Gay and bi men's health forum addresses MRSA, HIV and increasing syphilis rates

A Feb. 13 health forum at Club Caf? sponsored by Fenway Community Health proved that there's a fine line between keeping medical providers informed about issues in gay and bi men's health and perpetuating anti-gay stereotypes.

At the top of the forum's agenda was Methicillin-resistant Staphylococcus aureus, more commonly known as MRSA. Last month international media reported on a study showing that gay and bi men in Boston and San Francisco were at higher than average risk for acquiring a multi-drug resistant form of MRSA, which causes abscesses and ulcerations and which if left untreated can be life-threatening, and that among those men it may have been sexually transmitted. Critics at the time argued that many of those stories sensationalized the study and played into the stereotype of gay men as spreaders of disease (see "MRSA media panic," Jan. 24, 2008). Panelists at the Club Caf? dialogue critiqued the media coverage and talked about the myths and realities of MRSA within the gay community. But the Fenway's Dr. Ken Mayer, one of the researchers involved in the study and one of the evening's panelists, said his colleagues at University of California-San Francisco had good intentions in publicizing the study. He said the publicity was aimed at clinicians to make them aware that their gay and bi male patients infected with MRSA may have the multi-drug resistant strain and that they should take that into account when determining how to treat the infection.

"With a staph infection, you can't really tell the difference between a resistant and non-resistant staph infection just by looking at it," said Mayer. He said there are certain antibiotics that are more effective at treating multi-drug resistant strains of MRSA, and with multi-drug resistant strains it is important to drain the abscesses as soon as possible.

Yet while the goal of the publicity was to improve how clinicians treat their gay and bi male patients, one audience member said that doctors unfairly jumped to conclusions about the origins of his own MRSA infection after they learned that he was gay. The man declined to give his name.

The man said that two years ago, when he was visiting his mother in Ft. Lauderdale, Fla., he sought treatment at a hospital for what he described as a sun infection. Soon after, he noticed a blemish that resembled a pimple; his doctor diagnosed it as cellulitis. Within a week it had grown to the size of his hand. After three days in the emergency room doctors finally diagnosed it as MRSA. Once he told them he was gay, he said they immediately assumed it was a "community acquired" case through contact with other men.

"They kept trying so hard to connect it to community. I was in Florida with my mother, I had no connections with anybody, I didn't go in a pool, I didn't go in a hot tub, I was strictly in the ocean," said the man. "I had that one 40-minute visit to that hospital, and I'm sure that's where I got it. ... And yet they tried so hard to try to connect it with community, which really offended me. Finally I made such a fuss that they didn't. They put it down as undetected or whatever. But I think it's really scary that just because you tell them you're gay, immediately it's community connected."

Panelists argued that the media crossed the line from providing information about gay men's health to propagating anti-gay stigma last month in its coverage of the MRSA study. Eric Brus, AIDS Action Committee's director of HIV health promotion and one of the panelists, described how a press release put out by UCSF triggered a wave of media coverage. Many of the reports described the multi-drug resistant strain of MRSA as a gay disease, and at least one outlet labeled it "the new HIV." Comments from one of the UCSF researchers, Binh An Diep, that "Once this reaches the general population, it will be truly unstoppable," only fanned the flames, and soon anti-gay groups like Concerned Women for America were sending out press releases pointing to the study as evidence of gay male deviance.

Brus said in response to the negative media coverage advocates at the local and national level called on the media to correct the record and let the public know that MRSA is not a new disease and that it affects many populations, not just the gay community.

"I'm happy to report that these actions made a real difference," said Brus, who pointed to a New York Times article on the sensationalizing of the MRSA coverage and a public apology from UCSF as evidence that advocates' efforts to combat the misinformation around the coverage succeeded.

Mayer said Fenway first started noticing gay men coming in with multi-drug resistant MRSA infections in 2000, and currently between one and two men are diagnosed with it each week. But he said MRSA was not a crisis and that it should not cause panic. There is effective treatment, and he said people can reduce their risk if infection by washing their hands, showering after sex, and generally maintaining good personal hygiene.

"Personal hygiene is probably the best thing you can do, and vigilance," said Mayer.

Dr. Nancy Norman, medical director for the Boston Public Health Commission, said that it is difficult to tell at the city level how many MRSA infections there are each year because there is no reporting requirement for MRSA.

"We don't have great data that is specific to MRSA," said Norman, who added that the media coverage around MRSA has prompted the commission to examine whether it should track new infections.

On to other STDs...
Tom Bertrand, director of STD prevention for the state Department of Public Health's Bureau of Communicable Disease Control, gave an update on state surveillance of other STDs impacting the gay and bi male community. He said the number of newly diagnosed HIV infections has remained relatively steady over the past few years, averaging just over 300 cases in 2005 and 2006.

"The bigger picture here though is that overall HIV infection is going down, so MSM [men who have sex with men] are representing a larger percentage of total HIV infections," said Bertrand. He said gay and bi men account for just over half of all new HIV infections. The majority are aged 35-45, and Bertrand said that while men of color are slightly overrepresented among those infected, in general the population of gay and bi men infected with HIV reflects the population of the state in terms of race and ethnicity.

Bertrand said that since January 2007, when the state instituted its new requirement that providers report the names of people testing positive for HIV, the system has operated smoothly. Some HIV/AIDS advocates have criticized the system as a threat to patient confidentiality and a deterrent to people getting tested.

"I'm happy to report the transition has gone extraordinarily smoothly. Providers have cooperated. Clients have cooperated," said Bertrand.

Among gay and bi men Bertrand said infectious syphilis is on the rise among gay and bi men, from 150 cases in 2006 to 178 cases in 2007. He urged people not to take that as a sign that there was necessarily higher rates of transmission, saying it may be a result of better screenings.

One audience member asked the panel about the claim last month by Swiss health officials that some HIV-positive patients who have suppressed the virus through antiretroviral drugs pose no risk of infection to HIV-negative partners. Mayer called the statements by the Swiss National AIDS Commission "very irresponsible," saying that while there may be low risk of transmission from those patients, the risk is not zero.

"I wouldn't disagree with the general thrust of what they're saying," said Mayer. "If you are on anti-retroviral therapy, your viral load is controlled for a really long period of time, and you're in a stable monogamous relationship, and you've been screened very recently for sexually transmitted infections, I think the big difference, and it's all the difference in the world, is they're saying, well, we think there's zero risk because statistically it approaches zero. I'd say, 'I'm not God.' I can't say there's a zero risk. There are various circumstances we can delineate that might mean that that one particular time you might transmit HIV."