Background:
Since 2000, there has been an increased frequency of outbreaks or increases of syphilis in Los Angeles' MSM populations. MSM with a history of incarceration have been disproportionately affected by syphilis. Within this population are gay-identified men, transgendered male to female (MTF) persons, and others who share a transient social network while incarcerated.

Objective:
This presentation will focus on a rapid assessment of MSM in LA County that focused on transgendered MTF individuals at risk for syphilis, incarceration, or both. The complex circumstances of transgendered persons at risk for syphilis were chosen to explore some of the limitations and strengths of syphilis prevention efforts aimed at a heterogenous MSM population.

Method:
Ethnographic assessment of transgendered MTF persons was conducted in June, 2005 and examined in the broader context of MSM with a history of incarceration during the preceding six month period (from case reports). Potential recommendations for structural intervention to improve syphilis prevention efforts were developed.

Result:
Case report data indicate that there is broad variety of sexual identities for MSMs.. Some are not accessing STD services effectively and are at increased risk for syphilis or other STD though services may be available. Importantly, current syphilis prevention systems are not equipped to optimally address differential needs of transgendered MTF or other non-gay identified MSM subpopulation.

Conclusion:
Self identity for MSM important to:
• understand the social and sexual networks of syphilis transmission
• give added meaning to epidemiologic statistics describing infection patterns
• develop relevant and appropriate syphilis prevention interventions


Implications:
STD prevention services in Los Angeles County have made laudatory efforts to create a liaison between the county jail and the health department. The LACHD can facilitate additional improvements in STD prevention through continued development of liaisons with local agencies and greater attention to self-identification in MSM sub-populations