Epidemic early syphilis - Escambia County, Florida, 1987 and July 1989 - June 1990 (Morbidity and Mortality Weekly Report)

Article Abstract:

Syphilis is an infectious, sexually transmitted disease. A syphilis epidemic, reported in Escambia County, Florida, is thought to be related to the escalation in the use of crack cocaine. In Escambia County, there were 15 cases of syphilis reported per quarter in 1987. In 1990, this number increased to 75 cases per quarter. To further characterize the patients who were contracting syphilis, 82 patients diagnosed in 1987 and 256 patients diagnosed between July 1989 and June 1990 were evaluated. Patients diagnosed with syphilis during the epidemic were older, less likely to be employed, and more likely to be black than those diagnosed during 1987. The proportion of homosexual male syphilis patients decreased from 17 percent (prior to the epidemic) to 3 percent. Before the epidemic, six percent of the prisoners at the county jail (who have been routinely screened for syphilis since 1984) tested positive for syphilis; the figure increased to 26 percent in the 1989- to 1990-period. The majority of cases were diagnosed as primary or secondary syphilis, an indication of sexual transmission. Among pre-epidemic patients, 11 percent reported having used cocaine; none reported using the crack form of this drug. Thirty-five percent of patients diagnosed during the epidemic reported using cocaine; 94 percent of this group admitted to crack use. Epidemic patients were much more likely than pre-epidemic patients to have had multiple, anonymous sex partners. In an effort to identify new cases of syphilis, screenings were carried out at five different locations where crack was sold and used. Six of 38 individuals who consented to testing were found to be infected. In crack-related epidemics such as this, notification of partners (and subsequent slowdown in the rate of transmission) is hampered by the anonymous nature of sexual encounters, which often take place in exchange for drugs or money. On-site testing and treatment at crack houses may diminish this problem to some extent. (Consumer Summary produced by Reliance Medical Information, Inc.)

Sexually transmitted diseases, Florida, Complications and side effects, Risk factors, Syphilis, Cocaine abuse, Crack (Drug)

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Mandatory HIV testing of youth: a lose-lose proposition

Article Abstract:

HIV (human immunodeficiency virus) testing of young people is required by two of the nation's largest employment-training programs: the miliary and the Job Corp program. Young people apply to these programs because they want to improve their skills and better their lives, not because they want to be tested for HIV. A positive test excludes the person from the miliary, and until 1989 they were also excluded from the Job Corps. It is ironic that this mandatory testing, that has ended many hopes for so many young people, has provided important information about the incidence of HIV. One such study appears in the November 6, 1991 issue of The Journal of the American Medical Association. Although this information is important, it could have been obtained in other ways. Mandatory screening does not benefit the public or the individual. For most population groups, mandatory testing has been rejected as an invasion of privacy and a violation of civil rights. There is no evidence that mandatory testing has helped to curtail the epidemic. Those against this type of testing cite ample evidence of discrimination and other negative outcomes, which outweigh any future benefit to the individual. Mandatory testing might be justified if it permitted young people to receive earlier or better care. However, it is used to only to exclude them from the miliary, and is not associated with the provision of adequate treatment. It also might be justified if it had an impact on changing high risk sex and drug-use behavior, but this has not been shown to occur. This 'lose-lose' situation could be changed to a 'win-win' situation if test results were confidential, and if HIV-positive teenagers received services such as early medical and psychological interventions. (Consumer Summary produced by Reliance Medical Information, Inc.)

Editorial, Laws, regulations and rules, AIDS (Disease), HIV testing, HIV tests

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