New York City: Study Bares Unsafe Sex Picture

A study of syphilis among men who have sex with men, which the New York City Department of Health is poised to release, found high rates of HIV infection, unprotected sex and recreational drug use among the men.

The city, working with CDC and Michael Callen-Audre Lorde Community Health Center, recruited 88 gay or bisexual men with syphilis (cases) and 176 gay or bisexual men without syphilis (controls). Participants were New York City residents ages 18-55 who reported at least one male sex partner in the prior year. All the men were tested for syphilis and offered HIV tests. The men responded to a series of questions about their sex lives and partners, drug use, HIV status and other topics.

"What we found was that many MSMs, both cases and controls, were engaging in high risk sexual behaviors," said Dr. Susan Blank, assistant commissioner of the city department's Bureau of STD Control. "Specifically, that meant sex with multiple, anonymous partners, unprotected anal intercourse, barebacking, recreational drug use before sex, and not discussing HIV status prior to sex with a partner."

Among men with syphilis, the average number of sex partners in the prior six months was 16 compared to 11 among controls. When barebacking first became popular in the late 1990s, its most visible proponents were HIV-positive men who were seeking other HIV-positive men for unprotected sex. Those early barebackers would often reject men who did not know their HIV status or who were HIV-negative. That was not the case in the city study.

"People aren't talking about [HIV]," Blank said. "They are just having sex with other people without talking about it." Forty-three of the 88 men with syphilis and 29 of the 176 men without syphilis were HIV-positive, with 24 cases and 12 controls taking HIV drugs, respectively. Nearly all HIV-positive men knew their serostatus. Two cases and four controls were newly diagnosed during the study. On average, the HIV-positive men had been infected seven years earlier.

The study suggests that these men have largely abandoned safe sex practices, and notes that most of the men were not exposed to any recent safe sex messages.

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