Evidence of growing problem across U.S. raises concerns about new HIV infections
A Centers for Disease Control and Prevention (CDC) study is showing that syphilis cases in the U.S. increased 12.4 percent in 2002 and that growth is likely driven by new infections among gay and bisexual men.
“Although the new statistics do not include data about sexual orientation, we estimate that more than 40 percent of the new 2002 cases are among men who have sex with men,” said Dr. John Douglas, director of the Division of Sexually Transmitted Disease Prevention at CDC, during a November 19 briefing with gay press reporters.
In 2002, a total of 6,862 syphilis cases were reported to CDC and there were 6,103 such cases in 2001. The increase is attributed to gay and bisexual men because the study found that the ratio of male to female cases had changed, with more men getting infected with the bug.
In 2001, 4,134 male syphilis cases, or a rate of 3.0 cases per 100,000 people, were reported to CDC versus 1,967 female cases, or a rate of 1.4, and in 2002 there were 5,267 male cases, or a rate of 3.8, versus 1,594 female cases, or a rate of 1.1.
There were 435 syphilis cases in New York City in 2002. The rate among men was 11.0 while the rate among women was 0.4 per 100,000. New York City had the highest number of cases among 19 cities in the study that reported more than 50 cases, but 11 cities had a higher rate than the Big Apple.
The only good news in the study is that it found decreases in syphilis rates among African Americans. In 2001 and 2002, the rate, or the number of cases per 100,000 people, fell 10.9 percent among “non-Hispanic blacks,” according to the study. The rate fell 2.2 percent among black men and 22.6 percent among black women.
While the 2002 rate among blacks was still 8.2 times higher than the rate among whites that came down from 2001 when the rate among blacks was 15.7 times higher than among whites.
During 2001 and 2002, rates increased 71.4 percent among all whites and 83.3 percent among white men. Latinos saw rates go up by 28.6 percent overall and 36.4 percent among men.
Syphilis is a particular concern because it makes HIV easier to transmit and acquire and it indicates that some gay and bisexual men are having unsafe sex.
“Based on local data and recent studies, public health officials have learned that many of these men are also co-infected with HIV,” said Dr. Ronald O. Valdiserri, deputy director at the CDC’s National Center for HIV, STD and Tuberculosis Prevention.
A 2003 study that found that syphilis can increase the amount of virus in an infected person’s blood.
“The presence of syphilis may speed the progression of HIV disease among people who are infected,” Valdiserri said.
The press briefing also had some other bleak news. Dr. Robert Wood, director of the HIV/AIDS Control Program at Public Health, Seattle and King County, said his agency had tried “50 different kinds” of behavioral interventions over the past five years with little success. Most recently the agency used a media campaign to promote HIV testing.
“We haven’t seen any impact,” Wood said. “It hasn’t really changed the number of people we’ve seen coming in to get tested.”
Seattle’s recent sexually transmitted disease problem among gay and bisexual men dates to the mid-90s and Wood said his agency has seen 60 to 80 syphilis cases each year over the past five years.
Wood attributed the failure of interventions, in part, to the brief nature of the efforts.
“Many of the attempts haven’t been very broad-based and they haven’t gone on for very long,” he said. “The other consideration would be who knows what might have happened if we hadn’t done anything. The numbers might have gone higher.”
Both Valdiserri and Wood said that not enough prevention resources have been targeted at gay and bisexual men. Those limited funds are then divided among many AIDS groups.
“I do think there have been insufficient resources, but there is also the politics in prevention planning groups in that everybody wants a piece of the pie,” Wood said.