New campaign aims at fighting syphilis among homosexuals

KANSAS CITY, Mo. -- A sharp increase in syphilis cases in Kansas City, particularly among gay men, has prompted the city's health department to begin a new kind of public health campaign.

Using a technique called social marketing, the health department is working with the city's most famous drag queen, along with placing ads in alternative newspapers and youth-oriented radio stations and handing out more typical information brochures.

There were 117 syphilis cases last year in Kansas City, compared with 53 in 2004 and 44 in 2003. Until last summer, most cases involved heterosexuals, but gay men now account for a little more than half of the new cases.

To combat the sexually transmitted disease, the health department hired advertising firm Fleishman-Hillard to devise a marketing campaign that would inform the gay community about the disease and prompt gay men to seek testing and treatment.

One of the primary methods was convincing Flo, the grand dame of Kansas City's drag queens, to discuss the issue in her shows at gay-oriented nightspots.

Off stage, Flo is John Koop, who has long made Flo a crusader for gay health.

"When the health department contacted me I was right on board," Koop said. "If there's something in the gay community that needs to be put out there, usually Flo is the one they can call. We're giving them information in a serious way and a humorous way so it sticks in their mind."

While Flo does her routine, volunteers from area health departments and medical schools and the Kansas City Free Health Clinic circulate, offering each patron information about free syphilis testing.

They also hand out condoms and glow-in-the-dark bracelets with the health department's telephone number.

"Everybody is really receptive," said Mistie Stevens of Fleishman-Hillard. "A lot of people have told me they've already been tested."

Until last summer, syphilis rates had been low among all groups in Kansas City, with gays not even on the radar, said Lesha Dennis, an epidemiology specialist with the department.

"This is a new demographic for us," Dennis said. "Syphilis sort of made its way in. But when it becomes entrenched in this community all it does is spread out. Some of the men who have sex with men also have sex with women."

Another concern was that syphilis makes it easier to spread HIV, the virus that causes AIDS. Fifty of the men diagnosed with syphilis last year in Kansas City also were HIV-positive.

Syphilis is passed through direct contact with a syphilis sore during sexual activity. Pregnant women with the disease can pass it to the babies they are carrying. Contrary to popular belief, the disease cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing or eating utensils.

Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated.

The increase in syphilis in Kansas City reflects trends across the country.

In 1999, syphilis rates reached historically low levels in the United States. The federal Centers for Disease Control and Prevention launched a national plan to eliminate the disease, focusing prevention on disadvantaged heterosexuals. Gay men were not a major consideration.

Meanwhile, major cities, including Los Angeles, Chicago, Miami and San Francisco, began to see a rise in syphilis cases in their gay communities.

"We really don't have a clear picture of why this is happening," said Jennifer Ruth, a spokeswoman for the CDC.

She said easier communication for possible sexual partners through the Internet, as well as the increasing popularity of crystal meth as a party drug may be factors. In response, many larger cities have started social marketing campaigns aimed at their gay communities.

Kansas City's campaign helped the department identify 15 additional cases of syphilis in November and December.

Dennis said she expected other health departments in Missouri to adopt at least a version of Kansas City's campaign.

The health department is planning more efforts, including meetings with doctors, bar owners and community organizations to coordinate the effort.

"Everybody's talking about this. It's amazing the big push they've made," Koop said.