INTERSECTING%20EPIDEMICS%20IN%20THE%20NEW%20ENGLAND%20EPICENTER:%20HIV%20AND%20STD%20AT%20FENWAY%20COMMUNITY%20HEALTH

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INTERSECTING EPIDEMICS IN THE NEW ENGLAND
EPICENTER HIV AND STD AT FENWAY COMMUNITY HEALTH

• Kenneth H Mayer, Daniel Cohen, Sarit Golub,
  Wilson Lo, Jerald C Feuer, Stephen Boswell,
  Fenway Community Health, Boston, MA
• Yuren Tang, Paul Etkind, MA Dept of Public
  Health, Boston, MA

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FENWAY COMMUNITY HEALTH (FCH)

• Founded in 1971, FCH serves the regional LGBT
  community, as well as local elderly, students,
  and low-income local residents. gt7,000 Clients
  seen/year.
• Largest provider of health care to MSM in New
  England.
• Cachement area includes the Boston neighborhoods
  of Fenway, Kenmore, Back Bay, and the South End.
• Among FCH clients 80 describe themselves as
  Caucasian, 6 as African American, 5 as Latino,
  4 as Asian, and 4 as other.

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MEN LIVING WITH HIV/AIDS (N9,535)Risk and Race,
2000
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Fenway Gonorrhea Cases by Year
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METHODS

• Prior to 1997, a paper record was maintained of
  all FCH clients who underwent HIV or STD
  screening, subsequently Logician, an electronic
  medical record, was used.
• STD/HIV data were verified by the Massachusetts
  Department of Public Health (MDPH) who performed
  STD screening.
• Further analyses in 2000 included
  self-administered provider and client interviews.

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STD TESTING OF FENWAY MSM

• 1,190 MSM SCREENED IN 1999
• 75 SYMPTOMATIC
• 10 PARTNER KNOWN (OR SUSPECTED) TO HAVE STD
• 10 ROUTINE SCREENING
• 5 ASYMPTOMATIC SCREEN AFTER RISKY ENCOUNTER
• 17 OF THOSE SCREENED TEST POSITIVE
• (3 OF FCH PATIENT POPULALTION)
• 34 OF THOSE TESTED COME TO FENWAY FOR STD CARE
  ONLY

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Male Syphillis and GC Cases in Massachusetts

• .

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Gonorrhea Rates at FCH from 1995-1997
Year Number of GC cultures GC cases diagnosed Positive
1995 1000 60 6
1996 1300 52 4
1997 1466 44 3
1998 1171 82 7
1999 1190 131 11
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SYPHILIS AND HIV AMONG MASSACHUSETTS MSM

• FENWAY 2 CASES IN 1996 ? 12 CASES IN 2000.
• 50 OF MASS MSM WITH SYPHILIS IN 2000 WERE HIV
• 72 OF MASS MSM WITH SYPHILIS 1-9/2001 WERE HIV.
• PROVINCETOWN (1-11/2001) 10 SYPHILIS CASES 8
  HIV, 1 UNKNOWN.

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Zip Codes of Syphillis and GC Cases Diagnosed at
FCH 1997-1999
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Age Distribution of STD Cases compared to Total
Patient Population
p lt .01
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Percentage of FCH HIV Patients With STDs in
1999-2000, by Age Group
p lt .02
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RISKY PARTNERS (N74)
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DRUG USE (N74)

• 49 (N26) OF PATIENTS REPORTED SOME DRUG USE IN
  THE PAST 30 DAYS
• 20 OF THOSE WHO USED DRUGS REPORTED USING MORE
  THAN ONE DRUG, OF THESE
• 6 REPORTED USING ECSTASY
• 5 REPORTED USING COCAINE
• 2 REPORTED USING GHB
• 1 REPORTED USING METHAPHETAMINES

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HIV-POSITIVE MSM WITH A NEW STD

• HIV MSM WERE SIGNIFICANTLY MORE LIKELY TO TEST
  POSITIVE FOR STDs (X2 6.18, P lt .03)
• HIV MSM WERE ALSO MORE LIKELY TO REPORT SEX WITH
  AN HIV PARTNER (X2 16.68, P lt .001)
• HIV MSM WERE LESS LIKELY TO REPORT HAVING SEX
  WITH MULTIPLE PARTNERS (X2 4.78, P lt .05)
• THERE WERE NO SIGNIFICANT DIFFERENCES BY HIV
  STATUS IN SEX WITH UNKNOWN PARTNERS ANONYMOUS,
  BATH HOUSE/SEX CLUB, OR INTERNET USE

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Discussion and Conclusions

• Data indicate that gonorrhea and syphilis
  increased among FCH MSM starting in 1997,
  following a prolonged stable period.
• HIV coinfection was common, as was recreational
  drug use.
• STD pts cruised the internet, met partners in
  baths and sex clubs, but no single venue, or
  pattern was particularly implicated in the
  resurgence of MSM STD.

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Discussion and Conclusions

• There also is an increase in geographic
  variability among MSM presenting with STDs could
  portend a wider STD epidemic among MSMs in New
  England?
• New strategies are urgently needed to strengthen
  and reinforce prevention messages.
• Further studies are needed to determine the most
  effective means to promote behavioral change

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Acknowledgements
Bette Larsen Tom LaSalvia Louise Rice Jonathan
Appelbaum Nick Peterson   Thanks to Paul Etkind,
Abby Averbach, Kevin Cranston and their
colleagues in the Massachusetts Department of
Public Health for their support