Public Health Challenges of Syphilis Prevention Same, same but - PowerPoint PPT Presentation

Public Health Challenges of Syphilis Prevention Same, same but different

Sol olom omon on M M, Mayer K r K. Evol olution on of the s he syph philis epi epidem emic a among men who have s sex w with m men. Sexual Hea Health 201 2014 Between 1969 and 1976, the proportion of • men with 1 o & 2 o syphilis who named other men among sex partners increased fro 24% to 46% Prompted screening in bars, bathhouses, • bookstores and supporting clinics Incidence declines in 1980s due to changes in • sexual behavior related to HIV prevention campaigns End of 1980s, rebound due to resurgence in • high-risk MSM sex behaviour 1990s, seroadaptive (serosorting or • seopositioning 2000s, outbreak among MSM. Risks = • anonymous sex, frequenting bathouses, meeting partners on Internet, contact with sex workers, condomless sex and use of crystam methamphetamine

Don’t ask, won’t tell Don’t look, won’t find

Same, same….. Pre-AIDS Post-AIDS • Occult/asymptomatic infection • Occult/asymptomatic infection • Multiple partner • Multiple partner • Anonymous partners • Anonymous oddslot partners • “poppers” • Methamphetamine, viagra • Mistrust of medical community • Mistrust of medical community • Prejudice • Prejudice • Health equity • Health equity

But different? • An abandonment of safer sex practices • ART and undetectable viral load • PrEP • Internet: geosocial networking phone apps (Grindr) • Decreasing STD categorical clinics • Decreasing DIS

Recommendations • Screen, screen, screen • Internet outreach, opt-out testing • Counsel regarding limits of serosorting and other seroadaptive behaviors • May be good for HIV prevention but will not prevent STIs • ORAL SEX IS NOT SAFER SEX FOR SYPHILIS • Culturally tailor prevention counselling, education about pre- exposure prophylaxis and repetitive screening