Syphilis Elimination Initiatives
Following are descriptions of syphilis elimination efforts in several cities and counties throughout the United States. The first three are demonstration sites funded by CDC, part of the agency's effort to evaluate and refine national syphilis elimination strategies.
CDC-Funded Syphilis Elimination Demonstration Sites
Davidson County (Nashville), Tennessee
Ranked #7 in 2000, Ranked #4 in 1999.
Davidson County saw syphilis rates fall by 20 percent from 1999 to 2000, compared to the nine percent decline nationwide. The Metropolitan Health Department has developed a screening program at the county jail that provides 24-hour-a-day testing and treatment, and has partnered with STD Free!, a dynamic community coalition including members of faith communities, schools and higher education institutions, community groups, and health care agencies. STD education campaigns have appeared in public bathrooms and on city buses, as well as on radio stations and park benches in high-risk areas. Free syphilis testing has also been extended from STD clinics into non-traditional settings, including a mental health center and a library.
Marion County (Indianapolis), Indiana
Ranked #2 in 2000, Ranked #1 in 1999.
Marion County has also experienced marked success in decreasing rates of syphilis. Cases dropped by nearly 25 percent from 1999 to 2000, a decline nearly three times greater than the national average. The county has formed the Stamp Out Syphilis Coalition, comprised of grassroots organizations, community agencies, faith-based organizations, radio stations, neighborhood associations, city and state legislators and concerned citizens. Educational outreach has taken place in neighborhoods, clubs, barber and beauty shops and laundromats. HIV/Substance abuse outreach workers test community members for syphilis and HIV. The county jail has instituted a screening program and key hospitals provide STD prevention services. In addition, the project has initiated a syphilis prevention campaign through billboards, bus ads and radio spots.
Wake County (Raleigh), North Carolina
Ranked #39 in 2000, Ranked #32 in 1999.
Wake County experienced a sharp decline with a 27 percent decline from 1999 to 2000. The Wake County STD program has conducted intensive community efforts in identified "hot zones," providing in-home and on-the-street outreach, intensive education and free, on-site syphilis testing. A "Knock-Out Syphilis" community task force, which includes retired school teachers and librarians and representatives from sororities, substance abuse programs, young people's organizations, urban ministries, and family organizations, is working to raise community awareness. Prevention efforts have also been implemented in the county jail, including on-site testing and treatment.
Other Syphilis Elimination Initiatives
Baltimore City, Maryland
Ranked #5 in 2000 and 1999, Ranked #1 for 1998.
Baltimore, an independent city, has created a Syphilis Elimination Plan Working Group composed of representatives from the city and state health departments, laboratories, medical centers, managed care organizations, correctional facilities, and affected communities. Working closely with community members, health officials conducted surveys to learn where people with syphilis meet their sex partners, and mapped responses to identify "hot spots" of risk behavior and disease transmission. "Hot spots" are being targeted by a rapid response team assembled to perform outreach and coordinate testing and treatment for hard-to-find and high-risk individuals. The county is working with six community-based organizations to reach at-risk populations and has offered tests at community health fairs and dispatched outreach workers to the streets to encourage screening and treatment.
Cook County (Chicago), Illinois
Ranked #1 in 2000, Ranked #2 in 1999.
Cook County led the nation in new cases of infectious syphilis in 2000. The Chicago STD/HIV program has joined with community-based organizations to enhance HIV and STD screening of sex workers, to increase outreach in gay bathhouses, bars and other areas where men who have sex with men (MSM) congregate, and to work in partnership with outreach workers who are former substance users and commercial sex workers to bring syphilis education to high-risk individuals and locations frequented by drug users. In addition, Chicago has worked to increase community involvement in syphilis elimination, and to enhance screening and treatment of detainees admitted to Cook County Jail.
Dallas County, Texas
Ranked #11 in 2000, Ranked #9 in 1999.
Dallas County is working with local community-based organizations to enhance syphilis screening, treatment and education. Dallas has expanded STD clinic hours to improve patient access, and has increased syphilis screening and treatment in local detention facilities. More than 1,000 health professionals attended a recent HIV/STD conference, which featured numerous sessions on topics relevant to syphilis elimination, including prevention, partner notification, and needs of diverse communities. In addition, the city has launched a syphilis elimination media campaign that includes brochures, T-shirts, promotional materials and a public service announcement expected to reach nearly a quarter of all African-American households in the Dallas area.
Maricopa County (Phoenix), Arizona
Ranked #8 in 2000 and 1999
Maricopa County has experienced a relatively high percentage of cases among Latinos-forty percent of the county's total. Twenty-nine percent of cases in Maricopa County were among African Americans. In response, the Office of HIV/STD services has worked with Latino and African-American organizations and health care centers to create posters and hold weekly health education and risk-reduction classes in high-risk neighborhoods. Other efforts include initiatives to increase blood testing during STD outreach activities, and to initiate a new communicable disease - syphilis and TB-screening project at a local jail.
Seattle-King County, Washington
Ranked #22 in 2000, Ranked #16 in 1999
King County has experienced syphilis outbreaks concentrated among MSM. Eighty-eight percent of infectious syphilis cases in 2000 were among men, and 70 percent of those men were also HIV-positive. King County responded by developing new screening guidelines and enhancing screening in various venues, including bathhouses and STD clinics, providing interview and partner notification services for MSM diagnosed with gonorrhea and chlamydia outside the STD clinic, expanding training and education of health care providers, and strengthening alliances with community organizations. Recently, the county held a day-long summit to engage community leaders, community organizations, public health experts, University of Washington investigators and others in the fight against syphilis. Other planned activities include: conducting a media campaign in concert with community-based organizations that focuses on syphilis and other STD/HIV prevention in MSM; revamping disease intervention data management systems; conducting a population-based probability sample survey of MSM focused on sexual behavior related to syphilis, other STD and HIV transmission; and implementing innovative partner notification programs.