August 25, 1999

Privacy Issues Raised in Syphilis Cases Linked to San Francisco Chat Room

By EVELYN NIEVES

AN FRANCISCO -- In what health officials believe is the first time a disease cluster has been traced to cyberspace, the department of public health here has tracked an outbreak of syphilis cases to an America Online chat room.

Officials from the San Francisco Department of Public Health said six men who had contracted syphilis in the last three months have traced their last sexual encounters to partners they met through a chat room created by an America Online member, San Francisco Men 4 Men (SFM4M).

The case is a new development for public health officials who traditionally define an affected group by the members' physical proximity or relation and poses a question for the electronic age: when does the right to online privacy yield to public health issues?

Trying to trace sex partners known only by their computer nicknames.

Some of the men who were infected with syphilis know their multiple partners only by their computer nicknames, or "handles." While such anonymity could be an obstacle to public health officials in other cases, say among people who met in a bar, in this case, America Online knows the participants' real names but would not divulge them.

So the only way to contact the scores of sex partners the syphilis-infected men met online has been through e-mail and postings in the chat room itself.

Although the number of men known to be infected so far is small and their infections were identified early and are fully treatable, they represent a sizable number of the 17 syphilis cases reported in San Francisco this year, and the cluster has provided a frightening glimpse of a potentially larger public health risk, as more and more people use computers to find sex partners, officials said.

Besides the six men who met partners through the America Online chat room, which is open only to its subscribers, a seventh local man who contracted syphilis since June said he met his sex partners through an Internet relay chat room, known as an I.R.C. Together, the seven men have identified 99 sex partners in the last three months -- one man had 47 partners -- and five of the seven men have H.I.V., the virus that causes AIDS, health officials said.

At a time when both syphilis and AIDS cases are at an all-time low in San Francisco, as in the rest of the country, officials are now worried that these seven syphilis cases may indicate a new venue has been created for unsafe sex. The core group of individuals using cyberspace to meet multiple, anonymous sex partners is the same as that which would use bathhouses or highway rest stops or other pick-up venues to engage in unsafe, potentially dangerous sex, said Dr. Jeffrey Klausner, the director of the sexually transmitted disease unit at the public health department.

Not only did five of the infected men expose numerous partners to H.I.V., but because syphilis causes open sores that increase the vulnerability to H.I.V., their partners are at greater risk of contracting the virus, Dr. Klausner said.

"We've discovered that the Internet chat room is becoming an important sexual network," he said, "and one that poses particular challenges for us."

Once the health department traced the cluster of syphilis cases to the chat room, Dr. Klausner said he called America Online to find out how the department could contact all the exposed sex partners, as well as those men who might have contact with the exposed men.

America Online does not give out the names of subscribers as a matter of policy, unless presented with a court order or in the event of special cases like a physical threat, said Rich Damato, a spokesman. Asked whether the syphilis cluster constituted a physical threat, he said, "I would not want in this case to speculate what would constitute a physical threat."

Dr. Klausner said that the health department considered trying to subpoena the names of the chat room subscribers, but "there wasn't a large enough public health risk to warrant that."

Instead, in a move applauded by Internet privacy advocates, America Online put the health department in touch with Planet Out, a worldwide online service in San Francisco for homosexuals.

Tom Rielly, chairman of Planet Out said that the service used e-mails, volunteers and its own Web site ( www.planetout.com) to get the word out in the last two weeks to the chat room users who would be more likely to read mail from the service than from other sources.

"What we did first was send a letter out to the chat room names the health department obtained from the men who were infected," Rielly said. Then, he said, Planet Out posted instant messages to people who were in the chat rooms. It also trained 60 volunteers to visit the chat rooms and talk to people there, and posted information on its Web site.

Of the 99 men who were directly exposed to syphilis, 33 have been tested. Dr. Klausner estimated that perhaps another third had contacted their own doctors, while the remaining still do not know that they were exposed.

Deirdre Mulligan, staff counsel for the Center for Democracy and Technology, a policy organization in Washington that advocates protecting privacy rights in the cyber age, commended the health department and Planet Out for how they handled the situation. By contacting people online, the agency has a chance to reach not just infected participants, but also those who may be at risk, she said. "They're saying, 'Look, be careful,' " Ms. Mulligan said. "They're potentially reaching a much broader audience."

Tim Westmoreland, a senior policy fellow and public health expert at Georgetown University Law School, also applauded the effort. "I've never heard of a case like this -- ever," he said. One sticking point, he said, is that the health department cannot be certain that infected participants will return to the chat rooms. But on the whole, he said, warning people in chat rooms is an easier way of contacting people and more efficient than traditional door-to-door methods. "This is a new way of defining the community," he said. "It's not defined by physical geography, but by the use of cyberspace."

(A spokeswoman for the Centers for Disease Control and Prevention in Atlanta said that she had never heard of another cluster traced to cyberspace, but could not be certain that one exists but was not reported.)

There are thousands of chat rooms based in San Francisco alone, encompassing a broad range of subjects and sexual interests.

Rielly said about 100 to 1,000 of the chat rooms are geared to gay men and lesbians. Only perhaps six or seven of those chat rooms are expressly for people who want to meet sex partners, he added.

Dr. Klausner of the health department said that since Planet Out began its outreach, the numbers of men seeking testing at the department's sex clinics has nearly doubled. But in a SFM4M chat this afternoon, several participants rejected the notion that the syphilis cluster is anything to worry about. One man, who identified himself as a doctor, said incorrectly that the cluster represented a total of seven cases in San Francisco in seven months, rather than just over two months. Another said that "sex is dangerous no matter how you cut it."

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