FIVE YEARS AGO, the honchos at the Los Angeles County Department of Public Health were caught off guard. An outbreak of syphilis among gay men suddenly popped up on their radar, and leaders in the gay community quickly put pressure on the health officials to launch a timely marketing campaign to warn the public.
They chose a mascot for the county’s marketing campaign — a cartoon drawing of an unidentifiable red blob named Phil, meant to represent a syphilis sore. But in a decision that set the wags talking about absurd Los Angeles prudishness, county officials refused to also use a smiling cartoon of a talking “healthy penis” — a drawing so inoffensive it looked like a bratwurst.
San Francisco and Seattle used both the penis and the Phil cartoon in their campaigns, but Los Angeles officials, located in the filming capital of tits and ass, couldn’t handle the image of a happy cock. “The county was more concerned about people’s tender sensibilities than getting the message out,” says Michael Weinstein, president of AIDS Healthcare Foundation, the nation’s largest provider of HIV/AIDS medical care.
Today, the Department of Public Health faces a much bigger problem than that old dustup: That syphilis outbreak has not only refused to go away, but infection rates among gay and bisexual men have skyrocketed 365 percent between 2001 ?and 2005 to 1,585 cases.
The bad news gets worse. On June 29, the federal Centers for Disease Control and Prevention announced that neurosyphilis — a serious and rare form of syphilis, which can lead to blindness and stroke — had been found in HIV-positive gay and bisexual men in Los Angeles, San Diego, Chicago and New York.
Yet, in what appears to be a replay of their timidity five years ago, county bureaucrats have been extremely slow to react, failing to beef up their traditional three-pronged attack using prevention, testing and education — a proven strategy for fighting the syphilis scourge in other cities.
Critics are peeved that government bureaucrats in Los Angeles County, despite the raging syphilis and emergent neurosyphilis in gay men, have leisurely spent their time over the past year developing and testing yet another marketing campaign.
“Public Health almost promotes bad health as they keep fiddling and we keep telling them it’s going to get worse and worse,” says Miki Jackson, an activist and health care consultant to the gay and lesbian community. “And we’ve been right more times than we would like.”
Organizations such as AIDS Healthcare Foundation, AIDS Project Los Angeles and the Los Angeles Gay and Lesbian Center have been warning county health officials including Dr. Jonathan Fielding, director of Public Health, and John Schunhoff, chief of operations of Public Health, for years.
WHAT’S REALLY TROUBLING, critics say, is that while these leaders at Public Health knew something was going awry in their fight against syphilis, they moved aggravatingly slowly. In 2000, cases of syphilis among gay men zoomed from zero to 69, but after running an outreach program for just two months, the county declared success and stopped funding it. Gay leaders were mystified, warning health officials that the situation was worsening — and in 2001 syphilis cases jumped to 85.
In recent months, with the new numbers showing a massive problem, county officials argue that they didn’t issue a call for more action because the sharply rising data simply reflected the fact that more people who harbored syphilis had decided to be screened. “If you’re successful in getting people tested,” explains Schunhoff, “the numbers go up.”
On one level, Schunhoff’s right. But even he was reluctant to explain away the spike merely as a surge in data. In 2005, the county stopped funding the widely seen campaign using Phil the syphilis sore — the year syphilis infections hit a peak of 1,585 cases. And until last week, the county, with its $19.38 billion budget, had failed for 18 months to fund any public-education campaign warning of the mounting syphilis scourge.
“With HIV/AIDS, the county has been pretty responsive,” says Whitney Engeran III, director of prevention and testing at AIDS Healthcare Foundation. “When it comes to [sexually transmitted diseases], however, there’s not the same kind of action.”
Critics say the dichotomy is mind-boggling, since rising rates of sexually transmitted diseases clearly signal an increase in unsafe sex practices. And unsafe sex leads to more HIV/AIDS cases. Moreover, experts in Los Angeles point out that men with syphilis sores are more susceptible to HIV/AIDS. Either way, syphilis and other spreading diseases are not simply the material for crude jokes anymore. In the long run, they spell big trouble.
Schunhoff defends the 18 months it took the lumbering county to create its brand-new marketing campaign, featuring a hunky, half-naked man wrapped in a white towel preparing to take a shower, with the slogan: “Check yourself. Don’t assume you’re getting off clean.”
“We were trying to get a campaign that works with focus groups,” Schunhoff says. “The [Los Angeles County] Board of Supervisors wanted something that was really effective.” He predicts optimistically, “I think the outcome will result with more testing.”
Yet county officials never asked the gay health care community, with its decades of marketing experience, what “effectiveness” looks like, according to Miki Jackson. “They kept the entire campaign a secret,” she charges. “We had no input, and whenever we asked them a question, they were silent about it.”
AS DISCONNECTED as Fieldingis from these gay health care experts, however, he should still only take so much heat for a problem clearly caused by gay and bisexual men who insist on having sex without condoms.
Jackson points to a deadly silence within the community. She believes this widespread silence causes outbreaks like syphilis. “People don’t want to talk about AIDS or syphilis. It brings up the past and bad memories. They’re in great denial.”
Craig Thompson, executive director of AIDS Project Los Angeles, similarly blames “condom fatigue” — an attitude harbored by young men who weren’t around when AIDS was a virtual death sentence, as well as denial among men who even now aren’t comfortable with their homosexuality.
“The more homosexuality is hidden,” says Thompson, “the less likely you are going to negotiate safe sex.”
West Hollywood Mayor John Duran sees the use of crystal meth as a major culprit in the ballooning syphilis scourge. “It grabs people right from the very start, and people become addicted very quickly,” says Duran. “So they don’t have the ability to make the right choices.”
Duran also believes, “The message wears down after hearing this stuff for 20 years. We have to come up with something new.” Duran expects to start up a gay men’s health forum.
But for Michael Weinstein of AIDS Healthcare, the issue is more clear cut: “There has been a decline of safer sex in the gay community, and there hasn’t been a call to arms about it.”
Weinstein is a rare voice in Los Angeles, consistently and loudly demanding personal responsibility when it comes to gay sex. Only a few years ago, posters featuring a photograph of Weinstein mysteriously appeared in the windows of West Hollywood bars on Santa Monica Boulevard, labeling Weinstein a “Condom Nazi.”
At the time, Weinstein was pushing a citywide public referendum for mandatory condom distribution at all West Hollywood bars and clubs. The voters in the 35,716-resident city, which is about 40 percent gay or bisexual, shot him down, and Weinstein was shocked that people turned against him.
“There are people in the gay community who say we shouldn’t hold people responsible,” Weinstein says, “and they are very militant about it.”
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Regardless, the stubborn Weinstein has a plan to create a social climate where unsafe sex is not tolerated. Just as “friends don’t let friends drive drunk,” Weinstein wants gay men to accept the same notion about safe sex.
“Men — gay or straight — don’t want to use condoms,” he says, “but that doesn’t mean you can’t succeed.” Toward that end, AIDS Healthcare’s own marketing campaign emphasizes that testing and prevention should be a part of one’s grooming routine, like working out at the gym or brushing your teeth.
“It doesn’t help to judge,” says Weinstein, “but you can get the information out there and encourage people to get tested.”
In the meantime, bureaucrats at the county’s sprawling Department of Public Health will, in their own words, fight syphilis with “guerrilla marketing tactics” — and probably cross their fingers. Their new outreach program will run for two years. But if history repeats itself, they may need to start working on a replacement campaign today.?