Bay Area Reporter - January 15, 2009
Matthew S. Bajko, m.bajko@ebar.com

Based on the latest estimates for new HIV infection rates in San Francisco, the city failed to reach its goal. It did achieve a roughly 10 percent reduction in HIV rates and has downgraded classifying its HIV epidemic to now being endemic, meaning rates are remaining flat from year to year.

Back in 2004, when the reduction target was included in the San Francisco HIV Prevention Plan, the health department estimated there were 1,082 new infections of HIV each year, with gay and bi men accounting for 835 of those cases.

Today, the city has reduced those estimates, with approximately 975 new HIV infections expected each year, with gay and bi men accounting for 772 of those cases. The bulk of those individuals continue to be among white men.

"We are in an era of low level incidence rates that seems like it will go on for a long time," H. Fisher Raymond, an HIV epidemiologist with the health department, told members of the city's HIV Prevention Planning Council last week. "It will be harder to increase the effectiveness of our reduction campaigns. We are down to a small group of people who are hard to find, and therefore, it is hard to determine what to do."

The city also missed the goals it had set in terms of heterosexual transmission of HIV, which it had wanted to eliminate by 2008. Instead, the city is projecting women and straight men will account for 12 to 15 new infections this year.

Health officials did achieve two of their objectives laid out in the 2004 plan. They called for reducing new HIV infections among injection drug users by 50 percent and eliminating perinatal infections by 2008.

Four years ago the city predicted injection drug users accounted for 220 cases each year. Today, that number is down to 144, just shy of the 50 percent reduction. And the city expects to see just two cases of HIV transmission between mothers and newborns, though it is likely the actual number will be zero.

While the plan had limited a 50 percent reduction goal to male-to-female transgender persons, the city did achieve an overall 50 percent reduction in new HIV infections among all transgender people, excluding those who inject drugs. In 2004 it was estimated that 102 transgender individuals would become infected with HIV; now that number is down to 42 new infections per year.

In interviews last week with the Bay Area Reporter , HIV prevention officials would not characterize missing the 2004 plan's targets for gay and bi men, and heterosexual transmission, as failures but did concede that the fight to stop the spread of HIV is far from over.

"They were pretty high goals. I don't think it was a failure at all, considering all the progress in terms of people who didn't get HIV," said Perry Rhodes III, co-chair of the HPPC, which is tasked with drafting the prevention plan. "I am very encouraged HIV rates are now endemic in certain communities. But it is still not enough. I want to be clear on that."

While the 50 percent reduction in gay men was not met, being able to turn around the city's HIV epidemic into a more stable, or endemic, pattern, is a significant achievement, said HPPC member Tom Kennedy.

"When I see statistics still pointing toward an endemic, I am honestly relieved we are not in an epidemic anymore," said Kennedy.

AIDS activist Michael Petrelis said the city would not achieve its 50 percent target until health officials directly address gay men and promote such safe sex strategies as serosorting û only having sex with a person of the same HIV status û and seroadaptation, determining what sort of sexual behavior to engage in based on the HIV status of one's sexual partner.

"If they want that 50 percent reduction, they have to do more than hold weekday meetings downtown instead of the Castro," he said. "I would like the sexually active gay male community to receive positive (no pun intended) reinforcement for our smart, safe sex practices."

Goals in 2010 plan

The HPPC is currently rewriting its HIV prevention plan, with a deadline of 2010 for completing its work. It remains to be determined if the council will carry over the same goals for reducing HIV as it did in the 2004 plan.

"It has not totally been decided," said Rhodes, who works for the Black Coalition on AIDS. "I think it is okay in terms of evaluating and being able to measure how far you have gotten. It is important to set goals and then evaluate how realistic those goals are."

Dr. Grant Colfax, the city's HIV prevention director, said the council likely will establish goals for the plan, but could not predict if the 50 percent reduction would be maintained.

"We are working on it. I am supportive of having goals to reduce HIV infections," said Colfax. "For the 2010 plan, we need to determine how do we address an endemic situation and set goals to deal with an endemic situation."

HPPC officials said the 50 percent reduction targets of the earlier plan were in line with the goals the Centers for Disease Control and Prevention had included in its Healthy People 2000 goals. Nationally the CDC had set a target of no more than 800 new HIV infections per 100,000 people.

In evaluating the 2000 targets, the CDC has said data does show "progress toward" slowing the rise in the rate of new AIDS cases and containing the rate of HIV infection. The federal agency is now studying how its Healthy People 2010 plan is meeting its goals.

That plan is less specific in cutting HIV infections and calls for a generic reduction in the number of cases of HIV infection among adolescents and adults. It does set the target for AIDS among adolescents and adults at one new case per 100,000 persons. And for AIDS cases in gay men, it pegged reducing the number 25 percent to 13,385 new cases from the 17,847 new cases of AIDS seen in 1998.

Stop AIDS Project Executive Director Kyriell Noon, whose first official meeting as an HPPC member was this month, was noncommittal when asked what goals the HPPC should set for reducing HIV rates in the 2010 plan. He said he is open to having conversations on whether to maintain or change those targets in the new plan.

"Having an ambitious goal is a good thing," said Noon. "We have a lot of work to do still. We do have a clear opportunity to effect change."

Kennedy said he is in favor of keeping the 50 percent reduction targets in the city's new plan.

"I think the city should keep that lofty goal," he said. "I think it is possible."

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