inSPOT.org: A unique online partner notification system Deborah Levine, MA Internet Sexuality Information Services, Inc., San Francisco, CA Jeffrey D. Klausner, MD, MPH, Charlotte Kent, PhD, Katherine Ahrens, MPH, Kate Scott, MPH San Francisco Department of Public Health STD Prevention and Control, CA

Formative Research Developed in response to the rise in syphilis among MSM in San Francisco Developed in response to the rise in syphilis among MSM in San Francisco Focus groups of target population found: Focus groups of target population found: 1) Pre-AIDS vs. post-AIDS mentality towards STDs 2) Always tell partners about STDs, but not always hookups, f* buddies, etc. 3) Would tell casual sex partners if there were an easy, anonymous way

The Project Developed with a CAB of MSM; extensive usability testing in the Castro Developed with a CAB of MSM; extensive usability testing in the Castro Launched in October, 2004 to national media acclaim Launched in October, 2004 to national media acclaim Simple mechanics and design: Simple mechanics and design: –Tell Them –Get Checked Cards can be sent anonymously or from an address to up to 6 people Cards can be sent anonymously or from an address to up to 6 people –Drop down menu of STDs –Personal message optional No back-end database No back-end database Quickly gained community trust & support Quickly gained community trust & support

Enhances Existing Partner Services inSPOT does not replace traditional STD partner notification, PCRS or contact tracing inSPOT does not replace traditional STD partner notification, PCRS or contact tracing inSPOT does help self-referrals follow through on their own inSPOT does help self-referrals follow through on their own

Sample eCard

Use statistics 750 people visit the site each day 750 people visit the site each day 30,000 ecards have been sent to 49,500 recipients from SF site 30,000 ecards have been sent to 49,500 recipients from SF site Factoring for media coverage, curiosity, etc., an estimate of 250 ecards are sent for the intended purpose each month Factoring for media coverage, curiosity, etc., an estimate of 250 ecards are sent for the intended purpose each month –80% of ecards are sent anonymously –80% of ecards include a personal message >36% of people receiving ecards click-through for more info about STDs and testing sites >36% of people receiving ecards click-through for more info about STDs and testing sites

Number of InSpot ecards sent by month, 2005

Marketing Billboard in the Castro for one month Billboard in the Castro for one month Banner ads on Gay.com, Manhunt.net, Adam4Adam, Sex4HotMen, Tweaker.org, etc. Banner ads on Gay.com, Manhunt.net, Adam4Adam, Sex4HotMen, Tweaker.org, etc. Palm cards, postcards and stickers Palm cards, postcards and stickers Newspaper articles, press conference Newspaper articles, press conference Links on other websites and search engine optimization Links on other websites and search engine optimization National and local conferences National and local conferences Staff trainings for STD clinic and local CBOs Staff trainings for STD clinic and local CBOs Direct contact with local physicians Direct contact with local physicians

Evaluation Street intercept surveys Street intercept surveys Provider surveys Provider surveys Online surveys Online surveys Anecdotal data from DIS Anecdotal data from DIS

Street Intercept Surveys Convenience sample of 833 gay and bisexual men interviewed between March and December % knew what inSPOT was 19% knew what inSPOT was 2% had received an e-card 2% had received an e-card 4% had sent an e-card 4% had sent an e-card 73% said, if diagnosed with an STD, would consider sending an anonymous e-card 73% said, if diagnosed with an STD, would consider sending an anonymous e-card

Those 19% heard of inSPOT in various ways

Provider Surveys 150 surveys mailed to HIV providers in San Francisco; 46 (31%) returned surveys 150 surveys mailed to HIV providers in San Francisco; 46 (31%) returned surveys –26% had heard of inSPOT –9% had referred patients to site 84% would do so in the future 84% would do so in the future –74% agreed that palm cards were best way to give patients the information

Online Surveys Two week survey in April 2006 Two week survey in April 2006 Convenience sample Convenience sample Links posted on inSPOT portal, City Clinic website, HookingUpOnline.org, and Yahoo! Health Links posted on inSPOT portal, City Clinic website, HookingUpOnline.org, and Yahoo! Health Banner ads on Gay.com – SF only Banner ads on Gay.com – SF only

Characteristics of online survey respondents N=317 Mean age= 31 years, (18-55+) Mean age= 31 years, (18-55+) 64% female; 36% male 64% female; 36% male 48% Caucasian; 26% African-American; 11% Latino; 15% other 48% Caucasian; 26% African-American; 11% Latino; 15% other 33% spend hours/wk online 33% spend hours/wk online 14% spend more than 30 hours/wk 14% spend more than 30 hours/wk

Online surveys 13% knew what inSPOT was 13% knew what inSPOT was 3% had sent an ecard 3% had sent an ecard 3% had received an ecard 3% had received an ecard 65% of total respondents said they would consider sending an anonymous ecard if they were diagnosed with an STD in the future 65% of total respondents said they would consider sending an anonymous ecard if they were diagnosed with an STD in the future

Those 13% heard of inSPOT in various ways

Sites where recipients got an STD test N = 13

DIS experience We interviewed a guy who was Dx with secondary syphilis. He had received an anonymous card through InSpot informing him that he had been exposed. "Our patient's partner got an anonymous notification through inSpot that he had been exposed to syphilis and contacted our patient. Our patient immediately went to SFcityclinic.org for information, got tested at STDtest.org; had a reactive test and came to City Clinic for treatment. The power of the Internet age…"

Expansion December 2005, HIV mini-module added December 2005, HIV mini-module added December 2005, prescriptions made available online for gonorrhea and chlamydia treatment for recipients of e-cards notified of possible exposure in SF (online expedited partner therapy) December 2005, prescriptions made available online for gonorrhea and chlamydia treatment for recipients of e-cards notified of possible exposure in SF (online expedited partner therapy) March 2006, inSPOT portal launched, including Los Angeles, California, Indiana, and Romania March 2006, inSPOT portal launched, including Los Angeles, California, Indiana, and Romania By mid-summer, Chicago, Portland, Philadelphia, Colorado, Massachusetts, and Seattle will be added By mid-summer, Chicago, Portland, Philadelphia, Colorado, Massachusetts, and Seattle will be added COMING SOON: Expanded STD info for all sexual orientations (as per focus groups in SF, IN, and Philadelphia) COMING SOON: Expanded STD info for all sexual orientations (as per focus groups in SF, IN, and Philadelphia)

Internet Sexuality Information Services Mission To create innovative high-tech solutions for sexual health education and HIV/STD prevention Bay Area-based with national and international projects

Other ISIS Projects

Special Thanks Jeffrey Klausner Jeffrey Klausner Charlotte Kent Charlotte Kent Katherine Ahrens Katherine Ahrens Kate Scott Kate Scott Giuliano Nieri Giuliano Nieri Jaime Lebrija Jaime Lebrija The Stop AIDS Project The Stop AIDS Project Magnet Magnet

Contact Information ISIS, Inc th Street, Suite 1511 Oakland, CA www.isis-inc.org © 2006 ISIS, Inc.