Utilizing the Internet for Partner Notification Patti Constant, MPH STD & HIV Section Infectious Disease Epidemiology, Prevention & Control Division Minnesota Department of Health

Outline Why use the internet for partner notification Establishing a protocol How to use screen names & for partner notification

Why Utilize the Internet for Partner Notification? Useful tool -Meet that way, locate that way May locate otherwise unidentifiable individuals -Internet can increase anonymity -Travel/OOJ’s -Cluster example

MSM Cluster Example June 2002-May men who have sex with men 202 total disease events 79 separate infections -46 cases of HIV/AIDS -24 cases of primary, secondary, or early latent syphilis -7 cases of gonorrhea* -2 cases of chlamydia* 120 partners 3 suspects/associates (not direct partner) *GC/CT cases found in connection with an HIV/Syphilis case, no record search

syphilis HIV chlamydia gonorrhea Tested and/or preventatively treated unable to locate refused testing Internet Use in a Cluster of HIV, Syphilis, Gonorrhea, and Chlamydia Uses internet to meet sexual partners DIS contact via Internet successful DIS contact via Internet unsuccessful OOJ internet

Cluster Internet Use 108 (61%) report internet use for meeting partners Only / screen name to locate 50 (46%) of the (60%) contacted via -13 (26%) did not respond to attempted contact -7 (14%) sent to other states none of which would contact partners with only /screen name Internet use most likely underreported -Not reported by patient -Not asked/reported by DIS (case risk factor list recently revised)

Of the 30 we reached via , what difference did it make? 30 people notified who were otherwise unidentifiable -8 tested for HIV (negative at time of test) -9 tested & preventatively treated for syphilis -2 tested (negative) & preventatively treated for GC -7 became aware of exposure but unable to verify testing/results -4 previous positives received prevention info/counseling

Establishing a Protocol for Partner Notification via Internet Support of key players Collaborated with Human Resource Management and IT Developed a procedure to ensure employee safeguards and client confidentiality -DIS log visits to sensitive sites (example attached) -Establish clearly defined message that does not include health specific information -All s typically sent from Health Department validity, credibility

Procedure Protocol: Don’t send any message to any client via or internet that says any more than the below. These tools are not secure and anybody can read these messages -must speak via telephone or in person message -“Hello, My name is ____ and I work for the Minnesota Department of Health, I have important information that I need to speak with you about as soon as possible. Please contact me at ###-###-####”

How to find people when all you have is a screen name Verify which site screen name is from -gay.com, barebacksex.com, aol.com, men4sexnow.com, etc. Establish account or profile (if necessary to search) -Make up a general profile (my outintwincities.com profile attached) -Clients will typically NOT see/know this information -Did NOT use made up profile/ to communicate unless unavoidable Search for screen name/profile (examples attached) -Profiles usually include: photo, physical description, area they live, some include a personal or website link, and personal info

Considerations when all you have is a screen name Some sites: screen name = address -Screen name “pconstantly” on gay.com receives sent to -To verify, send test s from work to made up profiles If screen name isn’t an address -Send from made up profile but immediately identify yourself & clarify purpose May utilize multiple sites or screen names May change screen name / profile frequently

Important Information to Obtain From Original Patient What site they met on Seen on any other site/any other screen name Descriptive information Where they met for sex Area/state partners live -Could OP be ‘outed’ by a contact from DIS area code/region?

When Sending Send at least three messages -Send to multiple accounts if possible -Change message/subject each time so as to not look like a form or solicitation Subject Line -Stress importance/urgency (‘important personal matter’) -Make it personal (‘2 nd attempt, this is urgent’)

Response to Attempts May require 2-3 s or to multiple accounts -May not check accounts frequently -May not realize they have available on some accounts -May think it’s bulk /solicitation/spam May back & question further -Respond / clarify that you must speak with them -Stress importance without providing specific health information

When They Call Verify identity as with any other notification -Get name & date of birth - /screen name -Sole user of that account? -Utilize physical descriptors, etc. May be aware you only have their / screen name -May be less free with information (name, doctors, etc.)

Even if they don’t respond to attempts, they know the Health Department is trying to reach them and may seek medical care on their own

Lessons Learned Every interview should include questions about internet/screen names A well defined procedure for internet notification makes it secure for both clients and DIS The internet is an extremely useful tool when used in conjunction with traditional investigative tools Must be professional yet personal and persistent

For further information, contact Patti Constant