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Governments weigh e-mail warning service for gay men with STDs

WASHINGTON—Local governments in the United States and abroad are moving to adopt a new e-mail service that gay and bisexual men with sexually transmitted diseases can use anonymously to warn former partners of possible exposure.

Thousands of people have used inSPOT.org to notify up to six partners of their risk with one of six e-cards such as "It's not what you brought to the party, it's what you left with."

Users don't have to provide their e-mail addresses or names, and each e-card has a space for personalized messages.

The cards include maps of community health resources where recipients can get tested.

InSPOT, for Internet Notification Service for Partners or Tricks, is designed for San Francisco—the map lists only health resources in the Bay Area—but it's attracted attention nationally and overseas.

California is expected to launch the service statewide before Labor Day, according to Deb Levine, the executive director of Internet Sexuality Information Service, which launched inSPOT last October.

The Indiana State Department of Health recently signed on to take the program there. Last week, the Mazzoni Center, a Philadelphia group that's dedicated to helping sexual minorities, and the Philadelphia Health Department agreed to conduct focus groups to discuss adopting the service and expanding it to include heterosexuals. An international nongovernmental organization has agreed to replicate the service in Romania, according to Levine. Officials in Florida, Maryland, New York state and British Columbia have expressed interest.

The biggest obstacle to providing the service outside San Francisco isn't money but personalizing the cards and Web site for specific communities.

It will cost those groups $20,000 to adapt the service to their communities and an additional yearly maintenance fee to run the site, Levine said. InSPOT got its funding through a grant from the San Francisco Department of Public Health.

Because the goal is to educate people and help them get tested, Levine doesn't frown on heterosexual men and women using the service. But they should be aware that some services on the Web site and e-card are designed for gay and bisexual men.

"What we would really like to know is if these folks are going back in to get testing," Levine said.

The service comes at a time of renewed worry about the spread of STDs and HIV, the virus that causes AIDS. There are now more than 1 million Americans living with HIV, the most since the height of the epidemic in the 1980s, according to a report that the Centers for Disease Control and Prevention released last week.

There's little data regarding the transmission of STDs through contacts made online because of a lack of national comprehensive studies, but clinic workers in major cities have estimated that as many as 30 percent of gay men recently infected with STDs think they were exposed through partners they met online.

"Men finding men on the Internet for sex is actually considered on the rise, and it is a scary trend," said Nestor Rocha, a division director for prevention and health promotion at the Whitman-Walker Clinic in Washington.

The rise of anonymous online hookups has made notification more difficult. Sometimes men know only a partner's e-mail address and a meeting location. How do you tell someone whose name you might not even know that you may have given him an STD?

"It just made sense to have an online solution to an online problem," said Tom Kennedy, the communication director for Internet Sexuality Information Services.

Some health practitioners have expressed concern that the e-mail system could be abused.

Unlike most telephone and online partner notification programs around the country, inSPOT can be used anonymously, so there's no way for recipients to know whether the e-mail is legitimate or from a prankster. The program also doesn't require users to prove that they've tested positive for STDs.

Beau Gratzer, the director of men's health at Howard Brown Health Center in Chicago, said the service shouldn't necessarily be shunned because of the possibility of abuse.

"In many respects the worst thing that can happen is that someone can get tested for STDs," he said.

The service's level of automation and the fact that there's no way to gauge inSPOT's effectiveness also worries some health workers.

Mary McFarlane, of the CDC's division of STD prevention, said the national STD-prevention community was cautiously optimistic about the service. She warned, though, that it must adjust to each new community and provide as many human connections as possible to be truly effective.

"It is important at some point out there to have a human being," McFarlane said. "They need to know where there is a human to talk to."

Rocha, of Whitman-Walker, expressed the same concern for the unwitting recipient of an inSPOT e-mail.

"What I would be concerned about is people's reaction," Rocha said. "We have to consider that it can be detrimental" emotionally.

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(c) 2005, Knight Ridder/Tribune Information Services.

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