Washington Blade - May 3, 2002
Mike Fleming

"Gay community leadership is basically non-existent," said Judy Wasserheit, formerly of the CDC and now director of the HIV Vaccine Trials Network at the Fred Hutchinson Cancer Research Center in Seattle.

Meanwhile, a proposal to expand the federal government's syphilis prevention plan to include gay men has been in the works for more than a year and doesn't yet have a firm date to be released.

A surge in syphilis could foretell an increase in HIV cases, because the risky sexual behaviors that allow syphilis transmission also put partners at risk of contracting HIV, Wasserheit said.

"Health agencies need immediate involvement from the gay community to help stop the behaviors before it's too late," she said. "If we wait to see what happens, we could revisit the devastation of the 1980s."

The criticism comes as gay leaders are "hitting a wall" in methods to reach gay men with prevention messages that address "complicated lives," said gay activist and author Eric Rofes, who wrote "Reviving the Tribe," a book about the AIDS epidemic.

"Most men are aware of the risks and behave strategically," Rofes said. "But they are not eliminating the behaviors from their sex lives entirely. Many of these men have been dealing with safe sex and no cure for 15 or 20 years -- or they are young enough to be basically unaware of the real risks." Rofes agrees that there is a "lack of leadership" from gay groups, but points to slow research and institutionalized shame over sexual issues that makes researchers partly to blame.

"Both sides need to get together and envision what is useful, do some long-range planning, and give up their discomfort with discussing the issues," he said.

"AIDS workers are becoming really frustrated over a dawning awareness that the old messages aren't effective anymore."

Prevention isn't as simple as previous safe sex messages, said Gordon Mansergh, a gay CDC research scientist who studies the sexual behavior of gay men.

"Sexual choices are an extremely personal and complex issue," Mansergh said.

"The community needs to recommit and come together with the government to develop messages that address the myriad issues that affect sex decisions in men's lives."

An addendum to the CDC's 1997 National Syphilis Elimination Plan that officially adds "men who have sex with men" to the list of affected demographic groups has been more than a year in the making.

So far, the addendum has seen 14 drafts, a CDC official said.

There is no tentative date set to release the addendum, but it is expected to lay out prevention strategies that focus efforts on gay men and detail CDC plans to collaborate with state and local agencies.

Even without the addendum, syphilis prevention is already being integrated into safe sex messages at agencies such as AID Atlanta, Whitman-Walker Clinic in Washington, D.C., and the STD Clinic at the Atlanta Gay & Lesbian Center.

"We are already including syphilis and gonorrhea testing at the Center," said Bill King, head nurse at the Center in Atlanta. "From what we've seen, the rates continue to go up."

Cases of syphilis, treatable with antibiotics, remain relatively low nationwide, but the disease is spreading rapidly and its sores greatly increase the chances of transmitting HIV, King said.

Whatever the solution, immediate action from all sides is necessary, said Cornelius Baker, executive director of Whitman-Walker.

"We are staring down a national health crisis," Baker said. "We can't wait for studies or validation to do something."

The CDC has a two-year-old study in the works for tracking sexually transmitted diseases in "men who have sex with men," but those efforts will not produce results for at least another year, and not every area of the country reports the numbers, a CDC official said.

Mike Fleming can be reached at mfleming@sovo.com.

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