AEGiS-SFE: Revitalize AIDS prevention: A new emphasis on stopping the spread of HIV draws heat, but it's a common sense way to halt deadly new infections

Important note: Information in this article was accurate in 2000. The state of the art may have changed since the publication date.

Revitalize AIDS prevention: A new emphasis on stopping the spread of HIV draws heat, but it's a common sense way to halt deadly new infections

San Francisco Examiner - August 14, 2000

SAN FRANCISCO Health Director Mitch Katz uses unassailable logic to call for a sharp revision of AIDS prevention strategy. The educational emphasis of the last several years actually is sensible enough: It stresses the use of condoms by men having sex with other men, to avoid transmission of the HIV virus that causes AIDS.

The problem is not the message itself, but the fact that it has not worked to the extent it needs to. The generalized advice to always-use-a-condom is not sufficiently influencing behavior to control the epidemic among The City's substantial gay population. Katz cites a disturbing rise in the number of new HIV infections, from 498 in 1997 to 790 last year.

A degree of complacency among gay men about the threat of HIV is due to the development of drug combinations that permit AIDS patients to fend off life-threatening conditions indefinitely and continue relatively normal routines. HIV is no longer a death sentence, Katz observes. But once contracted, the virus is still ineradicable and potentially deadly.

As part of a new city prevention program, Katz proposes a narrower focus on the role of HIV-positive men who pass the virus on to HIV-negative men by means of unprotected anal intercourse - the practice blamed for much of the epidemic's resurgence. "No one wanted to be seen as being politically incorrect by suggesting that a negative person became infected because of a positive person," Katz said. "But that's the only way it happens."

The director of public health paid a price for voicing truth - he was targeted by extremists who disagree with mainstream science about the role of HIV in AIDS and object to The City's prevention efforts. But zeroing in on the specific subgroups and activities that have sent HIV rates climbing again is clearly a key to corraling the epidemic. A well-directed call for responsible behavior by those who can infect others is just common sense.

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