The Bay Area Reporter - August 31, 2000
Katie Szymanski

Talk about bad timing.

A couple of weeks ago, when DPH representatives appeared before the Board of Supervisors Finance Committee to justify how they ascertained the original estimate of 900 new HIV cases in San Francisco, the public learned that in fact, there was no exact explanation. Infection rates are determined, according to DPH Director Dr. Mitchell Katz, when a panel of experts get together, then "sit around and decide" what the likely numbers are, based on data known as HIV indicators. The "900 number," as it has come to be known, may have represented a high estimate for what is now believed to be around 600 cases. Again these numbers are not determined from actual HIV test results, but derived from a determined surge in risky behavior according to a variety of studies.

These HIV indicator studies showed an increase of rectal gonorrhea among men who have sex with men, an increase of the population of men who have sex with men, and an increase of condomless sex among that population. Based on these HIV indicators, DPH has determined that HIV is exploding in San Francisco.

While actual numbers behind the studies were never offered during the public hearing, it's no secret that practices like "barebacking" have enjoyed a renewed popularity, so the idea that HIV cases may be up -- if even by a handful of people -- is not hard to believe.

What is difficult -- if not extraordinarily frustrating for those who have tried to investigate the controversial new HIV rates that have branded San Francisco as having a "sub-Saharan" rate of infection -- is the fact that the very HIV indicator supposedly pointing to the gay male surge in HIV is nowhere to be found on this month's STD report issued by DPH.

The San Francisco Monthly STD Report, issued every 30 days by DPH, has for years included a category for male rectal gonorrhea cases. Yet this month, on the heels of proclaiming a rise in such rates, DPH dropped male rectal gonorrhea cases from its July report.

"Routinely STD Services evaluates à the content of the monthly report," said a statement issued last week by Jeff Klausner, director of DPH's STD services, the publishers of the monthly report. "With the limited context available for the monthly report, it was felt the information would be more useful with the expanded context afforded by the annual summary."

Yet the monthly reports, far from not providing a context, have regularly run rectal gonorrhea rates as compared to the previous year; reports for 1999 and 2000 each show the number of cases for the current month and the same month of the year before, as well as year-to-date cases. In fact the rectal gonorrhea "surge" that has reportedly occurred may be attributable to one month where the cases increased dramatically; in many other months the number dropped, remained the same, or increased by a couple of cases.

Given that one month may be responsible for a surge, skeptical members of the public this week wondered if July's rectal gonorrhea rates had plummeted, thereby challenging the DPH assertion that rectal gonorrhea was on the rise. Additionally, Klausner noted in his statement that "rectal gonorrhea is not a reportable disease," whereas gonorrhea, chlamydia, syphilis, etc. are the official categories. But this explanation doesn't explain the timing of the sudden omission. It is, after all, no less than bizarre that a health department pointing to a disease's increase would then proceed to leave that increase out of the public data.

But getting answers to these questions and speculations proved difficult. Klausner at first did not return several phone calls from the Bay Area Reporter, nor did Dr. Willi McFarland, the epidemiologist who originally alarmed the San Francisco Chronicle with his HIV estimates, then backpedaled and called his statements "unfortunate." Additionally, both Katz and Dr. Sandy Schwarcz, the director of AIDS surveillance at DPH, were on vacation this week. A representative from Klausner's office finally referred all inquiries to the media department, which had no information. Klausner then finally called the B.A.R. to say that he would request the information but that it would not be available before press time.

Therefore, the B.A.R. cannot report the actual number of male rectal gonorrhea rates for the month of July, even though these rates were recently referenced as HIV indicators for the city's infection rate. Only one DPH representative seemed willing to acknowledge that excluding this data from the report was not wise.

"It was a mistake to leave those numbers off the report. The timing was unfortunate," Steven Tierney, HIV prevention director at DPH, told the B.A.R. "I have put in a request to re-include these numbers, because the gay community has a right to know them, particularly when they were just used to explain HIV rates."

Other city officials were equally concerned.

Supervisor Tom Ammiano told the B.A.R. that he has placed a call to DPH and is "looking into the matter."

Roma Guy, president of the San Francisco Health Commission, said that even if rectal gonorrhea is no longer included in the reports, the infection rates must be released to the public.

"My position would be if rectal gonorrhea is a marker, and prevention is key, then we need to find a way to inform the public about this marker," Guy told the B.A.R. "And we have a department that is supposed to handle that, so they're responsible."

The B.A.R. will report the actual rectal gonorrhea rates for July as soon as the information is released; Klausner has said that could be as late as next week.

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