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Sunday, Nov 8, 2009
Technically, anyone, anywhere, of any persuasion, could use inSPOT.org's cards. But inSPOT.org was developed to target San Francisco's gay men because of what Klausner calls "an epidemic" of syphilis and other STDs, including chlamydia and HIV. In 1998, Klausner says, there were 10 cases of early syphilis among local gay and bisexual men. Last year, there were over 500. The Centers for Disease Control and Prevention has said that STDs "continue to be a major health threat in the United States," estimating that over 19 million infections occur annually. Syphilis, for one -- while decreasing among women and African-Americans in general -- is on the rise specifically among men who have sex with men, who may account for as much as 60 percent of all early cases reported in 2003.
To be sure, one person with one STD may take some antibiotics and be done with it. But it doesn't work that way for all 19 million infections. While syphilis is curable with antibiotics, when left to its own devices it can lead to organ damage, brain damage, even death; it can also make HIV easier to transmit. Chlamydia is curable as well, but it often presents no symptoms -- and someone who doesn't know he has it can wind up with an inflamed prostate, urethral scarring, even infertility. Also curable but dangerous: gonorrhea, crabs and other bacterial or viral infections. Hepatitis, herpes, human papillomavirus (HPV) and, of course, HIV are treatable but not curable. Like the others, they're most threatening when they go undetected and untreated.
Why the "epidemic"? Research points, in part, to the Internet. Klausner says that more than 50 percent of San Francisco syphilis cases can be traced to encounters that originated online. Back in the day, members of the gay community say, even random hookups were with people you met at bars or parties and would likely run into again. Now there are not only chat rooms and personals sites but also sex parties organized entirely via e-mail list. "These days it's a lot easier to have sexual encounters where you do not know who your partner is," says Knapper. "The virtual world is a lot bigger and more anonymous than the real world." Some have found that compared with people who find partners the old-fashioned way, Internet sex seekers are more likely to have previous STDs, more partners, more anal sex (with a higher risk of disease transmission) and more sexual exposure to HIV-positive partners.
Still, there's no simple blame-the-Internet explanation for the surge in STDs. What happened, for example, to all the urgent life-or-death messages about safe sex? Efforts at HIV awareness in the 1980s seem to have contributed to that decade's decline in STDs. But today, some advocates point to "condom fatigue," suggesting that the "safe sex" message, now 20 years old, sounds very five minutes ago. What's more, AIDS is no longer perceived as the grim reaper it once was. Because treatments for HIV have been successful, the disease is seen as "maybe not curable, but manageable with a few pills a day," Klausner says. "People are not as afraid. Loss of fear can be a good thing, but fear is also a highly motivating factor, especially when it comes to safe sex."
So as the quantity, anonymity and unsafeness of encounters go up, so does the risk of infection. And at the same time, the likelihood that past sex partners will be informed they're at risk goes down.
Standard partner-notification procedure is this: When someone tests positive for an STD, the DPH requests information about who else may have been infected and informs whomever they can (without revealing their sources) via phone, via e-mail or in person. But many patients balk at the prospect, often concerned about putting confidential information, and such personal news, in the hands of a stranger. "Eighty percent of people diagnosed with an STD choose not to give the information to the DPH -- they say 'I'll tell my partners myself,'" says Levine at ISIS. Then shame or denial takes over: Patients often flake out, or never meant to spread the word in the first place. "What we've heard from the community is, 'We tell our primary partners, we may tell our sex buddies, but we do not tell our tricks,'" says Levine. "So here we have 80 percent of people walking out of the Department of Public Health not telling 80 percent of their partners," she estimates. Klausner calculates that as many as 93 percent of people potentially exposed go uninformed.
