www.upi.com/view.cfm?StoryID=20031120-044239-3323r
The rise in syphilis infections indicates a growing number of gay and bisexual men are having unprotected sex, which worries health officials because the men could be spreading other diseases, including HIV/AIDS. Several other countries, including the United Kingdom, the Netherlands, Australia and several countries in western Europe have also reported increases of syphilis and other diseases among gay and bisexual men and in many of these there are high levels of HIV co-infection, said Dr. Valdiserri, deputy director of CDCs HIV, sexually transmitted diseases and tuberculosis prevention center. Valdiserri said there is no clear evidence HIV cases are increasing yet in the United States, but we are extremely concerned about that possibility. He noted a study released in July at the National HIV Prevention Conference in Atlanta found rates of diagnosis with HIV infection were up by 17 percent among men who have sex with men. This does not necessarily represent new cases, however, so it is difficult to determine if the HIV infection rate actually is increasing, but were very concerned about that increase because it wasnt observed in other risk groups, Valdiserri said. Heightening concern further is the fact that syphilis increases the risk of HIV transmission by two to five times, because the genital sores caused by syphilis serve as portals of entry for the AIDS virus, Douglas said. In addition, a recent study found HIV viral load increases when a person has syphilis, suggesting he or she may be more contagious. Certainly, the concern for us is the syphilis outbreaks are going to be heralding increases in HIV, Blank said. The CDC is now mobilizing efforts to battle the syphilis problem and officials are confident that prevention strategies can help keep the disease in check. Although syphilis increased in gay and bisexual men, education and intensified testing efforts appear to have resulted in a decline in cases among African-American men and a 19-percent drop among women overall - including nearly a 22-percent decrease in African-American females. However, prevention strategies will need to be tailored to the gay community to keep the disease in check in that population, Valdiserri said. Although the factors driving the increase among gay and bisexual men are multi-factorial - not due to one single cause - some of the reasons include a relaxed attitude about sexually transmitted diseases. This is due to the introduction of medications that can keep AIDS in check, Valdiserri said. Other reasons include substance abuse and emerging venues that facilitate unprotected sex including the Internet, he added. Blank noted when her department interviewed a number of gay and bisexual men in 2002 about their sexual habits, it found recruiting sexual partners over the Internet was a common practice, including among those infected with syphilis. Blanks group also found, however, men infected with syphilis were much more likely to report HIV infection than those not infected with syphilis. In addition, syphilis-infected men were more likely to report unprotected anal intercourse, attending private sex parties, use of illicit drugs and 11 or more partners in the past six months. One of the strategies CDC intends to employ is to encourage organizations that serve gay and bisexual men to get the word out about the importance of detecting and treating syphilis. Paul Feldman of the National Association of People with AIDS in Washington, said his organization would be willing to work with the CDC. But he noted a larger problem is a lack of funding for HIV and sexually transmitted disease prevention efforts. For the fiscal year 2004 budget, the Bush administration requested a reduction of $9 million in the funds for CDCs HIV prevention and surveillance efforts, Feldman said. Decreasing it in a time when an epidemic rages is insulting and frightening, he said. The administration also requested decreasing the CDCs budget for prevention of sexually transmitted diseases, which already barely registers at a scant $168 million for the entire country for 2003. The syphilis rise and potential increases in AIDS cases will cause untold increases in lost wages, healthcare costs and human suffering, Feldman said. All of this easily could be ameliorated with additional money, he said.
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