摘要：Objectives. We estimated the number and cost of syphilis-attributable HIV cases among African Americans. Methods. A mathematical model of HIV transmission was used to estimate the number of partnerships consisting of HIV-discordant African Americans in which infectious syphilis was present and the number of new HIV cases attributable to syphilis in these partnerships. Results. In 2000, an estimated 545 new cases of HIV infection among African Americans could be attributed to the facilitative effects of infectious syphilis, at a cost of about $113 million. Conclusions. Syphilis prevention could reduce HIV incidence rates and the disproportionate burden of HIV/AIDS on the African American community, resulting in substantial reductions in future HIV/AIDS medical costs. African Americans suffer disproportionate morbidity and mortality from a variety of preventable and treatable health conditions, including cancer, heart disease, and stroke. 1, 2 Elimination of racial health disparities is a major national priority, as is reflected in the federal government’s Healthy People 2010 goals. 1 With regard to HIV and AIDS, African Americans have higher rates of incidence, prevalence, and mortality than any other racial or ethnic group in the United States. 3 Of the 42 156 AIDS cases reported in the country in 2000, almost half (19 890) occurred among African Americans. 4 The reported AIDS rate among African Americans in 2000 was almost 60 per 100 000 population, about 8 times the rate for non-Hispanic Whites. 4 On the basis of recent estimates that African Americans account for about 54% of the approximately 40 000 new HIV infections that occur each year, 21 600 or more African Americans were infected with HIV in 2000. 5 African Americans also are disproportionately affected by other sexually transmitted diseases (STDs), including syphilis. 6, 7 The 4231 new cases of primary and secondary syphilis among African Americans reported in 2000 represent more than 70% of all such cases. 6 The rate of primary and secondary syphilis among African Americans (12.8 per 100 000) in 2000 was more than 20 times greater than the rate among non-Hispanic Whites. 6 Addressing this racial disparity in syphilis is 1 of the primary goals of the national campaign to eliminate syphilis that was begun October 1999. 8, 9 Syphilis elimination efforts also might have an impact on HIV incidence rates. Ulcerative STDs such as syphilis can increase HIV infectiousness and susceptibility through a variety of biological processes, such as disruption of epithelial and mucosal barriers to infection. 10– 12 In this article, we estimate the number of HIV cases, and associated costs, attributable to the facilitative effects of infectious syphilis on HIV transmission and acquisition among African Americans. These syphilis-attributable HIV cases represent a potential reduction in HIV incidence among African Americans that could be achieved through syphilis prevention efforts.
