In 1999, the Centers for Disease Control and Prevention launched the National Plan to Eliminate Syphilis. From 1999 to 2003 in San Francisco, early syphilis was epidemic, increasing from 44 cases to ...522 cases a year. Syphilis cases were more likely to be in gay or bisexual men, those with human immunodeficiency virus (HIV) infection, those who had anonymous partners, and those who met sex partners on the Internet. Increases in sexual activity and sexual risk behavior in men who have sex with men during this period have been attributed to the improved physical health of HIV-infected men on highly active antiretroviral therapy, HIV treatment optimism, increases in methamphetaniine use, and the use of Viagra. The San Francisco Department of Public Health's response to the epidemic included enhanced surveillance, expanded clinical and testing services, provider and community mobilization and sexual health education, and risk factor identification and abatement through investigations, public health advocacy, and treatment Collaborations with communitybased organizations and local businesses were key to the successful implementation of disease-control efforts. A multitude of converging risk factors and new environments contributed to the syphilis epidemic, requiring a comprehensive, innovative, and flexible disease-control strategy.
Background: Between 1999 and 2002, San Francisco experienced a sharp increase in early syphilis among gay and bisexual men. In response, the San Francisco Department of Public Health launched a ...social marketing campaign to increase testing for syphilis, and awareness and knowledge about syphilis among gay and bisexual men. Methods: A convenience sample of 244 gay and bisexual men (18-60 years of age) were surveyed to evaluate the effectiveness of the campaign. Respondents were interviewed to elicit unaided and aided awareness about the campaign, knowledge about syphilis, recent sexual behaviors, and syphilis testing behavior. Results: After controlling for other potential confounders, unaided campaign awareness was a significant correlate of having a syphilis test in the last 6 months (odds ratio, 3.21; 95% confidence interval, 1.30-7.97) compared with no awareness of the campaign. A comparison of respondents aware of the campaign with those not aware also revealed significant increases in awareness and knowledge about syphilis. Conclusions: The Healthy Penis 2002 campaign achieved its primary objective of increasing syphilis testing, and awareness and knowledge about syphilis among gay and bisexual men in San Francisco.
The Positive Reinforcement Opportunity Project (PROP) was a pilot program developed to build on the efficacy of contingency management (CM) using positive reinforcement to address the treatment needs ...of gay and bisexual men currently using crystal methamphetamines (meth). It was hypothesized that a version of CM could be implemented in San Francisco that was less costly than traditional treatment methods and reached gay and other MSM using meth who also engaged in highrisk sexual activity. Of the 178 men who participated in PROP from December 2003 to December 2005, many self-reported behaviors for acquiring and spreading sexually transmitted diseases including HIV infection. During the initial intake, 73% reported high-risk sexual behavior in the prior three months, with 60% reporting anal receptive and/or insertive sex without condoms. This report describes the implementation of PROP and suggest both its limitations and potential strengths. Initial findings suggest that PROP was a useful and low cost substance use treatment option that resulted in a 35% 90-day completion rate, which is similar to graduation rates from traditional, more costly treatment options. Further evaluation of the limited data from three- and six-month follow-up of those who completed PROP is currently ongoing.
The Positive Reinforcement Opportunity Project (PROP) was a pilot program developed to build on the efficacy of contingency management (CM) using positive reinforcement to address the treatment needs ...of gay and bisexual men currently using crystal methamphetamines (meth). It was hypothesized that a version of CM could be implemented in San Francisco that was less costly than traditional treatment methods and reached gay and other MSM using meth who also engaged in high-risk sexual activity. Of the 178 men who participated in PROPfrom December 2003 to December 2005, many self-reported behaviors for acquiring and spreading sexually transmitted diseases including HIV infection. During the initial intake, 73% reported high-risk sexual behavior in the prior three months, with 60% reporting anal receptive and/or insertive sex without condoms. This report describes the implementation of PROP and suggest both its limitations and potential strengths. Initial findings suggest that PROP was a useful and low cost substance use treatment option that resulted in a 35% 90-day completion rate, which is similar to graduation rates from traditional, more costly treatment options. Further evaluation of the limited data from three- and six-month follow-up of those who completed PROP is currently ongoing.
Objectives To determine the proportion of sexually experiencedAfrican American adolescents who report having been screened for sexually transmitted diseases and to determine the proportion who report ...having been screened for these diseases among adolescents who have had a preventive primary health care visit in the past 2 years. Methods A telephone survey of a population-based sample of African American adolescents aged 12 to17 years residing in a low-income neighborhood in San Francisco with a high prevalence of sexually transmitted diseases. Results Of the 302adolescents surveyed, 118 (39.1%) reported a history of sexual intercourse. Of these, 17 (26.2%) of 65 males and 31 (58.5%) of 53 females had been screened for a sexually transmitted disease in the previous 12 months. Twenty (30.8%)of the males and 32 (60.4%) of the females had been screened for a sexually transmitted disease in the previous 24 months. Of the 93 participants who had a preventive primary care visit since their first episode of sexual intercourse, 14 (26.4%) of the 53 males and 24 (60.0%) of the 40 females had been screened for a sexually transmitted disease in the previous 24 months.Conclusions Sexually experienced African American adolescents in SanFrancisco are being screened for sexually transmitted diseases at rates well below those recommended by current clinical guidelines. A low rate of screening was found even in adolescents who had been seen for a preventive primary care visit since they had first had sex. This suggests that the preventive primary care visit is not being used to its full potential as an opportunity to screen and treat adolescents for sexually transmitted diseases.Capitalizing on this opportunity to screen may increase the number of cases of sexually transmitted diseases diagnosed and, thus, decrease rates of these diseases in this population.
In contrast to rates for the United States as a whole, the incidence rate of gonorrhea increased 11% in San Francisco between 1986 and 1988, with substantial increases observed among black ...adolescents. Reports by health department personnel and police suggested that crack cocaine use, specifically the exchange of sex for drugs, contributed to this increase. To test this hypothesis, the authors conducted a case-control study from August 1988 to October 1988 that compared 68 prospectively identified adolescent gonorrhea patients with 136 neighborhood control patients. Thirty-two percent of the female gonorrhea patients had received money or drugs in exchange for sex, while none of the control patients reported having done so (P = 0.0001). Most of the female patients (89%) who had received money or drugs in exchange for sex had used crack. Crack use was less common among female patients who denied receiving money or drugs in exchange for sex (11%) and among control patients (6%). Crack use and providing money or drugs in exchange for sex were not risk factors for gonorrhea among the male patients, but were reported frequently by both gonorrhea patients and control patients. Not living with parents was a risk factor for male patients (odds ratio 4.9, 95% confidence limit 1.4 to 19.5). For all patients, a history of a sexually transmitted disease appeared to be an independent risk factor for gonorrhea. The conclusion is made that crack-related exchange of sex for money or drugs is a risk factor for gonorrhea among black adolescent girls in San Francisco. These findings suggest a need to better understand these behaviors and to develop strategies to reduce high risk sexual behavior and substance abuse in urban adolescents.
To determine the relative importance of various features of health clinics when African American adolescents consider seeking care for sexually transmitted diseases (STDs).
Confidential ...interviewer-administered telephone survey.
A predominantly low-income, African American neighborhood in San Francisco, Calif.
Random sample of African American adolescents aged 12 to 17 years; 302 (76.6%) of 394 identified eligible adolescents participated.
Items and scales measuring adolescents' sense of the importance of the attributes of the provider (alpha = .58), availability of services (alpha = .61), and perceived confidentiality of health services from family (alpha = . 72) when deciding where to seek care for possible STDs.
More than 90% (90.4%) of subjects rated items relating to provider attributes as being highly important when they consider where they would seek care for an STD; between 62.5% and 82.7% rated availability items as being highly important; and between 38.6% and 60.8% rated items pertaining to confidentiality as being highly important. Greater importance was placed on provider attributes and confidentiality by female than male adolescents. The importance placed on provider attributes and confidentiality increased as adolescents aged.
Low-income, African American adolescents place great importance on provider attributes, less importance on availability, and even less importance on confidentiality when deciding where to seek health care for a possible STD. Health care providers and organizations need to be aware of these adolescent preferences to better promote screening and treatment of STDs in this population.
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