Concentration of MSM contributes to high STD rate in South End

The South End leads the city in infection rates of several sexually transmitted diseases, including syphilis, gonorrhea and HIV/AIDS, according to the most recent "Health of Boston" report published by the Boston Public Health Commission.

"The South End, like any other neighborhood, has some diseases that are more common," said Dr. Anita Barry, director of the Boston Public Health Commission's Communicable Diseases Control Division, of the South End's higher infections rates. "I think a good thing is for some of them, we certainly know how to prevent them."

The "Health of Boston" report gives city and neighborhood statistics on incident rates, up to 2006, on three preventable or curable sexually transmitted diseases: syphilis, gonorrhea, and chlamydia. Though numbers of syphilis contraction are in fact low, the South End had the highest rate of infection in the city, almost four times the city average, with 31 cases; most of the cases citywide were among men, ages 30 to 49, and were transmitted through male-to-male sex. The South End also boasted the third highest rate of new gonorrhea infections in the city, with 61 cases, just behind North and South Dorchester. Gonorrhea is again a disease that affects more men than women citywide, and is more prevalent in individuals under the age of 25.

In fact, the only sexually transmitted disease where the South End does not have either the highest or one of the highest incidence rates is in the case of Chlamydia, a disease which citywide sees its highest numbers among women and among people ages 15 to 19.

While Barry says that it's difficult to say precisely why the South End might have rates so significantly higher than the rest of the city, there are a few possibilities. When it comes to syphilis, said Barry, "Some of the cases are with men who have sex with men [MSM] and I don't have the numbers, but I think that does explain a number of cases in the South End."

Barry also said the South End's large population of men who have sex with men may also explain why the neighborhood's rates of HIV/AIDS are the highest in the city. According to the report, the South End's HIV/AIDS incidence rate in 2006 was almost four times higher than the overall city of Boston rate. At a rate of 128.2 per 100,000 population, the South End was by far the highest rate - the next highest was Jamaica Plain, with 49.6 per 100,000. While the report does not track modes of transmission within neighborhoods, 47.2 percent of the citywide cases were transmitted through male-to-male sex.

"Male-to-male sex is the leading mode of transmission in whites and Asians, so I think that would explain partly why case rates are high in the South End," said Barry. Overall in the city, the incidences of HIV infection is on the decline, the most precipitous drop in the rates of infection among the black and Latino communities; among the white male population, however, the decline has been far less pronounced.

It is also important to note that while the incidence rate itself appears high, the actual count of new HIV/AIDS cases in the South End in 2006 was only 35, out of 194 in the entirety of Boston. Low, said health professionals, but concerning.

Dr. Stephen Boswell is the CEO of Fenway Community Health, a clinic that works particularly on LGBT healthcare needs. The HIV/AIDS epidemic in Boston, he says, is "really an MSM [male-to-male sex] epidemic." While HIV/AIDS infection has decreased in the city and state, he said, "The drop has not been uniformly represented in all groups and among men who have sex with men, there appears to be no drop, based on the most recent data."

In the South End, the higher numbers of HIV/AIDS, syphilis and gonorrhea are likely due to the larger population of gay men, he agreed; his clinic, for example, sees a significant number of patients from the South End. However, he explained, the rates of contraction for HIV/AIDS and even syphilis have remained stable or declined over recent years; moreover, in terms of absolute numbers, those new cases are relatively few - for HIV/AIDS, for example, there are around 1000 new cases statewide each year. In the South End, the numbers of sexually transmitted disease infections, though higher than the rest of the city, have remained relatively stable, he said, explaining that "there's been relatively little change in infections."

That kind of leveling off leads to another kind of issue in sexually transmitted disease and HIV/AIDS prevention. "It's been particularly difficult to push below the current numbers," he said. "The resources and focus on the people who are currently being infected require a great deal more than is currently being [offered]."

Reducing the rates of sexually transmitted diseases, both in the disproportionately affected South End and citywide, requires much more concerted effort, Boswell said. "I think ultimately we can be successful at doing this. I think it's going to require more than we're currently doing and the key to doing more ... is really more resources," he said. "And I think we have to focus on types of interventions that go beyond sending out public health messages, although I think that's important."

Regarding the South End's particular struggle with higher rates of sexually transmitted disease infection, Barry said that at the moment, she is not aware of any sort of Boston Public Health Commission program targeting the issue, aside from its existing work on HIV/AIDS. "I would hope that the people in the community that's involved with this would kind of use their creativity and their insights to get the prevention message out there," she said.