Los Angeles Times - April 13 2002
Charles Ornstein, Times Staff Writer

"The leadership out of the gay community on this issue has essentially been absent," said Dr. Judy Wasserheit, who directed the sexually transmitted disease prevention program at the U.S. Centers for Disease Control and Prevention for almost a decade before leaving last summer. "If we wait until we actually see those [HIV] increases in the community, it's too late."

Making matters worse, federal health officials have been slow to release a detailed national prevention strategy and have not allocated enough money to stem outbreaks, critics say. "This is a recipe for disaster," said Lee Klosinski, director of programs for AIDS Project Los Angeles, a treatment and advocacy organization.

Other gay leaders, however, say prevention isn't as simple as issuing an edict to practice safe sex.

"Sex is complex," said Brian Byrnes, deputy director of the San Francisco AIDS Foundation. "People are balancing their desire for sexual health against their desire to get their basic human needs met."

He said many AIDS prevention groups have tried to integrate syphilis prevention into their messages. In any case, he added, it is not productive to call gay men irresponsible for their sexual choices.

Syphilis is seen as a barometer of community sexual health because it, like HIV, is transmitted through unprotected sex. Although the number of cases is still relatively small and syphilis can be treated with antibiotics, health officials are worried because the disease is spreading rapidly and its sores greatly increase the chances of transmitting HIV.

San Francisco reported 139 syphilis cases last year, up from a historic low of 26 in 1998. Los Angeles logged 187 cases in 2001, up from a low of 88 two years earlier.

The outbreaks suggest a return to behaviors that devastated the gay community in the 1980s, said Wasserheit, now director of the HIV Vaccine Trials Network at the Fred Hutchinson Cancer Research Center in Seattle.

"Haven't we learned anything from what happened in the last two decades?" she asked.

Ironically, even some HIV prevention workers have become infected with HIV because of unsafe practices, disease control experts say.

"It's just unbelievable, unbelievable," said Peter Kerndt, director of sexually transmitted disease control for the Los Angeles County Department of Health Services. "From my perspective, it doesn't appear to matter what you say or do.

The [sexual] addictions are so strong that this type of behavior persists."

Brien Stewart, an HIV-positive designer in West Hollywood, said he began practicing safe sex again recently because of the syphilis outbreak in the county. But he said he doesn't look to community leaders for inspiration.

"They're out there, and they're saying to practice safe sex in their ads, but behind closed doors, they're really not," said Stewart, 32. "They don't practice what they preach."

Byrnes said he and other AIDS prevention advocates have learned through experience that gay men don't like to be told how they should act sexually.

Gay Men's Right to Reject Safe Sex Cited

"Gay men's sexual health choices are their sexual choices." he said. "They are not the sexual choices of public health officials."

Other AIDS prevention workers say their peers are reluctant to criticize unsafe sex because gay men are already demeaned by many heterosexuals for their sexual orientation.

Leadership is also a problem because the gay community is so diverse and spread out. People who don't publicly identify themselves as gay are hard to reach; they don't associate with the community or look to its leaders.

Federal health officials, meanwhile, are also struggling to respond. For the last several years, the CDC has focused primarily on eliminating syphilis in impoverished minority communities, particularly among African Americans in the Southeast. The outbreaks among gay men are forcing the agency to switch gears.

Yet the CDC, which recently lost two top officials who had overseen sexually transmitted diseases and HIV, has taken more than a year to finalize a report on the syphilis problem within the gay community. The report has gone through more than a dozen drafts.

Dr. Ronald Valdiserri, a senior official at the CDC, said the agency is hurrying to finish. In another attempt to address the crisis, he said, the agency hosted four town hall meetings--including one in Los Angeles--last year to discuss syphilis and other STDs among gay and bisexual men. The CDC also has allocated small amounts of money to some areas to improve their tracking systems for sexually transmitted diseases.

No Single Simple Solution in Sight

"We all wish there was a single simple solution, but there is not, and we need to keep working on it," he said. "We're struggling to try to get a better handle on what's going to work."

CDC officials face intense pressure from both ends of the political spectrum, those involved in STD prevention say. Conservative lawmakers have criticized the federal agency for allowing sexually explicit HIV prevention messages. Gay groups and their liberal counterparts want more freedom to craft messages that they believe appeal to their audience.

"There are a lot of people at the CDC who are very hard-working and good intentioned, but they have told me that their every action is heavily scrutinized and they really have to watch what they're doing and really have to be careful," said Tom Coates, director of UC San Francisco's Center for AIDS Prevention Studies.

Wasserheit and others say local health officials are not acting decisively enough either. In many jurisdictions, for instance, officials don't even collect information on the sexual orientation of people infected with sexually transmitted diseases. That prevents disease specialists from tracking their spread, these health officials said.

Some health agencies also don't understand the norms, attitudes and meeting places in the gay community, hindering their ability to quickly contain outbreaks, others said.

Still, safe-sex advice can only be taken to a point, said Jeff Bailey, director of health education at the Los Angeles Gay and Lesbian Center.

"We don't convey very positive messages about men in relationships when we tell people that they have to have safe sex by wearing a condom every time they have sex," Bailey said.

Others say there is no excuse for silence or inaction.

"We have a public health crisis staring us in the face, and the time to act is now," said Cornelius Baker, executive director of the Whitman-Walker Clinic in Washington.

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