Pubdate: Wed, 29 Jun 2005
Source: Riverfront Times (MO)
Copyright: 2005 New Times, Inc.
Contact:  http://www.riverfronttimes.com/
Details: http://www.mapinc.org/media/367
Author: Malcolm Gay
Bookmark: http://www.mapinc.org/coke.htm (Cocaine)

THE GREAT IMITATOR

The Scourge Of Syphilis Re-Emerges, Deadlier Than Before

Fresh sheets of plywood now mask the first-floor windows of the 
Better Donut Drive In. One story up, shards of glass give view to the 
red brick building's abandoned interior, and weeds sprout freely from 
its pitted concrete parking lot.

The doughnut shop's best days may be well behind it, but like any 
building, the phantom crumbling at the corner of Grand Boulevard and 
Cass Street occupies its own little place in history. During the 
crack cocaine boom of the early 1990s, this north St. Louis shop was 
ground zero for the city's syphilis epidemic.

"On Social Security check day, a lot of old men would meet there, 
drink coffee and eat doughnuts," recounts Frank Lydon, an 
epidemiologist for the Missouri Department of Health and Senior 
Services. "But there'd also be a big batch of young girls who'd 
prostitute for those checks. We had a lot of syphilis coming out of 
that old doughnut shop."

A few years earlier, crack cocaine had begun working its dark magic 
on the nation's urban cores. The notorious street war between the 
Crips and Bloods spilled out of southern California, and by 1990 the 
U.S. syphilis rate had crept to its highest peak in nearly 50 years.

St. Louis was behind the national curve, and it would take another 
two years for the disease to arrive here in earnest. But when it did, 
the city quickly grappled its way to the top. By 1993 the total 
syphilis infection rate within the city limits soared by more than 
2,100 percent, earning St. Louis the dubious distinction of Syphilis 
Capital, USA.

To public-health workers, this was an epidemiological inevitability. 
"Look at the eastern U.S.: All roads eventually lead to St. Louis," 
says Lydon, who came to the city as a greenhorn disease investigator 
in 1993. "Coming up from the coasts, you could see the outbreak 
popping up along the highways. The numbers kept getting higher and 
higher as they converged on St. Louis."

The city held the nation's highest syphilis infection rate for four 
years running, from 1992 through 1995, though rates dropped after the 
1993 peak. The brunt of the outbreak was borne almost exclusively by 
the city's African-American population. More than 94 percent of all 
reported cases in 1993 were among blacks, and investigators 
determined the disease had followed crack cocaine into the city.

"St. Louis was a drug-redistribution site. People could easily take 
the highway to St. Louis, break down their drugs and redistribute 
them," Lydon explains. "These guys are coming in with diseases. 
Eventually that ends up getting to your prostitutes, and from them 
into the general population."

Twelve years later, Frank Lydon now heads the team of state disease 
investigators who cover the city of St. Louis and ten outlying 
counties. His cramped, windowless midtown office is festooned with 
the detritus of disease prevention, including plastic bags that spill 
over with HIV test kits, copious prevention literature and a small 
red-and-white cooler ominously marked "STD." He's a slight man, 
impeccably groomed, with straight brown hair, delicate hands and 
wispy eyebrows that gather mass only at their outer reaches. Style be 
damned, he dresses tidily in chinos, a short-sleeve Oxford shirt and 
sensible brown leather shoes. He's also unfailingly polite, which 
might throw you off when he holds forth about oral dams or deviant 
sexual behavior with the same informality most reserve for the weather.

"That was good old-fashioned epidemiological work. Real shoe-leather 
stuff," he says, recalling the difficulty health workers had coaxing 
sex-partner information from the syphilitic patients who turned up at 
city health clinics. "It was a really difficult population to work 
with, because they were afraid. Take a crack addict with syphilis: 
Are they going to tell you where they caught it? Most likely, no. 
They're afraid that if they give us the name John Doe, and that's 
their dealer, they're going to lose their source of drugs."

By enlisting the help of dealers and pimps, investigators eventually 
managed to get prostitutes and drug users to open up. "One of the 
ways we tried to sell them was, 'You know, a healthy customer is 
going to keep coming back to you. If they're sick, they're not going 
to buy drugs,'" Lydon says.

Ultimately the age-old techniques of interviewing and networking 
prevailed: Within a few years, health workers were able to trace the 
progress of the epidemic and slow the spread of the disease.
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MAP posted-by: Beth