Bay Area Reporter - August 4, 2005
Matthew S. Bajko, m.bajko@ebar.com

Since 2000, new HIV infections dropped from 900 and remain stable at 748 per year. The city's HIV prevalence rate - the number of people living with HIV - has also dropped, going from 1 in 3 men who have sex with men to 1 in 4.

Data from 2003 also has shown a dip in the HIV incidence rate among the city's gay and bisexual men. In 2000 the HIV incidence rate was 2.2 percent per year, meaning that out of 10,000 people, 220 became infected with HIV. New data for 2003 has shown an HIV incidence rate of 1.2 percent per year, meaning out of 10,000 people, only 120 contracted HIV. Health officials expect to see the same downward trend in the 2004 data, which will be released later this summer.

"It is a reduction and people should celebrate it," said Steven Tierney, the health department's director of HIV prevention. "The numbers have leveled and are decreasing, that's good news for me and I think people in the community have a right to know it and celebrate it and continue the behaviors that caused it."

While sounding a more cautious note, Dr. Willi McFarland, a San Francisco Department of Public Health epidemiologist, said he is hopeful San Francisco's HIV rates are trending downward.

"Since 2000 it's plateaued off and may be tapering down. I am hoping it's going down. Our HIV incidence being closer to 1.2 percent is quite good. We are the only city anywhere near the goal of cutting our incidence in half," said McFarland. "San Francisco was number one in 1995 for HIV infection rates. In the last 10 years our dubious honor of having the highest HIV rate has gone down to number three."

McFarland, who was criticized by some in the gay community for his June 2000 comment comparing the city's HIV levels to those seen in Africa, said perhaps the alarms raised back then have led to the burgeoning turnaround in the city's HIV epidemic.

"My worry is this is one of those good news and bad news things. It might belie the fact there is still a lot of transmission," he said. "I don't want to paint too rosy a picture but there is a lot of good news we should get out there."

Currently, the city estimates that there are 9,000 HIV-positive gay men living in San Francisco, with another roughly 8,500 gay men living with AIDS. McFarland cautioned that having 120 in 10,000 gay men seroconvert each year is still too high a number.

"It is still a sufficient number to sustain the HIV epidemic without it extinguishing," he said. "Ideally, we want this epidemic to go away. If it goes further down then I think that is great news. If it stays at 1.2 percent, then we will remain at the status quo for a long time."

Other indicators - such as an increase of safe sex among gay men, more people getting tested for HIV, anti-crystal meth campaigns, and growing numbers of gay men serosorting, where they opt to only have sex with men of the same HIV status - are leading health officials to declare that the city's HIV prevention methods are working.

"In spite of what some would have us believe, men in the gay community do take care of themselves and negotiate for the safety of their partners," said Tierney.

Stop AIDS Project spokesman Jason Riggs added, "The numbers are encouraging and obviously HIV prevention works and especially prevention around HIV positive guys. Our data shows it is working."

Michael Cooley, coordinator of Stop AIDS Positive Force program for HIV-positive guys, said serosorting is playing a large role in how the gay community in San Francisco approaches HIV prevention and is leading to the downward trend in HIV rates. Since 2001 the agency has asked men about serosorting, and as with other studies looking at the trend, has seen more and more men who say they serosort.

"We are a tight-knit community here, we all know each other. There are a lot of fish in the pool so you can find somebody you think is hot who is the same serostatus," said Cooley.

Riggs added, "The last several years we have been struggling to find a new normal for what is good, healthy sex in the shadow of the epidemic if you are positive or negative. We are finally getting to a point where we are able to understand what that new normal looks like in a positive, healthy way."

According to a study in the Centers for Disease Control and Prevention's June 24 Morbidity and Mortality Weekly Report , San Francisco fares better in its efforts to stop HIV transmission when compared to Baltimore, New York City, Los Angeles, and Miami.

The study is based on data from the National HIV Behavioral Surveillance System, which tracks the behaviors of MSM in 25 cities every three years. Out of the five cities, San Francisco had the highest level of HIV testing, with 99 percent of the men surveyed saying they had been tested at least once.

The city also had the lowest HIV incidence rate of 1.2 percent, with Los Angeles a close second at 1.4 percent. Miami had 2.6 percent, New York City 2.3 percent, and Baltimore had the highest at 8 percent.

San Francisco also had the lowest amount of unrecognized infection out of the five cities, with 23 percent of the 1,764 men who participated in the study not realizing they were HIV-positive. Los Angeles came in at 42 percent, Miami at 46 percent, New York at 52 percent and Baltimore at 62 percent.

Changes

The study, overseen in San Francisco by H. Fisher Raymond, the health department's assistant director of HIV/AIDS statistics and epidemiology, will help health officials to better target their prevention messages to address what gay men are really doing when it comes to having sex. The study's findings are providing health officials a detailed look at the high-risk sex both positive and negative men are engaging in. The results are turning some long held notions on their head.

HIV prevention leaders have increasingly turned their attention to men hooking up on the Internet. But the study found the number one place men are meeting high-risk sex partners remains gay bars. Nearly 40 percent of the 54 negative men who barebacked with a positive top met the guy at a gay bar, with online hookup sites coming in second at 20 percent. Fifteen percent of the men said they met people on the street, while only 9 percent met at sex clubs. With the 34 positive men who fucked a negative bottom without a condom, most met in bars, with the Internet coming in as the second most popular place to meet someone.

"It is not happening where you would think, like sex clubs," said Raymond.

And of the 972 negative men who had anal sex in the past six months taking part in the study, the 54 who bottomed without a condom with a positive top accounted for only 4 percent. Another 260 reported engaging in high-risk sex with another negative.

"That doesn't seem so bad," said Raymond. "Negative people having unprotected anal sex with other negative people is not high risk sex."

While the city has stepped up its efforts to combat what some have called a second epidemic of crystal meth, the drug of choice for most men in the study was pot, with 40 percent having used marijuana in the last 12 months. Speed use came in second at 21 percent, ecstasy third at 20 percent, poppers at 18 percent, and cocaine at 17 percent.

But the drug that continues to play the biggest role in men having unprotected anal intercourse is alcohol, said the researchers.

"Speed is not the most popular drug they were on. The most popular was alcohol," noted McFarland. "It raises questions about the theory on drug use and no condoms."

Concerns

Two statistics revealed by the study do concern the epidemiologists. One is an intergenerational gap that showed a five-year age difference between older positive men having sex with younger negative men, which in turn, can sustain the epidemic between the generations.

In general, Raymond said, "A lot more 36- to 40-year-olds are having unprotected sex."

The researchers also revised upward the number of gay men living in the city, from 50,782 in 2001 to now between 61,566 and 65,333. San Francisco continues to have the largest adult gay male population of any United States city.

"We have seen a substantial increase over the last five years," said McFarland. "The caveat to the finding is residing in San Francisco less than one year is a predictor of very high risk. We are worried that people moving to San Francisco are placing themselves at higher risk than where they were living."

Overall, health officials said the new data is giving them hope that gains are being made in the fight against HIV.

"This is not a fatalistic moment. It is a time we really have an opportunity to reduce new infections and make a huge impact on the generations that follow us," said Riggs.

050804
BR051102

Always watch for outdated information. This article first appeared in 2005. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2005. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .