Washington Blade - December 26, 2003
Ryan Lee

The federal Centers for Disease Control & Prevention on Dec. 19 highlighted the Web-based approaches of the San Francisco Department of Public Health in delivering safe sex messages in response to a 4-year syphilis outbreak within the city concentrated in heavy numbers among gay men.

"Some studies show that people who meet partners online may participate in more risky sexual behavior," said Jeffrey Klausner, director of the STD Prevention & Control division of the San Francisco Health Department. "And right now because a majority of new syphilis cases are from men who have met online, we had to bring our staff up to speed on how to use the Internet to reach people."

In 2002, gay and bisexual men with early-stage syphilis accounted for 88 percent of the 495 reported cases in San Francisco, a spike from 22 percent of the 41 cases reported four years earlier.

To determine what role the Internet played in feeding the rise of syphilis among gay men, researchers collected information from 415 of the gay and bisexual men who were diagnosed with early syphilis in 2002.

Those men reported a combined 6,482 sex partners during the period in which they may have acquired syphilis. The Internet proved to be the most common venue for meeting sex partners: Nearly 33 percent of hook-ups resulted from online meetings. Bars accounted for about 21 percent of hook-ups among the men, with bathhouses and sex clubs ranking third and fourth, respectively.

Of those gay and bisexual men in San Francisco who have syphilis, some 37 percent met sex partners online in the last half of 2002, compared to 12 percent during the first six months of 2000.

Data from January through April of 2003 shows that 44 percent of the gay and bisexual men with early syphilis sought sex partners online.

But just as the Internet facilitates easy sexual hook-ups, it also establishes a new paper trail of a person's sex partners, Klausner said.

"The patients do usually have an e-mail address, or screen name or some piece of identification that would assist us in notifying people that they may have been exposed," Klausner said.

For gay or bisexual men who meet sex partners at a bathhouse or sex club, there is often little information available to contact partners of men with STDs, he added.

The San Francisco Department of Public Health created a set of guidelines to help health agencies use the Internet to contact potential sex partners. The guidelines are intended to ensure prevention messages protect confidentiality and aren't discarded as spam or junk mail, two impediments to online prevention, health officials said.

The guidelines include encouraging the original patient to notify his sex partners before a health agency does, using subject headings like "Urgent Health Matter" and using credible e-mail accounts - like ones that end with .gov - to deliver messages.

Online support

On Dec. 19, the National Coalition of STD Directors called on Internet Service Providers to help curb the spread of STDs through online hook-ups. Health officials must reach out to the companies just as they did with bar and bathhouse owners, but prevention efforts will only be effective if the service providers are willing to cooperate, according to the coalition.

"The Internet has the potential to increase the spread of HIV and STDs, but also has unique characteristics which, if we take advantage of them, can help reduce transmission," Theresa Raphael, executive director of the National Coalition of STD Directors, said in a prepared statement.

The coalition, established in 1997, includes some 65 directors of public health STD programs across the U.S. The group praised Web sites - like www.safesexcity.com - that promote safe sex.

The degree to which service providers participate with health researchers varies, according to Klausner, ranging from Gay.com being "very cooperative and supportive" to AOL being "quite obstructive and not so helpful."

"Ideally researchers would like to work more together [with service providers], and perhaps we need to find legal ways to make the companies take some responsibility and provide care for those they do business with," Klausner said. "All the feedback we've gotten from the people we contact online has been extremely positive.

"People are surprised to learn about the resources that are available out there, and they're appreciative," Klausner said. "I think the businesses fail to appreciate that, or recognize that."

On Tuesday, an AOL official took exception to the company being labeled "obstructive." The company has posted CDC banners in chat rooms and includes STD prevention information in its health section, according to Nicholas Graham, an AOL spokesperson.

"I vigorously dispute [Klausner's] assertion," Graham said. "We feel we have done what is necessary, what is appropriate and what is possible for us to do. It's important to know that we have worked with the CDC with issues relating to public health."

In late 2001, Klausner was criticized after a Congressional aide said he urged Virginia to use its "public health powers" to shut down the online chat rooms of the Virginia-based AOL.

Klausner denied asking AOL to close gay chat rooms, and said he asked them to post warnings about a syphilis outbreak inside a chat room for gay men in gay San Francisco, which AOL declined to do.

The CDC, in its Dec. 19 issue of Morbidity & Mortality Weekly, said the health agency has been working with Internet companies and community-based organizations to coordinate Web-based STD prevention and research efforts.

The agency announced in July that it was accepting grant applications from researchers who use the Internet to deliver safe sex messages to gay and bisexual men. But a CDC spokesperson did not respond to an interview request this week requesting how much money has been set aside for the grants.

Klausner and gay health advocates said it is vital that public health funding follow current trends.

"Given that this is a new and emerging field, there's no, or few, proven Internet prevention strategies," said Russell Westacott, assistant director for the Institute for Gay Men's Health at the New York Gay Men's Health Crisis. "That's what CDC is looking for."

Connie Smith, director of social marketing for the Atlanta-based National AIDS Education & Services for Minorities, said the agency uses the Internet to direct men of color to safe sex messages, with mixed results. Still, she said Internet prevention efforts must be expanded.

"The Internet is an extremely powerful tool, and we have to target it," Smith said. "It is the new dating service for a lot of individuals who find technology gives them the freedom to speaks openly about sex."

031226
WB031209

Always watch for outdated information. This article first appeared in 2003. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2003. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .