Outbreak of Hepatitis A Among Men
Who Have Sex with Men
Journal of Infectious
Diseases
Vol. 187: P. 1235- 1240
By: Suzanne M. Cotter; Stephanie Sansom; Teresa Long; Elizabeth Koch;
Scott Kellerman; Forrest Smith; Francisco
Averhoff; Beth P. Bell
APRIL 15, 2003
In the United States, hepatitis A remains one of the most frequently reported diseases that is preventable by vaccine; the vaccine was licensed in 1995. Recognized risk factors include contact with an infected person, contact with a day care center, use of illicit drugs, being a man who has sex with men (MSM), and international travel. Of reported cases, however, 40 percent to 50 percent do not involve a recognized risk factor.
Among MSM in the United States, Canada, Europe and Australia, periodic hepatitis A outbreaks have been reported
during the past three decades. In 1996, the Advisory Committee on Immunization Practices recommended hepatitis A vaccination for sexually active MSM. Between January and March 1999, the Columbus city and Franklin County, Ohio, health departments noted an increase in hepatitis A cases compared to previous years, and MSM were disproportionately infected. Researchers studied the community-wide outbreak, evaluated the risk factors for hepatitis A among MSM and looked for potential opportunities to deliver the hepatitis A vaccine to MSM.
There was no association between hepatitis A and the number of sex partners: 10 case patients (21 percent) reported no sex partners; 24 (51 percent) reported one sex partner; and 13 (28 percent) reported more than one sex partner in the referent exposure period. There was no association between hepatitis A and anonymous sex, visiting a bathhouse, or specific sex practices, such as digital-anal or oral-anal sex.
"The results of our investigation and those of other studies suggest that risk factors that promote the transmission of HAV among MSM may vary and that, at least in some MSM communities, the majority of hepatitis A cases cannot be attributed to specific high-risk sex practices," the authors wrote. "...Our findings indicate that HAV transmission can occur among MSM who do not report any sexual activity during the incubation period and suggest that all MSM, regardless of their reported sexual practices, should receive hepatitis A vaccine."
"Dance of Death - Crystal Meth Fuels HIV"
San Francisco Chronicle (05.04.03)::Christopher Heredia
A San Francisco Health Department study last year found that, in one high-risk clinic, 25 percent to 30 percent of those with new HIV infections reported crystal methamphetamine use in the previous six months. At a meeting about crystal meth in Sacramento last month, the state's top HIV/AIDS prevention officials said that gay men who use speed are twice as likely to be HIV-positive as those who do not. "The crystal meth epidemic is playing an important role in increasing sexual risk behaviors, and that is leading to new HIV and STD infections," said Dr. Jeffrey Klausner, the city's director of STD control and prevention.
Of gay and bisexual men testing positive for syphilis, 25 percent reported recent speed use, said Klausner. HIV-negative gays who used meth were three times more likely to have rectal gonorrhea than nonusers. Men on speed say that meth tends to make them "instant bottoms" - the receptive position in anal sex - because the drug induces temporary erectile dysfunction.
A statewide study found that among 63,098 gay and bisexual men tested in 2001 and 2002 at public clinics, 7.1 percent of meth users were HIV-positive, compared to 3.7 percent for nonusers. And 10.5 percent of the men reported meth use. Officials found that 39.2 percent of gay non-users "always" use a condom for anal receptive intercourse, compared to 24.6 percent of meth users.
An SFDH study published in February, of gay and bisexual men who frequented late-night dance clubs, parks after hours, sex clubs, and adult bookstores found the incidence of recreational drug use extremely high:
Ø More than three-fourths of the 350 men surveyed reported non- injection drug use. Half said they had tried methamphetamine in the previous three months.
Ø Three-quarters said they had had unprotected anal intercourse in the same period.
Ø Nearly one-third said they already had HIV or tested positive for the first time, indicating they possibly had transmitted HIV to casual sex partners while using drugs.