Utilizing the Internet for Partner Notification

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

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

3. 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

4. MSM Cluster ExampleJune 2002-May 2003 • 176 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

5. Internet Use in a Cluster of HIV, Syphilis, Gonorrhea, and Chlamydia 2002-2003 Uses internet to meet sexual partners DIS contact via Internet successful DIS contact via Internet unsuccessful OOJ internet syphilis HIV gonorrhea chlamydia refused testing unable to locate Tested and/or preventatively treated

6. Cluster Internet Use • 108 (61%) report internet use for meeting partners • Only email / screen name to locate 50 (46%) of the 108 • 30 (60%) contacted via email • 13 (26%) did not respond to attempted email contact • 7 (14%) sent to other states • none of which would contact partners with only email/screen name • Internet use most likely underreported • Not reported by patient • Not asked/reported by DIS (case risk factor list recently revised)

7. Of the 30 we reached via email, 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

8. 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 email message that does not include health specific information • All emails typically sent from Health Department email • validity, credibility

9. Procedure • Email Protocol: Don’t send any message to any client via email 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 • Email 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 ###-###-####”

10. 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/email to communicate unless unavoidable • Search for screen name/profile (examples attached) • Profiles usually include: photo, physical description, area they live, some include a personal email or website link, and personal info

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

12. 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?

13. When Sending Email • 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 email • Subject Line • Stress importance/urgency (‘important personal matter’) • Make it personal (‘2nd email attempt, this is urgent’)

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

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

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

17. 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

18. For further information, contactPatti Constantpatricia.constant@health.state.mn.us