STD: Sometimes Tough to Discuss

Last week’s HIV scare in a suburban St. Louis high school brought to the national forefront the continuing stigma associated with HIV and other sexually transmitted diseases (STDs). Within hearing the news that up to 50 students might possibly have come in contact with the virus, high school relationships were immediately strained or ended, nearby sports rivals withdrew from events, and an entire community was engulfed in fear. As I read and watched, disheartened by the news, I wondered how much of the scare was the result of the lack of open communication about STDs and HIV in America.

Think about it – when was the last time you had a discussion about STDs? While an uncomfortable topic, the fact that there are 19 million new sexually transmitted disease cases diagnosed each year in the United States means you quite possibly could have to face the issue sooner than later. Communication about STDs can become even tougher when you realize you have contracted one and need to inform your partners. For many in major markets, discussing possible infection has taken a new, less confrontational form – e-cards.

Last week, four-year-old inSPOT, the first online STD partner notification system using electronic postcards, released an evaluation of the service on the Public Library of Science (PLOS) Medicine forum that received strong pick-up from Reuters, CNN and U.S. News & World Report.

inSPOT initially began in San Francisco, a project of the San Francisco Department of Public Health and Internet Sexuality Information Services (ISIS), in response to high demand from gay men and men who sleep with men regarding a local syphilis outbreak. Focus group research found that many of these men were not telling casual sex partners of their STD status because there was no easy, convenient and anonymous way.

inSPOT has since grown into a site with contractual agreements with 10 major cities, such as New York and Chicago, and countries such as Canada and Romania, with more than 750 site visitors daily. Recipients can select from six types of e-cards to send their message either anonymously or with a personal message, many times from the testing centers that originally diagnose the infection. The e-cards also provide disease and testing center information to the recipients.

Since it began, the focus has expanded to include all sexually active individuals and more than 30,000 people have sent more than 49,500 e-cards. In 2006 and 2007, the 23,594 e-cards sent were distributed as follows: 15.4% for gonorrhea; 14.9% for syphilis; 11.6% for Chlamydia; 48.8% for “Other” (cervicitis, crabs, scabies, hepatitis A, B, C, etc.); and 9.3% for HIV. ISIS has reportedly received fewer than 10 reports in total from individuals who received the cards in error.

When my boyfriend shared the article with me, I initially balked – how could someone so carelessly shoot off an e-card to let former sexual partners know that they may be infected with an STD requiring medical attention for quite possibly an infection that is ultimately fatal?

Looking deeper into the articles and exploring on inSPOT’s site, two positions are quite clear, as summarized by the quotes below:

“By notifying them – even if it’s done anonymously, even distantly, even with an e-card – the benefits of getting someone diagnosed and treated outweigh the concerns of insensitivity.” – Jeffrey D. Klausner, director of STD Prevention and Control Services, San Francisco (CNN.com)

“It’s such an impersonal way to discuss a highly intimate experience. It seems to me to reinforce that people can continue to be irresponsible and they don’t have any consequences.” – Gail Wyatt, clinical psychologist and psychiatry professor, University of California—Los Angeles, (U.S. News and World Report)

Those in favor of the site and its services note public health organizations’ inability to notify all infected individuals’ health partners as practiced in previous decades. The site also offers another channel to disclose this crucial information for those who would find it impossible to do so in person. Also, with the rise of popular online hookup sites like ManHunt.com, those recently diagnosed with STDs may only be able to connect with their previous partners via online communications.

Those against the site highlight the insensitivity with which personal and possibly life-changing information is shared, while also noting the site’s effect of trivializing the consequences of unsafe sex practices and multiple partners.

In the end, the goal is to communicate information to ensure the health of the public and those possibly infected. Because anonymous online hookup sites and certain people’s inability to have these difficult conversations are present today and will likely remain in the future, I believe inSPOT is providing a communication channel that enhances public health, despite its noted and valid shortcomings.

What do you think about e-cards disclosing the possibility that you might have an STD or HIV? Is it a form of responsible communication or a cheap way out? What messages on sexual health and practice is the site communicating? We’d love to hear your thoughts in the comments below. 

Share | October 27th, 2008 3 Comments »
Tags: Healthcare · Media