The Washington Blade - September 10, 1999
Kai Wright

It started back in early July, when the San Francisco health department's division of STD Prevention and Control discovered a syphilis transmission between two Gay men who had a sexual encounter after meeting in an America Online chat room. The men had met and engaged in sex with several other men they met in the same chat room, but each knew only the online aliases of those other sexual partners.

San Francisco public health officials asked AOL to identify the additional men from the chat room believed to potentially be infected with syphilis. AOL, holding to its strict policy of refusing to release information about its members without a court order, declined to match the aliases with real names.

Instead, the company put public health officials in touch with a Gay Internet company, PlanetOut. PlanetOut helped public health officials devise a plan to track down the additional cases without compromising the men's online privacy and, according to PlanetOut, without causing unnecessary panic about the safety of the chat room. Using the plan, officials found six more syphilis infections and conducted STD prevention counseling to countless potentially infected Gay men in the chat room.

In August, the press heard of the project and, much to PlanetOut chair Tom Rielly's dismay, the story about 'syphilis spreading between Gay men meeting in chat rooms' exploded -- complete with startling accounts of how many sexual partners the men had met in the chat room in recent months.

"It's not about Gay men and syphilis -- and Gay chat rooms are cesspools of disease," a frustrated Rielly said this week. "We had to try to frame it as a public health [innovation] story."

To San Francisco's STD Prevention and Control Chief Jeffrey Klausner, it isn't so much a public health story as it is an example of how things are, ideally, supposed to work in public health.

When Klausner first realized that an AOL chat room was the link between two new syphilis cases, he thought he had a problem. Normally, in an effort to get newly infected people into treatment and prevent further spread of the disease, Klausner would have gone into "the field" to find and notify sexual partners identified by the two men who tested positive. He would send letters to those he had names for. To alert those he couldn't identify, he would put up STD alert fliers in public areas known to attract men looking for sex or in public venues where the sexual partners met. But in this case, there was no park or public venue, at least tangibly.

"The 'field' had moved from the tangible landscape to cyberspace," Klausner explained.

So public health officials went to AOL. But AOL refused to release the names of the men Klausner was looking for, and, according to PlanetOut's Rielly, the company was unsure how to handle the situation. Last year, AOL was at the center of controversy when a staffer violated the company's privacy policy by releasing the name of Navy officer Timothy R. McVeigh to military investigators who were attempting to prove he was Gay so they could discharge him. This time, AOL called PlanetOut for help. The chat room in question was not a PlanetOut chat room, but AOL does hold a minority stake in PlanetOut.

Rielly and his staff helped public health officials craft an electronic message that did not appear to be "spam," or electronic junk mail, which they were then able to send to the e-mail addresses of the aliases identified as people potentially infected with syphilis. Using this system, public health officials were able to identify six more people in the chat room who were infected.

Klausner stressed that public health officials never learned the names or identifying information of the people they contacted until those individuals provided them. Moreover, he said, he didn't need to. The cyber version of the partner notification program, he said, worked the way public health officials would prefer all partner notifications to work -- anonymously. In most cases, that's not possible, he said. In cyberspace it was.

The next part was more revolutionary, however. Rielly agreed to train around 60 PlanetOut volunteers to discreetly "enter" the AOL chat room where the people with syphilis had met each other, offer STD prevention messages, and encourage anyone having sexual relations with people in the room to go in for testing.

"[It was] outreach that we would normally do if we were on the street," Klausner explained.

David Pasquarelli of ACT UP/San Francisco, which has lobbied public health officials to reopen bathhouses in the city, charged PlanetOut and public health officials with creating an unnecessary panic about the dangers of sex between men and meeting people in chat rooms to arrange for sexual encounters. But Rielly says the project was quite low-key and merely notified people of a potential risk.

In addition to PlanetOut's efforts in the chat room, Klausner issued a "syphilis alert" to STD clinics in the area, notifying them of the eight new cases found in the chat room and asking them to keep an eye out for more. The department also ran an ad in the Bay Area Reporter, a Gay newspaper, encouraging Gay men to seek a syphilis test. As a result of all the attention, Klausner said, the number of Gay men seeking STD tests in the area since the beginning of August has roughly doubled. Public health officials have uncovered no new syphilis cases, however.

There did appear to be some backlash to the media attention, though. According to a San Francisco Examiner story, people have been entering the chat room and harassing participants with anti-Gay rhetoric. Rielly said his staff was in the room during one such incident and that PlanetOut and AOL have set up an alternative chat room for regular visitors to use until the media attention dies down.

"The point was not to have all of this media frenzy," Rielly said this week, sounding exhausted from taking phone calls on the topic. He said, ultimately, PlanetOut, AOL, and public health officials were simply figuring out how to walk the same line between public health needs and privacy concerns in cyberspace that the Gay and AIDS communities have been navigating for decades.

"I think we walked that line pretty OK," Rielly concluded.
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