A national plan to eliminate syphilis in the United States has been created by the Centers for Disease Control. This plan has specific health implications for people at risk for and living with HIV. Syphilis infection is known to increase the transmission risk of HIV, and co-infection with syphilis in people already infected with HIV can adversely impact their health status and antiretroviral therapy. The national plan focuses on 28 counties around the country (including King County in Washington State) that have experienced a resurgence in the number of syphilis cases in the past few years, and suggests specific strategies that local health departments can follow to eliminate syphilis in their communities.

The specific intervention strategies recommended by the Centers for Disease Control are:

• Rapid outbreak response: development of an outbreak response plan and criteria for when the plan should be implemented.

• Expanded clinical and lab services: providing easily accessed screening, treatment, and counseling at places where people at high risk for syphilis go (such as bath-houses and sex clubs, something currently done in Seattle).

• Enhanced health promotion: implementation and evaluation of effective health promotion interventions.

Elimination of syphilis will require more than just prevention messages geared toward people engaging in high-risk sexual behaviors. Important issues linked to syphilis, as reported by the CDC, are: racism and poverty, sexism and homophobia, recreational drug use and prostitution, stigma associated with STD's, government distrust (Tuskegee Study and Eugenics Movement legacies), and confidentiality of reporting.

The CDC report says, "It will be important to collaborate effectively with communities affected by syphilis." The report goes on to clarify exactly what this means by calling on local public health organizations to:

• Facilitate more effective communication

• Restore, build, and maintain trust

• Improve access to services

• Develop culturally competent interventions

• Mobilize participation of communities to develop community capacity to eliminate syphilis

Elimination of syphilis in our community may reduce the transmission of HIV and reduce the health risks to those already living with HIV. For more information on the National Plan to Eliminate Syphilis from the United States, including a report on the syphilis epidemic among gay men in King County, you can view their website at: http://www.cdc.gov/stopsyphilis.

(Note: In Seattle, screening for STD's including syphilis is available at the STD Program At Harborview. Their phone number is: 206-205-4160.)