Testing Behavior and Perceived Risk for Syphilis in a Time-space Sample of Men Who Have Sex with Men

Background:
Men who have sex with men (MSM) experience disproportionately high syphilis morbidity, making up 66% of cases in Los Angeles County. Regular testing can reduce this burden, but many MSM fail to routinely test

Objective:
To better understand MSM's perceived risk for syphilis and influences on testing behavior, in order to improve testing programs.

Method:
In May 2007, a baseline survey to evaluate a syphilis prevention social marketing campaign was conducted with 203 ethnically diverse MSM in Los Angeles. The survey utilized a time-space sampling methodology and contained questions about demography, knowledge, beliefs, risk and testing behavior.

Result:
Only 53% of respondents reported getting tested for syphilis in the last 6 months. A logistic regression was conducted to investigate influences on syphilis testing. Overall, ethnicity had a strong effect on testing. African Americans were 3.1 times as likely to test as whites (p=0.021) and Latinos were 2.6 times as likely to test (p=0.026). Similarly, HIV positive men were 5.7 times as likely to test (p=0.006) as HIV negative men. Those who perceived themselves at risk were 2.2 times as likely to test (p=0.026). However, when self-reported risk behavior was examined, 72% of MSM who never use condoms for anal sex did not perceive themselves to be at risk for syphilis infection.

Conclusion:
Regular syphilis testing was associated with HIV-positive serostatus, non-white ethnicity, and higher perceived risk. Furthermore, there is a disconnect between high risk behaviors and low perceived risk among some surveyed MSM.

Implications:
Efforts aimed at reducing syphilis among MSM must find ways to target those who do not test regularly, such as HIV negative men and those who report risky behaviors yet do not see themselves at risk. Additionally, further research into the contribution of ethnicity to syphilis testing is necessary.