Bay Area Reporter - November 16, 2006
Heather Cassell

Five years ago when the call to action was initially released it was the only one out of several policy statements around other health issues produced by Satcher that wasn't signed off by then-Secretary of Health and Human Services Tommy Thompson or supported by the department's administration.

"I'm grateful that we were allowed to release the report," Satcher said. "The fact that people were not comfortable signing off on the report about sexual health tells volumes about where we are as a nation when it comes to discussing this issue that is so important in our lives and has such a tremendous impact on our society."

Sexually transmitted diseases are on the rise nationwide. In San Francisco, the health department's monthly STD report for September shows 1,869 cases of male rectal gonorrhea reported so far in 2006, compared to 1,777 cases for all of 2005. For syphilis, there have been 427 cases reported among adults this year, compared to 382 in 2005, according to the report. HIV rates have remained steady since 1992 with a slight increase between 2003 and 2004 according to the 2005 annual report, but recently have been showing a decline.

Health officials said last week that a new trend they're seeing in the city concerns HIV cases among female to male transgender men who identify as gay. Reported cases of HIV infection by DPH in 2004 among white, African American, and Latino MTFs were 94, 106, and 100 persons respectively.

While this is a small population, Dr. Dawn Harbatkin, medical and executive director of Lyon-Martin Women's Health Services, said, "The thing that is most concerning to me that we are starting to see here [is] transgender men who are having high risk sex with gay men and we are seeing cases of HIV infection that I two years ago never saw." Harbatkin noted that health professionals she has spoken with in New York are seeing the same thing. "So there's something that is shifting in that community that I don't think that anybody has taken enough of a look at," she said.

The statistics provide a perspective of an imbalance between men and women, primarily among gay and bisexual men and lesbian and bisexual women. Infection rates for STDs, sexually transmitted infections, and HIV among women are either on the decline or continue to remain at a steady rate between 4 percent and 8 percent varying among the different ethnic populations in San Francisco. But sexual orientation for lesbian and bisexual women falls in an unidentified sexual orientation category by the health department, making actual recorded cases difficult to identify. Information about transgender women isn't recorded at all by the health department (in the 2005 report from DPH, only FTMs are recorded), but according to Harbatkin, within the last six months at Lyon-Martin there have been five positive HIV test results with four of the women out of the five being MTF. She isn't sure whether this is due to increased testing or if HIV is on the rise in this population.

Dr. Jeffrey Klausner, director of the health department's STD Prevention and Control unit, was asked about the alarmist tone of the sexual health experts and STD rates in San Francisco at the November 2 news conference. Klausner, who was not in attendance, said this week that the ratio of infections have been fairly stable over the past five years. Klausner also said that the gay and bisexual male community is responding to their health issues in a positive, proactive way by utilizing available services like Magnet, a gay and bisexual men's health clinic in the Castro, as well as online resources such as www.Inspot.org, which provides an electronic notification card to send to sexual partners and educational resources, and www.Bucksyphilis.org, another sexual health information Web site. Additionally, DPH has launched various media campaigns urging people to get tested for STDs.

The health department's STD section is working aggressively with city health clinics and professionals to combat the rising STD and STI rates, especially among gay and bisexual white men who seem to be disproportionately affected, along with African American heterosexual men. To increase accurate information, beginning in 2004 the department requested health providers to gather information about the gender of sexual partners from clients, but this information is slow to accumulate due to providers adjusting to asking their patients for this information.

The LGBT community is very sexually literate and has been active with sexual health and responsible sexual behavior for years and recognizes the need for continuous education. Satcher, Elders, and sexual health experts said the current problem with the rising STD and STI rates as well as with HIV transmission rates is the Bush administration's focus on abstinence-only sexual health education rather than a comprehensive sexual health education model and the administration's refusal to listen to scientific evidence and reasoning. The politicizing of sexual health when it is a public health issue greatly disturbs Satcher and Elders, they said.

"We can't legislate morals," Elders said. "We've got to teach responsibility. We have a very high rate of sexual activity in our society, but a very low rate of sexual literacy. We are not trying to protect our people or our society. We think of sex only for procreation, that's not the only reason to have sex and in fact that's not the major reasons we have sex. Ninety-nine percent of sex is about pleasure and we need not to forget about that, so we have the three 'P's': Procreation, Pleasure, and Protection. Let's protect ourselves and protect others and our communities."

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