100 Years of Stamping Out STDs

This year, the euphemistically named San Francisco City Clinic celebrates 100 years of diagnosing and treating sexually transmitted diseases. That's 10 decades of inspecting orifices and creating cutting-edge new media, from all the way back when old media was shockingly new. And City Clinic did it all while making sexual health sound fun and, well sexy.

In honor of the anniversary, the San Francisco Department of Public Health circulated this historical document, with the headline "Our Nation's Health Endangered by Poisonous Infection." Reading it, the shocking thing is not how much things have changed, but how much they haven't.

You might not believe that sexting and new media have anything in common with the way the world worked 100 years ago, back before the days of either antibiotics or birth control. But get a load of this quote from Dr. Julius Rosenstirn, chairman of the advisory committee, in the 1913 pamphlet wherein he passionately defended the work of the clinic, then called The Municipal Clinic: "The taboo that educators have put on the theme of sexual relations, on a thorough instruction in the origin of human life and its procreation, has resulted in the profoundest ignorance among the laity of these most vital matters."

He added, "Do these same good people really believe they can safeguard the fiercely dominant sex call of awakening youth with mild and vague precepts?"

So what was it that threatened the very existence of the fledgling clinic back in those days? What forced Rosenstirn to come to its defense? Was it simply talking about sex?

Noooo. It was more, much more than that. The thing that got the clinic in deep, deep trouble was a program to teach women how to diagnose themselves. And not just how to diagnose, but also how to act on that information, an approach that would resonate today with e-patients all across America.

And we're not just talking about the horrors of empowering any old group of women. These women were (gasp) prostitutes. In other words, the most disenfranchised, poverty-stricken, and irredeemable victims of lifelong health disparities. Prostitutes who had nothing to protect themselves against a host of risks, except knowledge and behavior change.

Prostitutes who, frankly, loved the program. Prostitutes who got healthier (even, sometimes, didn't die!) because of the program. They even learned how to teach (brace yourself) each other. All of this is known, because The City Clinic, even 100 years ago, backed its interventions with solid evaluation and documented results.

These acts of radical patient-centered information sharing have continued right up until new-media-now. In 2004, Dr. Jeffrey Klausner, then the clinic's director, asked Deb Levine, founder and executive director of ISIS (Internet Sexuality Information Services), to build a website in response to a rising epidemic of chlamydia and gonorrhea among SF's youth, particularly among African-Americans. Levine told him that she thought websites were overdone, and usually ineffective, but she promised to look into it.

She hung out at Mission High School and saw teens doing something with their cell phones "that wasn't calling." That was back in the days when many adults had no idea what a "text" was (other than an APA citation for a manuscript). It was clearly the way the clinic's target population communicated. And so the program was born. It was developed with youth "from the ground up." Youth served on their advisory board, vetted all the language in the texts, and acted as "secret shoppers," visiting all the referral resources to verify whether the service providers were truly youth-friendly. The program went live in 2006.

When the successful results of the program's evaluation were shared at a national public health conference in 2008, Tucker Carlson was deeply offended. (You can watch his outrage and Klausner's hilarious, and effective, dead-pan response here.)

The City Clinic also leveraged media to inform the public about the rising syphilis epidemic. This time, a seven-foot plush penis got into the (safer sex only!) act. The Healthy Penis campaign even made it on to Jon Stewart.

Levine describes Klausner as a very good "educated risk taker." Their partnership found "lots of ways we could innovate and still be true to the science and mission of public health," she said.

And both continue to take their message to the public in innovative ways. Levine has answered sexual health questions as Alice at Go Ask Alice!, as Delilah for AOL, and as the sexuality blogger on Yahoo! Health. And Klausner's Ask Dr. K is the most accessed page of all the DPH web pages, with such tantalizing titles as "Blowjobs and Bronchitis?" and "38-Year-Old Gay Virgin." [Obligatory public health warning: you could easily lose an hour or two of your life cruising his posts.]. The website for City Clinic, which Levine's group designed, was picked by the New York Times as one of the Top Ten Health Websites in 2005, "right up there next to the Mayo Clinic," she says.

So what's the future frontier for using new media to empower patients around sexual health? Check out this recent white paper from ISIS for some great info.

Levine says, "Mobile is here to stay." And she adds, "Most young people, especially those who are most vulnerable, are accessing more multimedia -- images and movies. Not apps -- they're fabulous, but only have a penetration of about 20 percent. Mobile web is more like 100 percent. And low-income urban youth are accessing Facebook through their phones or not at all."

Hmmmm. Makes you wonder what the next 100 years will bring, doesn't it? Looking at City Clinic's approach over the last 100 years, it seems like some things never change. I'm pretty sure the clinicians who started things way back in 1911 would be pretty pleased with the work being done today. But hey, if City Clinic time travel really were possible, I would love to see the passionate Dr. Julius Rosenstirn take a turn as Tucker Carlson's guest.

April is STD Awareness month. You can keep an eye out for City Clinic's 100 tips for sex and romance on its website, send a message to 100yearsofsex@sfdph.org, or follow them on Facebook or Twitter (@SFCityClinic).

Does your local area have an innovative, new media approach to disseminating public health information? Is there a public health clinic whose successful track record is ripe for coverage? Share in the comments section.

(Cell phone photo by rjg329 via Creative Commons on Flickr)