Lack of Leadership From Gay Community, Health Officials Hampering Efforts to Halt Rise in Syphilis Among Gay Men

A "failure among many gay leaders" to issue warnings about rising syphilis rates in gay communities throughout the country, coupled with a lack of leadership from the CDC and local health agencies, is hampering efforts to control the disease, the Los Angeles Times reports. Many health officials see syphilis, which is treatable with antibiotics, as a "barometer of community sexual health" because it is transmitted through unprotected sex. The sores associated with the disease also facilitate HIV transmission, and syphilis outbreaks often serve as "precursors to a rise in HIV." Gay communities in California and throughout the country have recently seen a rise in new syphilis infections; San Francisco recorded 139 cases last year compared to an all-time low of 26 in 1998, and Los Angeles had 187 official new cases in 2001 compared to 88 in 1999. While rates are rising, leadership from the gay community has "essentially been absent," Dr. Judy Wasserheit, a former director of the CDC's STD division who now serves as director of the HIV Vaccine Trials Network at the Fred Hutchinson Cancer Research Center in Seattle, said. According to Brian Byrnes, deputy director of the San Francisco AIDS Foundation, tailoring effective prevention messages is "complex" because gay men "don't like to be told how they should act sexually," and many HIV prevention workers are "reluctant to criticize unsafe sex because gay men are already demeaned heterosexuals for their sexual orientation." Diversity in the gay community also makes prevention difficult, especially because many men who have sex with men do not identify themselves as gay and therefore do not associate with the gay community. Brian Stewart, an HIV-positive gay man from West Hollywood, Calif., added that the fact that some HIV prevention workers have become infected with the virus through unsafe sex adds to a feeling of hypocrisy. "They're out there and they're saying to practice safe sex in their ads, but behind closed doors, they're really not," Stewart noted.

Lack of Federal Guidance
Syphilis prevention efforts are further hampered by a lack of direction from the CDC and local health agencies, the Times reports. Until recently, the CDC has largely focused its syphilis prevention work on low-income minorities, especially African Americans in the Southeast. The recent rise in cases among gays has forced the agency to "switch gears." The CDC has taken more than one year and 12 drafts to finish a report on syphilis in the gay community. Dr. Ronald Valdiserri, a senior agency official, said that the CDC is "hurrying" to finish the report and noted that it has taken action in the gay community, recently hosting four town hall meetings -- including one in Los Angeles -- on syphilis and other STDs. The CDC has also allocated "small amounts" of money to some local health agencies to improve their disease tracking systems. Valdiserri added that the CDC is "struggling to try to get a better handle on what's going to work" against the spread of syphilis because there is no "single simple solution." Matters at the CDC also have been complicated by the loss of Wasserheit, who left the agency last summer, and "intense pressure from both ends of the political spectrum," with some members of Congress criticizing the agency for allowing groups that receive CDC funding to use "sexually explicit" HIV prevention messages and gay groups calling for "more freedom" to tailor prevention messages to their community. In addition, many local areas' surveillance programs do not ask for sexual orientation when recording STD cases, preventing epidemiologists from tracking diseases within communities. The Times reports that many local health officials do not "understand the norms, attitudes and meeting places in the gay community," complicating quick-response efforts (Ornstein, Los Angeles Times, 4/13).