Bay Area Reporter - August 2, 2007
Mike Smith and Jason Riggs

In case you missed it, the article (http://www.aegis.org/news/bar/2007/BR070712.html) was about whether or not to reclassify San Francisco's HIV epidemic as "endemic." These two terms have very different meanings when used by epidemiologists than when used in everyday language. As the article explained, the term epidemic technically means that the number of new infections is rising, while an endemic technically means that the number of new infections are about the same year-to-year. Technically speaking.

However, the terms epidemic and endemic also have cultural meaning. For many (probably most) B.A.R. readers, a headline declaring that the HIV epidemic is over is tantamount to saying HIV is over. To those who continue to be directly impacted by HIV/AIDS this is disrespectful and painful. It plays into our fears that the world will abandon us, because the wish for it to actually be over is so strong. It disregards the disproportionate impact that HIV/AIDS continues to have on people of color and transgender women. It toys with our deepest desire and desperate hope to live to see the day when HIV is actually over.

For many of the people we've talked to in the last week, the word endemic implies that no matter what we as gay men do, the number of new infections is going to remain the same and that this is "taken for granted." For them endemic means "par for the course" while epidemic means "urgent." For others, reclassifying the HIV epidemic as endemic helps them express that new strategies are urgently needed to reduce HIV transmission.

The real story is about a larger discussion by a growing number of community members, activists, organizations, providers, and the Department of Public Health. For more than 15 years, most people in HIV/AIDS services and activism have been grappling with how to remain effective in the context of a changing epidemic and changing community. It is clear that prevention and treatment strategies that work well in one phase of the epidemic may not work well in another. This constant questioning and renewal is a critical and ongoing process and has been for some time.

There is growing consensus that the phase of the HIV epidemic that we are now in requires some fundamental changes to how prevention and care are approached. Each success brings its own challenges. The good news is that, overall the number of new infections is San Francisco is not going up. This is a hard won accomplishment by gay and bi men. In some respects, even steady numbers are a prevention victory of sorts. The fact that there is a growing population of gay and bi men in San Francisco and that people with HIV are living longer should portend rising numbers of new infections. This isn't happening. This is due to the diligence and care of each of us in the daily decisions we make, the strategies and hard work of community groups and service providers, and the values and cultural norms that the LGBT community has fostered and sustained. We need to recognize this success and build from it.

Whatever we call it, the fact remains that on average 15 to 19 people become infected with HIV every week in San Francisco. One in four gay or bi men has HIV and 20 percent of those with HIV don't know they have it. AIDS is still the leading cause of death for gay men ages 15-64 and almost 300 people die of an AIDS-related illness every year. This is the equivalent of an airplane full of San Franciscans crashing every year. Most everyone agrees that this situation isn't "par for the course," it is catastrophic.

Whether HIV is endemic or epidemic doesn't change the very real human impact or the challenges of providing care to an ever-growing population of people with HIV/AIDS. Even with "only" 800 to 1,000 new infections each year, we still have more and more HIV-positive people moving to full-blown AIDS or disabling HIV. Many of these people are expending their resources, declining into poverty and becoming reliant on community-based agencies and the DPH for housing and basic health care services.

It is clear that whatever it is called, our community needs to be focused on several goals, including: zero new HIV infections, housing for people with AIDS, and access to quality health care for all, regardless of ability to pay. When we can achieve these goals, we can move that much closer to the day when the B.A.R. can accurately print a headline declaring that the HIV epidemic is over.

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Mike Smith is the executive director of the AIDS Emergency Fund; Jason Riggs is the deputy director of Stop AIDS Project.

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