"It's not what you brought to the party—it's what you left with." If an electronic postcard bearing this or a similar slogan lands in your E-mail inbox, don't just click it to your trash bin. The message might be a warning that you've been exposed to a sexually transmitted disease.
These free E-cards are part of inSPOT, a peer-to-peer, Web-based system developed by the nonprofit Internet Sexuality Information Services and the San Francisco Department of Public Health to help people face the daunting task of divulging an STD diagnosis to sexual partners. The cards, which say things like, "No one wants to be the bearer of bad news...but I got diagnosed with STDs (You might have one, too)," can be sent to up to six people, anonymously, or they can include contact information with a personalized note. They can be customized for various infections, including gonorrhea, chlamydia, crabs, and HIV. Since inSPOT's launch in 2004, more than 30,000 people have sent more than 49,500 of the cards, and more than 750 people browse the site each day, according to the site's creators, who share an early evaluation of usage in this week's PLoS Medicine. Privacy isn't an issue, since there is no database that stores E-mail addresses or details about senders and recipients. And while misuse by pranksters is a possibility, fewer than 10 recipients have complained since 2004 of receiving a message in error.
"People absolutely need to be told" about STD exposure, says Jeffrey Klausner, director of the San Francisco Department of Public Health's STD Prevention and Control Services, senior author of the new paper, and one of inSPOT's masterminds, "because untreated STDs can lead to complications such as infertility or sterility. This tool makes it very easy for the individual to fulfill that responsibility to tell partners." Notifying partners is key to curbing the continued spread of these infections (there are 19 million STD cases diagnosed in the United States each year, according to the paper) and for ensuring that people who have been exposed can get treated, he adds.
While these cards can be sent to anyone anywhere, recipients living in one of the 10 cities, nine states, and three countries that have contracted with site developers can receive additional helpful information tailored to their geographic location, including maps to local clinics and details about other testing and treatment services in the area. "To be able to hook people up with healthcare resources right after they find out that they've possibly been exposed, that's a great chain of events," says Mary McFarlane, a research behavioral scientist in the Centers for Disease Control and Prevention's Division of STD Prevention.
McFarlane suspects that this kind of tool will prove especially useful now that people are flocking to the Internet for social and sexual interactions. "If there are opportunities for risk online, then we need to have opportunities for help online," she says. In fact, the Internet has been linked to several recent outbreaks of syphilis—a disease that was at one point nearly eradicated in the United States—among men who meet other males online for sex. If people have no other information about a partner than an E-mail address, a service like inSPOT becomes invaluable, says Klausner. Though inSPOT was initially designed for men with same-sex partners, it was extended to everyone in 2006. "It's useful for any sexually active person," says Klausner, who maintains that recipients usually realize that were it not for these cards, they probably weren't going to be told at all.
Not everyone shares the enthusiasm. "To me, this is inhumane. It's such an impersonal way to discuss a highly intimate experience," says Gail Wyatt, a professor in the psychiatry department at the University of California-Los Angeles and a clinical psychologist who counsels patients diagnosed with STDs. "It seems to me to reinforce that people can continue to be irresponsible and they don't have any consequences." It's the easy way out, agrees clinical psychologist Bonnie Jacobson, an adjunct professor in the applied psychology department at New York University. While an E-card may make telling partners less daunting, it may devastate the recipient when the news comes from an anonymous sender who doesn't offer a chance for discussion. "You don't have to listen to [partners] scream and yell and cry and say, 'I hate you,' " says Jacobson. "You don't have to deal with the person's reaction. It's pretty cold." This system runs the risk of depersonalizing sex and the responsibilities that go with it, Wyatt adds.
"The end-goal here is to make sure more people don't get infected and that more people don't end up [with] whatever the consequences may be from not treating themselves, however that information gets transmitted," McFarlane counters.