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“There’s no easy way to say this. . .”

A Health in Action paper published in PLoS Medicine recently describes the success of an innovative project called inSPOT – an e-card notification system that enables people who have been diagnosed with a sexually transmitted disease to inform their sexual partners that they may also be at risk.

Whilst news coverage reveled in the dark humour of some of the cards (“Roses are red, violets are blue. I’ve got the clap, and you may have too”, said The Times), it recognized that an easy and anonymous way of informing casual sex partners can help circumvent the stigma and embarrassment attached to sexually transmitted diseases and spread awareness of possible infections.

“We know inSPOT works,” Dr. Jeffrey Klausner, one of the authors of the paper, told the Washington Post. “I see patients, they come in and say they’ve been notified [about having an STD], and their contact is through inSPOT.” And as the Scientific American noted – with one of the e-cards illustrating its report – the e-cards provide specific and up to date disease information: 15.4% of the e-cards were sent for gonorrhea, 14.9% for syphilis, 9.3% for HIV, 11.6% for chlamydia, and 48.8% for other STDs. Given that 19 million new STD cases are diagnosed annually in the United States, this information is desperately needed.

In their evaluation of the project, which was conducted in 20 health jurisdictions in the United States, the authors analyzed rates at which e-card recipients clicked a link embedded in the card that connected to STD information, a map of local testing sites, and links to online resources. Of e-cards sent since December 2005 the “click-through” rates averaged at 26.8%, ranging from 20.4% in Los Angeles to 48.2% in Idaho, resulting in 29,137 people accessing STD testing information as a result of receiving an e-card.

Coverage in CNN and the Daily Telegraph report on the variety of styles that cards can be sent in: from the direct and serious (“Who? What? When? Where? It doesn’t matter. I got an STD; you might have it too”) to those that use puns to catch the attention of the recipient (“I got screwed while screwing, you might have too”). College students across America at Vanderbilt, Northwestern, USC and Yale discussed the merits of the inSPOT website. And in case you were wondering about the site’s susceptibility to pranks, the LA Times health blog quotes the authors as saying “while we prepared for the possibility of misuse…fewer than 10 recipients have reported receiving a card in error.”

The coverage was so extensive one could even speculate that the e-cards were being sent from news organization to news organization. CNN International’s story ranked as the most emailed and fifth most viewed story on October 21st. It quoted the authors to explain that the traditional system of notification through the public health department was struggling:

“Resources of the health department have been decimated. They don’t have the capacity to do that kind of notification anymore. We needed to come up with something to serve the needs, to notify, that would be used and have an impact.”

The authors believe the inSPOT website can have an international impact. It has been translated into Romanian and French, and will soon be available in Spanish as well.

Andrew Hyde, Darcy Gill, Nisha Doshi

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