Decentralizing STD Surveillance: Toward Better Informed Sexual Consent

Publication Title

Yale Journal of Health Policy, Law, and Ethics


AIDS/HIV+C13, minorities, partner notification, sexually-transmitted diseases

Document Type



This Article explores how public health policies can respond to changing sexual culture and the need for more reliable information sharing. Specifically, it recommends facilitating voluntary test results sharing and priority flagging of actors most in need of intervention. Such approaches devolve power into the hands of people in the marketplace by creating a system of decentralized carrots and sticks. The carrot strategy seeds a healthier culture of verification through the incentive of enabling individuals to become more marketable as a potential sex partner. More reliable verification may be enabled through password-protected results web pages that may be readily shared with potential partners, facilitating informed consent to sex and enhancing marketability.[para] The stick strategy focuses on the challenge of potentially problematic actors who repeatedly infect partners without disclosing disease status. The Article advocates for utilizing the better vantage of doctors to identify potentially problematic actors based on reports by patients, in the privacy of the doctor's office, about individuals whom the patient believes deceived them and, potentially, others. In a time when budget-strapped public health authorities are in triage mode and unable to engage in contact tracing for all cases, a priority flag approach would be more efficient in identifying potentially problematic actors in need of stronger surveillance and educational intervention. This method of identification is also salutary because it relies on accounts of behavior warranting concern, rather than on heuristics about who is high-risk that may reinforce old stigmas and stereotypes. [para] This Article proceeds in three parts. Part I discusses the traditional state-centric out-group focus of STD surveillance and the survival by transformation of aspects of the paradigm today. Part II discusses the information deficit in the marketplace for sex and romance and how the deficit impedes informed consent to sex. Part III argues for decentralizing and devolving power to seed a healthier culture of informed consent and to improve the identification of actors most in need of intervention based on behavior.