Sifting through your e-mail inbox, you see the subject line “e-card from a concerned friend.” The address is getchecked@ inspot.org. You've become skeptical of e-mails from “a friend,” but the “get checked” part won't let you ignore it—so you click.
“I got screwed by screwing,” the anonymous e-card informs you. “You may have too. Get checked for gonorrhea.”And that's it. How do you feel? And, more important, what are you supposed to do now?
InSPOT.org launched its anonymous e-card program in 2004. Since then, more than 50,000 messages have gone out to people in eight U.S. cities, including Los Angeles and San Francisco. The service started in San Diego this past July. Terry Cunningham, chief of the HIV / STD / Hepatitis division for the San Diego County Department of Public Health, said the launch was purposely timed to coincide with San Diego's Gay Pride Festival because rates of STDs among gay men are on the rise. The number of syphilis cases, for instance, have jumped from 24 in 1998 to 345 last year (the number for 2008 is expected to be even higher). Gay men account for 84 percent of these cases, Cunningham said.
While inSPOT isn't strictly for gay men, that's the population its creators had in mind.
“Gay men were early adapters of the Internet and technology,” said Deb Levine, executive director of Internet Sexuality Information Services (ISIS), which started inSpot. “We knew there was an opportunity,” Levine said. The site was a response to a rapid rise in syphilis among gay men San Francisco, she said. At the time, Evite—the e-mail invitation service—was becoming popular, and ISIS used the site as a model for its own.
It works like this: Users choose a card and either write in a personal message of their own or select from a drop-down list of STD-specific messages, then enter up to six e-mail addresses for recipients and simply click “send.” The whole process can take less than one minute. When the e-card's recipient goes to the inSPOT.org site, he or she can get information on where to go for low-cost or free STD screening and also find out about symptoms, treatments and safe-sex tips.
Levine said ISIS conducted research and found that while gay men are open about STDs with primary partners and significant others, they tend to keep casual sexual partners in the dark.
“If you have a laundry list of things to do, going back to XYZ bar at 10 p.m. to tell someone that they might have an STD or symptoms drops down the list,” Levine said.
In the realm of STDs, awareness is key, especially with syphilis. If someone tests positive for the disease, it can be easily cured with a shot of penicillin. But, left untreated, syphilis can cause brain damage and organ failure.
Compounding matters, the Centers for Disease Control and Prevention (CDC) said in a 2006 report that gay men infected with syphilis have been documented to have high rates of HIV co-infection and tend to engage in high-risk sexual behavior.
Funding for the program comes from the state Department of Public Health's STD Control branch, which receives some of its funding from the CDC. Cunningham said there's been an outreach campaign to inform the public about inSPOT through ads on bus-shelter posters, in magazines and newspapers and on billboards. He said the program costs about $10,000 annually, with a first-year start-up cost of $42,000.
“InSPOT has been proven to be successful in San Francisco, Los Angeles and New York, and we decided we needed to get on the bandwagon,” Cunningham said.
So far, he's received positive feedback about the program.
“We get more hits every week,” he said, noting the 500 visitors the site received in August.
Since its launch, more then 30,000 people have used inSPOT to send e-cards to nearly 50,000 others, Levine said. Getting duped by an angry ex or a friend with a twisted sense of humor is possible but not likely—Levine said that only a handful of people have reported getting an e-card in error.
In Hillcrest, on the corner of Sixth and University, where an inSPOT billboard was up until recently, opinions on the website varied.
“I think it's a brilliant idea,” said Nicholas Nelson. “I'm all for [it] because, especially in our community, it's an important thing. Any way to promote positive ways of disclosing that kind of information.”
Others said it's too impersonal and that avoiding face-to-face disclosure is irresponsible; one man called it a “chicken-shit” way of handling the situation.
Gwen, who preferred not to provide her last name, said the program is good as a last resort for people who would otherwise not tell their partners, though she thinks it'll encourage people to take the easy way out. “Even if they could confront their past partners, they probably wouldn't, just because they know there's an easier, more synthetic way of doing it,” she said.
“That's a difficult conversation to have,” said Raphael Acevedo, co-founder of San Diego Young Positives, a social group for HIV-positive men. When it comes to confronting past partners, there are a “myriad of reasons” people choose not to, he said. Acevedo notes that people have different ways of coping with information they feel makes them look like they acted irresponsibly. He thinks the idea behind the website is a good one, as long as it encourages people to “do the right thing” and convey information to one another.
Levine makes it clear that the cards and the site are not a replacement for a comprehensive public-health outreach program or frank discussions between sexual partners. Rather, it's “another tool in the toolbox,” she said.
Levine plans to take inSPOT national by February 2009.