Chris M. O’Leary, Ph. D. , Jorge A. Montoya, Ph. D. , & Peter R

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Presentation transcript:

Syphilis, HIV, Sexual Networks and Men who Have Sex with Men in Los Angeles County, California Chris M. O’Leary, Ph.D., Jorge A. Montoya, Ph.D., & Peter R. Kerndt, MD, MPH Sexually Transmitted Disease Program Los Angeles County Department of Public Health Contact: Jorge A. Montoya, Ph.D. jamontoy@ph.lacounty.gov

Sexual Networks & STD Transmission Infections come from unambiguous relations Core transmitters are easily identified “Bridges” readily apparent Easier to determine best way to interrupt Use other data to determine specific STD exposure; Refine

Methodology Elicit contacts Find contacts Repeat…until exhaustion Additionally Critical period for syphilis, defines likely exposure Analyzed with UCINet  Graphical result

Internet Sexual Network 1 person with syphilis with 66 partners b/w July and August 2007 (2 prior syphilis infections) Field staff investigation led to 319 partners (280 anonymous) Met online Limited data on demographics, drug use Average age=37.4 (n=29) Syphilis history (n=22) Average 2.2 previous syphilis infections 17 “Bridges”

Internet Sexual Network

Diseases & Exposure in Internet Network 11 (3%) no disease, or out of time period 9 (3%) syphilis (primary and secondary) 5 (2%) HIV only 15 (5%) syphilis/HIV 279 (87%) unknown Exposure 1 degree (sex with infected person) 24 (8%) no known exposures 36 (11%) syphilis only 44 (14%) HIV only 217 (68%) to syphilis/HIV 2 degrees (sex with somebody who had sex with somebody) 100% syphilis/HIV

Maximize Disruption of Internet Network Remove ONLY three actors Network=159 members (50% drop)—17 unconnected clusters

Bar Sexual Network 1 person with syphilis with 19 partners (July-August 2007) Field staff investigation led to 123 partners (102 anonymous) Mostly through bars, some online Some drug use Avg. age=24.3 (n=19) Syphilis history (n=5) Average 1.4 previous syphilis infections 5 “Bridges”

Bar Network Diagram

Disease and Exposure Disease Exposure 17 (14%) no disease, no contact during critical period 3 (2%) syphilis 0 HIV only 1 (1%) syphilis/HIV 102 (83%) unknown Exposure 1 degree (sex with infected person) 69 (58%) no known exposures 50 (42%) syphilis only 11 (9%) to syphilis/HIV 2 degrees (sex with somebody who had sex with somebody) 42 (34%) syphilis/HIV 100% syphilis

Disrupting the Bar Remove three actors Network=26 members (79% drop)—2 unconnected clusters

Implications Prioritize cases based on venue Internet case over bar/club Focus on “removal” of cores and bridges How to identify before transmission occurs? Proxy to identify likely “core transmitters” Re-infection (“Re-infectors”) a possibility Voluntary preemptive field visits (some case management) Client-centered interventions

Implications Focus our efforts on interventions with previous syphilis cases (likely “core transmitters”) e.g., Number of Early Syphilis Incidences, January 1, 2000 through October 31, 2007 Number of times infected Frequency Percent (%) Cumulative Frequency Cumulative Percent (%) 1 5968 89.9 2 555 8.3 6523 98.3 3 101 1.5 6624 99.8 4 10 .1 6634 99.9 6 .02 6635 100 This information is readily available from most reporting systems

Chris M. O’Leary, PhD 1973 - 2008 Contact: Jorge A. Montoya, Ph.D. jamontoya@ph.lacounty.gov (213) 744-5958