You’re at the
GUM clinic for a check-up and have just been told you have a sexually
transmitted infection (STI). You’re ushered in to see the health adviser. Maybe
you’re embarrassed, maybe you’re in shock from the news of an HIV diagnosis;
either way, you only half-hear them saying “...it’s a good idea to contact people
you’ve had sex with recently and let them know. One of them infected you and
may not know it, and others may have caught it; they’d want to get a check-up
You know this
is the right thing to do, but it’s scary.
reassure the adviser you’ll contact the two people you’ve mentioned (she
doesn’t need to know about the other five), but know you won’t. Clutching your
prescription, you exit guiltily...
Which would be
a pity. Contact tracing is one of the most efficient ways of detecting STIs. An
audit at London’s 56 Dean Street clinic in July 2010 found that the rate of HIV
diagnosis in men who have sex with men (MSM) referred by a sexual contact was
23%, significantly higher than the estimated prevalence of HIV amongst MSM in
London (about 10%).1 Contact tracing may also be a good way of
detecting recent infections.
Now there’s an
alternative. The gay men’s health charity GMFA is piloting an STI notification
scheme – the Sexual Health Messaging Service (SHMS).
SHMSs are a
new idea in the UK, but launched
in the US in 1999, after a
sudden upsurge in syphilis cases in gay men in San Francisco. Public health workers found
that the only means many men had of contacting partners was through their
online profile name. A collaboration with a dating website enabled the scheme
to contact 40% of the named partners of men diagnosed with syphilis.2
An SHMS does
the partner notification for you. In GMFA’s scheme, if you know your partner’s
email address, mobile number or profile name on one of four gay men’s dating
sites (Manhunt, Fitlads, Gaydar or Recon) and the dating app Bender, it can
send an automated message that you’ve been diagnosed with an STI and they
should get a check-up. You can be anonymous, or identify yourself but let the
system decide what to say.
Heath found that: “A lot of people I talked to at first said ‘You can’t do
that’.” But after he explained how it would work, many clinics and potential
users came round.
“is a hybrid of two approaches”. US services have varied from open-access
systems not even requiring proof of diagnosis to ones where messaging is done
by health advisers.
inSPOT (www.inspot.org) is an open-access messaging system
developed in San Francisco in 2004, now covering
the US and Canada. You could in theory use it
anywhere, though there is only referral information for these countries.
illustrated e-cards to your contacts, bearing the heading “From a concerned
friend”. A typical one reads: “It’s not
what you brought to the party, it’s what you left with. I left with an STI, you
might have too. Get checked out soon” and directs them to inSPOT. You can
be on-record or anonymous.
A 2006 report3
showed that 16,000 e-cards were sent (over 75% anonymously) to 26,000
recipients in 2005; 38% of recipients sought more information.
The snag with
inSPOT is that anyone can access it, so it lends itself to stag-night pranks.
Donal says: “Though inSPOT seems well used, a lot of bogus messages have been
approach is a collaboration between clinics and the gay dating site Manhunt.
Here there’s no direct contact, even anonymous and net-filtered, between
patient and recipient. Health advisers from clinics and voluntary organisations
put up their own profile on the site and do the messaging when someone is
“It seems to
have been quite successful; what’s great about this approach is that recipients
of messages can reply and ask questions of the health advisers,” says Donal.
But so far there’s not a lot of evaluation data.
resource-heavy in these austere times. One problem is that this approach still
relies on the patient telling the truth about who they’ve had sex with. There’s
also the matter of people’s contact names. “It might feel OK to tell the
adviser about Niceguy42, but Rawfukka42 less so.”
compromised between the two systems. You can only get on the system if you have
a diagnosis and are given a unique ID and PIN; then you can contact people
yourself by logging in to a secure website address - delivering messages as an
email, an SMS text or a dating-website message. The four-stage process feels
familiar to anyone who’s shopped online.
The subject of partner notification will still have to be handled with skill and sensitivity, but this provides one more option. Donal Heath, GMFA
You don’t have
to specify your STI diagnosis (people may be scared of disclosing the more
serious STIs like HIV) but GMFA’s own research found that recipients were much
more likely to seek help if they were told, and more likely to respond to named
rather than anonymous informants.
Then you add
the contact details of your sexual partners and specify the messaging method.
Messages are tailored to the specific medium. Typing in a profile name will
pull up the profile so you can check you’re messaging the right person. You
then preview your message, tick boxes to say you understand the terms and
conditions – just like internet shopping – and send. You can also ask your
clinic to do it for you.
Donal sends a
test SMS to my phone. A couple of minutes later my phone pings and the
following message arrives, from ‘gmfaNoReply’: “Someone you had sex with has been diagnosed with an STI. We advise you
to get checked at a GU clinic.”
notification contains a reference number and a web address to contact a clinic
for a fast-track service. This reference is anonymous but detects that someone
has responded, enabling clinics to measure the effectiveness of contact
tracing. You or your clinic can also use it to tell the system about a check-up
and any treatment. If people don’t respond, they get one reminder message.
The project is
a pilot, provided by seven GUM clinics in London,
Brighton, Sheffield and Manchester,
and relatively few people have used it so far.
a proportion of people for whom the SHMS is the ideal thing,” says Donal. “In
some cases it’s not the right thing:
for instance, if you are diagnosed with HIV and need to contact someone so they
can get post-exposure prophylaxis (PEP).”
have been cautious about their users’ possible reaction to getting unsolicited
STI warnings. On Gaydar and Recon you have to specifically allow messages from
GMFA. Gaydar is about to launch a publicity drive about the messaging service
and will have a button on your profile to allow messages. If the pilot is a
success, there are plans to expand it.
system can’t make partner notification completely painless. One study of gay
men, two-thirds of them with HIV, commented that several with HIV “felt too
consumed by their own thoughts and fears to consider engaging in partner
notification”.4 Equally, as Donal says, “People say they want to be informed, but finding out that you might have
been in contact with an STI can blind you… Partner notification is a no-brainer,
but where STIs are concerned emotions still have the power to overthrow logic.”
of partner notification will still have to be handled with skill and
sensitivity,” concludes Donal, “but this provides one more option.”