. In other words, they would collectively agree that Participant n, has indeed gone to clinic x, and is “STD/STI free”.
The interaction of users, that is, the ones engaging in short-term relationships with one another, will not be used to confirm the status token granted to participants. Instead, their role will be to confirm communications between participant x and participant n, for audibility in the instance of an STD/STI being spread.
In this case, participants signing up for the dating application must go through a two-step verification process. In order to use the application, the participant must conduct a full-panel STD/STI test prior to using the application, of which the clinics can then assign the result of the test — itself a piece of highly private information — to the participant, and then communicate the information to the other nodes for validation.
In this instance, there also needs to be a validation system that allows the ‘passing’ users to access the application and the ‘failing’ users not to use the application. Much like the concept of a vending machine, when the medical center confirms their status, a token must be issued to the participating user on the network (Perhaps as a ERC 720 Token). The token would be considered an asset that grants “a time-allotted” access to the participant user. After an allotted time phrase has passed, say, for example, three months, then the user’s privileges to use the application may be revoked. In this regard, access control for new participants need not be controlled because they won’t show up on the ‘available to match’ user interface. The participant will then possess a token, of sorts, that grants him or her ‘available’ status for x number of months.
From an entering participant perspective, it can be thought of as a time-constrained ticket that verifies the status of health; which is kind of like purchasing a day-pass to “Disney World”, but different.
To the counterparty users, potential partners, it will be a verification that the partner they are interested in is true, free of sexually transmitted infections.
Other Thoughts and Considerations
The possible blockchain solution is another real-world application involving the ownership of personal medical information applied to the world of online dating. Should there be a verification system that allows for the secure verification of an individual’s sexual health status, then there are a number of benefits available to both everyday participants and health care providers and insurance companies.
SafeApp is currently doing this. And if their solution works for everyone, then a blockchain solution may not be necessary. If, however, it is necessary, then the implications are worth exploring.
The most interesting factor to consider with this use case is the interconnectedness of the statuses of the participants. Suppose for a moment that John, after having intercourse with Jane, would like to continue using the application to find new sexual partners. During the remaining three months John has had seven other sexual partners. Since it has been three months, to continue using the application, John is now due for an STD/STI screening. Suppose then John finds out that he has contracted Chlamydia. In this instance, due to the shared network of statuses and sexual partners, the smart contract code could automatically contact all previous partners notifying them — anonymously — that they may have been exposed to this infection and should be notified.
This has three main benefits: (1) upon notification, users will be automatically notified. This will allow clinics and academics to better understand the trends in the epidemiological movement sexually transmitted infections. (2) systematizing screening processes should, at least theoretically, decrease the prevalence of the spread of incurable diseases (such as HIV) because of sorting mechanisms available to end users, (3) insurance companies, with the permission of participants of course, could provide more precise insurance information depending on health information provided by participants.
There are a number of challenges with this application’s viability.
The first, and perhaps most interesting challenge is the underlying assumption that participants on the network and application will exclusively use the application to find new partners. That is, if the user is both meeting partners on this application and elsewhere. If they are using multiple platforms, then it puts other users that are honestly validating their status at undue risk. This is mitigated with the automated reporting system and audit trail of the communications. Much like an immune system, the smart contract could and should notify all potentially exposed participants and provide solutions as to how to attack the issue. Such would be useful due to the inherently difficult task of tracking the spread of infection.
The second challenge will likely involve the navigation of the regulatory environment of medical records — especially those as sensitive as sexual health statuses. Participants are going to be wary of having their sensitive information placed onto a “blockchain”, which, to most people, is still largely misunderstood or, more so, just unknown altogether.
The third major challenge will be to design the consensus mechanisms. The medical field is complicated, diverse, with many different actors that have different access to information. This may prove challenging to build a mechanism that is efficient and secure.
Closing Thoughts
All and all, people are going to continue to have sex with one another. It’s a fantastic thing to do. Younger people tend to have poorer and riskier sexual habits and, if education doesn’t work, then perhaps it’s time to harness technology to eliminate some of the uncomfortable and untrustworthy aspects all-together.
This application can’t solve the spread of infection altogether. But by reducing the number of infections in young people, then perhaps we will be able to realize a world where more-partners doesn’t necessarily imply riskier behavior.
There are many technological and regulatory challenges to be overcome for this idea to work. So if you’re a developer or are just interested, please feel free to contact me or leave a few claps. If you can see a way to improve my work I’m more than happy to discuss it with you.
Also, criticism is equally welcome. Ideas are only good ideas if they work.
With that said, the goal here is universal scalability, data-safety, and trackability of data to stop the spread of sexually transmitted infections.
Now, allow me to close this article with a quote from a piece of cinema I love:
“There are two things in this world, wonderful, visceral, sexy sex, and death. Horrible, boring death. — Kieran, Dinner for Schmucks”
If done right, STD prevention should be hardly a problem at all.
