The Bay Area Reporter - Friday, May 14, 1999
Cynthia Laird and Mike Salinas

That's right. Fewer cases.

"AIDS cases have been decreasing since 1992," confirms Sandy Schwarcz, director of AIDS surveillance for the city's Department of Public Health (DPH).

The city tracks AIDS cases through its quarterly surveillance reports, the most recent of which shows that 62 AIDS cases were diagnosed in the city between January 1 and March 31 of this year. Of those cases, 39 (or 63 percent) were among gay or bisexual men, nine (14.5 percent) were among gay or bisexual male injection drug users (IDU), and nine were among non-gay male IDUs. One case was a blood transfusion recipient, and four were in the "other" category.

The number of AIDS cases diagnosed in that three-month period has dropped by 10 percent since the same period in 1998, when there were 69 cases, of which 53 were gay or bisexual men; five gay or bisexual male IDUs; nine non-gay IDUs; one heterosexual; and one "other." That, in turn, was a 16 percent drop from that period in 1997, when 82 AIDS cases were diagnosed, with 61 being gay or bisexual men; five gay or bisexual male IDU; 13 non-gay male IDUs; one heterosexual, and two "other."

All in all, the incidence of AIDS diagnoses in San Francisco has dropped by 25 percent in only two years. For gay men who don't inject drugs, the rate has dropped by more than a third.

Such news would have raised shouts of joy in the past, but city officials aren't exactly broadcasting the latest numbers. In fact, it isn't easy to tell if they have been aware of the trend; last week Mayor Willie Brown issued a news release with the inaccurate statement, "Statistics show the number of AIDS cases is increasing here."

Schwarcz told the Bay Area Reporter that is incorrect, and she didn't know where the mayor or his staff got that impression that AIDS cases are on the rise.

'Unclear factually'

San Francisco Health Director Dr. Mitch Katz reiterated the declining number of AIDS cases Monday, May 10 when he delivered his State of the City Public Health address to the Board of Supervisors. In that document, Katz said AIDS cases have been declining since 1992 and deaths have been decreasing since 1995, but that doesn't mean the epidemic is over.

"AIDS continued to be the leading cause of preventable death in San Francisco, as measured by the expected number of years lost in a person's life who dies from the disease," said Katz. "Due to improved treatment, the number of persons living with AIDS is increasing. Declines in the number of AIDS cases have not been as great among women, youth, and persons of color, indicating unmet needs in the area of HIV prevention."

But among people of color, they are declining in all ethnic groups except Latinos. According to the quarterly surveillance report for January through March of this year, of the 62 AIDS cases diagnosed, 32 were white, 11 were African-American, 17 Latino, and two Asian/Pacific Islander. For the same period in 1998, of the 69 diagnosed AIDS cases, 42 were white, 13 were African-American, 11 were Latino, and three were Asian/Pacific Islander. For the same three-month period in 1997, of the 82 AIDS cases diagnosed, 51 were white, 16 were African-American, 13 were Latino, and two were Asian/Pacific Islander.

Bill Barnes, the mayor's HIV/AIDS policy advisor, told the B.A.R. that his office didn't put together the mayor's press release, but that he has gotten calls about the discrepancy and has talked with the mayor about it.

"While a bit unclear factually," he said, "what the mayor was trying to say is that the cumulative number of AIDS cases in San Francisco keeps going up."

AIDS activist Michael Petrelis is one unhappy activist who contacted the office about the inaccuracy. "The mayor said AIDS is increasing and then Dr. Katz said AIDS is decreasing," he complained. "Which is it and where is the science?

"Mayor Brown and Dr. Katz should follow the recommendation of the AIDS Summit of January 1998 [preliminary report] that says 'We recommend that researchers make greater efforts to disseminate the results of their work in the community, especially any research findings that could assist in designing prevention programs.'"

'Give me data'

All health workers interviewed for this article focused on prevention, because it alone affects the number of HIV infections each year. The drop in reported cases is only of full-blown AIDS, not HIV infection, in an era when aggressive anti-viral intervention is believed to delay the onset of opportunistic infections that form the basis for an AIDS diagnosis. As Schwarcz pointed out, it isn't the same as lower rates of HIV infection.

"All of our evidence suggests HIV cases are not declining," she stated.

DPH estimates some 15,000 San Franciscans are living with HIV, and 8,162 have been diagnosed with full-blown AIDS.

Because of privacy concerns and political wrangling, it is virtually impossible to get an accurate number of annual HIV seroconversions, but the city's HIV Consensus Report estimates 500 new infections in San Francisco each year. A letter from former AIDS Office Director of Prevention Barry Brinkley in 1998 outlined 540 positive test results at the city's eight HIV testing sites over the previous year, from 16, 561 people tested. The Urban Health Study and the Forensic HIV Project had the highest percentage of positive tests, with nearly one in 10, while the Haight Ashbury Free Clinic had less than two in 100 testing positive. The Special Program for Youth had a rate of 7.5 percent.

Shawn O'Hearn, a member of the city's HIV Prevention Planning Council (HPPC) told the B.A.R. that the number of seroconversions used by health officials is "completely pulled out of thin air." He said that a report issued when Brinkley, as the HIV prevention director, stated there were 1,500 seroconversions a year. "Obviously, there's no formula here," O'Hearn said, adding he's been relentless in trying to get raw data from DPH. "I question all percentages and I got really adamant. I don't want percentages without raw data."

O'Hearn said raw data is needed so that prevention planners can appropriately spend the $9.8 million in federal, state, and local HIV prevention funds.

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