Syphilis Outbreak Could Signal Complacency on HIV/AIDS, CDC Reports
Risky sexual behavior among men who have sex with men may be on the rise, according to a new CDC report on last year's Southern California syphilis outbreak. The outbreak occurred between January and July 2000, during which period 130 syphilis cases were reported to local health departments in California. During the outbreak, California public health workers collected demographic information and interviewed syphilis patients about behavioral indicators, such as number of sex partners, HIV status and drug use. A review of this data indicated the following:
- Among the 130 syphilis cases reported, 66 (51%) involved men who have sex with men (MSM), compared with 26% of syphilis cases reported in the same time period one year earlier;
- Among the 66 MSM case-patients identified, 41% were white, 36% were Hispanic, 18% were black and 3% were Asian/Pacific Islander;
- Interview records on MSM indicate that 50% said they had "anonymous sex," 26% had met sex partners in bathhouses, 3% had met sex partners though the Internet and 6% had sex with a commercial sex worker;
- Twenty percent of MSM reported using a condom during their most recent sexual encounter, and 40% reported using illicit drugs, with 18% reporting methamphetamine use; and
- Of the 57 MSM who knew their HIV serostatus, 34 (60%) reported they were HIV positive.
The CDC report states that study findings "suggest that an increasing number of MSM are participating in high-risk sexual behavior that places them at risk for syphilis and HIV infection," an observation consistent with recent behavioral studies. The report postulates that the advent of effective AIDS drugs, such as highly active antiretroviral therapy, has decreased the "actual and perceived threat of HIV to MSM." In addition, the report notes that the syphilis outbreak may indicate an increase in new HIV infections, as syphilis increases the "likelihood of acquiring and transmitting HIV infection." The study determined that the Southern California syphilis outbreak was unlike other outbreaks, as it involved mostly white and Hispanic MSM, most of whom were HIV-positive and had access to health care (Morbidity and Mortality Weekly Report, 2/23).
Dr. Ronald Valdiserri, deputy director of the CDC's National Center for HIV, STD and TB Prevention, said that HIV/AIDS "is no longer perceived to be the threat that it once was," adding, "These are very serious findings." John Schunhoff, chief of public health operations for Los Angeles County, added, "You've got people who are doing well on the (HIV) drugs and believe then that they don't have to worry about infection. Some people argue that there is burnout. They get weary of being protective" (McClam, AP/San Francisco Chronicle, 2/23). Michael Weinstein, president of the AIDS Healthcare Foundation in Los Angeles County, said, "The message of safer sex as a whole is not being heeded," adding, "We're not doing anything to make it sexier or hip to practice safe sex" (Rhone, Los Angeles Times, 2/23). To access the report, go to http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5007a2.htm.