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Health workers hit the streets to fight spread of syphilis

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HOLBROOK, Ariz. - U.S. public health officials have warned that syphilis, a bacterial-borne venereal disease which if not cured could cause brain damage, is once again on the increase throughout the country - including the Navajo Nation.

Navajo Nation, state and federal health care workers, fighting an infection rate seven times the national average - two cases a year in 1999 to 55 this year - have tracked the infection to people from cities, such as Phoenix, Los Angeles, and San Francisco, said Dr. Jonathan Iralu, infectious disease specialist for the Navajo Area Indian Health Service.

For nearly a year, a multi-agency task force has fought syphilis through education and unusual means: setting up inside bars with safe sex kits, going into jails and educating inmates, and asking tribal members to voluntarily agree to syphilis testing.

They have held highly coordinated community outreach campaigns called "syphilis blitzes" at fairs and in towns bordering the reservation where alcohol is sold such as Farmington and Gallup, N.M that requires approaching people considered high-risk for syphilis and asking them to volunteer to a syphilis test, said Navajo Nation sexually transmitted disease coordinator Larry P. Foster, a veteran of 44 blitzes over 23 years.

"We have found that alcohol plays a big part in those who have been infected with syphilis," Foster said. "Alcohol abusers are considered high risk because alcohol lowers a person's inhibitions. They'll have contact with someone they normally wouldn't."

This is why in mid-September, the group organized another blitz - their 15th in the past 34 months - during the Navajo County Fair in Holbrook, Ariz., a bordertown community with several nightclubs often frequented by tribal members. The 16-member task force came from three agencies: the Navajo Nation, Winslow (Ariz.) Indian Health Care Corporation, and the Arizona Department of Health.

The task force split up into groups of five or six. One group set up in the parking lot of a Safeway shopping center; another in front of Winner's Circle, a popular nightclub; and a third walked the alleys, behind buildings, and places where "high risk" people gather.

As people walked in and out of the nightclub or the Safeway shopping center, they were approached by a "recruiter" an STD educator who asks them to volunteer for an on-site test. If they agree, a recorder fills out a patient information form and a nurse takes a blood sample. And if they're willing, they're also tested for HIV, said Nicole Boulanger, a WIHCC public health nurse who set up a table in front of the nightclub.

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"We tell them about how the screening is done and educate them about STDs and HIV," Boulanger said. "We tell them about activities that put them at risk for HIV. Once completed, we give them incentives such as toothpaste, snacks, laundry detergent, and Gatorade."

And just so everything goes smoothly, they rehearse their duties before heading to their posts, said Foster. "For some health care workers this is their first time, so we role play and go over the steps. They all must follow a standard script when approaching people," he said.

Surprisingly, the group on the sidewalk of the nightclub has no problems, said WIHCC public health nurse Roderick Antone. Most of the bar patrons Antone approached usually consented to a test. "Usually, we don't run into problems," he said. "We talked to over 100 people and tested about 50. Most were cooperative."

Boulanger said her location was good. "People were quite enthusiastic about it," she said. "My first reaction was that I thought the location was a good choice. It was interesting for me. We ended up screening more people than we thought. We have to go where there is a crowd," said Boulanger. "Because of the outbreak of syphilis ? That is the most popular bar in the area. If we stood outside the library we probably wouldn't have got that many people."

"The people we're targeting are hard to reach," Foster said. "The only way to reach them is to physically go to them. So far, we're happy with the outcome from all the blitzes we've held."

At day's end, they tested 58 people for syphilis and HIV. No positives were found in the tests.

The challenge continues to be finding its carriers, interviewing them under "anonymous" contact investigations to determine who their sexual partners are and have been, then bringing them in for blood tests and treatment.

George Joe is a senior public information officer for the Navajo Division of Health. Contact him at