‘Safer Sex’ Pleas Failing, Experts Fear

An outbreak of syphilis among gay men in Los Angeles County is one more troubling sign that the “safer sex” message often is not getting through or is being shrugged off, experts said Thursday.

Syphilis, though easily treatable when caught in its early stages, is a good marker for the level of risk a population is willing to hazard in its sexual practices. That 26 cases of syphilis have recently cropped up in the county, most within six weeks, has public health officials and AIDS prevention advocates worried. They fear that an increasing subset of gay men are not using condoms during sexual intercourse--the golden rule in HIV prevention.

That concern was heightened Thursday as officials revealed that two-thirds of the men affected in the syphilis outbreak already have AIDS or the human immunodeficiency virus that causes AIDS. The sores created by syphilis infection makes it easier to spread and acquire HIV.

“What most of these men have in common is [frequenting] sex clubs and bathhouses and having unprotected sex with multiple partners or . . . male prostitutes,” said Dr. Jonathan Fielding, director of public health for Los Angeles County.

Advocates for AIDS prevention in Los Angeles are scrambling to put together warnings and alerts to people at risk.

“This is just a really startling, eye-opening situation, which calls attention to the ongoing difficulty of maintaining safer sex practices,” said Lee Klosinski, director of education for AIDS Project Los Angeles.

The cases are confined mostly to the communities of Silver Lake, West Hollywood and Hollywood, although a few cases have cropped up in Long Beach and Orange County. The cases have not been tied to a single event or location, although it is possible that the spread occurred mostly over the Christmas and millennium celebrations.

An official with the Centers for Disease Control and Prevention in Atlanta called the pattern extremely disturbing.

“What we’re seeing here is not unique to L.A.,” said Dr. Judith Wasserheit, director of the sexually transmitted disease prevention program at the centers. She said that despite the overall decline in syphilis, her agency has noticed increasing outbreaks of syphilis and other sexually transmitted diseases among gay men nationally.

“It does indicate a trend toward relapse to risky sexual behaviors,” Wasserheit said.

Tom Coates, director of UC San Francisco’s AIDS Research Institute, agreed, saying: “All the warning signs are there.”

He cited increases in cases of rectal gonorrhea in San Francisco and elsewhere. In addition, he said, behavior-tracking systems suggest that unprotected sex and sex with multiple partners are on the rise among gay men.

The explanations are complex. Prevention messages may not be well targeted to specific communities such as young men or minorities. That may not be a factor in the Los Angeles outbreak, however, because the average patient was 37 and most were white.

In the case of older men, experts said, some may be suffering from “epidemic fatigue” and are tired of complying with safety measures. Others have become so encouraged by development of new drug therapies--the famous drug “cocktails”--that they no longer perceive AIDS as a fatal disease.

That attitude is not limited to gay men. A recent study of nearly 2,000 HIV-negative or untested people--drug users and heterosexuals as well as gay and bisexual men in San Francisco--showed that nearly a third had relaxed their concerns about contracting the AIDS virus, under the impression that drug cocktails could save their lives. Two-thirds of the gay men who reported a more relaxed attitude had engaged in unprotected anal intercourse.

“We’ll see more of this,” Coates said of the spike in sexually transmitted diseases among high-risk groups. “We are 20 years into the [AIDS] epidemic, the drugs are keeping people alive. . . . A lot of [young] people are not as exposed [to the potential dangers], and a lot of new people are coming into town having sex . . . for the first time.”

He said health officials may assume all the information is out there, but “if people acted on the basis of information alone we wouldn’t have the tobacco problem.”

The information needs to be hammered in regularly and tailored to specific audiences, experts said. And framing the message can be difficult.

“You want to capture the successes and say we have treatments for people and can help people . . . [but] that does not mean there is no mortality or that those treatment regimens are easy” or inexpensive, said Jennifer Kates, senior program officer with the Kaiser Family Foundation.

The Department of Health Services is offering free testing over the next few weeks for men and women for syphilis and other sexually transmitted diseases.

For information on test locations, call (800) 758-0880. For information on treatment or to report a case, call (213) 744-3376 (8 a.m. to 5 p.m.) or (213) 458-5915 (evenings).