Twenty-five years after the discovery of the HIV/ AIDS virus, Central Brooklyn hosts some of the highest concentrations of gonorrhea, chlamydia, syphilis, and HIV/ AIDS in NYC. Human Papilloma Virus (HPV) and several minor sexually transmitted diseases are also prevalent.
This week, the NYC Dept. of Health reported new HIV diagnoses rising in NYC among young men who have sex with men (MSM). New HIV diagnoses among MSM under age 30 have increased by 33% during the past 6 years, and have doubled among MSM ages 13 to 19. Among all MSM, Blacks received twice as many HIV diagnoses as whites in 2006. These figures do not include MSM who were diagnosed with both HIV and AIDS. In 2006, 20% of MSM diagnoses concurrently with HIV and AIDS (285 men). The Health Dept. attributes this with missed opportunities for care to stay healthy and may have unknowingly spread HIV to others.
As of June 2006, there are 43,874 Black Persons Living With HIV/AIDS (PLWHA) in NYC, 45% of all cases in the city. Within Brooklyn, 24.8% of the city’s PLWHA reside here. Of these 25,234 PLWHA in Brooklyn, most live in Central Brooklyn.
Blacks accounted for 532 deaths of PLWHA throughout the city Jan. – June 2006, 52.3% of the total. Brooklyn had 291 deaths, 28.5% of the total.
Risk factors for HIV/AIDS include: men who have sex with men, injection drug use history, heterosexual sex and perinatal (childbirth). Amazingly, 28,525 PLWHA, or 29.1% of the city’s total, did not identify any of these risk factors.
Sadly, in NYC, there were 3,828 children infected through perinatal HIV/AIDS transmission (born to HIV/AIDS-infected mothers) and diagnosed before age 13 through Dec. 2005. In addition, there were 82 children infected through other means (74 from contaminated blood products). There are 1,228 perinatally infected children living in Brooklyn, 32% of the citywide total. Blacks accounted for 58% of the citywide total of children infected through perinatal transmission.
HIV infection among young people ages 13-24 is also an issue. Among adolescents ages 13-19, there were 2,493 infected (58% were males), and of the 9,643 young adults diagnosed at ages 20- 24, 64% were males. For the males in both groups, the most common risk factor is sex with other men (57%). Males reported an unknown risk factor of 23%. For the females, the risk factor was heterosexual sex (39%). This heterosexual sex included sexual abuse (5%). The females had an unknown risk factor of 57%.
Citywide, the rates of HIV/AIDS in Black infected males 13- 19 is 60%, Black males 20-24 is 48%. For Black females, the rate is 68% for those aged 13- 19, and 66% for ages 20- 24.
Brooklyn is the borough of residence for 30% of diagnosed males 13- 19, and 27% for males 20- 24. The rates of infected young females living in Brooklyn is 35% of the NYC total for ages 13- 19, and 34% for ages 20- 24.
For those who think HIV/AIDS infection is a young people’s disease, think again. According to a Fact Sheet on HIV/AIDS among people over age 50, published by the NYC Dept. of Aging, people 50 years of age and older now comprise 31% of the more than 95,000 PLWHA in NYC. 47% of deaths citywide as a result of HIV/AIDS infection in 2005 occurred in persons 50 years or older.
The NYC Dept. of Health reports anyone age 12 or older can get free, confidential, anonymous HIV testing and STD treatment at the Health Department’s 10 STD clinics. Services are available without parental notification and without regard to insurance or immigration status. The clinics provide rapid HIV testing on a walk-in basis; results are typically available within 30 minutes. They also offer free testing for syphilis, gonorrhea and chlamydia, as well as hepatitis immunization.
(The Health Dept. offers confidential partner notification to people who think they may have exposed others to HIV or another STD.)
Other common sexually transmitted diseases infecting Central Brooklyn are chlamydia, gonorrhea and syphilis. The syphilis rates include early and late latent syphilis, neurosyphilis and tertiary syphilis. (Don’t some people ever go to the doctor?)
Chlamydia occurrences in Crown Heights, East Flatbush, and East New York are soaring. Like some other STD’s, the absolute numbers of infections in men are less than in women, leading to the belief that some men are infecting multiple women. In East New York, there were 141 infections in men ages 20- 24, and 438 infections in females of the same age. In Crown Heights, males age 15- 19 accounted for 185 infections, while there were 783 infections in females of the same age.
We should not sleep on chlamydia. Chlamydia is known as a “silent” disease because its symptoms are mild.
Untreated chlamydia in men typically causes urethral infection. It sometimes spreads throughout the reproductive system, causing pain, fever, and potentially, infertility.
In women, chlamydia can spread through the uterus into the fallopian tubes and causes pelvic inflammatory disease (PID). PID can permanently damage the female reproductive organs, leading to chronic pelvic pain, infertility and potentially fatal ectopic pregnancy (pregnancy outside the uterus). Babies born to infected mothers can get chlamydial infections in their eyes and respiratory tracts.
Rates of gonorrhea in Crown Heights and East New York reflect similar male/ female ratios. In Crown Heights, males ages 15- 19 have 87 infections, while females of the same age have 170 infections. In East New York, there are 48 males ages 20- 24 infected with gonorrhea, and 92 females in the same age group.
Gonorrhea is a bacterial infection spread through intimate contact with an infected person. Left untreated, gonorrhea can spread and cause severe pain and permanent damage to the reproductive system. It may make both women and men infertile. Like other STD’s, if left untreated, gonorrhea can increase a person’s chance of getting or spreading HIV.
Citywide, syphilis is increasing. At one point, the NYC Dept. of Health was considering declaring war against syphilis. That is no longer the case. Last year, females accounted for 549 cases of syphilis. Total male numbers for syphilis are 1,238, including 379 that report having sex with men and 591 that have sex with women.
Syphilis is a bacterial infection spread through direct, skin-to-skin contact with a syphilis sore, lesion or moist rash. Usually, contact occurs during vaginal, anal or oral sex. Kissing can spread syphilis if syphilis sores are present in the mouth or on the lips. Syphilis can also be passed from a woman to her unborn baby. Left untreated, syphilis can cause very serious and permanent damage to the heart, brain and nervous system. The results of this damage may not show up for many years. The final result may be death.
HPV is the most common sexually transmitted infection in the U.S. There are approximately 6.2 million new infections each year, 74% of which occur in the 15-24 age group. HPV infection is responsible for 70% of cervical cancers and 90% of genital warts. On average, there are 9,710 new cases and 3,700 deaths from cervical cancer. Although not mandatory in NYC, the Dept. of Health recommends the routing use of HPV vaccine for females 11-12 years of age. The vaccine may also be given to girls aged 9-10 years and as a catch -up vaccination for females at 13-26 years. Ideally, the vaccine should be given before the onset of sexual activity (i.e., before exposure to HPV), but sexually active females should also be vaccinated in order to obtain some protection. The HPV vaccine is not a treatment.
(All figures are derived from the www.nyc.gov/health. Reports include The Bureau of Sexually Transmitted Disease Control Quarterly Report- 2nd quarter 2007, HIV Epidemiology & Field Services Program Semiannual Report- April 2007, and the Pediatric/ Adolescent HIV/AIDS Surveillance in NYC: Semiannual Report, June 2006) and Health Advisories.
The costs of sexually transmitted diseases are enormous. In the April 2006 report from the Public Advocate’s Office entitled Patients Losing Patience: A Performance Review of New York City’s STD Clinics: “The approximately 19 million STD infections that occur each year (including HIV) are estimated to cost $13 billion annually in direct medical expenses. Reducing the incidence of STDs through prevention, screening and treatment efforts, however, can help to realize significant cost savings.
Effective programs can halt the spread of STDs and prevent future health complications among infected individuals. For example, early diagnosis and treatment can reduce the duration of STDs, thereby reducing the number of partners exposed to infection. In addition, early diagnosis and treatment can help to prevent the serious health effects that occur when STDs go untreated. According to Dr. John Douglas, director of CDC’s STD prevention programs, “STD prevention efforts are increasingly shown to be effective and economically sound strategies for improving the nation’s health.”
For example, research has shown that every $1 spent on chlamydia control saves $12 in future health care expenditures. As previously mentioned, untreated chlamydia can lead to pelvic inflammatory disease (PID), which can cause permanent damage to the uterus and fallopian tubes. Screening and treatment of chlamydia, however, has been found to reduce the incidence of PID by as much as 56 percent. Cost savings are realized primarily by averting cases of PID, as well as ectopic pregnancy and infertility- complications also associated with untreated chlamydia.
STD prevention, screening and treatment programs are particularly valuable for their role in preventing future HIV infections. As previously discussed, individuals with STDs are three to five times more likely than noninfected individuals to contract HIV if exposed through sexual contact. Curing bacterial STDs through diagnosis and treatment can lessen individuals’ susceptibility to HIV. In addition, increased HIV testing can help to halt the spread of the virus. HIV-infected individuals who know their status are less likely to transmit the disease than those who are unaware. Given that estimates indicate that the average lifetime cost of treating an HIV infection is $195,000, in addition to the human costs that HIV and other STDs exact, investments in effective STD and HIV prevention, diagnosis and treatment programs are well-advised.”
Racism and white supremacy control a lot of things, but thankfully, neither choose who we have sex with or how. It is up to us to take responsibility for our own health and the health of other members of the community. Until that happens, think twice before having sex with someone in Central Brooklyn. The life you save may be your own.