260374 A syphilis-HIV co-infection cluster investigation involving young african american MSM in Milwaukee WI: Emerging trends and challenges for local public health agencies (LPHAs)

Monday, October 29, 2012

Paul A. Biedrzycki, MPH, MBA , Health Department, City of Milwaukee, Milwaukee, WI
Irmine Reitl, MSN , Health Department, City of Milwaukee, Milwaukee, WI
Otilio P. Oyervides, BBA , Health Department, City of Milwaukee, Milwaukee, WI
Sandra Mattson, BSEd , Health Department, City of Milwaukee, Milwaukee, WI
Darlene Turner-Harper, MPA , Health Department, City of Milwaukee, Milwaukee, WI
During the summer of 2011, the City of Milwaukee Health Department (MHD) identified a cluster of 12 confirmed syphilis cases among young African American (YAA) Men who have Sex with Men (MSM). The number of cases exceeded the annual incidences in the region and historically represented one of the largest cluster investigations within the City. In addition, a high percentage of cases (60%) reported HIV co-infection.The MHD along with the State of Wisconsin Division of Public Health (DPH) initiated a case-contact investigation and identified additional epi-links and infected individuals. Community partners and service providers were briefed as to social interactions associated with many of the cases which consisted of YAA males (age range 17-34 years of age) who utilized social media to communicate among partners and in arranging meetings at non-traditional locations. Lessons gleaned from the investigation include: need to integrate HIV and STD programs more closely at the State and local level to ensure continuity of case screening, counseling and care; ensuring a common client database and/or electronic communication between HIV and STD information management systems; early notification and engagement of community partners in strategic planning and coordinated response; increased emphasis on prevention activities for high-risk tested “negatives” and, exploring reasonable legal recourse upon identification of “willful” exposure of disease transmission. Effective LPHA response to significant and related cases of STD-HIV co-infection demand closer attention to LPHA program coordination, effective community engagement and adoption of a prevention focus to mitigate the significant health consequences for YAA MSM populations.

Learning Areas:
Administration, management, leadership
Advocacy for health and health education
Diversity and culture
Planning of health education strategies, interventions, and programs
Protection of the public in relation to communicable diseases including prevention or control
Public health or related public policy

Learning Objectives:
1.Identify ways in which State and local STD and HIV programs can better integrate case-contact investigations and improve data sharing and analysis for strategic response to clusters or outbreaks in the community. 2.Describe how the MHD and State of WI Division of Public Health developed a strategy in response to a large cluster of Syphilis-HIV co-infection in young black MSM cohort in the City of Milwaukee. 3.Summarize various prevention and intervention activities designed to mitigate transmission of STDs and HIV in the community as a result of LPHA identification of clustered cases.

Keywords: Sexual Risk Behavior, STD

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I serve as Director of Disease Control and Prevention at the City of Milwaukee Health Department and oversee the STD/HIV Program
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3293.0: PRSH Posters: STIs and HIV