Potential for community-based screening, treatment, and antibiotic prophylaxis for syphilis prevention

Background: The recent syphilis epidemic in Louisiana occurred predominantl y among disadvantaged African Americans who may distrust public health agen cies and prevention efforts. Objectives: To determine community perceptions regarding trust and use of p ublic health clinics, to assess whether race of provider is important to pe rsons at risk for syphilis, and to assess the willingness of persons to par ticipate in syphilis screening, treatment, and antibiotic prophylaxis. Study Design: Qualitative interviews were conducted with 18 community leade rs and 38 community members who were at risk for syphilis. Quantitative sur veys were completed by persons with primary or secondary syphilis (n = 92), their sexual contacts (n = 56), and with neighborhood controls (n = 143), Three possible programs for syphilis screening and antibiotic prophylaxis w ere proposed (1) bar setting; (2) home setting, and (3) mobile health-van s etting in high-risk communities. Results: In qualitative interviews, community leaders and community members reported a high degree of trust in the public sexually transmitted disease clinic. A majority of respondents felt that race was not a factor in choos ing healthcare providers. Respondents favored the provision of services in a mobile health van over in a bar or in their homes. In quantitative interv iews, more than 80% of community members surveyed reported that they would go to a mobile health van for syphilis testing. Nearly two thirds of respon dents reported that they would be willing to take oral prophylaxis for syph ilis, and more than half of respondents reported that they would accept an injection. Conclusions: Community members trust the public sexually transmitted diseas e (STD) clinic, are generally not concerned with the race of healthcare pro viders, and are supportive of community-based STD screening, treatment, and antibiotic prophylaxis provided from a mobile clinic.