KING COUNTY, WASHINGTON - In response to recent increases in newly identified HIV cases seen by Public Health STD providers and continuing, disturbing trends locally in sexually transmitted diseases (STDs), community leaders have joined with Public Health - Seattle & King County to encourage gay and bisexual men to take a more active role in promoting their health and the health of their community through testing, disclosure of HIV status and condom use.

"All sexually active gay men can contribute to reducing the rates of sexually transmitted diseases," said Jack Johnston, Program Director of Positive Power, a group that seeks to empower HIV positive men. "Knowledge, communication and safer sexual choices are the keys to protecting the health of the entire community."

"There are more people living with HIV today in King County than ever before," said Dr. Alonzo Plough, Director of Public Health - Seattle & King County. "Consistent, correct condom use, frequent testing for HIV and STDs and disclosure of HIV and STD status to new partners cannot be overemphasized for sexually active gay and bisexual men."

Recent trends

"Sexually transmitted disease rates among King County gay and bisexual men are at extremely high levels and continue to rise, primarily due to increases in unsafe sexual practices among some men," said Dr. Hunter Handsfield, Director of Public Health's STD Program.

Key trends in HIV and STDs among gay and bisexual men in King County:

• Among gay men tested for HIV by Public Health, the number of newly identified HIV-positive individuals in 2002 increased by 40% from 2000 and 2001. Based on this year's trend, another 60% increase could be seen in 2003. Even though there was an encouraging 11% increase in the number of persons tested in 2002, increased demand alone cannot explain such increases in new cases of HIV infection.
• The proportion of gay and bisexual men that Public Health has previously tested who were negative and are now positive has increased steadily over the past four years, from 1% (1999) to 2.2% (2002). These facts suggest that the rates of new infections may have increased.
• By 1995, syphilis had been eliminated in King County, but in 1997 syphilis returned in some gay men, and is now continuing in the gay population at rates similar to those seen in the pre-AIDS era, with 58 cases in 2002. Based on this year's trend, 90 to 100 cases could be seen in 2003.
• Continuing an upward trend, gonorrhea cases in gay and bisexual men increased sharply from 166 cases in 2001 to 289 cases in 2002, a 74% rise. Chlamydia cases also are rising.

"These rapidly increasing numbers of HIV positive individuals found strongly suggest a possible new wave of HIV infection in gay and bisexual men locally. We had feared this earlier, based on the resurgence in STDs and its association with HIV," said Dr. Bob Wood, Director of Public Health's HIV/AIDS Program. "The presence of STDs make it much easier for HIV to be transmitted."

Recommendations for both HIV-positive and HIV-negative men

Through their partnership on the local MSM STD Task Force, Public Health and community partners have developed recommendations for sexually active men who have sex with men (MSM) to best protect themselves and the community. The MSM STD Task Force is comprised of more than 30 community members collaborating to promote HIV & STD prevention locally. These recommendations include:

• getting tested for HIV and STDs regularly and frequently
• using condoms consistently and correctly to avoid HIV infection and STDs and their complications
• knowing and always disclosing their HIV and STD status, whether positive or negative, to new sexual partners before engaging in any sexual activity

Additionally, sexually active MSM who have HIV or suspect they might have other STDs can best protect themselves and others by:

• getting and adhering to recommended treatments
• assuring that exposed sexual partners are informed of their need to be tested for HIV or other STDs. Free, confidential assistance for doing this is available through Public Health by calling (206) 205-STDS (7837).

"Education and testing are important and necessary components of our prevention strategies," said Quinten Welch, Executive Director of the Seattle Treatment Education Project. "It is critical for gay and bisexual men to continue to believe that they can make a difference in reducing STDs. Building an atmosphere of trust in the community for individual disclosure of HIV status to a sexual partner must become a highly valued community norm for any significant change to occur."

Existing prevention activities

Public Health has greatly intensified its HIV and STD prevention efforts for gay and bisexual men in the past five years. These efforts include expanded anonymous and confidential HIV counseling and testing, encouragement of health care providers to counsel and test their patients at risk, and collaboration with community-based organizations to educate gay and bisexual men and publicize the problem of STDs and increased HIV risk.

Following priorities established by the HIV/AIDS Community Planning Council, Public Health funds over 15 different community-based programs to promote HIV prevention among MSM. Programming is based on the best research available and includes various approaches, including HIV testing, STD screening, outreach to peer education and individual counseling.

Information about the MSM STD Task Force, HIV/AIDS, STDs, and clinics that provide STD services and anonymous or confidential HIV counseling and testing is available at Public Health's HIV/STD Hotline, (206) 205-7837 (STDS), and at Public Health's HIV/AIDS website at www.metrokc.gov/health/apu