Community Reactions to a Syphilis Prevention Campaign for Gay and Bisexual Men in Los Angeles County
Nanin, Jose E., Bimbi, David S., Grov, Christian, Parsons, Jeffrey T., The Journal of Sex Research
The health of many sexually active individuals in the United States continues to be threatened by rising rates of sexually transmitted infections (STIs), particularly syphilis and HIV. From 2000 to 2003, syphilis infection rates in the United States exhibited a 19% increase (Centers for Disease Control and Prevention [CDC], 2003). In fact, from 2002 to 2003, primary and secondary infection cases increased from 2.4 to 2.5 per 100,000 people (4.2%), representing a rise in cases from 6,832 to 7,177. During this same 1-year period, early latent syphilis cases decreased 0.8%, whereas late and late latent cases increased 6.3% (CDC, 2003).
Despite syphilis infection rates decreasing in various groups (e.g., women, African Americans), a resurgence of new infections was occurring among gay and bisexual men and other men who have sex with men (MSM) throughout the United States. According to national STI clinic data collected by the CDC (2003), within a 4-year period, the proportion of syphilis cases among MSM rose from 4.1% in 1999 to 10.5% in 2003. These numbers are consistent with increases in other STIs, including gonorrhea and HIV.
Syphilis rates also increased in all regions of the United States in 2003, except for the Midwest. The Western region had a 22.7% increase in syphilis contraction rates (2.2 to 2.7 cases per 100,000; CDC, 2003). The state of California experienced a 351.1% increase within a 5-year period, from 282 syphilis cases in 1999 to 1,288 cases in 2003 (California Department of Health Services [CDHS], 2005).
Of all counties in the state of California, Los Angeles (LA) County had the highest rate (449 cases, or 4.8 per 100,000; CDHS, 2005). Over 60% of primary and secondary infection reports in LA in 2003 were among
MSM, and HIV-positive MSM accounted for 60% of these cases (Los Angeles County Department of Health Services [LACDHS], 2003). In addition, among male neurosyphilis cases reported in LA between 2001 and 2004 (n = 103), MSM constituted the majority (68%; Taylor et al., 2008). Epidemiological data suggested a concurrent epidemic of HIV and syphilis among gay and bisexual men in LA and other urban areas of the United States (CDC, 2003); thus, there was much cause for concern.
Decreased condom use, complacency in HIV risk, and the subsequent rise in syphilis cases along with other STIs, including HIV, have been attributed to the availability of HIV antiretroviral medication therapy along with subsequent proclamations (and perceptions) of HIV as a "manageable" disease and "HIV prevention fatigue" (CDC, 2006a; Katz, Schwarcz, & Kellogg, 2002; Stockman et al., 2004). These phenomena have also been linked to relapse into risky sexual behaviors among significant numbers of MSM. Since the late 1990s, increases in unprotected sex among MSM in LA, as well as other parts of the United States, have been also facilitated by drug use, online hookups, and easier access to sex venues (Buchacz, Greenberg, Onorato, & Janssen, 2005; Klausner, Wolf, Fischer-Ponce, Zolt, & Katz, 2000; Taylor et al., 2005).
In response to this emerging health disparity and recidivism to risky sexual behaviors, the LACDHS funded the development of a social marketing campaign. Social marketing is a person-centered, research-based approach to increasing awareness on important issues; in the health care sector, it is used to disseminate health promotion messages to affected segments of a population for the purposes of facilitating positive behavior changes (Lamtey & Price, 1998; Kotler, Roberto, & Lee, 2002). (The CDC has recently renamed the approach health marketing to emphasize the use of social marketing for health promotion purposes; CDC, 2006b.)
The innovative campaign funded by LACDHS, entitled "Stop the Sores" (STS; www.stopthesores.org), was specifically created for reducing the number of syphilis cases among gay and bisexual men and other MSM in the county. …