Wednesday, November 16, 2011

Study asks: Will Changes in Gay Men's Sexual Behavior Reduce Syphilis Rates?



: We developed an agent-based stochastic model to examine syphilis transmission among a population of gay men, representative of gay men in Australia. This model was used to explore the potential impact of changes in sexual behavior over 1 month, 3 month, and indefinite time frames on syphilis epidemics.


: Simulations of interventions showed that short-term reductions in rates of partner change and increased condom use would have negligible impact on the long-term trends of syphilis epidemics. If no interventions are introduced, then the model forecasts that the syphilis prevalence in the population could continue to rise, with an increase of 80% in the number of men infected with syphilis during the next decade. However, if changes in sexual behavior are maintained in the long-term, then syphilis epidemics can be mitigated. If condom use is sustained at 80% in partnerships that are HIV discordant or of unknown status, then the prevalence of syphilis is estimated to decrease by 9% over 10 years. Similarly, if partner acquisition rates decrease by 25%, then there will be a 22% reduction in syphilis prevalence.

So let's go over that. If 80% of the serodiscordant couples (and I use that word loosely) use condoms, then syphilis will still increase by 9% over 10 years. So if all that effort is deployed to get 80% of couples to use condoms (a very high number) then there will still be a lot of syphilis cases.

Well, it's better than no improvements, and it's certainly better than the 80% increase, you say.

That's still ninety thousand cases in a population of 1 million over a period of ten years. That's a heckuva a lot of people who are not saved by condoms.

And fewer partners reduces the number of cases by 22%. That's still peanuts.


: Interventions promoting partner reduction or increased condom use would be ineffective in the short-term, and would have limited prospects for success in the long-term unless very large changes in behavior are sustained. Complementary social research indicates that such long-term changes in behavior are unlikely to be adopted, and therefore other intervention strategies need to be developed to reduce syphilis among gay men.


Sex Transm Dis. 2011 Dec;38(12):1151-8.
Will Changes in Gay Men's Sexual Behavior Reduce Syphilis Rates?
Gray RT, Hoare A, McCann PD, Bradley J, Down I, Donovan B, Prestage G, Wilson DP.

From the *Kirby Institute for Immunity Infection and Society, University of New South Wales, Sydney, Australia; and †Australian Research Centre in Sex Health and Society, La Trobe University, Melbourne, Australia.


Would gay men change their sexual behavior to reduce syphilis rates?


: One quarter of survey respondents (26%) indicated that they would be highly likely to reduce partner acquisition rates in order to reduce their chances of syphilis infection. However, among the 475 (21%) men who reported greater than 10 partners in the previous 6 months, only 11% indicated being "highly likely" to reduce partner numbers to avoid syphilis. Among 606 (26%) survey respondents who reported not always using condoms in the previous 6 months, 34% indicated being highly likely to always use condoms with casual partners to avoid syphilis. In the focus groups, men indicated little commitment to sexual behavior change but some willingness to consider short-term changes to reduce community syphilis levels.


: Interventions promoting partner reduction or increased condom use are unlikely to be adopted on a long-term basis by men at greatest risk. Behavioral interventions alone are unlikely to materially contribute to syphilis prevention among gay men.

Here's the deal: as long as men have no prospect of having children, and don't have to cater to women and their desires for intimacy, generally speaking, they will engage in promiscuous activity. This is a no-brainer. It's the nature of men. Throw in rampant drug use (which is very common among gays), and you have a recipe for an epidemic of STD's.

But don't listen to a social conservative. Do your own thing. Learn the hard way.