'Not a simple answer' for desert’s syphilis problem
By Brian Joseph
The Desert Sun PALM SPRINGS -- In the year since health officials warned of a growing syphilis problem here, the alarming but easily curable disease continues to overrun the Coachella Valley. Despite a year of education and testing efforts, Palm Springs alone has a syphilis rate of 81.8 per 100,000 people in 2003, twice the rate of the nation’s No. 1 city for syphilis, San Francisco. As of the end of August, 73 cases were reported in Riverside County, compared with 78 during the same period in 2003. In both years, most of the cases were coming from the Coachella Valley. The disease, health officials say, is being spread in the desert almost exclusively by gay men, many of whom are also HIV-positive. "We’ve considered it being at epidemic levels since 2002," said Barbara Cole, director of disease control in Riverside County and the lead official on the valley’s syphilis outbreak. Cole says syphilis in the Coachella Valley is among the biggest health problems in the entire county -- and it isn’t just a "gay problem." Bisexual men could eventually spread the disease to others, including wives or girlfriends. "I wouldn’t want the heterosexual community to feel like they’re not at risk, because this is going to spread to other communities," said Robin Johnson, assistant director of social services for the Desert AIDS Project, the lead agency on desert syphilis. Syphilis is of particular concern because while it is easily treatable with antibiotics such as penicillin, it can be deadly. Left unchecked, syphilis can cause blindness, neurological damage, heart disease and death. And it is often left unchecked. In its primary stage, the only symptom is a small, painless sore at the site of infection, usually the genital area, mouth or anus. The sore can disappear after only a few weeks, after which there are no more symptoms. Infected people can go years without knowing they have it. The challenges in efforts to stop the spread of syphilis are numerous and compounding, but national experts say the Coachella Valley is doing all that it can with a community-tailored public education campaign and aggressive disease testing. Syphilis has been found in men of virtually all ages and races. There isn’t just one, or even a few factors fueling the epidemic: Drugs, particularly crystal meth, have been linked to some cases, but not all. The same goes for anonymous sex and alcohol -- they’re additional risk factors but they’re not linked to every case of desert syphilis.Research suggests that some gay men are no longer concerned about HIV and AIDS and have grown tired of the safe sex message. Health officials say an increasing number are participating in high-risk sexual behavior at resorts or bath houses, or through meetings initiated over the Internet.Even if men are heeding the safe sex message, the disease can get around it. Condoms don’t necessarily stop the spread of syphilis.Money is limited. The county health department and the Desert AIDS Project are essentially sharing a $67,000 grant from the Centers for Disease Control and Prevention for confidential syphilis testing and a public education campaign. The money has to last 18 months, from July 2004 to December 2005. "The message hasn’t been out there for a long time," Johnson said of syphilis education. "Syphilis 20 years ago was almost eradicated in this country. Our message is syphilis is back." Something happened
Syphilis in the United States was in decline across the board in the 1980s and 1990s. According to the CDC, syphilis occurred mainly among heterosexual blacks in the South and in large cities in the 1990s.
The incidence of sexually transmitted diseases declined substantially among gay men as a result of a decrease in risky sexual behavior as fears of HIV and AIDS spread. Then something happened, at least in gay communities. Syphilis started popping up again.
First there was an epidemic in the Seattle area in the late 1990s. Then an outbreak in Southern California.
Today, health officials say there is a syphilis problem in several American cities with substantial gay populations -- San Francisco, New York and Atlanta. In all of Riverside County, 25 cases of syphilis were reported in 2001. In 2002, 94 cases were logged, the vast majority of them located in the Palm Springs area. That increase led the county health department to send out an alert warning of the syphilis problem in early 2003. That touched off a lot of public hand-wringing about that year’s White Party, one of the nation’s largest gay circuit parties hosted in Palm Springs every year. Stories in The New York Times and the Los Angeles Times quoted nervous public health officials openly worrying that the White Party would birth an epidemic. Then the coverage abruptly stopped. The disease didn’t. The number of syphilis cases in Riverside County rose to 105, most from the Coachella Valley in 2003. Knee-jerk reactions
The question is why? There are many theories, but no definitive answers. One of the most common is that gay men have begun engaging in risky sexual behavior because they’ve grown tired of the safe sex message, or are no longer concerned about AIDS. The CDC states that since the 1996 introduction of highly active antiretroviral therapy, a successful HIV and AIDS treatment, the incidence of AIDS and related deaths have declined, "decreasing the actual and perceived threat of HIV." Locally, according to the county health department, about 75 percent of the gay men infected with syphilis also have HIV. Several people in the valley think same-sex apathy applies at least to a portion of the desert’s gay community. "They think ‘If I get AIDS, it will be like I have diabetes. All I have to do is take a pill every day,’ " said Charlie Sharples, executive director of the Desert Business Association, which represents nearly 400 gay and lesbian businesses in the valley. Sharples said from his perspective gay men in the Palm Springs area are aware of the risks, but some engage in unprotected sex anyway. "It’s like people who want to smoke. They say ‘Well, George Burns smoked and he lived to 100,’ " he said. Also, he said, "there’s people out there who just don’t care." Another potential cause suggested is that drugs are playing a role in the epidemic. Johnson of the Desert AIDS Project said crystal meth is particularly popular in the desert among gay and straight people. Crystal meth is a smokeable form of methamphetamine. It’s a nervous system stimulant that can make users agitated and can lead to erratic behavior. Johnson said when people are under the influence of drugs or alcohol they can make poor choices regarding sex. The county reports that from 2000 to 2003, at least 34 people infected with syphilis used meth. At least another nine over that same period used crack, heroin or cocaine. "I think the gay community is struggling to figure out what to do about crystal meth," said Dr. Jason Schneider, member of the Gay and Lesbian Medical Association’s board of directors and a clinical instructor in the department of medicine at Emory University. It’s possible, however, that there isn’t a substantial rise in unprotected sex in the desert. "There hasn’t necessarily been a rise in risky sexual behavior," said Tri Do, the president-elect of the Gay and Lesbian Medical Association and an assistant professor of medicine at the University of California, San Francisco. That’s because syphilis can be spread even with the use of a condom. Indeed, the county states that many infected people report having used a condom the last time they had sex. "You have to be careful to say, knee-jerk, that they’re not using condoms," said Dr. David Malebranche, another instructor at Emory University who works with HIV and AIDS patients in Atlanta. It’s also possible, Do said, that syphilis rates are already in decline in the desert. After the county learned of the desert’s high numbers in 2002, it began an aggressive campaign of testing at the Palm Springs and Indio family care centers and at the Desert AIDS Project. Since 2002, the number of syphilis cases have increased slightly and the numbers for 2004 are on pace to match the 2003 figures. With the increased testing, that could indicate the disease is already under control. "Any time you have increased screening you’re going to have a higher incidence of disease," Malebranche said. Said Do: "That could be evidence that the campaigns are working." Code Red
In April, the county formed the Syphilis Elimination Task Force to refine the safe-sex message. Composed of public health officials at the state and local levels as well as other health workers, the task force is brainstorming ways to update and refine their public education campaign. Thus far, the campaign has consisted of a few print advertisements, pamphlets, wallet-sized cards and a billboard at Vista Chino and Date Palm Drive that screams: "Simply Red: Syphilis is Back." "If people see the same thing over and over again, it loses" impact, said Cole, the county’s lead official on syphilis. Johnson said the Desert AIDS Project has added syphilis and other sexually transmitted disease curriculum to its community programs on HIV and AIDS, and the task force is exploring other groups to partner with on syphilis education such as local drug rehabilitation centers. In fact, experts said local health departments and the Desert AIDS Project are doing virtually everything that can be done to stop the spread of syphilis: public education and testing. "There’s not," Do said, "a simple answer. |