Decentralizing STD Surveillance: Toward Better Informed Sexual Consent

Abstract

For six years, Tony Perkins met scores of women through the online site plentyoffish.com and exposed them to AIDS. At least twenty-six women are pressing criminal charges for his failure to warn and endangerment of their health. The women in the Perkins case are being tested for HIV, the virus that causes AIDS. As of February 2010, none of the women had tested positive for the disease. The Texas women who Philippe Padieu met, often online, and exposed to HIV were not so fortunate. Padieu transmitted HIV to at least six of the women. The cases from America's heartland came as a shock. But they should not. Rather, they illustrate the need for better earlier intervention. The cases also illustrate the need to dislodge narratives about who is vulnerable to infection and who is not. Historically, sexually transmitted diseases have been treated as an affliction of the morally degenerate "Other" and the consequence of deviation from the dominant sexual culture. However, sexual culture and our national sexual health have evolved. Sexually transmitted diseases (STDs, also referred to as STIs) are widespread and spreading further. There are nineteen million new STD infections each year, according to Centers for Disease Control and Prevention (CDC) estimates. Transmission is facilitated by social, cultural, and technological shifts and the increasingly prevalent phenomena of online connections with near-strangers, concurrent partners, and casual partners - whether one party realizes her partner is having sex with others or not. Sexual culture has changed since the early 1900s, when the nation's STD surveillance paradigm crystallized. These social shifts strain our STD surveillance polices and laws, which remain strongly shaped by the inherited paradigm of the past. Surveillance strategies include disease reporting, sexual contact tracing, and data collection regarding individuals infected with STDs, such as the four nationally reportable diseases of Chlamydia, gonorrhea, syphilis, and chancroid, and HIV/AIDS under certain state statutes. Information and power is centralized in the state, which receives, stores, and sometimes acts - albeit with increasing infrequency in a time of severe budgetary strain - on information reluctantly reported by healthcare providers.