WHiSPER: Counseling for Internet Partner Notification

Ellen Thometz Rudy, Los Angeles County Department of Public Health

Background. Approximately 25% of people living with HIV are unaware of their infection in the United States. Partner notification (also referred as Disclosure Assistance Counseling) facilitates prompt identification and treatment of HIV/STDs which may decrease the spread of these diseases. The internet has the vast potential to facilitate HIV/STD partner notification. Men who have sex with men's (MSM) use of the internet as a venue to meet sex partners is growing and is associated with the participation in high-risk behaviors. Often an internet address is the only link an infected client has to an exposed partner. In response to the growing number of persons who report the internet as a venue to meet sex partners and the need to find innovative approaches to partner notification, the Los Angeles County STD Program launched inSPOTLA.org, a new website designed to facilitate HIV/STD partner notification in Los Angeles County. This website enables users to send an e-card (electronic postcard) to sex partners regarding potential HIV/STD exposure.

The goal of the proposed study is to evaluate through a randomized, controlled trial the effectiveness of the WHiSPER (Web-based HIV/STD Partner Engagement Resource) intervention in increasing the number of infected clients who notify their partners of an HIV/STD exposure. The intervention is an enhanced, internet partner notification counseling module provided by the disclosure counselor during the disclosure assistance counseling session for clients who choose to self notify their partners. The module focuses on building the client's skills to increase their self efficacy to notify partners by: 1) ensuring the client has basic computer and internet skill levels; 2) interactively familiarizing the client with the inSPOTLA website; and 3) counseling the client on possible choices of e- cards and e-messages to send to partners and addressing any concerns in regards to internet partner notification.

Methods. The proposed study consists of four main components: a randomized, control intervention, a baseline survey, a quantitative follow-up survey 30 days after the initial counseling visit, and three follow-up focus groups to commence six months into the study. All newly positive HIV or newly STD- infected clients (including previously HIV positive, newly STD infected clients) attending the Los Angeles Gay & Lesbian Center's Sexual Health Program will be referred to the disclosure counselor. In addition to the standard disclosure assistance counseling practices, the DC will implement the WHiSPER intervention on a randomized basis among clients who choose to self notify their partners. Both control and intervention arms will be offered to participate in the baseline and follow-up surveys, and the focus groups. The baseline survey will be administered by the disclosure counselor at the end of the initial counseling visit and will assess clients' use of the internet for meeting and communicating with sex partners. The follow-up survey administered over the phone by the disclosure counselor will assess the number of clients who log onto the inSPOTLA website, who notify their sex partners of a possible HIV/STD exposure, and clients' attitudes about the initial disclosure assistance counseling session. The follow-up focus groups will assess perceived barriers and motivators to internet partner notification and perceptions of the initial disclosure assistance counseling session as well as suggestions for improvements. Primary hypotheses to be tested are: 1) clients who receive the WHiSPER module will log onto the inSPOTLA website more frequently compared with clients who receive the standard of care (SOC) counseling; 2) clients who receive the WHiSPER module will notify more partners compared with clients who receive the SOC disclosure counseling.

Implications. The WHiSPER module has the potential to reduce the STD/HIV transmission in Los Angeles County and the capacity to be widely implemented in disclosure assistance settings.