STD Quarterly-Nightclubs join effort to stem STD spread

San Francisco public health officials and local club owners have joined forces to promote testing for sexually transmitted diseases (STDs) by offering free admission or a free drink to those who get tested.

While it is early in the promotion period, project organizers believe the "free passes" are putting the San Francisco Department of Public Health’s City Clinic on the radar screen of club patrons, says Larry Hanbrook, community health specialist in the community-based STD services unit of the Department’s STD Prevention and Control Services.

Recent data indicate increases in sexual risk taking among men who have sex with men (MSM) in a growing number of cities in the United States, including San Francisco.1 The rise in sexually transmitted diseases (STDs) in this population is of concern, since STDs enhance the risk of sexually transmitted HIV infection.2

A target population for the San Francisco project is young gay men who are now experiencing the club scene, says Hanbrook. These young men are not aware of the increase in STDs and the need to protect themselves in light of the risk for HIV, says Hanbrook.

"Even if people don’t come into the clinic, at least it will put the clinic on the radar screen," says Hanbrook. "

Four popular clubs are participating in the promotion, which kicked off during April, observed as STD Awareness Month in San Francisco, says Hanbrook. Three are offering free admission as an incentive; one club, which does not charge admission, is offering a free drink.

When patrons enter a participating club, they are presented a business card-sized foldover card. The front flap resembles a theater ticket, with the headline, "Free Pass." Underneath the headline, the card instructs patrons to take the pass to the City Clinic, get a checkup, have the card stamped, and return it for a free entry or a free drink.

The inside of the card carries the message that many STDs may have symptoms, but they are not always apparent. Each card is site-specific, stating that "[name of club] wants to support your sexual health." Directions to the clinic are included, as are its operating hours. Cost for the project was low - under $100 for card production, says Hanbrook. The clubs are underwriting the entry or drink incentives. Hanbrook says he approached the clubs with the idea for the pilot project, and the owners readily agreed to join with the health department.

Stemming the spread

Health departments across the nation have recognized the increases in sexual risk behaviors, STDs, and - in San Francisco - HIV in men who have sex with men, says Jeffrey Klausner, MD, MPH, director of the city’s STD Prevention and Control Services and assistant professor of medicine at the University of California, San Francisco. These increases are of great concern because they come after years of reduced sexual risk behaviors and dramatic declines in STD and HIV incidence in the MSM population, he says.

According to Klausner, many factors play into the increases: decreased concern about the seriousness of HIV infection and AIDS related to recent advances in HIV treatment; persons with HIV living longer and healthier lives and having restored interest and participation in sex; a decreased community focus on HIV prevention; misperceptions about the transmissibility of HIV while persons are on HIV therapy; the continued influx of sexually active gay men into urban centers where the community memory of AIDS devastation has waned; and possibly, safe sex exhaustion among gay men without exposure to effective safer sex maintenance interventions.

Regardless of what is driving the increases in STDs, health departments must respond, contends Klausner. The San Francisco health department is participating in the media campaign, "HIV Stops With Me," which encourages persons with HIV to take responsibility. The San Francisco campaign combines multiple strategies, such as mass media, support groups, social events, community forums, provider training, and outreach, to help HIV-positive gay and bisexual men gain and use the skills necessary to prevent new HIV transmissions. (Check out components of the San Francisco campaign at www.hivstopswithme.org.)

Guidance for STD Clinical Preventive Services for Persons Infected with HIV, a new publication from the California STD Controllers Association and the Sacramento-based California Conference of Local AIDS Directors, recommends routine sexual health assessments and screening in persons infected with HIV, states Klausner. The document can be downloaded free of charge as an Adobe Acrobat PDF file at www.dph.sf.ca.us/sfcity clinic/info/bulletin%204_18.pdf.

"The key message that every patient needs to understand is that the sign of a good provider is

For more information on the San Francisco program, contact:

Larry Hanbrook, Community-Based STD Services Unit, STD Prevention and Control Services, San Francisco Department of Public Health, 1360 Mission St., Suite 401, San Francisco, CA 94103. E-mail: larry_hanbrook@ dph.sf.ca.us.

one who asks about sexual health and screens for STDs, when appropriate," says Klausner. "Pro-fessional organizations and public health agencies have advocated for sexual health to become an important part of every clinical examination, but not until patients expect this from providers will providers practice behavior change."

References

1. Centers for Disease Control and Prevention. Consultation on recent trends in STD and HIV morbidity and risk behaviors among MSM. Meeting Report. Atlanta. Oct. 30-31, 2000.

2. Wasserheit JN. Epidemiologic synergy. Interrelation-ships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis 1992; 9:61-77.