Bay Area Reporter - October 5, 2006
Matthew S. Bajko, m.bajko@ebar.com

While it is true most people diagnosed with HIV who have access to AIDS drugs are living longer, the reality is that in San Francisco, AIDS is still the leading cause of death within men ages 15 to 54 years old, and is considered to be the main killer of gay men ages 15 to 64.

Death reports do not list a person's sexual orientation, but AIDS advocates said due to the fact that nearly 90 percent of the city's AIDS cases are gay and bisexual men, it is no leap to say that AIDS is the leading cause of death in the gay male community.

"There is not a doubt in my mind that AIDS is the leading cause of death in gay men in San Francisco," said Brian Basinger, the founder of the AIDS Housing Alliance, who last month asked city health officials about the impact of AIDS on death rates after he attended a meeting this summer and heard one official state that people are no longer dying from AIDS.

"That doesn't jibe with my personal experience and my work experience," said Basinger, who has lost five alliance members this year and has several friends who are currently battling life-threatening illnesses. "Our community is bearing huge, huge loses. It is so extreme in gay men those numbers are trumping the death rates of all men in San Francisco."

Ling Hsu, co-director of the department's HIV/AIDS Statistics and Epidemiology Section, in an e-mail to Basinger noted that HIV/AIDS was the leading cause of death for men ages 15 to 54 years in 2003, the most current year with complete data available in San Francisco. According to the section's data, Hsu said there were 52 HIV/AIDS related deaths per 100,000 San Francisco male residents in that age group.

When men ages 55 to 64 were added to the analysis, Hsu found that the rank fell down to third, with 58 HIV/AIDS deaths per 100,000 men, next to heart disease and cancer (72 and 71 deaths per 100,000, respectively). As a comparison, Hsu stated that in California and the United States, HIV/AIDS ranked about the sixth cause of death among males 15 to 54 years old.

In her e-mail to Basinger - and a subsequent e-mail to the B.A.R. - Hsu stressed that while the department does have an estimated population size of gay men in the city, it does not have cause of death data among gay men nor the age breakdown. However, Hsu wrote in her e-mail to Basinger that "I think it is reasonable to assume that HIV/AIDS would be the #1 cause of death among gay men ages 15-64, because of the high HIV prevalence among gay men and that most HIV/AIDS deaths occurred during that age group."

HIV prevention officials said the numbers bear out what many people have assumed all along regarding the impact of AIDS on the city's gay male community.

"I think what she is suggesting in there - and the reason you haven't heard it before - is everyone assumed it was the case in San Francisco given the number of deaths," said Steven Tierney, deputy executive director of the San Francisco AIDS Foundation. "I think people haven't made a newsworthy piece of it because people assumed it was true. I think people have a right to know that; it might have some impact in people's decision making."

Jennifer Hecht, education manager at the Stop AIDS Project, added that the death statistics are "a reminder we are living in a community still seriously affected by HIV and AIDS. I think a lot of men are very aware of improvements made in HIV medications and less aware that men are dying from AIDS and AIDS-related deaths."

As the number of people dying each year due to AIDS continues to decline in San Francisco, the age of those who do die continues to rise. According to the city's 2005 annual report on HIV and AIDS, the number of AIDS deaths declined between 2002 and 2004; however, reporting of deaths in recent years is not yet complete.

Cumulatively, the report said that most deaths occurred in the 30-39-year-old age group; but in recent years, the largest number of deaths occurred in the 40-49-year-old age group. In 2005, the report listed 228 AIDS deaths, with 100 people dying between the ages of 40 and 49, with the next largest number of deaths, 66, occurring in people 50 to 59. In 2004, the report listed 224 deaths, with 90 among people 40 to 49 and 57 among people ages 50 to 59. In 2003, there were 297 deaths and in 2002 there were 316.

The report also states that the proportion of deaths in which HIV/AIDS was listed as the underlying cause of death decreased from 88 percent of AIDS deaths occurring between 1992-1995 to 72 percent in 2000-2003. Other frequently occurring underlying causes of death in 2000-2003, states the report, include non-AIDS cancer (6.7 percent), heart disease (5.2 percent) and liver disease (2.3 percent), diseases that may be due to HIV-related risk behaviors or tobacco use. The report also noted that the proportion of persons with AIDS who died of these non-HIV/AIDS-related conditions increased over time.

Basinger said it is important that the LGBT community knows how AIDS is impacting its members, especially at a time when lawmakers in Washington, D.C. want to shift federal AIDS funding away from California to other areas of the country.

"If we minimize AIDS by spreading inaccurate information it makes it okay to do that because AIDS isn't a problem anymore," he said. "It allows for what is going on in Congress right now where they have been attacking San Francisco's funding and playing games with the funding formula to try and dismantle the San Francisco model [of care]."

The same sentiments are behind the L.A. Gay and Lesbian Center's new "HIV is a Gay Disease" campaign, which some in the LGBT community have attacked as another fear-based message that inaccurately blames gay men for the spread of HIV. But center chief of staff Darrell Cummings said the campaign is meant to bring attention to the fact that especially on the West Coast, it is gay men who make up most of the HIV cases.

"Back in the 1990s we stopped talking about gay and bi men and instead about men who have sex with men. I realized we were de-gaying the epidemic in a way I thought could have a negative impact in the future," said Cummings, 49, who is himself gay. "We were talking about a sexual behavior and ignoring the cultural context we as gay and bi men find ourselves in. Addressing this epidemic without [addressing] homophobia is a huge mistake."

Cummings said he agrees with Basinger that the gay community needs to be reminded that AIDS still disproportionately impacts its members. He said that in Los Angeles County gay and bi men make up less than 7 percent of the county's population but account for almost half of the 700 AIDS deaths it will record this year.

"Our community is no longer recognizing that reality," he said.

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