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Syphilis outbreak among Hispanic immigrants in Decatur, Alabama: association with commercial sex.
Sexually Transmitted Diseases 2004;31(1):20-25.
Paz-Bailey G, Teran S, Levine W, Markowitz LE.
Abstract
BACKGROUND: Despite national progress in syphilis control, increases in rates
have recently occurred, and syphilis is still an endemic problem in the southern
United States. An outbreak of infectious syphilis among Hispanics was identified
in Decatur, Alabama. GOAL: An investigation was initiated to describe the
outbreak and to assist with prevention activities. STUDY DESIGN: We reviewed
case interview records and syphilis surveillance data. The Morgan County
Health Department (MCHD) performed voluntary door-to-door syphilis screening
in neighborhoods where a large number of cases had been identified. During
screening activities, sociodemographic and behavioral data were collected.
RESULTS: From June 2000 to February 2001, 49 cases of syphilis were reported;
26 (53%) were primary or secondary, 17 (35%) were early latent, and 6 (12%)
late latent. Of the early syphilis cases, 70% were male and half were Hispanic;
93% of cases were linked to commercial sex and 70% of female cases reported
crack cocaine use. During the screening, 172 individuals completed a questionnaire;
70% of participants were male, 83% were Hispanic, 17% of Hispanic participants
spoke English, 21% reported sex with a commercial sex worker, and 8 (5%)
had positive syphilis serology. Among men, factors associated with commercial
sex were not having a regular partner (odds ratio [OR], 3.9; confidence interval
[CI], 1.1-14.3), not living with a family member in the United States (OR,
4.5; CI, 1.6-12.8), and having visited their country of origin since arrival
to the United States (OR, 9.2; CI, 2.3-36.5). CONCLUSIONS: Factors contributing
to this outbreak were crack cocaine use and increased prostitution in close
proximity to the Hispanic community. At present, there are an increasing
number of Hispanic immigrants in the United States, the majority of whom
do not speak English. To prevent similar outbreaks in the future, public
health officials need to be aware of the health and health education needs
of these populations.