warns D.C. doctors, as cases appear nationwide
'Too many gay men are once again acting totally irresponsibly,
and hideous diseases and physical manifestations are once again
appearing,' said longtime AIDS activist Larry Kramer, about the
conduct that apparently is resulting in the mysterious spread
of drug-resistant staph infections among gay men.
By JENNIFER J. SMITH & LOU CHIBBARO JR.
The Whitman-Walker Clinic has warned D.C. area doctors that a
drug resistant skin infection that has surfaced among gay men
across the country could be transmitted, among other ways, through
sharing drug paraphernalia used to inhale drugs through the nose.
In a Feb. 28 e-mail alert sent to doctors who treat gay men in
D.C. and the surrounding suburbs, Whitman-Walker noted that Methicillin-Resistant
Staphylococcus Aureus, or MRSA, is frequently found in the noses
of large numbers of people in a non-infective state. The Whitman-Walker
alert noted that the MRSA bacteria could be spread among people
who share drug paraphernalia such as spoons, straws, or other
devices used to inhale drugs such as cocaine or crystal methamphetamine
Gay men who use recreational drugs also routinely share "bumpers,"
small plastic devices through which they inhale recreational drugs
like ketamine ("Special K") and cocaine.
Although MRSA and other forms of staph bacteria usually remain
dormant in the nose, the bacteria could be spread from the nose
to other parts of the body through poor hygiene, according to
the U.S. Centers for Disease Control and Prevention.
Doctors who treat gay men in the District told the Blade last
week that they diagnosed MRSA in at least seven gay men during
the past few weeks. The skin condition, which is resistant to
commonly prescribed antibiotics, began surfacing in gay men in
Los Angeles and San Francisco late last year.
"When we first learned about this, we called our colleagues
in the gay health clinics to discuss how we should address this,"
said Michael Cover, Whitman-Walker communications director.
Cover said the e-mail alert released by the clinic last week
included a fact sheet describing the staph infection outbreak
among gay men. He said it also urged area doctors to inform their
patients about the condition and ways to avoid it as the patients
appear for routine visits.
A spokesperson for the D.C. Department of Health said the department
had not learned of MRSA infections appearing in D.C. until the
Blade contacted the department last week. Dr. Karyn Berry, a communicable
disease specialist with the department in charge of monitoring
developments such as an MRSA outbreak, did not return a call by
Activists demand response
After confirmation of staph infections among gay men in at least
half a dozen U.S. cities in recent weeks, gay health activists
are calling for an orchestrated acknowledgement and response from
public health officials.
"No one is officially doing MRSA tracking, and that's a
real problem," said Dr. Ken Harrel, president of the Gay
& Lesbian Medical Association. "This is a large, emerging
problem that no one seems to have a handle on."
The infections manifest themselves as boils and abscesses on
various parts of sufferers' bodies, including rectal and groin
infections. Public health officials in several cities said the
infections appear to be spread from skin to skin contact, including
sexual contact and public spaces like gyms and bathhouses.
Doctors confirmed cases among gays in Atlanta, Houston, Washington,
D.C., Boston and New York City last week.
Until the late 1990s, the skin infection was confined mostly
to elderly patients in hospitals and nursing homes, according
to the CDC. But since 1997, non-hospital population groups such
as prison inmates, members of athletic teams and Native Americans
have reported the drug-resistant staph infections.
But CDC epidemiologists have said new cases outside San Francisco
and Los Angeles appear to confirm earlier findings by CDC researchers
that a new, undetermined factor is causing drug-resistant staph
to flourish in a wider group of people that now includes gay men.
No deaths have been recorded from the staph cases reported in
gay men, but some patients have been hospitalized. Physicians
monitoring the infections say they could produce life-threatening
complications if not treated promptly.
Solid information on patterns of infection and the national scope
of the disease isn't available, according to health care providers,
because MRSA is not widely "reportable" under current
data gathering processes. Reporting MRSA diagnoses is not required
to state health departments or the CDC like other diseases that
could be a public threat.
CDC does have one "surveillance program" involving
four states that voluntarily report MRSA findings, according to
Scott Fridkin, a CDC medical epidemiologist and MRSA expert,
said lack of reporting "isn't really the issue. It's the
clinic recognition we're after, recognizing the need to do an
appropriate test, the appropriate therapy and to have close follow-up
Learning from AIDS
Some gay health advocates compared the mysterious emergence of
the cyst-like boils and abscesses on gay men to the early days
of the AIDS epidemic.
"When I first heard about the staph infections among gay
men, it reminded me of the first stories in the early '80s about
a 'new cancer' appearing among gay men," Chris Parsons, director
of advocacy and community relations for AID Atlanta, Atlanta's
oldest and largest HIV/AIDS agency, said last week.
The type of conduct that apparently spreads the new staph infections
among gay men parallels the risky behavior enjoyed by some before
HIV, according to Larry Kramer, the nationally recognized writer
who co-founded Gay Men's Health Crisis in New York and ACT UP,
the AIDS advocacy and protest organization.
"Too many gay men are once again acting totally irresponsibly,
and hideous diseases and physical manifestations are once again
appearing," Kramer said.
But such comparisons could contribute to public hysteria about
staph, said Cleve Jones, founder of the NAMES Project and the
AIDS Memorial Quilt.
"It's certainly worrisome, but I would be cautious drawing
parallels between this and HIV," Jones said. "This resistance
has been well documented for decades, and we know this is an issue
facing medical professionals, which is very different than at
the beginning of the HIV pandemic where we knew nothing."
The lack of coordinated public health response is both telling
and predictable, said Eric Rofes, author of ÒReviving the
Tribe: Regenerating Gay Men's Sexuality and Culture in the Ongoing
Epidemic," and an organizer of last year's GLBT Health Summit.
"I think that what this story reveals that is most interesting
is the consequences of not having a specific entity that feels
knowledgeable and responsible for gay men's health," he said.
"Whose job is it in the national and even on a local and
state context to provide oversight, planning and responsiveness
for gay men?
"Is it the traditional public health system, which has traditionally
been homophobic and has not prioritized this community?"
he asked. ÒIs it the GLBT system, which has not been as
organized and networked as they could be?"
Call for reporting
Some private physicians have called for quick action on the part
of the public health care system.
"This is the time to jump on it and get out in front of
it," said Douglas Ward, a Washington, D.C., physician whose
office has treated at least three gay men for drug-resistant staph
infections since late last year. "The sort of study that
needs to be done doesn't go real quickly anyway, so the sooner
"It's also going to be a lot tougher down the road to study
thousands and thousands of cases and cross-analyze contacts and
places of origin compared to doing it now, when maybe there is
only a couple of hundred," Ward said.
Ward talked to his local health department officials who said
they will "fully investigate" the cases, he said.
Public health epidemiologists working for state agencies have
also joined in the call for mandatory reporting.
FOR MORE INFO
Centers for Disease Control & Prevention
1600 Clifton Rd.
Atlanta, GA 30333
One public health official urged state agencies to become more
involved in the push to make staph infections a reportable medical
"What is the dimension of the problem? We don't know,"
said Matthew Boulton, the state epidemiologist for Michigan. "What
populations are we seeing it occur in? We don't know. What are
the risk factors? We don't know."
Boulton spearheaded the move to make MRSA reportable by drafting
a resolution for the Council for State & Territorial Epidemiologists.
CSTE maintains the list of reportable diseases in the U.S. and
works as an advisory body to the CDC.
The resolution, which Boulton has not publicly released, was
turned in to CSTE last month, he said. It is scheduled to be voted
on in June, and if passed could go to the CDC as early as this
fall. CDC could send new reportable lists including MRSA to states
early next year, he said.
CSTE officials declined an interview to confirm the resolution
through CDC spokesperson Nicole Coffin-Ott.
With national reporting, the CDC or another agency could begin
the kind of in-depth study gay health activists seek.
"I don't know of anybody who is doing MRSA contact tracing,
and I think it would be a fantastic study," said Harrel of
the GLMA. "The really important work is to compare the strains
from city to city and see if they're the same. Right now we don't
do any of that."
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