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In October of that year, Satcher announced the formation of the National Plan to Eliminate Syphilis. The plan funnels money to affected state and local governments, which then work with community-based organizations to stamp out the disease. (St. Louis was among the CDC's so-called Syphilis Elimination Zones. The state awarded its most recent syphilis-elimination grant to the Community Wellness Project, a nonprofit healthcare organization that serves minority populations.)
Within a year of Satcher's announcement, researchers began seeing infection rates climb in New York City and Los Angeles. Ever since, the epidemic has slowly but surely been making its way into the nation's interior. By 2003, the last year for which national data are available, primary and secondary syphilis infection rates had risen more than 7 percent from their 1999 low.
At first blush, the jump is unimpressive. What that figure conceals, though, is that while infection rates among African Americans and women have steadily declined since 1990, primary and secondary syphilis rates have soared among men. During the five-year period between 1999 and 2003, male syphilis rates climbed more than 43 percent.
Although the CDC doesn't currently collect information regarding sexual orientation, National Syphilis Elimination Effort chief Kevin Fenton says the data are clear: "There's been a steady increase among gay men, but because we have more heterosexual men than we do gay men -- although syphilis was increasing among men who have sex with men -- it still didn't overcome the declines in the heterosexual male population. But by 2003 we really began to see an upturn in the epidemic curve. Five years ago most of the syphilis in this country was among heterosexuals. Today we estimate that about 60 percent of cases are among men who have sex with men."
The other lesson area health workers are taking from the national story is best encapsulated by an announcement made on February 11, 2005. On that day authorities with the New York City Department of Health made public the discovery of a gay man who'd contracted a drug-resistant strain of HIV. First diagnosed late last year, the man had progressed to full-blown AIDS -- a process that often takes a decade or more -- a mere twenty months after testing HIV negative.
The announcement also brought to light that the man -- described as gay and in his forties -- had reportedly slept with more than 100 partners in the six months before his diagnosis. He met many of his partners over the Internet and routinely engaged in unprotected sex while high on methamphetamine.
Cheap and readily available, meth is a chemical stimulant and mood enhancer. It's known to induce euphoria, increase awareness and reduce fatigue. It also jolts the libido.
"It is an enormous problem here. It's been a problem for a long time. If you go to a Web [chat room], you can see people in there who will say they're looking for 'Tina,' or 'Tina' just left -- which means they're hungover," says Adams, invoking a common meth nickname in the gay community. "It's five o'clock in the morning, they haven't slept in a day or two, and they're still looking for sex."
Health workers say meth's libido-heightening, fatigue-resisting combo is particularly dangerous, enabling users to engage in daylong sexual marathons while under the influence.
While meth may initially increase a user's sex drive, it eventually causes impotence. But with the introduction of erection-inducing drugs such as Viagra, men are able to counteract "crystal dick."
The result, says Lydon, is a public-health nightmare. "Methamphetamine and Viagra is a particularly deadly combination," the epidemiologist maintains. "Viagra provides an erection for hours upon hours, so you can just go and go and go."
There is very little hard data regarding meth use among gays. But at this year's National HIV Prevention Conference in Atlanta, CDC officials highlighted a survey of more than 19,000 men who have sex with men in the Los Angeles area. In that survey, researchers found that meth use nearly doubled between 2001 and 2004, to 10.3 percent. The rise was even greater among the HIV-positive contingent, which jumped from 11.7 percent in 2001 to more than 30 percent in 2004. Similarly, the number of meth users who reported using the drug during sex grew from roughly 73 percent to more than 86 percent.
"It's a huge effect," says the CDC's Fenton. "Individuals who use methamphetamines are up to six times more likely to be infected with syphilis than those who don't."
Pulling into one of the city's many parks, Carolyn Guild and Jeremy Beshears are careful not to attract attention. Although their vehicle, a white Ford F-450 camper they've christened "Priscilla," is plenty conspicuous, the pair quickly ducks into one of the park's many wooded glades.
As employees of the St. Louis Effort for AIDS, Guild and Beshears are officially taking Priscilla on an STD-prevention tour of St. Louis. This afternoon's quarry: men on their lunch break cruising for sex. Unofficially, however, the pair is on the hunt for new outdoor hookup spots in the city's parks.
As AIDS-prevention workers, Beshears and Guild are something of an odd couple. Olive-skinned with a wide face, Beshears keeps his hair closely shorn and cultivates a patch of stubble just shy of a beard. Guild, meanwhile, has light red shoulder-length hair, green eyes and is given to wearing ripped jeans and leopard-print Birkenstocks. Together they have an infectious banter: Beshears teases Guild about her phobia of dairy products (it can't touch the skin?); Guild fires back about Beshears' dulcet new ring tone: a polyphonic rendition of Def Leppard's hard-rocking 1987 ode to sexual abandon, "Pour Some Sugar on Me."
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