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Role With It Baby: DIS & Their Roles. Featuring: The apolloza Tour! Jen Jackson, Program Consultant DSHS HIV/STD Prevention & Care. Why are we here?.

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role with it baby dis their roles

Role With It Baby: DIS & Their Roles


The apolloza


Jen Jackson, Program Consultant

DSHS HIV/STD Prevention & Care

why are we here
Why are we here?

To gain an understanding of what Partner Services is and to learn how we can support DIS in their disease intervention efforts to help stop the spread of disease in communities.

what is a dis
What is a DIS?

Disease Intervention Specialist:

disease investigator

identifies people who are infected or at risk of infection

notifies of risk and offers testing, treatment

ultimate goal is to understand and stop the movement of disease (source, spread)

big moments in std history
Big moments in STD history…
  • 1495-1496: First reports of Syphilis in Western Europe
  • 1595: Shakespeare writes of herpes in “Romeo and Juliet”
  • Early 1900s: Most physicians treat syphilis with mercury
  • 1936: First National Conference on Venereal Disease
  • WWI & II: 465,000 cases of syphilis
big moments in std history1
Big moments in STD history…
  • 1943: penicillin determined effective syphilis and gonorrhea treatments
  • 1932-1972: Tuskegee Study - Black men not informed they had syphilis.
  • 1972: Federal gov’t creates laws to protect human subjects in research
  • 1997: Clinton formally apologizes to Tuskegee survivors and relatives on behalf of the nation
big moments in std history2
Big moments in STD history…
  • 1965-1975: Sexual Revolution “Free Love” – Syphilis rate more than quadruple
  • Term VD is replaced by STD
  • 1976: Chlamydia first identified & HPV is identified as an STD
  • 1981: AIDS first identified
  • 1982: Time magazine devotes the cover story to Herpes
big moments in std history3
Big moments in STD history…
  • 1985: HIV-1, a new sexually transmitted virus is identified
  • Ryan White barred from his high school after announcing he is HIV+
  • Crack emerges & Syphilis rates rise
  • 1990s: At least one HIV case reported from each region worldwide
  • First FDA-approved HIV antibody test developed. Blood banks begin screening.
  • Ryan White dies at age 18 & Ryan White Comprehensive AIDS Resources Emergency (CARE) Act is enacted
big moments in std history4
Big moments in STD history…
  • 1990s: Magic Johnson announces he is HIV+
  • Red ribbon introduced as the international symbol of AIDS awareness at the Tony Awards
  • PID impacts over a million women
  • HPV recognized to cause 90% of cervical cancers
  • 1999: STD infection estimates at all time high – 15.3 million new cases/year
  • Strains of HIV and gonorrhea begin showing resistance
big moments in std history5
Big moments in STD history…
  • A New Millennium: more than 25 STDs in the U.S.
  • Estimated 45 million people infected with Herpes; 20 million with HPV
  • 2/3 of STD infections occur in people under 25
  • Current trends: Crystal, Online hook-ups, Phone App hook-ups…

STD History Slides adapted from “STIs: A Historical Perspective.” –CDC, PTC ISTDI (

public health follow up
Public Health Follow-up

DIS are part of public health follow-up

STD/HIV are not the only diseases which prompt public health investigation

Many other diseases public health investigates: tuberculosis, rabies, anthrax, measles, mumps, brucellosis, cryptosporidiosis...

reportable stds in texas
Reportable STDs in Texas
  • HIV
  • Syphilis
  • Gonorrhea
  • Chlamydia
  • Chancroid
public health follow up surveillance
Public Health Follow-upSurveillance

DIS rely on data collected by surveillance (it’s not what you think!)

Disease surveillance: systematic collection and analysis of data to understand trends in disease

Passive surveillance: collection of data

Active surveillance: case finding

public health follow up surveillance1
Public Health Follow-upSurveillance

DIS use this data to:

know when to begin an investigation

direct efforts in disease intervention to specific areas or populations

analyze outcomes for quality control

what does a dis do
What does a DIS do?

Interview clients

Notify infected or at-risk clients

Counsel and Test

Lather, rinse, repeat

the interview
The Interview

DIS collect

personal history

medical history

sexual history

DIS also

refer to appropriate services (including treatment)

assist clients in reducing risk

DIS interview infected and uninfected people in the course of an investigation

notification vs elicitation
Notification vs. Elicitation

Partner elicitation is the process of gathering names and locating information of people at risk of infection

Partner notification is the process of notifying those people of their risk and offering services


DIS first research all information available on the client

Telephone call and/or email, if possible

Field notification – visits to locations where the client may be located

Often home, but can include other locations – hangouts, work, shelters, clubs, online, virtually anywhere

Notification should be performed ONLY by trained DIS

notification confidentiality

DIS are trained to carefully guard confidentiality when notifying clients

If any method of notification is deemed a confidentiality risk, another method is chosen

Notification should NEVER occur with others present or through others

counseling and testing
Counseling and Testing

Pre-counsel: discuss status, address concerns, pre-test education

Blood draw and/or clinic visit as necessary

Post-test counsel, interview if investigation requires it

Re-start the cycle

how do dis decide which partners to elicit
How do DIS decide which partners to elicit?

Incubation period

Testing history

Symptom history

Sexual history


Medication is offered to infected and some uninfected clients

Treatment for uninfected: sex partners within incubation periods (potentially developing disease)

Treatment is always at the medical provider and client’s discretion

disease intervention
Disease intervention

Primary intervention: treatment which aborts incubating infection

Prevents development of symptoms, potential to spread disease to others

Secondary intervention: treatment of infection indicated by symptoms and/or positive test results

disease intervention preventive treatment
Disease InterventionPreventive Treatment

Gonorrhea, chlamydia, PID, LGV

Partners exposed last 60 days


Primary: 3 months plus symptom duration

Secondary: 6 months plus symptom duration

Early latent: within the last year


Partners exposed in the last 10 days

is there primary intervention for hiv
Is there primary intervention for HIV?

In limited cases, there has been success with post-exposure prophylaxis (PEP), typically in the case of occupational exposures (needle-sticks)

PEP is rare at this time

characteristics of a good dis
Characteristics of a Good DIS

good communication skills

quick learner



careful, methodical, good eye for detail

able to adjust rapidly to changing situations

types of notification
Types of Notification
  • DIS Notification: DIS notifies partners for the infected individual.
    • Face-to-Face
    • Confidential
  • Self-Notification: infected individual notifies partner(s)
    • Face-to-Face
      • One-on-One
      • May have a DIS present
    • inSpot
      • Confidential
      • Anonymous
the apollooza tour

The apolloozaTour



gotta get myself gotta get myself gotta get myself connected
“Gotta get myself…gotta get myself…gotta get myself connected….”
  • E-mail: often, a preferred method of contact
  • Online Connections: chat, personals, cruising/social networking sites
i need you tonight
“I Need You Tonight…”
  • “Your moves are so raw”:

Insufficient public health resources to utilize partner services for STDs other than HIV and syphilis.

  • “I’ve got to let you know”:

Expanding services for STD partner self-notification to the web.









who are you who who who who
“Who are you?Who who…who who?”
  • “Hello, it’s me”:
    • Self notification tool (for those diagnosed with an STD)
    • User-friendly IPN service, created in 2004 by ISIS Inc (
    • Purpose: To utilize current technology to prevent the transmission of disease and educate communities
here s a little story i got to tell
“Here’s a little story, I got to tell…”
  • inSpot was first launched in San Francisco, CA
  • Moved to servicing specific states, targeted cities, and some international locations
  • Recent changes to InSpot – National inSpot (U.S.)
  • inSpot currently services: Canada, United States, Guam, American Samoa, Northern Mariana and Puerto Rico
more than words
“More than words….”
  • Default Language: U.S. English
  • “Voices Carry”: Other language selections
    • Canadian English
    • French
    • Spanish
i want you to want me
“I want you to want me.”
  • “Where it’s at…”:(web address)

  • inSpot currently provides:
    • Tell them: STD self-notification through a variety of anonymous or confidential e-mail postcards
    • STD info: Up-to-date information on STD signs and symptoms
    • Testing: Links to local testing
    • Resources: Links to websites with more information
    • Tips for self-notification
what i am is what i am
“What I am is what I am…”
  • What inSpot is:
    • A tool for notification of partners of persons with gonorrhea, Chlamydia and other STDs for which health department notification services are not available.
  • What inSpot is not:
    • inSpot is not an alternative to Partner Services.
    • It does not contain any tracking software to identify individuals or confirm testing/treatment.
    • It is not a site that compiles names of people with STDs to “out” those infected and it does not post names on the internet.
    • Not a data collection tool:
      • Keeps a count of number of e-cards sent and received
      • Collects optional demographic and disease data
is it worth it let me work it
“Is it worth it? Let me work it.”
  • How can public health use inSpot?
    • Referrals to inSpot can be made by:
      • Health Departments
      • CBOs
      • Community Clinics/Family Planning Clinics
    • Referrals can be made by anyone who counsels patients about notifying their sexual partners of a possible exposure:
      • Providers, Nurses/Nursing Assistants
      • Case Managers
      • Risk Reduction Specialists
      • Health Educators/Outreach Workers
i always feel like somebody s watching me
“I always feel like somebody’s watching me…..”

The preferred method for notification for syphilis and HIV is DIS notification; however DIS may refer clients to inSpot Texas for e-mail self-notification to augment sexual contact notification efforts.

wow this std is no fun i guess i should tell my partners so they can get tested and treated
“Wow. This STD is no fun. I guess I should tell my partners so they can get tested and treated!”
okay my language is english u s and my region is texas hmmm time to pick a card
“Okay…my language is English (U.S.) and my region is Texas. Hmmm…time to pick a card.”
wow a security question i guess they really don t want bots spamming inspot e cards
“Wow. A security question. I guess they really don’t want bots spamming inSpot e-cards!”
what s next optional demographics used for statistical purposes only hmm ok i ll fill it in
“What’s next? Optional demographics used for statistical purposes only? Hmm…ok. I’ll fill it in.”
rock hey that was easy hey there baby what are you doing later
“Rock!! Hey, that was easy!” (Hey there, baby…what are you doing later…?)
  • Sending an inSpot card is as easy as 6 simple steps:
    • Select language
    • Select region
    • Pick a card (enter the security words)
    • Create message (optional statistical data)
    • Preview
    • Send
wait oh yes wait a minute mister postman
“Wait! Oh yes, wait a minute mister postman!”

What’s that in my inbox?

Oh look! An email from Jesse!

oh no i better get tested
“Oh no! I better get tested!!!
  • Gmail Chat
  • Jessej
  • Fun49
  • Mom
here s where the story ends
“Here’s where the story ends.”

Boy, I sure am glad I let my partners know!

how do rumors get started
“How do rumors get started…”

How will inSpot be promoted in Texas?

  • Print materials: posters, flyers, cards
  • Locations: health depts, CBOs, community clinics, family planning clinics

Sample inSpot card – front Sample inSpot card – back

i ll send an sos to the world i hope that someone gets my
“I’ll send an SOS to the world. I hope that someone gets my…”
  • inSpot Marketing Activities:
    • Banner Ads
    • Posters
    • Cards
    • Training and Information
    • Webpage
    • Periodic inSpot Reminders
treat me like your mother
“Treat me like your mother.”
    • Any expressions of hatred, bigotry, abuse or harassment will not be tolerated by The people responsible for sending hateful or harassing words are subject to immediate and permanent suspension from the site. inSpot asks that all users refrain from profanity and defamatory comments on their cards.
    • If you are having problems with a person who may have maliciously sent ecards from the site, please contact inSpot at If you feel another person is violating these community and membership guidelines, please contact the site as well, or if you have questions about or problems with sending/receiving ecards yourself.

inSpot Community Guidelines:

everybody s down
“Everybody’s Down”

Take inSpot for a test drive!

  • Send a card – Make sure your co-worker knows that the card is coming from you!!
  • Find a clinic
  • Check out the links
  • Check out the guidelines
so what can you do to support partner services
So…what can YOU do to support Partner Services?
  • Inform your clients about Partner Services
  • Assist DIS with locating individuals
  • Learn the visible signs/symptoms! (ex. rash on palms)
  • Refer clients with possible infections to testing/treatment
  • Promote inSpot!
you know my name look up the number
“You know my name. (Look up the number.)”

Have questions or suggestions??

Need inSpot materials??

Wanna hang out?

Jen Jackson