# Presentation: 078920

## INTERSECTING EPIDEMICS IN THE NEW ENGLAND EPICENTER: HIV AND STD AT FENWAY COMMUNITY HEALTH

-  Kenneth H Mayer, Daniel  Cohen, Sarit Golub, Wilson Lo, Jerald C Feuer, Stephen Boswell, Fenway Community Health, Boston, MA
-  Yuren Tang, Paul Etkind, MA Dept of Public Health, Boston, MA;

## FENWAY COMMUNITY HEALTH (FCH)

**Largest provider of health care to MSM in New England.**
**Cachement area includes the Boston neighborhoods of Fenway, Kenmore, Back Bay, and the South End. **
**Among FCH clients:  80% describe themselves as Caucasian, 6% as African American, 5% as Latino, 4% as Asian, and 4% as other.****  **

_**FENWAY COMMUNITY HEALTH (FCH)**_

## MEN LIVING WITH HIV/AIDS (N=9,535)Risk and Race, 2000

## Fenway: Gonorrhea Cases by Year

## METHODS

**Prior to 1997, a paper record was maintained of all FCH clients who underwent HIV or STD screening, subsequently Logician, an electronic medical record, was used.**
**STD/HIV data were verified by the Massachusetts Department of Public Health (MDPH) who performed STD screening.**
**Further analyses in 2000 included self-administered provider and client interviews.**

## STD TESTING OF FENWAY MSM

**1,190  MSM SCREENED IN 1999**
**75% SYMPTOMATIC**
**10% PARTNER KNOWN (OR SUSPECTED) TO HAVE STD**
**10% ROUTINE SCREENING**
**5% ASYMPTOMATIC SCREEN AFTER RISKY ENCOUNTER**
**17% OF THOSE SCREENED TEST POSITIVE**
**	****	****(3% OF FCH PATIENT POPULALTION)**
**34% OF THOSE TESTED COME TO FENWAY FOR STD CARE ONLY**

## Male Syphillis and GC Cases in Massachusetts

- .

## Gonorrhea Rates at FCH from 1995-1997

| Year | Number of GC cultures | GC cases diagnosed | % Positive |
| --- | --- | --- | --- |
| 1995 | 1000 | 60 | 6% |
| 1996 | 1300 | 52 | 4% |
| 1997 | 1466 | 44 | 3% |
| 1998 | 1171 | 82 | 7% |
| 1999 | 1190 | 131 | 11% |

## SYPHILIS AND HIV AMONG MASSACHUSETTS MSM

**FENWAY: 2 CASES IN 1996 ******** 12 CASES IN 2000.**
**50% OF MASS MSM WITH SYPHILIS IN 2000 WERE HIV+**
**72% OF MASS MSM WITH SYPHILIS 1-9/2001 WERE HIV+.**
**PROVINCETOWN (1-11/2001): 10 SYPHILIS CASES; 8 HIV+, 1 UNKNOWN.**

## Zip Codes of Syphillis and GC Cases Diagnosed at FCH 1997-1999

## Age Distribution of STD Cases compared to Total Patient Population

-        = p < .01

## Percentage of FCH HIV+ Patients With STDs in 1999-2000, by Age Group

-             = p < .02

## RISKY PARTNERS (N=74)

## DRUG USE (N=74)

**49% (N=26) OF PATIENTS REPORTED SOME DRUG USE IN THE PAST 30 DAYS**
**20%  OF THOSE WHO USED DRUGS REPORTED USING MORE THAN ONE DRUG, OF THESE:**
**6 REPORTED USING ECSTASY**
**5 REPORTED USING COCAINE**
**2 REPORTED USING GHB**
**1 REPORTED USING METHAPHETAMINES**

## HIV-POSITIVE MSM WITH A NEW STD

**HIV+ MSM WERE SIGNIFICANTLY MORE LIKELY TO TEST POSITIVE FOR STDs (X****2**** = 6.18, P < .03)**
**HIV+ MSM WERE ALSO MORE LIKELY TO REPORT SEX WITH AN HIV+ PARTNER (X****2**** = 16.68, P < .001)**
**HIV+ MSM WERE LESS LIKELY TO REPORT HAVING SEX WITH MULTIPLE PARTNERS (X****2**** = 4.78, P < .05)**
**THERE WERE NO SIGNIFICANT DIFFERENCES BY  HIV STATUS IN SEX WITH UNKNOWN PARTNERS ANONYMOUS, BATH HOUSE/SEX CLUB, OR INTERNET USE**

## Discussion and Conclusions

**HIV coinfection was common, as was recreational drug use.**
**STD pts cruised  the internet, met partners in baths and sex clubs, but no single venue, or pattern was particularly implicated in the resurgence of MSM STD.**** **

_**Discussion and Conclusions**_

## Discussion and Conclusions

**There also is an increase in geographic variability among MSM presenting with STDs; could portend a wider STD epidemic among MSMs in New England?**
**New strategies are urgently needed to strengthen and reinforce prevention messages.**
**Further studies are needed  to determine the most effective means to promote  behavioral change**

## Acknowledgements

**Tom LaSalvia**
**Louise Rice**
**Jonathan Appelbaum**
**Nick Peterson**
** **
**Thanks to Paul Etkind, Abby Averbach, Kevin Cranston and their colleagues in the Massachusetts Department of Public Health for their support**

**Acknowledgements**