Bay Area Reporter - July 31, 2008
Matthew S. Bajko, m.bajko@ebar.com

The positive diagnosis for the city's fight against HIV and AIDS can be found in the health department's 2007 HIV/AIDS Epidemiology Annual Report. Released earlier this month, the report states that by the end of last year, 8,980 of the city's residents were living with AIDS while 6,490 people were living with HIV.

The report also shows that the number of new HIV diagnoses fell from 839 in 2003 to 500 in 2006. Last year, the number was 467, though the figure is expected to climb higher due to delays in reporting. The 2006 report initially had pegged the number of new HIV cases that year at only 406.

In terms of AIDS cases, 1,642 people were diagnosed with AIDS between 2004-2007. That was a slight drop from the period between 2000-2003 when 2,096 people were diagnosed with AIDS.

As for AIDS deaths, the reporting in recent years is not yet complete, with data only showing 184 in 2007 and 213 in 2006. For both 2004 and 2005 the city recorded 304 and 315 deaths respectively.

"I think this could be an encouraging sign that the diagnoses is decreasing," said Ling Hsu, co-director of the HIV Epidemiology Section and a lead author of the report. "It doesn't mean new infections are decreasing, that is another matter."

Nonetheless, the report is further proof that the city's HIV epidemic has entered into an endemic stage, where rates remain relatively stable. The majority of new HIV cases in the city continue to be among gay and bisexual white men between the ages of 25 and 49.

HIV researchers and officials cautioned it is too soon to tell if the city is gaining the upper hand in its efforts to eliminate HIV.

"I do hope that any new data that we see in the near future will point to a decrease in HIV incidence, and that we do not have an endemic but are heading in the right direction. Unfortunately, aside from the above potentially encouraging decrease in new HIV case reports, I don't see any new data that supports this," wrote Dr. Willi McFarland, director of the health department's HIV seroepidemiology unit, in an e-mail. "For the moment, I would still say 'the endemic continues.'"

Mark Cloutier, executive director of the San Francisco AIDS Foundation, also stopped short of saying the city's HIV rates had entered a period of year-over-year declines, though he expressed optimism that data from future years may show that it has.

"It is a good report and provides some evidence there is a possibility that incidence is going down. We will know that after we see another couple years of data," said Cloutier, who first noted last year that the city's HIV epidemic had entered an endemic period. "It is hard to tell without a couple more years of data whether or not actual incidence is dropping. It raises the question that it may be."

The report's finding of 15,470 people living with HIV and AIDS is far below the city's 2006 HIV consensus estimate, which predicted a total of 18,735 persons living with HIV and AIDS.

The gap between the consensus estimate and the case reporting data is partially due to the report's numbers not being complete, its authors reasoned, and also a likely indication that many people with HIV do not know they are positive or are not seeking out medical care.

McFarland said the health department estimates that the percent of persons living with HIV not counted in the system to be between 10 and 20 percent. In his e-mail response to questions, he wrote that if the report had included 15 percent of the persons living with HIV/AIDS who have not been diagnosed or reported, then the total would be 18,200, which is close to the 2006 estimate.

"So, I think we are not far off," wrote McFarland, adding that the estimate is based on data now a few years old and will need to be updated in the next couple of years. "At present though, I don't see compelling evidence that it has changed a lot or that we were far off the mark."

He said the research section is currently conducting a study to better gauge how many people are unaware of their HIV status.

Housing needs

This year's executive summary in the report highlighted AIDS cases among the city's homeless population, which has remained stable at around 10 percent each year. It noted that those people living on the streets with AIDS face "significantly worse" chances of survival, with the lack of housing increasing the risk of death by more than 20 percent.

Giving weight to claims made by such groups as the AIDS Housing Alliance of San Francisco, the report states that by providing housing to people with AIDS can lead to "more appropriate use of health care services, better adherence to medications and reduction in HIV risk behaviors."

"Thus, these housing services benefit individuals beyond those who are homeless," concludes the report.

"It is an encouraging finding and has important policy implications," said Hsu.

Blogger Michael Petrelis, however, questioned why the summary did not highlight the downward trend of HIV cases and faulted the health department for not doing more to publicize the report.

"The annual report is showing continued declines of a terrible epidemic and San Francisco's health department is keeping the news from fags in San Francisco," he said. "It's as if the people who wrote the thing do not want to acknowledge the continuing declines. Why not? Isn't success fewer guys getting infections? Isn't that what we have wanted since 1991?"

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