An outbreak of syphilis in Southern California last year has provided alarming new evidence that gay and bisexual men are lowering their guard against AIDS, the government said Thursday.
More than half of the syphilis cases in a four-county area during the first half of 2000 were in men who reported having had at least one male sex partner – up from 26 percent a year earlier.
Health officials said the numbers are a signal that gay and bisexual men, encouraged by news of powerfully effective drug cocktails and longer lifespans for AIDS patients, are worrying less about HIV.
Both HIV and syphilis are sexually transmitted; condoms can protect against their spread.
HIV “is no longer perceived to be the threat that it once was,” said Dr. Ronald Valdiserri, deputy director of the National Center for HIV, STD and TB Prevention, which is part of the Centers for Disease Control and Prevention. “These are very serious findings.”
The Southern California cases and similar outbreaks in other major cities came after the national syphilis rate dropped in 1999 to its lowest level on record.
Just 6,657 cases were reported in 1999, the last year for which national figures are available, or about one case per 40,000 people.
Syphilis outbreaks in major cities “show that the disease can make a comeback,” said Ken August, spokesman for the California Department of Health Services.
“It’s important for health-care providers to ask patients about their behavior and to deliver a strong prevention message.”
In four California counties – Los Angeles, San Diego, Orange and Riverside – 66 of 130 syphilis cases from January to July 2000 were in gay or bisexual men, compared with 26 of 100 cases in the same period in 1999.
Of the 66 cases in 2000, 33 reported they had had anonymous sex, and 17 said they had met sex partners in bathhouses. Only one in five reported using a condom during his most recent sexual encounter, and two in five reported using illegal drugs.
“These men were engaging in high-risk sexual behavior,” Valdiserri said. “When we see reports of increasing risk behaviors, that’s when we take action. We don’t wait till we see the spike nationally” in HIV.
Thirty-four of the 66 men reported they were HIV-positive, and nine said they did not know their HIV status.
“You’ve got people who are doing well on the (HIV) drugs and believe then that they don’t have to worry about infection,” said John Schunhoff, chief of public health operations for Los Angeles County. “Some people argue that there is burnout. They get weary of being protective.”
The CDC recommended a search for new, innovative ways to get the safe-sex message to gay and bisexual men in large cities.
Syphilis infections in 1999 remained concentrated in the South, with roughly one case per 22,000 people. Three-quarters of syphilis victims nationwide were black.
About 300 syphilis cases were reported in 2000 in California.
On the Net:
CDC syphilis information page: http://www.cdc.gov/nchstp/dstd/Fact—Sheets/Syphilis—Facts.htm
California Department of Health Services: http://www.dhs.cahwnet.gov