Rates Of Syphilis Infection Research Articles

Socio-demographic and behavioral correlates for HIV and syphilis infections among migrant men who have sex with men in Beijing, China

Migrant men who have sex with men (MSM) may be particularly vulnerable to sexually transmitted infections (STIs) including HIV. This study examines the rates of HIV and syphilis infections and associated socio-demographic and behavioral factors among migrant MSM in China. Data from 307 migrant MSM were collected in Beijing, China. Blood specimens were collected to test for HIV and syphilis infections. HIV and syphilis rates were 5.9% and 20.2%, respectively. Multivariate logistic regression analyses showed that having ever been married, living a longer period in Beijing, having more sexual partners, and having a foreign MSM friend were significantly associated with HIV infection. Migrating from a rural area, experiencing one's sexual debut at an older age, having a male as first sexual partner, having more sexual partners, and being recruited from peer outreach and social network were associated with syphilis infection. Migrant MSM in China are at high risk for HIV and syphilis infections. HIV prevention programs targeting rural migrant MSM who have been married are needed.

Systematic Differences in Risk Behaviors and Syphilis Prevalence Across Types of Female Sex Workers

Female sex workers (FSWs) have become one of the key populations for HIV/STI control in China. Categorization of FSWs can help prioritize HIV/STI intervention efforts. We examined 2 possible categorizations of FSWs and the relationship with syphilis infection risk in Liuzhou City, China. From October 2009 to February 2010, a total of 583 FSWs recruited by respondent-driven sampling in a cross-sectional survey were tested for syphilis and interviewed to collect sociodemographic and behavioral information. Respondents were categorized based on transaction price for vaginal sex and type of sex work location. The relationship between the 2 categorizations and syphilis infection risk was assessed using univariate and multivariate logistic regression analysis. The prevalence rates of lifetime and active syphilis infection were 8.6% and 4.1%, respectively. Lifetime and active syphilis prevalence was higher among FSWs in the lowest price category (52.7% and 25.4%, respectively) and those working in streets (69.7% and 39.8%, respectively) or through telephone (46.3% and 17.0%, respectively). Multivariate analysis showed that lifetime syphilis prevalence was significantly higher among street- (adjusted odds ratio [AOR]: 38.7, 95% confidence intervals [CI]: 10.7-139.9) and telephone-based FSWs (AOR: 10.8, 95% CI: 3.3-35.1), and that active syphilis prevalence was significantly higher among street-based FSWs (AOR: 15.2, 95% CI: 3.7-62.1) after adjusting for demographic and behavioral factors. Categorization based on sex work location was more closely related to the risk of syphilis infection than the price classification. Street- and telephone-based FSWs had significantly higher risk of syphilis infection. Focused interventions among these particular high-risk FSWs subgroups are warranted.

1. Changes in Rates of Syphilis Testing and Infection in an Urban Adolescent Clinic During a Local Syphilis Outbreak

In response to local public health reports of increase syphilis rates in adolescent, in which rates were higher in males than females, we examined testing practices and disease incidence within a large urban primary care adolescent clinic to explore differences by patient gender.

Increasing gay men’s testing rates and enhancing partner notification can reduce the incidence of syphilis

We sought to determine whether gay men would be willing to increase syphilis testing and partner notification, and assessed the possible epidemiological impact these changes might have in the Australian population. We conducted an online survey (n=2306) and focus groups to determine whether interventions to increase testing for syphilis and enhanced partner notification are likely to be acceptable to gay men in Australia. An individual-based mathematical model was developed to estimate the potential population-level impact of changes in these factors. Of all men surveyed, 37.3% felt they should test more frequently for sexually transmissible infections. Men who recent unprotected anal intercourse with casual partners and men who reported a higher number of partners were more likely to indicate a greater willingness to increase testing frequency. HIV-positive men were more likely to indicate that their frequency of syphilis testing was adequate, incorporated as part of their regular HIV monitoring. Lack of convenience was the main barrier reported. Partner notification was broadly acceptable, although perceived stigma presented a potential barrier. The mathematical model indicated that increasing testing rates would have a substantial impact on reducing rates of syphilis infection among gay men and partner notification would further reduce infections. Interventions promoting testing for syphilis among gay men and increases in partner notification may be acceptable to gay men and are likely to result in decreased infection rates. Rapid testing and modern communication technologies could strengthen these interventions, and have an impact on the syphilis epidemic.

An analysis of blood donors infected with syphilis in Zhongshan Area

Objective To explore the current situation of syphilis infection in voluntary blood donors in Zhongshan,to evaluate the quality of syphilis screening kit and to provide effective preventive measures for blood safety.Methods Treponemal antibody was detected by ELISA in all the Blood donors; and those with antibody positive and then comfirmed by TP particle agglutination test ( TPPA ).The epidemiological characteristics of syphilis infection were analyzed.Results During the period of January 2006 to June 2011,a total of 232,484 blood donors were detected for treponemal antibody,1092of whom ( 0.47％ ) were positive.The positive rate of TP did not differ significantly between years,male and female,different blood collection spots,individual and group donors ( P＞ 0.05 ),but differed significantly among different age groups ( P＜ 0.005 ).The sensitivity of initial ELISA was 99.42％ and that of repeat ELISA was 99.65％,but the specificity was only 27.81％ and 63.91％,respectively.Some false positive results were found.Conclusions The rate of syphilis infection in voluntary blood donors in Zhongshan area during January 2006.1 to June 2011.6 remains at a relatively stable level.It is of significance to have TPPA confirm the positive samples detected by ELISA in blood donors. Key words: Blood donor; Treponema pallidum; Enzyme linked immunosorbent assay; Treponema pallidum particle agglutination test

Analysis on sexually transmitted diseases and the related risk factors among men who have sex with men in Jiangsu province

To investigate infections of syphilis, neisseria gonorrhoeae, chlamydia trachomatis and the related risk factors in men who have sex with men (MSM) in Jiangsu province. A total of 400 MSM were enrolled by Snowball Sampling Method from August to October in 2010 and then 328 cases were surveyed by a questionnaire and collected serum sample 5 ml per person as well as rectal swab on the spot; all of the serum samples were tested for syphilis by ELISA and TRUST, and all of the rectal swabs were tested for neisseria gonorrhoeae or chlamydia trachomatis. The influencing factors of syphilis, neisseria gonorrhoeae, chlamydia trachomatis were analyzed by logistic regression analysis. The 328 MSM were (32.46 ± 9.72) years old, 59.15% (194/328) were unmarried.75.00% (246/328) MSM had rectal sex with men in the past 3 months, and condom use rate for recent sex was 56.71% (186/328), while 53.05% (174/328) MSM didn't have sex with women in the last 3 months. The syphilis infection rate among MSM was 13.41% (44/328), the neisseria gonorrhoeae infection rate was 3.66% (12/328), and the chlamydia trachomatis rate was 11.59% (38/328). The number of sex partners was the key factor that influenced syphilis infections (OR = 4.213, 95%CI: 1.133 - 15.656). The prevalence of syphilis and chlamydia trachomatis was high in MSM in Jiangsu, while risk behavior rate were high in the MSM and then should be intervened.

O5-S4.04 Targeted STD screening among high-risk men who have sex with men

BackgroundSubgroups of men who have sex with men (MSM) are at high risk for HIV infection and other viral and bacterial STDs. Since the mid-1990s, increased rates of early syphilis,...

P5-S6.07 The management of syphilis and gonococcal infections among men who have sex with men (MSM) in a community medical center named “Centre Oasis, Ouagadougou, Burkina Faso”

Background“Centre Oasis” is a community medical center of an NGO named “Association African Soildarité” (AAS). It provides to MSM a framework for management and prevention of STIs and HIV/AIDS. The...

A comparison of four sampling methods among men having sex with men in China: implications for HIV/STD surveillance and prevention

Sample representativeness remains one of the challenges in effective HIV/STD surveillance and prevention targeting men who have sex with men (MSM) worldwide. Although convenience samples are widely used in studies of MSM, previous studies suggested that these samples might not be representative of the broader MSM population. This issue becomes even more critical in many developing countries where needed resources for conducting probability sampling are limited. We examined variations in HIV and Syphilis infections and sociodemographic and behavioral factors among 307 young migrant MSM recruited using four different convenience sampling methods (peer outreach, informal social network, Internet, and venue-based) in Beijing, China in 2009. The participants completed a self-administered survey and provided blood specimens for HIV/STD testing. Among the four MSM samples using different recruitment methods, rates of HIV infections were 5.1%, 5.8%, 7.8%, and 3.4%; rates of Syphilis infection were 21.8%, 36.2%, 11.8%, and 13.8%; and rates of inconsistent condom use were 57%, 52%, 58%, and 38%. Significant differences were found in various sociodemographic characteristics (e.g., age, migration history, education, income, and places of employment) and risk behaviors (e.g., age at first sex, number of sex partners, involvement in commercial sex, and substance use) among samples recruited by different sampling methods. The results confirmed the challenges of obtaining representative MSM samples and underscored the importance of using multiple sampling methods to reach MSM from diverse backgrounds and in different social segments and to improve the representativeness of the MSM samples when the use of probability sampling approach is not feasible.

Investigation of HIV and syphilis infection and AIDS-related behaviors among money boys, in Guangzhou, China

To explore the HIV and syphilis infection and AIDS-related behaviors among money boys (MB) in Guangzhou. A total of 152 subjects were recruited from MB gathering place (clubs, parks, Internet etc.) by a local NGO. Of which, 151 individuals completed the investigation and blood sample collection. An anonymous face to face interview were used to obtain data of AIDS-related behavior, knowledge and attitudes. Venous blood samples were collected for HIV and syphilis antibody test. χ(2) test were used to compare the characteristics of HIV and syphilis infection subjects and P < 0.05 was counted as significant. HIV and current syphilis infection rate were 11.3% (17/151) and 19.9% (30/151), respectively. Among the subjects, 47.0% (71/151) had unprotected anal intercourse (UAI) with commercial male sex partners, 43.7% (66/151) had UAI with non-commercial male sex partners in the past six month. 85.4% (129/151) were aware of AIDS-related knowledge, while 34.4% (52/151) thought they have no risk of HIV infection, 24.5% (37/151) didn't know the prevalence of HIV among MSM in China, and 55.0% (83/151) had no idea of HIV prevalence or thought HIV prevalence was not serious at all among MB. MB who had experienced sex after drunk/used drugs had higher proportion of syphilis infection (33.3% vs 16.5%; χ(2) = 4.26, P = 0.039), and who had ever been experiencing condom broken during sex had much higher syphilis infection rate than those didn't (36.7% vs 15.7%; χ(2) = 6.64, P = 0.010). A multi-Logistics regression analysis showed that subjects had ever been experiencing condom broke during sex in the past six month were associated with syphilis infection (χ(2) = 6.24, P = 0.012; OR = 3.11, 95%CI = 1.28 - 7.57). Money boys have high prevalence of HIV and syphilis infection. They are lack of perception of HIV risk and active in unsafe sex behavior.

Analysis of HIV/syphilis/HCV infection among drug users in 15 cities, China

To study the HIV infection rate and relevant behavioural characteristics among drug users (DUs) in the 15 cities of China-Gates HIV/AIDS Program. By literature review from the public security sector and expert consultations, the size of drug using population was estimated, questionnaire was used to survey relevant behavioural characteristics of DUs, and blood specimens were collected for HIV, syphilis and HCV testing. In 2007, the number of registered DUs in the 15 cities was 176 004, while the estimated number was 477 989. DUs mainly used heroin and crystal meth. Of the survey subjects, 41.0% (2685/6155) had correct knowledge about HIV/AIDS, and Hangzhou 97.6% (410/420), Qingdao 85.5% (342/400), Wuhan 69.7% (308/442), Kunming 63.8% (255/400), Shanghai 45.4% (237/522), Xi'an 44.5% (178/400), Nanjing 38.8% (155/400), Beijing 36.5% (237/650), Guangzhou 29.5% (122/413), Haerbin 25.4% (114/447), Haikou 23.8% (96/402), Chongqing 22.4% (90/401), Sanya 20.0% (80/400), Tianjin 16.2% (41/253), Shenyang 9.8% (20/205), and the difference among the cities has statistical significance (χ(2) = 1482.833, P < 0.05). The rate of needle sharing at the last injection was 10.8% (665/6155), and Hangzhou 10.8% (45/420), Chongqing 26.4% (106/401), Guangzhou 2.6% (11/413), Shenyang 31.3% (64/205), Shanghai 0.4% (2/522), Kunming 10.8% (43/400), Beijing 10.6% (69/650), Tianjin 5.4% (14/253), Xi'an 3.3% (13/400), Wuhan 17.9% (79/442), Sanya 20.0% (80/400), Haikou 2.2% (9/402), Haerbin 8.5% (38/447), Nanjing 21.4% (86/400), Qingdao 1.5% (6/400), and the difference among the cities has statistical significance (χ(2) = 483.044, P < 0.05). Only 5.0% (8737/176 004) of DUs and 1.2% of HIV positive DUs participated in needle exchange. The HIV, syphilis and HCV infection rates were respectively 2.76% (155/5620), 3.38% (190/5620) and 32.35% (1818/5620). The HIV infection rates of different city was:Hangzhou 0.4% (1/273), Chongqing 7.5% (30/401), Guangzhou 2.9% (12/413), Shenyang 0.5% (1/205), Shanghai 0.32% (1/316), Kunming 16.25% (65/400), Beijing 2.6% (16/624), Tianjin 2.0% (5/253), Xi'an 1.25% (5/400), Wuhan 0.24% (1/411), Sanya 1.75% (7/400), Haikou 0.2% (1/402), Haerbin 1.1% (5/447), Nanjing 1.1% (3/275), Qingdao 0.5% (2/400), and the difference among the cities has statistical significance (χ(2) = 354.203, P < 0.05). The HIV prevalence rate of IDUs in 15 cities slowly decreased although the HIV prevalence rate of IDUs in Chongqing and Kunming and other cities had surpassed the international warning level. The risk of sharing needles for HIV infection was dropped, and more attention should be paid to the potential risk of HIV transmission via unsafe sex due to the use of new drugs, such as amphetamine chloride.

Trends in Age Disparities Between Younger and Middle-Age Adults Among Reported Rates of Chlamydia, Gonorrhea, and Infectious Syphilis Infections in Canada: Findings From 1997 to 2007

The objective was to determine trends in age disparities between reported rates of chlamydia, gonorrhea, and infectious syphilis among younger versus middle-age Canadians. We examined age- and sex-specific reported rates of chlamydia, gonorrhea, and infectious syphilis between 1997 and 2007. Sexually transmitted infection (STI) rates in the younger age group (15-29 years) were compared to the middle-age group (40-59 years) over the 11-year period. We used Poisson regression to examine trends in age-specific (younger:middle-age) rate ratios. Between 1997 and 2007, both the number and rate of reported cases increased for all 3 nationally notifiable STIs. Although chlamydia and gonorrhea rates continued to be higher among younger adults, rates of all 3 STIs increased more dramatically among middle-age adults. Between 1997 and 2007, chlamydia rates increased by 86.8% among adults aged 15 to 29 (P <0.0001) and 165.9% among adults 40- to 59-years-old (P <0.0001). The corresponding increases for gonorrhea were 133.3% (P <0.0001) and 210.2% (P <0.0001) respectively. Infectious syphilis rates increased 5-fold among younger adults compared to an increase of 11-fold among middle-age adults (P <0.0001) since 1997. The reported rate ratios (younger:middle-age) decreased over time for chlamydia (P <0.0001), gonorrhea (P <0.0001), and syphilis (P = 0.005). Males were disproportionately represented among reported chlamydia, gonorrhea, and infectious syphilis cases, constituting 59.8%, 87.6%, and 93.0% of middle-age adult cases, respectively, in 2007. Middle-age adults may be increasingly affected by chlamydia, gonorrhea and infectious syphilis. There is a need for sexual health information targeting Canada's middle-age adults and their health care providers.

Prevalence and Correlates of HIV and Syphilis Infections Among Men Who Have Sex With Men in Chongqing Municipality, China

To examine the prevalence and correlates of HIV/syphilis infections and sexually transmitted diseases (STDs) among men who have sex with men (MSM) in Chongqing, China. Cross-sectional surveys were conducted to provide information, including sociodemographics, sexual and drug use behaviors, HIV knowledge, and HIV-related services in 2006 and 2007, respectively. Multiple methods, including venue-based recruitment, community outreach, Internet advertisements, and peer referral, were used to identify men in Chongqing willing to participate in this study. Of the 1692 participants, 10.8% were HIV-infected (range by district: 7.0%-15.0%), 8.6% were syphilis-infected, and 15.3% self-reported STD-related symptoms. HIV infection was associated with older age, recruitment from bathhouses/saunas, less education, more male sex partners, sex with a woman in the past 6 months, syphilis infection, and STD-related symptoms. Syphilis infection was associated with older age, less education, inconsistent condom use with a man, STD-related symptoms, and HIV infection. STD-related symptoms were associated with older age, being of nonlocal residency, inconsistent condom use with a humans, having ever paid for sex with a humans, HIV infection, and being from District 1. HIV and syphilis infections have reached alarmingly high rates in Chongqing's MSM population. Better targeted, in-depth and comprehensive intervention strategies are needed urgently, including education, condom promotion and distribution, STD control, drug use-related intervention, and advocacy for HIV counseling and testing with bridges to HIV prevention and care services. Widespread testing for HIV, syphilis, and other major STDs in this risk group should be considered as measures for control.

Risk Factors for Repeat Syphilis in Men Who Have Sex With Men, San Francisco

Syphilis incidence has increased dramatically in the United States since 2000, occurring primarily among men who have sex with men (MSM) and disproportionately affecting those with human immunodeficiency virus (HIV) infection. The continued increases in syphilis rates among MSM signals the need for enhanced prevention methods. We undertook a study to examine the rate of repeat syphilis infection among MSM in San Francisco and to identify risk factors associated with syphilis reinfection that may inform additional prevention strategies. We developed a retrospective cohort of all cases of primary, secondary, and early latent syphilis among MSM diagnosed in San Francisco in 2001 and 2002. We evaluated data through the end of 2003 to determine all cases of syphilis reinfection, defined as a new infection that occurred within 1 year after prior syphilis infection and treatment. We found that 6.7% (42/624) of cases had a repeat syphilis infection within 1 year. HIV infection was associated with an increased risk of repeat infection (OR = 4.7; CI, 1.8-12.0). No differences in age, race, number of period sex partners, illicit substance use, or partner meeting venues were observed between cases with and without repeat infection. Our study revealed that HIV-infected MSM with syphilis represent an at-risk group for repeat syphilis infection. Targeting increased screening and risk reduction interventions to HIV-infected MSM in care could reduce the overall incidence of syphilis among MSM.

Burden of syphilis infections in Shenzhen, China: a preliminary estimation

Information on the prevalence and incidence of sexually transmitted infections is important for developing prevention and control strategies and allocating human and financial resources. However, there are no available estimates of such information for many areas in China. In this study, we used the existing data to make a preliminary estimation of syphilis infections in Shenzhen city, in south-eastern China. Data on prevalence rates of syphilis infections among different populations were obtained from the local HIV/sexually transmitted disease second-generation surveillance programme, and the sizes of different populations were estimated based on the most recently available figures. It was estimated that 83,760 (range 77,490-90,020) people are currently infected with syphilis, giving a prevalence of 0.71-0.82% (0.76% on average) in Shenzhen. Around 18% of these syphilis infections occur among men who have sex with men and another 15.8% and 8.7% occur among female sex workers and their clients, respectively. These estimates suggest that a combination of unprotected paid sex and sex between men may be sustaining the epidemic of syphilis in the study area. The preliminary estimates will assist the government in planning and improving its comprehensive intervention programmes for the future control and prevention of syphilis.

Syphilis Infection Rates in U.S. Jumped 12% From 2006 to 2007

Syphilis Infection Rates in U.S. Jumped 12% From 2006 to 2007

Sexually Transmitted Infections and Risk Factors Among Truck Stand Workers in Dhaka, Bangladesh

This study was conducted to determine the prevalence of selected sexually transmitted infections (STIs) and their risk factors among workers in and near a truck stand in Dhaka, Bangladesh. A random sample of 696 men and 206 women were recruited into a cross-sectional study using a census that enumerated transport agents, motor mechanics, laborers, and vendors in Tejgaon truck stand. The prevalence rates of syphilis (rapid plasma reagin and Treponema pallidum hemagglutination), gonorrhea (polymerase chain reaction [PCR]), and chlamydial infections (PCR) among men were 4.1%, 7.7%, and 2.3%, respectively, and among women were 2.9%, 8.3%, and 5.2%. Multivariable analysis revealed that having >or=2 sex partners in the last month, never using a condom with sex workers, and ever injecting narcotics were significant predictors of STI among men. Being never married, working as a laborer, older age, and living within the truck stand were significant predictors of practicing high-risk behaviors among men, but none predicted infection with STIs. Both behavioral and STI data suggest that truck stand workers should be included in the STI/HIV intervention programs.

Sexually Transmitted Infections

Sexually transmitted infections (STIs) other than HIV have reappeared as an important public health problem in developed countries (1). In the late 1970s and early 1980s, research and treatment of the 'classic' STIs - gonorrhea, syphilis and chlamydia - were a major focus of infectious diseases practice and research. There were large outbreaks of syphilis in parts of Canada (2), penicillin-resistantNeisseria gonorrhoeaewas a concern (3), and high rates ofChlamydia trachomatisinfection with complications of pelvic inflammatory disease and ectopic pregnancy were being reported (4,5). Then, HIV infection emerged, with its spectre of a wasting, early death. There was no effective treatment, and safe sexual practices were embraced and adhered to by high-risk populations as the only effective way to avoid infection. These practices effectively prevented other STIs; rates of syphilis, gonorrhea and chlamydia infection plummeted in developed countries (5). For at least a decade, it appeared that HIV might be an end to all STIs, at least for some parts of the world. STIs continued unabated in developing countries, as many epidemiological and therapeutic studies explored the association of STIs with HIV infection.

Trends in sexually transmitted diseases and condom use patterns among commercial sex workers in Fukuoka City, Japan 1990-93.

To investigate trends in sexually transmitted diseases (STDs) among female commercial sex workers and in their condom use patterns during the period from 1990 to 1993 in Fukuoka, Japan. The study group consisted of a total of 824 commercial sex workers who attended an STD clinic to undergo screening for STDs including chlamydia, gonorrhoea, syphilis, hepatitis B and HIV-1 infection during the period from 1990 to 1993. For detection of Chlamydia trachomatis and Neisseria gonorrhoeae, endocervical smear specimens were taken from the women. Blood samples were obtained for serological diagnosis of syphilis, hepatitis B and HIV-1. Commercial sex workers who visited the clinic during the period from November to December of 1993 were interviewed concerning past (1990 and 1991) and recent (1992 and 1993) condom use patterns. The annual detection rates of C trachomatis and N gonorrhoeae declined significantly from 16.3% in 1990 to 12.2% in 1993 (P < 0.0001) and from 1.5% in 1990 to 0.8% in 1993 (P = 0.0096), respectively. There was a remarkable reduction in the annual syphilis infection rate, from 7.5% in 1990 to 0.5% in 1993 (P = 0.0011). The positive rate for the hepatitis B surface antigen in the women ranged from only 0.6% to 1.9% and none were found to be positive for HIV-1 during the 4-year period. During the same period, there was a significant increase in the proportion of commercial sex workers always using condoms from 6.3% in 1990-91 to 25.3% in 1992-93 (P = 0.0023). The prevalences of chlamydia, gonorrhoea, and syphilis infections decreased significantly among commercial sex workers in Fukuoka from 1990 through 1993, and no commercial sex workers were HIV-1 seropositive. The reductions in the prevalence of major STDs may be related to the increased use of condoms.

HIV seroprevalence among Atlanta's homeless.

Brief communication 83 HIV SEROPREVALENCE AMONG ATLANTAS HOMELESS During the 1980s, America was hard hit by two epidemics: HIV/AIDS and homelessness. By 1990, the Centers for Disease Control and Prevention (CDC) reported more than 115,000 cumulative cases of AIDS and an estimated 1 million infected persons.1,2 The connection between poverty and poor health, including HIV infection, is a result of many interrelated factors including lack of access to health care, poor nutrition, lack of adequate housing, and increased incidence of substance dependence.3 Homelessness is one of the most dramatic indicators of poverty. Of the 185 million adults identified by the census in 1990, about 13.5 million have been literally homeless at some time during their lives with 5.7 million homeless during the past five years. The conditions of homelessness pose severe problems for the control of infectious diseases and put homeless people at risk of serious debility and disability.4 The combined effects of HTV/AIDS and homelessness make these among the most challenging and pressing of public health problems. Atlanta, Georgia has been dramatically affected by both AIDS and homelessness . The city's economic prosperity has often masked the public health challenges created by a lack of affordable housing and creation of service sector jobs with little stability and no health benefits. According to the city's Task Force for the Homeless, more than 20,000 people call Atlanta's streets "home. "5 In 1993, Atlanta ranked eighth among all U.S. cities in the cumulative number of AIDS cases.6 HIV/AIDS is not the only epidemic facing metropolitan Atlanta. In 1991 and 1992, Atlanta had the highest rate of tuberculosis of all U.S. cities7; in 1992, it also had the highest rate of syphilis infection. Both tuberculosis and syphilis are strongly associated with HTV/AIDS. Addressing the health care needs of the homeless led Mercy Mobile Health Care (MMHC) into a partnership with the Georgia Department of Human Resources (DHR). One result was a seroprevalence study designed to quantify the level of HIV infection among the homeless. The blinded study targeted the approximately 7,500 homeless persons in inner-city Atlanta who received primary care from MMHC. During seven months of 1990 (March to September), 676 clients were tested (9 percent of the estimated target population ). Clients were served in parks, shelters, soup kitchens, and labor pools by outreach workers, health advocates, nurses, and doctors. The initial result of the survey pointed to the immediate need for HIV counseling/testing and early intervention programs for the homeless, both of Journal of Health Care for the Poor and Underserved · Vol. 7, No. 2 · 1996 84 HIV Seroprevalence Among Homeless which have been initiated. Further analysis of data obtained from two and a half years of the nonblinded seroprevalence study provided information that is being used to enhance risk reduction and prevention efforts. Background MMHC was created during the mid-1980s to provide primary care, social services, and health education to Atlanta's homeless as a part of Saint Joseph Health System's outreach to the poor in the inner city. The mission of MMHC is to improve the health status of the medically underserved. This is accomplished by using an interdisciplinary multicultural staff; a fleet of vans and mobile clinics; and a network of donated community sites and numerous collaborative relationships to deliver health care, education, and social services. As information about HIV began to be collected during the late 1980s, MMHCs staff and volunteers realized that homeless clients were at significant risk of acquiring and transmitting the virus. Clients reported unprotected sex with multiple partners, exchanging sex for drugs, and substantive alcohol and drug use, and were regularly diagnosed with sexually transmitted infections. However, homeless clients did not recognize that these behaviors were associated with HIV transmission. After diagnosing with AIDS several homeless individuals who had no knowledge of the disease and were unaware of their risk for infection, the MMHC staff set out to develop a comprehensive HIV services program. The first grant was obtained in 1988 from the CDC for street outreach and risk reduction education. That same year, the DHR was selected by the CDC to...