CINCINNATI - In our series "Out from the shadows: Cincinnati's syphilis epidemic," WCPO contributor Anne Saker, reports on the disease's impact and the battle to defeat its scourge in the Tri-State.
On a recent weekday, lunchtime sunlight streamed over the Winton Terrace low-income apartments, yet few people were outside. At the curb along Winneste Avenue sat a big, round recreational vehicle with an exterior photo wrap of smiling women and infants. A hand-lettered sign on a chalkboard on the sidewalk read: “Come in! Ask us about free testing, male & female.
“We have a crisis going on here,” said social worker Kay Brogle, the organization’s president. “The public health department said if this were measles, we’d all be inoculated. It’s that prevalent.”
Battling "alarming" syphilis rates
For the past six years, Hamilton County has been the first among Ohio’s 88 counties in the number of syphilis cases and the rate compared to the population. In early 2012, the county’s public health department launched a public health war on syphilis, a highly contagious infection transmitted through sex. Hospitals now are required to test patients with symptoms of any sexually transmitted infection and to treat the patient immediately.
Even more alarming than the adult rate of syphilis are the numbers of congenital cases. In each of the past four years, at least half of all Ohio infants born with syphilis arrive in Hamilton County.
The county reached out to Healthy Moms & Babes, which for 27 years has been sending nurses in two converted RVs to a dozen low-income neighborhoods. The mandate is to help women with pregnancy testing and referrals to prenatal care. The vans also offer free urine testing for gonorrhea, chlamydia and trichomoniasis. Last year, with financial help from the Hamilton County Public Health Department, the van added the blood test for syphilis.
Out of the shadows, into conversation
The RV visits Winton Terrace every other Wednesday. The immediate crisis over syphilis demands attention, Brogle and her team agree. But the view from inside the Healthy Moms & Babes RV is that the epidemic speaks of broader social problems bound up in the most intimate decisions human beings make about each other.
“Healthy Moms & Babes is a very trusted, established thing,” Brogle said. “People know who we are. They know what we do and what we don’t do. We’re not dispensing anything. We’re educating. Mostly, that’s about pregnancy. Twenty-seven years ago, syphilis was not even talked about. Now we have epidemics, and that’s why everybody’s buzzing about this.
“It’s real hard to tease this thing apart, why syphilis has gotten so much attention right away. From our experiences, it’s about the sexual activity. And the drug abuse. And the violence. And the needle sharing and everything else that’s going on in these women’s lives.”
Carol Hafner of Cincinnati is a registered nurse who has been working on the mobile van for 16 years. She said educating clients about pregnancy and syphilis often means bumping into a fear of snitching or a lack of personal respect.
“What I don’t think they realize is that you can get keep getting re-infected, and that everybody in that relationship has be treated. Everybody. They’ll say, ‘Oh, yeah, I’m just with this one partner.’ But how many partners does he have? Does she want to admit that?”
“Or,” added Brogle, “he’ll have gotten another girl pregnant, and our client will say, ‘Well, that was just one night.’”
“A lot of our clients are gullible where men are concerned,” Hafner said. “Somebody tells her that she’s beautiful, and maybe she didn’t have that with her parents, so when it’s offered to her, she’s right there.”
“And they’re kind of afraid to share,” Brogle continued. “There’s this whole thing where she won’t say he raped her or abused her because his friends would come back and hurt her. That’s a whole other level of violence that goes on here, the protection that happens for people who really shouldn’t be protected.”
Licensed practical nurse Veree Russell has just celebrated 17 years working in the mobile van for Healthy Moms & Babes. “One of the questions I ask a client is, Do you want to be pregnant? And I’ll get women saying, ‘He wants me to be pregnant,’” Russell said.
Next page: Who's at risk?
A population at risk
The syphilis epidemic overwhelmingly is concentrated among black men between the ages of 15 and 34, which Brogle, Russell and Hafner say shows the general strains within the African-American population.
Ohio is 49th in infant mortality among African-Americans, “and part of this is genetic,” Brogle said. “When you have two or three hundred years of generational stress that leads to poor health outcomes, more heart disease, more cancer, it’s impossible not to see the racial disparities and how they relate back to slavery.”
Russell pointed out that popular culture, especially on television, sends a sexual message that is hard to ignore. Food, too, is an issue.
“When you look at the foods that you’re buying, you can see that the nutrients in the food are not as strong as they used to be," she explained. "They get picked out of season to ship them up here, so we can eat watermelon year round. It just isn’t as good for you as it used to be.”
- READ: Part I "The numbers are way too high," say Hamilton Co. health officials battling syphilis epidemic
On the front lines
As the Healthy Moms & Babes women talked at Winton Terrace, they spotted movement around the RV. An older man approached and checked it out. The women watched with the huge side-view mirrors as he walked around the RV then stops to read the hand-lettered sign on the chalkboard. He approached the door and knocked.
Hafner greeted him: A tall and slim man, in his early 60s, with grizzly gray hair topped by a baseball cap. “Yeah, what kind of testing you do?”
“Won’t you come in?” Hafner asked. He does. Hafner looked over at Russell. “You ready to draw?” Russell nodded.
The man took a seat at the table.
“We offer testing for sexually transmitted diseases,” Hafner said. “Are you sexually active?” The man said yes. “Do you want to be tested?” Yes, he said again. Hafner explained that if he tests positive, she will contact him, to get treatment at a county or city van. The man nodded.
For about 10 minutes, Hafner filled out the man’s paperwork. Then Russell led him to a chair. He rolled up his sleeve. She stuck him with a needle and drew his blood. After the man thanked the Healthy Moms & Babes team, Russell said, “Tell your friends we’re here every other Wednesday.”
“I will,” the man said and then departed.
Look for Part III of "Out from the shadows: Cincinnati's syphilis epidemic," next Thursday.