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Early Syphilis By Sexual Orientation & Month Of Diagnosis, 2001-2003

Commercial Sex Venues: A Closer Look At Their Impact on the Syphilis Epidemics Among Men Who Have Sex With Men in Los Angeles. Getahun Aynalem, MD, MPH, Kellie Hawkins, MPH, Lisa V. Smith, Ms, Dr PH, Cathleen Bemis, MS, Melanie Taylor, MD, MPH, Peter Kerndt, MD, MPH

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Early Syphilis By Sexual Orientation & Month Of Diagnosis, 2001-2003

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  1. Commercial Sex Venues:A Closer Look At Their Impact on the Syphilis Epidemics Among Men Who Have Sex With Men in Los Angeles Getahun Aynalem, MD, MPH, Kellie Hawkins, MPH, Lisa V. Smith, Ms, Dr PH, Cathleen Bemis, MS, Melanie Taylor, MD, MPH, Peter Kerndt, MD, MPH Los Angeles County Department of Health Services STD Program

  2. Early Syphilis By Sexual Orientation & Month Of Diagnosis, 2001-2003 2002 2001 2003 Cases *Does not include cases lacking partner information Source: LAC-DHS, Early Syphilis Surveillance Summary – as of December 31, 2003 Los Angeles County - DHS

  3. Early Syphilis Cases By HIV Serostatus & Sexual Orientation, 2000 – 2003 (n=1465) Sexual Orientation Source: LAC-DHS, Early Syphilis Surveillance Summary – as of December 31, 2003 Los Angeles County - DHS

  4. Objectives To identify the demographic and behavioral characteristics of MSM diagnosed with syphilis that reported using commercial sex venues for sexual encounter during the “Critical period” for syphilis infection. To assess the difference in risk behaviors between those who use commercial sex venues for sexual encounter and those who do not. To assess whether MSM were also using other venues for the same purpose. Critical period:Primary syphilis - 90 days , Secondary syphilis - 6.5 months preceding the onset of symptoms; and Early latent – one year prior the date of treatment. Los Angeles County - DHS

  5. Methods Study population Data collection Data elements Data analysis Los Angeles County - DHS

  6. Age Comparison of MSM with Early Syphilis Who Did and Did not Frequent Commercial Sex Venues * p-value < 0.05 Source: LAC-DHS, Early Syphilis Surveillance Summary – as of December 31, 2003 Los Angeles County - DHS

  7. Age Comparison of MSM with Early Syphilis Who Did and Did not Frequent Commercial Sex Venues YES (N=251) NO (N=668) p-value = 0.03 Source: LAC-DHS, Early Syphilis Surveillance Summary – as of December 31, 2003 Los Angeles County - DHS

  8. Race/ethnicity and HIV Status Comparison of MSM with Early Syphilis Who Did and Did not Frequent Commercial Sex Venues * p-value < 0.05 Source: LAC-DHS, Early Syphilis Surveillance Summary – as of December 31, 2003 Los Angeles County - DHS

  9. HIV Status Comparison of MSM with Early Syphilis Who Did and Did not Frequent Commercial Sex Venues YES (N=239) NO (N=622) p-value < 0.01 Source: LAC-DHS, Early Syphilis Surveillance Summary – as of December 31, 2003 Los Angeles County - DHS

  10. Risk Behavior Comparison of MSM with Early Syphilis Who Did and Did not Frequent Commercial Sex Venues * p-value < 0.05 Source: LAC-DHS, Early Syphilis Surveillance Summary – as of December 31, 2003 Los Angeles County - DHS

  11. Risk Behavior Comparison of MSM with Early Syphilis Who Did and Did not Frequent Commercial Sex Venues Had sex or met sex partner at bathhouses & sex clubs Risk BehaviorsTotal Yes N (%) No N (%) P - value Condom used0.78 Yes 258 68 (31.8) 191 (32.8) No 537 146 (68.2) 391 (67.2) Incarcerated past year 0.57 Yes 34 8 (3.7) 26 (4.6) No 756 211 (96.3) 545 (95.4) IV Drug user 0.06 Yes 20 9 (3.8) 11 (1.7) No 867 228 (96.2) 639 (98.3) Non-IV drug user 0.02* Yes 260 84 (35.7) 176 (27.3) No 620 151 (64.3) 469 (72.7) *p-value<0.05 Source: LAC-DHS, Early Syphilis Surveillance Summary – as of December 31, 2003 Los Angeles County - DHS

  12. Risk Behavior Comparison of MSM with Early Syphilis Who Did and Did not Frequent Commercial Sex Venues *P < 0.05 Source: LAC-DHS, Early Syphilis Surveillance Summary – as of December 31, 2003 Los Angeles County - DHS

  13. Drug Use Comparison of MSM with Early Syphilis Who Did and Did not Frequent Commercial Sex Venues Source: LAC-DHS, Early Syphilis Surveillance Summary – as of December 31, 2003 Los Angeles County - DHS

  14. Influence of Demographic and Behavioral Characteristics on Having sex or Meeting sex Partners at Commercial Sex Venue Among MSM with Syphilis Diagnosis Los Angeles County - DHS * p<0.05

  15. Other Venues Use Comparison of MSM with Early Syphilis Who Did and Did not Frequent Commercial Sex Venues Source: LAC-DHS, Early Syphilis Surveillance Summary – as of December 31, 2003 Los Angeles County - DHS

  16. Conclusions • MSM diagnosed with syphilis that frequent commercial sex venues are: • twicemore likely to be HIV infected • five times more likely to report having sex with anonymous partners • one and half times more likely to use drugs (non-injection) than those who did not. • The most common drug used at commercial sex venues is methamphetamine (60%). • Cases who attended CSV were: • more likely to report condom non-use, IV drugs • less likely to have sexual encounters at other venues (bars/clubs, motels, parks, Internet, dancehalls, streets). Source: LAC-DHS, Early Syphilis Surveillance Summary – as of December 31, 2003 Los Angeles County - DHS

  17. Limitations • Behavioral and HIV status data are self reported and it is possible that study subjects may have been reluctant to report their risk behaviors • Therefore, our findings are likely to be conservative estimates of the role commercial sex venue play in syphilis and HIV epidemics in Los Angeles. • The study sample did not consist of participants randomly selected for this study which limits generalization of our finding to MSM and the general population. Los Angeles County - DHS

  18. Recommendations General: • HIV and STDs prevention interventions tailored to MSM who frequent commercial sex venues is an immediate priorityif we are to control syphilis, HIV and other STDs infections in this population. • Venue and behavioral specific interventions that foster communication, risk awareness, HIV testing,disclosure of HIV status and condom use should be delivered onsite. Los Angeles County - DHS

  19. Recommendations Venue specific: • CSV must develop and enforce guidelines that eliminate drug use and unprotected anal sex by maintaining an environment that fosters communication, risk awareness, HIV testing, disclosure of HIV status,and condom use . • CSV guideline should include structural elements such as adequate light, facility for HIV/STD testing and counseling services, and notice to patrons of the risk for HIV and STD transmission and acquisition. • Provide safe sex materials and supplies such as condoms and lubricants. • Drugs use should not be tolerated. Los Angeles County - DHS

  20. Recommendations Individual specific: • Practice positive behaviors that reduce risk such as: • HIV/STD testing • Disclosure • Condom use • Recreational drug non-use Further study is needed to identify specific barriers for positive attitudes and social norms at these environments. Los Angeles County - DHS

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