A sharp rise in syphilis infections in Detroit and Oakland County among men who have sex with men has local health and prevention experts concerned.
According to figures released by the Michigan Department of Community Health, early syphilis cases reported in 2002 in Oakland County rose an astounding 250 percent among MSMs; in Detroit, they rose 63 percent.
These local increases mirror similar statistics nationwide.
Although the sexually transmitted disease actually decreased among the general population, the jump in infections within the MSM community sends experts a clear warning signal: Safer sex practices that once helped curb the HIV infection rate within the MSM population are no longer followed as closely as they used to be.
“It signifies that all of our prevention efforts for HIV are perhaps not as effective as they once were, and that folks are having exposure to people who have syphilis,” said Mark Miller, manager of the STD Section of the Michigan Department of Community Health.
How the disease is transmitted and who is getting it
Syphilis is a bacterial infection that can be transmitted in only one of two ways: through sexual contact with an infected person or in-utero during pregnancy. It is an easily curable disease, but left untreated, it can cause cardiovascular and neurological problems and blindness; damage done by the disease during its later stages cannot be reversed.
Although the latest outbreak does not recognize the Eight Mile Road border, it does take on different characteristics depending on which side of the street the disease is found.
In Detroit, for example, only 5 percent of early syphilis cases reported in 2002 were MSMs, while that figure was 33 percent in Oakland County; among MSMs, the disease is spreading most rapidly in Detroit among men in their 30s, but in Oakland County, it is among men in their 40s that the steepest increase is seen.
“We’re surprised that there’s that big of a difference between north and south of Eight Mile,” said Mark Peterson, community outreach coordinator for the Midwest AIDS Prevention Project in Ferndale.
Another fact that has officials concerned is this: About half of all MSM syphilis cases reported in both Detroit and Oakland County involve men who are also HIV-positive.
“If you think about it, HIV and syphilis are spread the same way,” Peterson said. “If you do have syphilis, it puts you at greater risk of contracting HIV if you’re exposed to the virus”. “It weakens your immune system, and the open sores provide another entry for HIV. But if a person is already HIV+ and they contract syphilis, too, now you’re talking about a double hammer coming down on your health. It can exacerbate your HIV disease.”
What’s more, experts agree, t”he problem is intensified when methamphetamines, cocaine or drugs like Viagra are used that enable people to engage in large amounts of unprotected sex with multiple partners.”
Looking for common threads
State law mandates that any person diagnosed with syphilis must be interviewed by a disease intervention specialist. During the confidential interview, a number of questions are asked that allow officials to assemble a picture of how and where the disease is being spread.
After sifting through the 2002 data, state health officials discovered a common thread among many of the infections in Oakland County: A significant number of those interviewed said they had patronized Detroit’s two bath houses, TNT Health Club and the Body Zone.
Although those weren’t the only businesses that showed up in the data – some of the bars, parks and Internet sites were mentioned, as well – TNT and the Body Zone were identified multiple times, Miller said.
MAPP’s Peterson agrees with Miller’s assessment. “They’re going to certain places, and they include bath houses, and we think there may be a connection there.”
For Craig Covey, MAPP’s chief executive officer, the part the baths play with this latest health problem is eerily reminiscent of the early days of the AIDS crisis.
Across the nation in the early ’80s, most of the bath houses were shut down in cities like New York, San Francisco and Los Angeles. Michigan never opted to go that route.
“We used to have good cooperation with the bath houses. In the late ’70s and early ’80s, TNT had STD screenings that went on at the bath house, and that was a neat thing. And when the Body Zone opened a few years back, they worked closely with us. They’ve done education programs in the past, and we’ve provided them with tens of thousands of condoms, so that was a good thing, too.”
Today, however, local experts say neither bath house expends much energy on STD education and prevention efforts beyond providing condoms.
“TNT has no contact with any of the AIDS groups,” Covey said. “To the best of our knowledge, they do not provide brochures or anything else to their members. They have also in the past refused to allow us from coming in and working with them on prevention programs.”
Such has not been the case with the Body Zone.
“They distribute thousands of free condoms, and they’ve always met with us and supported our work,” Covey said.
“These entities need to understand that this is the health of their very own patrons we’re talking about. If detected and treated early, syphilis can be dealt with, but we still have an HIV epidemic on our hands, too.”
The need: a community-based approach
Rather than imposing a state-mandated solution on Detroit’s baths and clubs, health department officials would prefer to see the gay community develop and implement its own response to the syphilis problem.
“What we’d like to do is encourage the owners of the baths and some of the bars to provide educational materials which we will develop jointly and distribute so that people are informed,” Miller said. “A lot of this is just getting the word out.
“So we’re putting together efforts with people like Craig Covey at MAPP and some of the other community-based organizations to piggyback our syphilis and STD messages onto their current HIV prevention efforts. The community-based organizations already have access to the populations that might be at risk. It makes it easier for us to access the population if we go through the folks that are already their gatekeepers.”
MAPP, quite naturally, is ready to tackle the project head-on.
“If people are getting syphilis, then they are not practicing safer sex. They are putting themselves at risk for a host of diseases, including HIV/AIDS. MAPP policy always is to be on the cutting edge of any developments going on, especially with men having sex with men health issues,” Covey said.
What’s also needed, Covey said, is for the community to take ownership of both the problem and its solution.
“There has to be responsibility from the business owners, of course, but the community has to demand this, and that’s what is often lacking in Detroit. If you don’t get strong direction from the county health department or the city health department, and if the gay community’s leaders don’t seem to be too concerned, then there’s not much just one agency can do.”
What health officials and prevention specialists can do, they both agree, is develop and implement a comprehensive package that takes into account both the public impact of individual behavior and the individual’s right to privacy.
“I think it’s important to not look at places like our bath houses and bars, or even parks where there is public sex that occurs, as sort of ‘vectors of disease’ and only that,” Peterson reflected.
“They are parts of our community, and we need to treat them with respect as part of our community. We hope to work collaboratively with them, and what I’d personally like to see, is that the bath houses would be open to bringing in some education and screening programs.”
In fact, such planning is already underway.
Officials from MAPP, the Detroit Health Department and the state met last week with management of the Body Zone to begin planning future education and prevention efforts.
“We provided Body Zone with information on syphilis, including posters, brochures, reports and a video tape,” Covey said. “We learned about their current practices of providing condoms to their patrons, and they agreed to allow us to do educational outreach programs there, which we will begin in April.”
Also under discussion is the possibility of providing onsite screening for syphilis and HIV by medical personnel.
“The meeting could not have been more productive and cordial. We look forward to working with them and reaching this group of men with important health information.”
Paul Devlin, owner of the Body Zone, said he is pleased to cooperate in this venture.
“Many people say they met their sex partners in bars and health clubs just so they don’t have to disclose the names when they get into situations where they have to report to the health department. We have, in our three years of operation, always cooperated with organizations such as MAPP in distributing safe sex information and materials. This isn’t a new effort; it’s an ongoing effort on our part.”
Attempts to reach Steve Daniels, an owner of TNT, were unsuccessful.
Plans are also underway to involve other community-based groups, such as Affirmations, in the battle against syphilis and other STDs.
“The bottom line is that men out there need to understand that if they are having multiple partners and they’re having unprotected intercourse, it’s not a matter of IF they get a sexually transmitted disease,” Covey concluded.
“It’s a matter of WHEN.”