Increase in Syphilis Cases Among MSM in California Does Not Correspond to Rise in Number of HIV Cases, Study Says
An increase in the number of syphilis cases among men who have sex with men in Los Angeles and San Francisco has not corresponded to a rise in the number of HIV cases, according to a study published in the July 9 issue of CDC's Morbidity and Mortality Weekly Report, Reuters reports (Reuters, 7/8). Health officials had thought that the syphilis outbreak indicated risky sexual behavior among MSM was increasing and that there would be a corresponding increase in the number of HIV cases, according to the AP/Los Angeles Times (AP/Los Angeles Times, 7/9). CDC officials analyzed data from HIV counseling and testing centers in Los Angeles and San Francisco and a municipal sexually transmitted disease clinic. Researchers found that in San Francisco between 1998 and 2000 the number of syphilis cases among MSM increased from four to 260 and the incidence of syphilis increased from eight cases per 100,000 MSM to 512 cases per 100,000 MSM. Researchers also found that in Los Angeles County between 2000 and 2002, the number of syphilis cases among MSM increased from 67 to 299 (J.W. Dilley et al., MMWR, 7/9). However, 1.9% of MSM in San Francisco were HIV-positive in 1998, compared with 2.4% in 2002, the AP/Times reports. In addition, 4.8% of MSM in Los Angeles were HIV-positive in 1998, compared with 4.1% of MSM in the city in 2002 (AP/Los Angeles Times, 7/9). The researchers conclude that the "outbreaks of syphilis had not had a substantial impact on HIV incidence among MSM in these two cities," adding that a "continued increase in syphilis cases in MSM underscores the need for integrated HIV and STD prevention strategies to control syphilis outbreaks and prevent potential increases in HIV infections and for further systematic studies of HIV incidence among MSM infected with syphilis" (MMWR, 7/9). CDC officials said that about 60% of newly reported syphilis cases among MSM in San Francisco and Los Angeles were among men that were already HIV-positive, according to the AP/Times. Dr. Scott Holmberg, an epidemiologist with the CDC's National Center for HIV, STD and TB Prevention Divisions of HIV and AIDS Prevention, says, "We will continue to monitor the situation closely" (AP/Los Angeles Times, 7/9).
An increase in high-risk behaviors -- including reports of increases in sex without condoms -- may signal an increase in the number of HIV cases in California, according to the first in a series of reports from the University of California Universitywide AIDS Research Program released on Wednesday, the AP/Ventura County Star reports (Chavez, AP/Ventura County Star, 7/8). New HIV cases in the state had been declining steadily for several years, but the recent increase in risk behavior makes researchers concerned that the progress "has stalled," UARP Director Dr. George Lemp says. There have been increases in the number of men seeking male sexual partners on the Internet; the number of Latino and black men on the "down low," who have sex with men but do not mention their male relationships to their female sex partners, friends or family members; and the number of methamphetamine and cocaine users, the Chronicle reports (Perlman, San Francisco Chronicle, 7/8). The report says that there are about 127,000 people living with HIV in California, and the number of people living with AIDS in the state has increased to 55,000 (AP/Ventura County Star, 7/8). However, Lemp says that the statistics are not "firm," according to the San Francisco Chronicle (San Francisco Chronicle, 7/8). "All the factors lead us to be greatly concerned that HIV can again increase and be on the rise again across the state," Lemp says. HIV prevalence statistics may have increased already, however the increase may have gone undetected because the HIV reporting system is "not strong enough," Lemp says, according to the AP/Star (AP/Ventura County Star, 7/8). Lemp says, "We may well be on the threshold of a new upsurge in overall HIV rates, or it may already have arrived without being aware of it. We're trying to get a firmer handle on it right now" (San Francisco Chronicle, 7/8).