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)

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.