Over the last 20 years, the number of syphilis cases in the United States has increased by more than 400%, according to Omeid Heidari, PhD, MPH, ANP-C, assistant professor at the University of Washington School of Nursing in Seattle, and colleagues. Most of the increase occurred among men, particularly gay, bisexual, and other sexual minority men. Furthermore, Black sexual minority men, including those with HIV, have disproportionate rates of syphilis infection. Left untreated, syphilis can damage the heart, brain, or other organs, and it can be fatal.
Encouraging others to get tested for syphilis is associated with a nearly two-fold increase in individual STI testing
Dr. Heidari and his colleagues analyzed data on 256 Black male adults from a previous study in Baltimore, MD. As part of data collection at the start of the study, all reported engaging in sex with a male partner in the past six months and engaging in condomless sex with any partner in the past six months. In total, 43% had HIV and 40% had a history of an STI. Each participant listed and described key members of their social network, such as people who talked with them about personal issues, provided economic support, used alcohol or drugs with them within the past six months, or had sex with them in the past 90 days.
Nearly two-thirds of the men had not been tested for syphilis within the past 12 months, the research team found. Individuals who did get tested for syphilis in the past year had significantly more people in their network, more male partners, and more people in their network with HIV.
The odds of syphilis testing increased 89% for each increase in the number of network members who had been encouraged to get a syphilis test. Furthermore, men who reported feeling comfortable accompanying a friend for HIV/STI testing were more than twice as likely to have been tested for syphilis as those who said they would be uncomfortable.
Some other important characteristics of men who went to be tested for syphilis were; they had more people in their network they said they could talk to about HIV testing and ask for health advice, they reported a significantly higher number of people they could talk to about private matters, and they were twice as likely to say that 75% to 100% of their friends think it’s important to tell their health care providers they have sex with men, compared with men who said none of their friends think that.
Network approaches to testing and treatment can promote positive social norms around testing and leverage for hard-to-reach populations
Dr. Heidari and colleagues conclude, "Through increased social support, individuals can increase their self-efficacy and gain more confidence in their ability to perform health-promoting behaviors ... Public health campaigns should include messaging about STI testing as well as PrEP (pre-exposure prophylaxis) and utilize widespread outreach to increase uptake and messaging about testing for STIs. Providers should equip patients with knowledge and training, so their patients can inform and encourage their social networks to seek HIV and STI testing. Through peer educator training, patients in PrEP care can serve as ambassadors to their networks about HIV and STI transmission, prevention, and treatment."
