Infected and untreated, prostitutes behind Knox County syphilis outbreak

By J.J. Stambaugh (Contact)
Tuesday, June 30, 2009

Dozens of Knoxville’s street-level prostitutes are infected with syphilis or HIV and many of them don’t even know it, according to the Knox County Health Department.

Even when prostitutes do know that they’re potentially spreading a lethal disease and might face a stiff prison term for it, many continue plying their trade from the sidewalks of North and East Knoxville with little concern for themselves, their customers or the innocent who might end up infected, said Gary Messer, who does public outreach for the Health Department.

“It hasn’t stopped some of these women from continuing the process out there,” Messer said. “Right now there are around 10 prostitutes who are HIV-positive.

“I know of one case in particular where we’ve not been able to even get to this girl to notify her. We’ve left information for her to call us back, but she’s running away from our attention to her.”

A syphilis upswing

Right now, he said, the biggest problem facing local health officials is trying to stem an outbreak of syphilis that’s been ravaging prostitutes and their customers for the past three years.

“Last year, Knoxville made the list of the top 30 U.S. cities for syphilis,” he said. “Typically, all your problems are farther west in the state, but there are now things we’ve got to get out and do in this community to clean this up.”

Health officials are confident the primary reason for the upsurge is street prostitution.

They first noticed a sharp increase in new syphilis infections in 2006, Messer explained, and the numbers have climbed nearly 30 percent since then.

There were more than 200 new cases of syphilis in Knox County last year. Messer said approximately 75 percent could be traced to streetwalkers and their customers.

“It’s definitely the major player,” he said. “The bulk of it is coming from people being arrested for prostitution.”

Knoxville is unique among Tennessee’s major cities, according to statistics from the health departments that cover Chattanooga and Nashville.

Hamilton County has far lower syphilis infection rates while Knox’s rate is generally comparable to that of Davidson’s, which is far larger and more urban, statistics show. But authorities in both counties agree that prostitution doesn’t appear to be driving syphilis rates in their communities.

“In Hamilton County, the majority of new syphilis cases are found in men who have sex with men or men who have sex with men and women,” said Hamilton County Communicable Disease Program Manager Nettie Gerstle. “New cases of syphilis have not been specifically linked to prostitution in Hamilton County.”

In Nashville, being a prostitute doesn’t appear to be any more of a risk factor for catching syphilis than other types of high-risk behavior, according to Brad Beasley, director of the STD/HIV program for the Metro Davidson County Health Department.

“Prostitution is not driving it,” Beasley said.

Infecting the innocent

Syphilis, which can be crippling or fatal if it’s not treated in time, is spread through anal, oral or vaginal sex and doesn’t require an exchange of bodily fluids to cause an infection. Its highly contagious nature means that johns often end up spreading the illness to innocent third parties before they realize they have anything more serious than a sore or rash, Messer said.

“We’ve had males, normally in their 30s, who are married or have a steady partner, who have been engaging with prostitutes and getting infected,” he said. “They then infect their wife or girlfriend, and we’ve been seeing some of these women going to the emergency room with secondary rashes.”

Treatment is readily available and free at the Health Department, but Messer said that officials often have a hard time getting people to come in for testing and medication.

Part of the problem is ignorance, which Messer hopes can be cured by passing out information and by word of mouth in the hardest-hit communities. Some people, however, are afraid to come to the Health Department because they falsely believe they’ll end up in legal trouble, he said.

“We’re disease investigators,” he said. “We deal with the disease aspect, and the Police Department deals with crime.”

To the prostitutes themselves, catching a disease is only one of many threats they face on a daily basis and not necessarily the most urgent one, according to defense attorney Jamie Niland of the Knox County District Public Defender’s Office, who has represented many of Knoxville’s streetwalkers.

“It’s a really, really dangerous thing,” Niland said. “They take huge risks for low amounts of money … I understand these women are a nuisance, but it really makes a difference when you sit down and learn their backgrounds. It’s really sad.”

Even though medical treatment is available through the Health Department, many prostitutes suffer from severe drug addictions or mental problems that prevent them from seeking help or even recognizing the kinds of dangers they face, she said. Even if they want to change, quality psychological treatment is hard to come by for those with little money and no health insurance.

“They don’t have very good self-preservation instincts, so when anyone approaches them they just say, ‘Do you want a date?’ ”

Immediate testing

Since the syphilis outbreak was discovered, Messer and his co-workers have made themselves familiar sights in the neighborhoods around Magnolia Avenue and Central Street by handing out packets of information to streetwalkers and business owners.

“It’s our job to find these people and treat them,” Messer said. “Abstinence is the best thing, but condom use is the next thing. I think also a key component is for the general community to understand how it’s transmitted, the nature of the infection and what symptoms to look for.”

Authorities try their best to track the diseases carried by prostitutes, but there are many ways in which those who are infected can slip through the cracks, he said.

Whenever someone is busted for prostitution, state law requires them to undergo an HIV test, Messer said. Testing for other STDs isn’t mandatory, but the Knox County Detention Facility tries to screen all inmates for syphilis, tuberculosis and HIV once they’ve been incarcerated for 48 hours.

“We’re trying to get people who are just processed into the jail tested — even if they are immediately released on bond — but that’s probably a ways down the road due to staffing issues,” he said. “We’ve also talked about getting chlamydia and gonorrhea added to those tests, but it just hasn’t gotten approved.”

Knox County Sheriff’s Office spokeswoman Martha Dooley said that jail employees try to screen prisoners as quickly as possible. Up to 36,000 inmates are booked into the facility each year, however, and it can take as long as five days after booking to get individual inmates tested.

“If they get in and out before they are tested, or if they make bond, then their name is sent to the Health Department,” she said.

Once a prostitute tests positive for HIV, he or she can be charged with the felony of aggravated prostitution if they’re caught selling their bodies again. There are no similar laws covering other STDs, according to Messer.

The good news is that, with the exception of syphilis, STD rates have remained steady in recent years, he said.

“Historically, in Knoxville and Knox County, you’re going to typically have about 1,400 cases of chlamydia and 800 cases of gonorrhea,” Messer said. “In 2008, we only had 37 cases of HIV. When you compare it to some other cities in the country, we don’t have a lot of HIV.”

J.J. Stambaugh may be reached at 865-342-6307 .

Original at KnoxNews

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