Public health departments use Internet as a new venue to fight STDs, HIV/AIDS

October 2007

A few years ago, InSPOT was a small web-based system allowing people to anonymously let their sex partners know that they may be at risk for STDs. The program began in San Francisco in response to an increased rate of syphilis among men who have sex with men.

Today, InSpot’s web-based partner notification services are used by city and state public health departments across the United States and beyond. The service – which has expanded to allow people to inform their partners about potential exposure to other STDs, including HIV – has been used by thousands of people since its inception.

InSPOT is currently being translated into French and Spanish and plans are underway to add a new website to serve Brazil.

“It is definitely informing more people about their exposure to STDs or HIV infection providing clear motivation for people to get tested and treated,” Jeffrey D. Klausner, MD, MPH, director of STD prevention of control services at the San Francisco Department of Public Health told Infectious Disease News.

InSPOT design

InSPOT allows users to send anonymous notification cards through its website created and maintained by Internet Sexuality Information Services (ISIS). For STD notification, people can choose from several e-card styles, which differ by city or state. The e-cards vary from light-hearted notes with clever wording to cards with serious tones.

The HIV notification card is a standard for all cities and states and its wording reflects both the serious nature of the card and the immediacy of the encouragement to seek testing. The HIV card is not available in all cities and states.

“When people have a choice of cards, they can take ownership of the situation and of their own health,” Klausner said. “That is what we are trying to promote: healthier people taking ownership of their health.”

The wording is precise and ways to get treatment and help are offered with the notification. The cards are accompanied by local public health listings, hotlines and support numbers as well as information on where to go for free testing and services.

“The most important thing to know is that the cards do not say you have an STD. They are very clear in wording to say that you may have been exposed to an STD,” said Deb Levine, executive director of ISIS. “Further, the cards say that someone cares enough about you to suggest you get tested.”

The service was designed with input from focus groups of men in the San Francisco area. Public health officials wanted a product that the target audience would use and with language the group would find user-friendly and appropriate. The site was originally designed for men only but was changed to include women in 2005 after an overwhelming response to become “hetero-inclusive” by focus groups in several states.

Cards are completely anonymous. ISIS keeps no backend database and if someone uses his or her own email address, it is not collected. About 80% of those who use the service send cards anonymously.

Using the Internet

InSPOT began in 2004 as a partnership between the San Francisco Department of Public Health and the community-based organization ISIS. The program was originally designed as an innovative way to reach MSM because syphilis rates were increasing in this population.

“We knew there had to be some way to use the Internet because this is what people are using to find sex partners,” Levine said.

Public health officials realize that even though this service may inspire more people to inform their sex partners about potential health risks, there are limits to Internet notifications. “We realize that the people who are most affected by epidemics are poor and don’t have Internet access, but we are working on plans to address this issue,” Klausner said.

Levine said the Internet can be considered another option in the fight against STDs and HIV/AIDS. “New technology is another tool in the tool kit,” Levine said. “It will never replace clinical services or in-person prevention and counseling, but we can’t ignore technology as a tool to help prevent HIV and other STDs. We know, from a public health standpoint, that notification is one of the best tools in stopping transmission.”

InSPOT growth

In 2006, there were 181,000 visitors to InSPOT. Nearly 17,000 e-mail notifications were sent to 26,455 recipients. Of those, 14% were notified about chlamydia, 17% were gonorrhea and 15% were syphilis notifications. Seventy-seven percent were sent anonymously and 38% of recipients clicked on links for more information

InSPOT does not recruit cities, states or countries for the service. Public health departments notify ISIS and a website can be created. At present, the cost for the website is about $14,000. Klausner said such an expense was negligible compared with the financial and quality of life costs of an epidemic. “Establishing a service in a city or state requires a certain amount of enlightenment on the part of the community, but not a lot of money,” Klausner said. “When you think about the cost of an epidemic, Internet notification is a cost-effective way to help keep people healthy.”

Marketing is done by the individual areas so that it may be tailored to fit the needs of the community. InSPOT advertising includes banners on popular website, billboards and palm cards distributed to physicians. Clinicians can give the cards with the website address to patients as another level of support and counseling.

Well-received

In partnership with the San Francisco Department of Public Health, ISIS surveyed primary care providers in San Francisco. More than half were familiar with the service and about 84% said they would refer clients to the service. Many also requested InSPOT business cards for clients.

“The response from infectious disease physicians has been overwhelmingly positive, in part because they do not always have adequate time to counsel patients on partner notification,” Klausner said.

In San Francisco, the site also offers ways to get prescriptions for treatment of more easily-treated STDs.

Klausner said that he is flooded with calls and e-mails from people thanking the department for providing the service. Personal e-mails have included notes from people who wrote they have been able to take care of their health because of InSPOT notification.

“The site gives people the chance to take control over their own health, which is very meaningful,” Klausner said. “It takes the stigma away and allows people to take control of their lives.”

On the other side, Klausner has received only five phone calls from people who were victims of misuse. “The benefits of the site clearly outweigh the risks,” Klausner said.

The numbers of states, cities and countries who request InSPOT continues to increase.

“The ability of the Internet to reach large numbers of people is something that is very different in terms of the standard one-on-one approach and this provides a community tool people can accept,” Levine said. “We certainly hope that it is making a dent.”

For more information:

• Visit InSPOT’s website at www.inspot.org.