The current edition of the Bay Area Reporter contains an article by Matthew Bajko about a rise in gay syphilis infections in San Francisco. Yes, the homos are still having sex and the health officials have not devised an effective multi-pronged approach to controlling syphilis. Of course, this STD has been with us for quite a long time and since there is no vaccine against it, syphilis will be with us for decades to come.
Matthew mentioned a December paper written by San Francisco Department of Public Health staffers Susan Philip, Stephanie Cohen and Joseph Engelman, and the former director of STD services here Jeffrey Klausner who is now a researcher at UCLA. During his polarizing DPH tenure that turned off many gay health advocates and sexually active men, one of Klausner's most stigmatizing efforts was a social marketing campaign based on fear that equated people with syphilis with time-bomb ready to explode and cause damage. Not the best way to conduct outreach.
In their scientific paper, the four STD experts trotted out their usual blame-the-victims excuses for their failed prevention efforts. Let's unpack their excuses:
The syphilis epidemic among MSM has been attributed to individual, network, and population level factors, including (1) a decrease in safer sex practices secondary to HIV prevention fatigue, antiretroviral treatment optimism, and an increase in recreational drug use, especially methamphetamines and erectile dysfunction medications;
Since 1981 when AIDS first hit the gay community, there's been prevention fatigue and it's like saying pregnancy prevention isn't working because women are still getting pregnant and giving birth. In other words, the researchers are denying reality and trying to force gays to conform to their condom-driven way of thinking.
Whenever I see treatment optimism cited like this, I hear dog-whistling on the part of the scientists who seem to have a wish to return to when there were no treatment for AIDS. We've had cocktails since 1996, long enough for public health officials to adapt their STD prevention programs to this reality and cease with implying HIV treatments are a bad development for syphilis control.
Drug use in the gay community? Get used to it and let's move away from the emphasis on whether it's up, down or stable. Gays, like straights, take advantage of recreational and erectile substances during sex. This fact is not going away.
(2) harm-reduction strategies like serosorting (selective unprotected sex with partners of the same HIV-serostatus) and oral sex, which may decrease the risk of HIV transmission but can facilitate syphilis transmission;
Would they prefer we didn't have poz guys having sex only with other poz guys? Sero-sorting does reduce HIV transmissions and is one prevention strategy that was community-developed without the moralizing of public health officials. It's also problematic that the researchers equate HIV prevention with syphilis prevention when the former is harder to acquire than the latter. This is why HIV infections rates goes down but the syphilis trend does not.
(3) rising use of the Internet as a meeting venue, which has revolutionized sexual networks and facilitated sex partnering, leading to increased number of sex partners, including anonymous partners who cannot be reached for partner services;
Well, in San Francisco we used to have more bricks-and-mortar venues including bathhouses and back room bars like My Place, which was closed by Klausner when he was at DPH's STD control unit and pressuring the alcohol control board and police to shut it down, where sexual partners could more easily be reached than on the web for counseling. Don't complain about more dudes hooking up online when you're reducing physical location for public health outreach.
That said, the web as a cruising venue has been around as long protease inhibitor cocktails and maybe the problem is that these researchers don't know how to adapt their outreach and prevention messages to this fact.
(4) decreasing AIDS mortality, which has increased the size of the population at risk for syphilis.
Again, I hear dog-whistling that says because people with AIDS are living longer and developing fewer and less virulent opportunistic infections it's bad for syphilis prevention. Did the researchers think just because we're not dropping like flies that for some magical reason PWAs would not have sex? It's time for the researchers to stop trying to use shame and finger-wagging and wringing their hands over cocktails and such to create the community norms they'd like to see.
One huge factor, in my view, that has contributed to gays tuning out DPH's social marketing campaigns and alarmist messages about syphilis (and HIV too), is that we have seen the stats manipulated for funding purposes, ads equating folks with an STD as explosives about to cause widespread harm, and a general disconnect between those with numerous degrees from fancy universities and cock- and cum-hungry queers hunting for sexual love and intimacy.
It's time for SF DPH and Klausner to take responsibility for their lousy gay syphilis control efforts. I'm not buying DPH researchers and their paper peddling absolving them of that responsibility.
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