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American Navajos Confront Syphilis Outbreak - 2003-06-27

Syphilis was first described the 1500s when it was known as the Venetian, Naples, or French disease depending on who was describing it. Left untreated, the sexually transmitted disease can damage the heart, bones and liver and lead to blindness, insanity and death. Here in the United States, syphilis rates have been on a steady decline for about the last 50 years. But although syphilis is easily and cheaply curable, it has yet to be eradicated and there are disturbing signs that a new outbreak may be occurring.

This clinic at the Gallup Indian Medical Center is where most of the cases in the current Four Corners syphilis outbreak are being treated. Dr. John Iralu, who works here in Gallup, says that since the late 1980s, only about two cases a year of syphilis have been seen on the Navajo reservation.

But in 1999, Dr. Iralu says, rates started to rise. "In 2001, we realized we had a significant problem when we started counting up to 34 cases that year, and then in 2002, we repeated that figure at 34 cases," he says.

Thirty-four cases a year doesn't sound like a huge number, but when looked at in the context of the total Navajo population of about 250,000, it's comparable to a rate of infection seven times that of the United States as a whole. So, Dr. Iralu says, health investigators are aggressively looking for people infected with syphilis, even if they show no outward symptoms. "We have instituted a program of testing all people who are being seen for an alcohol related illness or injury," he says. "So, say someone came because they broke their leg while they were intoxicated. We would obtain a blood test for syphilis automatically in that case, so we can screen them and go back and treat them. To be blatantly obvious, when a person drinks alcohol, their inhibitions are lowered, they may have contact with someone with who they wouldn't normally have contact, and that's how syphilis is ordinarily transmitted."

That's why health officials are targeting people who drink and go to bars like this one in reservation border towns.

The Class Act is one of Gallup's most popular nightspots. There's live music tonight, and the sign out front advertises a wet T-shirt contest next week. But lately the Class Act has also been hosting an outreach worker from the Navajo AIDS Network, who sits behind a small table beside the door, offering free condoms and information on how to avoid syphilis and other sexually transmitted diseases.

Bar manager Lucy Lozano says she hopes her patrons get the message. "To have clean sex, to protect themselves, because usually when you go into a bar, usually that's what people do, they walk into the door and right away that's what's on their mind, so why not help make it safe," she says.

It seems simple and logical: attack the syphilis outbreak in border town bars, which health investigators have documented as locations frequented by people who acquire the infection. But Larry Foster, who's been fighting sexually transmitted diseases here for 21 years, says it's not that easy. "We used to go into the border town bars and distribute condoms at some of the bars. Not all of the bars, some of the bar owners wouldn't allow us to put that into their bars. So we saw both sides of that situation there, so we know certain bars will welcome us, and some of them won't," he says.

So Navajo Nation health officials decided to try a new approach. They issued a high-profile public call for bar owners to join them in fighting the syphilis outbreak. They launched the effort this April in Gallup, inviting bar owners to meet with them and the town's mayor. George Joe, spokesman for the Navajo division of health, said they wanted to shine a spotlight on the bars. "Yeah, it probably put some pressure on them, I'm sure, and I think many of them recognize that there is a problem, and they want to help be a part of the solution," he says.

The strategy is one that Mr. Joe says would have been unthinkable even a year ago. That's before new Navajo President Joe Shirley took office, and appointed Cora Phillips as the Nation's Health Director. "I don't take things lightly, especially when human lives are at stake. And I've always to a certain degree been radical in nature myself. So I'm taking these measures that will help us produce positive outcomes," she says.

Where the previous administration fought syphilis in a very behind the scenes manner, Ms. Phillips has no qualms about going public. Wanting to put a human face on the campaign, she convinced President Shirley to take out full-page newspaper ads featuring his own photo, urging Navajos to be safe and get tested. She also pushed aside concerns about the Navajo Nation partnering with bar owners in neighboring towns, when alcohol is illegal on the reservation itself. "It is definitely a radical step. Because it's something that has not been attempted before. Although it may be radical in nature, however, the partnership still needs to happen, if not now, in the future, to establish some sort of a mutual understanding, because after all we are neighbors," she says.

So far, the Class Act and one other Gallup bar have agreed to allow outreach workers inside to distribute condoms and disease prevention information. Cora Philips is calling this a precedent setting victory.

In June, the Nation is taking its campaign to bars in neighboring towns, and plans to move on to Arizona border towns after that. With substance abuse the number one problem among Native Americans, the Navaho Nation's Health Director says she hopes that bar owners will keep their doors open to help out with other alcohol related health problems on the reservation.