No more STD flavors of the month!

by Mark Hubbard

Recently, I was brainstorming possible topics for a statewide meeting of HIV advocates. As the chair, I always prefer to respond directly to the interests of our members. Our previous meeting in May could be described as a high point and the group has been relatively quiet since, so I was having trouble.

As I read through the various emails I receive daily, it occurred to me that syphilis might be of interest. I thought perhaps we could discuss it from two angles - providing practical knowledge of syphilis symptoms, testing, and treatment, and discussing what (if any) connection between syphilis and HIV infection rates exists or is important. (I freely admit I'm skeptical based on the west coast history.)

It seems I hit that one out of the park.

Less than a week later, responding to an August 12 New York Times story describing a rise in the city's syphilis cases, one of those lists entered into a passionate debate about the latter angle. Posts seemed to fall into two categories: "of course a rise in syphilis cases predicts a rise in HIV infections!" or "we learned in San Francisco and L.A. that simply isn't so."

While I can see the simple logic of making a connection, I firmly believe the matrix of factors driving STI infection is much more complex. I just don't think it's generally useful or productive to tie syphilis to HIV infection. I'm convinced that the very fact that there are such outbreaks and the very fact that the discussion is occurring results directly from "flavor of the month" thinking and a dearth of comprehensive STI / sexual wellness initiatives.

Choosing two STI's to highlight isn't much better than choosing one (I'm so sick of HIV-focused tunnel vision). One good reason is that any syphilis campaign that emphasizes an HIV connection risks leaving positive persons turned off and tuned out. Another is that otherwise great HIV doctors who provide care around the globe often "get it" about gay rights but don't really "get it" about gay sex. They don't consider or even feel comfortable discussing the sexual choices their patients are making outside of the rote HIV framework (if at all) and often they don't discuss, much less routinely screen for other STI's.

My wish is that we stop framing health promotions, warnings, etc. in terms of recent epi trends based on data which we know are a) delayed, b) subject to reporting issues, c) not complete without non-reportable STI's, and d) not accompanied by behavioral data that would make them useful.

I understand that this game has its origins in the lack of funding (so funding ends up being largely tied to those "flavors of the month.") Yet I wish we'd stop endorsing by participation a system that juggles STI's individually. Then let's find / demand funding for, and help create sustainable comprehensive sexual wellness programs.

I'd like to see long term efforts that frankly link all STI's with what they really have in common: dick-, ass-, and mouth-sex and related choices. I'd like to see a campaign that references the complete list of things every one of us as gay men should know about our sexual health. And finally, when someone goes in for testing, I'd like to see an evidence-based decision-making process embedded in a culturally sensitive protocol that's funded generously enough to avoid forcing triage when deciding what testing is appropriate.

I'm thankful to see MSM rise back to the top after a long period of being categorized as a lower funded risk category / priority in good old Tennessee, USA. I am afraid however that the few resulting new dollars will be used to fund more of the same boring cookie-cutter initiatives we've seen in the past (and I'm afraid we will continue to spend nearly zero dollars on STI prevention social marketing.)

Meanwhile, if any of you knows of a knowledgeable community advocate who can present both sides of the issue and back them up with facts please let me know.
Peace,
mark

[Mark Hubbard is a volunteer who works for just about everyone and is employed by no one working in the field in Middle Tennessee. He is the Chair of the Tennessee Association of People With AIDS and the community liaison for the Vanderbilt AIDS Clinical Trials Center Community Advisory Board. Send him a note here.]

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