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Below is the article
Published by www.nytimes.com
Author DAVID TULLER
After Hookups, E-Cards That Warn, ‘Get Checked'
SAN FRANCISCO - Steve, a health care worker in his 30s, had been told more than once that he had been exposed to a sexually transmitted infection. So when it happened again, he was not upset - even though this time he learned about it through an anonymous online postcard, e-mailed by a man with whom he had had sex.
"What was important was that I was being notified that there was a possibility that I may have been exposed to syphilis," said Steve, who asked that his last name be withheld to protect his privacy.
The Internet has made it much easier to connect for sexual hookups. In response, public health officials have been exploring ways to harness the online world for conducting safe-sex education and preventing the spread of sexually transmitted diseases by alerting people exposed to them.
The e-card, which allows the sender to select the disease involved and includes links to public health sites and services, is part of that strategy.
"Notifying the person exposed to a sexually transmitted infection is the critical piece in preventing further spread," said Dr. Susan Blank, New York City's assistant health commissioner for sexually transmitted disease. "And as the reach of the Internet expands for use in finding instant sex partners, we're using that technology as part of the solution."
Along with 10 other cities and 10 states, New York City has been working with inSPOT, the online partner notification system through which Steve, in San Francisco, received his syphilis e-card. The system was developed in 2004 by Internet Sexuality Information Services, a nonprofit agency in Oakland, Calif., with the support of health officials in San Francisco. Deb Levine, the agency's executive director, said two factors in San Francisco led to the idea: the rise in Internet use among men who have sex with men, and an increase in syphilis among that group.
Research indicated that men with a sexually transmitted disease often failed to tell their casual sexual contacts about it.
"They did tell their partners, the people they saw every day, but they didn't take the time to follow up with other people
they were having sex with," Ms. Levine said. "They said to us, ‘If there was an easy and convenient way to do it, we would.'"
In a parallel strategy, some public health departments have established online profiles on popular gay-oriented social network sites.
Through these profiles, self-identified health outreach workers are available to counsel men about safe sex and, when requested by members with a sexually transmitted disease, to electronically notify sexual partners they have met through the site.
David S. Novak, a public health strategist at Online Buddies, a company in Cambridge, Mass., said almost 30 city and state health agencies now had partner notification profiles on its popular gay site, manhunt.
Mr. Novak said that men who met on a social networking site often did not exchange e-mail addresses and therefore could not use inSPOT. Moreover, he said, because public health agencies confirm cases of infection before contacting sexual partners, their involvement reduces the risk that false information will be disseminated. "I think there's room for both approaches,"
Ms. Levine said inSPOT was intended to complement rather than replace the role of public health workers in partner notification, especially for easily treatable illnesses like gonorrhea and chlamydia. Public-health notification programs are aimed primarily at more serious diseases, in particular HIV and syphilis.
Evaluating inSPOT is difficult, since the agency cannot measure whether recipients of e-cards have been tested. And Mary McFarlane, a specialist in sexually transmitted diseases at the Centers for Disease Control and Prevention, said she wondered whether many of those who sent anonymous cards about crabs and scabies were playing pranks on friends. Still, she said, "if people are engaging in risk online, we need to engage in public health online and to make it as usable and feasible as possible."
Dr. Kees Rietmeijer, director of sexually transmitted disease control at Denver Department of Public Health, which is included in Colorado's inSPOT site, said that because in-person partner notification was time-consuming and expensive, it was important to find other ways to communicate. "Having said that," he added, "as far as the effectiveness, the jury is still out. If you have X number of hits on the Web site, we don't really know if that translates to people coming to the clinic to be tested and treated."