"I didn't know that Syphilis was still a problem since antibiotics, specifically, Penicillin, was discovered for treatment". "What, Nashville, in the center of the Bible belt, has an epidemic of Syphilis"? These were statements that I heard over and over when we first began our work with syphilis elimination in 1998.

There has been significant progress in the control and prevention of syphilis in the United States. The rate of primary and secondary (P&S) syphilis reported in the US decreased during the 1990s and in 2000 was the lowest since reporting began in 1941. Ironically, Nashville had the highest rate of P&S syphilis in cities with populations of 100,000 or more. When we launched our initiative, we knew that our rates would go up because of increased awareness and education, but we were not anticipating that we would become the chart topper.

In 1998, the Nashville Davidson Metro County Health Dept. (MPHD) hosted a community forum to inform individuals and organizations in Nashville about the syphilis epidemic and mobilize them in an effort to eradicate syphilis from our community. The forum launched the STDFree! Initiative. The many programs and agencies involved in Nashville's syphilis elimination effort were the STD/HIV Division and Health Promotion Division at (MPHD), the Tennessee Dept of Health, advisors and consultants from the Centers of Disease Control and Prevention (CDC) and the members of the STDFree! Initiative.

Through the efforts of the five workgroups (Education, Faith, Community, Health and Law Enforcement) of the STDFree! Initiative, many Nashvillians learned about the risks of STDs, prevention and treatment. Many were given the opportunity to know if they were infected by providing screening, often in their own neighborhoods, at the library, at school, in the park, at the grocery store and even on street corners. Some of the annual events like the Haunted House on the campus of Tennessee State University and HIV Test Day have allowed us to screen over 300 individuals for syphilis and HIV at each event.

We used various media outlets, like bus benches, Tennessee Titans public service announcements, the STDFree! logo on pens, pencils, pads, posters in bathrooms and advertisements inside busses. Displays and/or presentations were made at the State Fair, various health fairs, Alcohol and drug inpatient and outpatient recovery facilities, colleges, high schools, alternative schools, probation and parole departments, homeless shelters and programs, public housing meetings, youth church gatherings, in-services for medical students and physicians in training, and correctional institutions. We hosted special educational symposiums for ministers and physicians. We also conducted train-the-trainer sessions for community leaders and residents several times a year. This is just a short list of the many activities and sessions conducted by the STDFree! Initiative.

Now, it is the summer of 2005…where is Nashville now? We know that in 2000, Nashville had 200 cases and was ranked #1 in the country. In 2003, Nashville had 21 cases which ranked us #35 in the country. This has taken us out of the top counties and cities that account for 50% of reported P&S syphilis cases and has shown that when the community is involved in solving the problems of their community, good things happen and positive results are realized.