Overlapping Syndemics of HIV, STDs, TB, and Viral Hepatitis HIV TB Viral Hepatitis STDs Percentage of TB Patients Having Known HIV Status, U.S. Excluding California, 19932005 69% 35% 81% 52% 0% 20% 40% 60% 80% 100% 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 All Ages Aged 2544 National TB surveillance system, unpublished data, accessed in April 2007 ASD P&S Syphilis Incidence Rates: HIVinfected patients, 19982003 0 100 200 300 400 500 600 Rate (Cases/100,000 Person Years) 2002 2003 2001 2000 1999 1998 Incident P&S Syphilis Diagnosis Year Source: AIDS Surveillance Data, 19982003 Test Positivity for Gonorrhea, Chlamydia, & Syphilis Seroreactivity among MSM, by HIV status: STD clinics 2005 Median positivity HIVpositive HIVnegative or unknown 0 5 10 15 20 25 Urethral gonorrhea Pharyngeal gonorrhea Urethral chlamydia Syphilis* *Seroreactivity Source: MSM Prevalence Monitoring Project Overlapping HCV & HIV Epidemics 40 million 40 million 175 million 175 million 10 million 10 million HIV HIV Hep C Hep C Estimated 300,000 HIV/HCVcoinfected individuals in the United States