Monitoring indicates safe-sex relapse in Boston
Phenomenon now apparent coast-to-coast
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The trend of men who have sex with men (MSM) resorting to increasingly unsafe sexual practices is becoming apparent throughout the developed world, as studies continue to highlight increases in the prevalence of sexually transmitted diseases (STDs). Studies presented at the 14th International AIDS Conference in Barcelona, Spain, showed increasing trends of STDs among MSM in New England’s largest MSM clinical care site and at Paris STD clinics.
Fenway Community Health in Boston has charted STD trends among gay men and lesbians in New England for three decades. The clinic’s records showed that the lowest prevalence rate in STDs occurred in the late 1980s and early 1990s, after AIDS deaths had become a strong motivating factor in safe sex practices.
"Because of education about safer sex and people being scared about the epidemic, the number of new cases of gonorrhea hit a low point in 1994 and several years before that," says Kenneth H. Mayer, MD, medical research director at Fenway Community Health. Mayer also is an infectious disease physician at Miriam Hospital in Providence, RI, and a professor of medicine and community health at Brown University in Providence.
Gonorrhea cases had reached a nadir of 43 and there were no syphilis cases at Fenway in 1994.1 "Now that rate has started going back up," Mayer says. "The number of STDs tripled between 1994 and 2000." By 2000, there were 113 patients diagnosed with gonorrhea and 10 with syphilis. Of these patients, 75% presented with no symptoms, and 10% had been notified by sexual partners.1
"The experience at Fenway is a phenomenon seen all around," Mayer says. "We’ve seen a relapse from safer sex among many gay men." Earlier studies have highlighted similar trends in San Francisco, which also has some data showing increases in HIV infection rates among MSM.
The trend, however, is not limited to the United States. Paris experienced a sharp increase in syphilis cases between 1998 and 2001, according to another study presented in Barcelona.2 In 1998, there were four syphilis cases reported in Paris STD clinics; in 2001, there were 91 cases reported. Prior to the late 1990s, syphilis had been a rare disease in Paris, and its resurgence is consistent with evidence that gonorrhea cases also are increasing, especially among MSM.2 "Therapeutic optimism is part of the equation," Mayer says.
While MSM in their 40s and 50s have lived through a time when their friends became sick and many died from AIDS, the younger MSM have grown up with AIDS as a fact of life and have not necessarily personally been affected by it, Mayer says. "Say you’re 20 years old, and by the time you decide to have sexual contact, your impression is that this is an infection that you may not get because of good drugs, and the people taking the drugs are looking good and feeling well," Mayer explains.
Although the data collected on HIV infection at Fenway are not precise enough to measure HIV prevalence rates over time, there is an increased likelihood that HIV rates have gone up in New England among MSM, just as they have in San Francisco, Mayer adds.
References
1. Mayer K, Golub S, Cohen D, et al. Intersecting Epidemics: High co-prevalence of STD and HIV in MSM at a Boston community health center. Presented at the 14th International AIDS Conference. Barcelona, Spain; July 7-12, 2002. Abstract WePeE6545.
2. Couturier E, Dupin N, Janier M, et al. Syphilis: Increasing trends in Paris, France, 1998-2001. Presented at the 14th International AIDS Conference. Barcelona, Spain; July 7-12, 2002. Abstract ThPeC7591.
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