Bay Windows - National News, July 20, 2000
Peter Cassels, Bay Windows staff

The Chronicle reported that the estimated number of new HIV infections among gay men at anonymous testing sites in San Francisco had risen to 900 in 1999, up from 500 such cases in 1997. The figures reportedly were included in an abstract published in connection with the recently ended International Conference on AIDS in Durban, South Africa.

The figures allegedly are estimates based on the use of a new HIV test that can determine whether a person was infected within the previous five months. Called detuned ELISA, the test has been used in trials in several cities including San Francisco, but has not yet been approved by the U.S. Food and Drug Administration for regular use.

If the standard ELISA test, which has been used for at least a decade, shows a person is HIV positive, the detuned test can be given. If it shows a negative reading, the person was recently infected.

Because the SFDPH has not yet seen the abstract, authored by Dr. William McFarland, an SFDPH epidemiologist, the origin of the figure of 900 new infections has not yet been confirmed. McFarland has said the figure is not ôofficial.ö

Eileen Shields, an SFDPH spokesperson, told Bay Windows July 18 she did not know when the full abstract will be released. ôI have to talk to William when he returns to the city next week from South Africa,ö she said.

The figure was not included in copies of overhead slides McFarland provided to Shields, which she faxed to Bay Windows. One slide reported that HIV incidence was an average of 2.2 percent at the cityÆs anonymous testing sites from 1996 through 1999, and the ôannual incidence significantly increased from a low in 1997 (1.3 percent) and highest in 1999 (3.7 percent).ö It noted that ôHIV incidence for anonymous testing site clients in 1999 have been updated and differ from the abstract.ö

Whether the figures are accurate or not, the news has stirred AIDS activists, educators and health care providers who worry that HIV is on the rise in the gay community despite close to two decades of fighting the disease.

Some have questioned the leaking of the figures, saying it was timed to gain publicity during the Durban conference and Congressional reauthorization of Ryan White CARE Act expenditures.

Increased infection rates have been attributed to a variety of causes, including the popularity of so-called ôbarebackingö (engaging in anal sex without a condom and other forms of unsafe male-to-male sex), and complacency about contracting AIDS now that people are living longer with the disease. Because people are living longer, thereÆs now a larger pool of infected people, who in turn are infecting others.

SFDPH director Dr. Mitch Katz told the Bay Area Reporter, a San Francisco gay weekly, that the size of the gay population itself also may be a factor. ôThe reason why the [900] number of new infections is a less reliable data point is that itÆs very sensitive to estimates in the size of the population,ö Katz said. ôAnd while I have not yet reviewed the documentation that supports the 900 new infections a year, what I do know is that part of the increase from 500 is due to a better estimate in the size of the gay male population which increases in size, and also it may be that the community itself is growing in size. Obviously the more gay men or the more people at risk in general that you have, the higher the number of new infections.ö

Because San Francisco is one of the epidemicÆs epicenters, AIDS experts around the nation examine even minor fluctuations in statistics closely. ôSan Francisco usually leads the curve on cases, so we may end up seeing an increase in Boston,ö Amy Rosenberg of the AIDS Action CommitteeÆs public policy office told Bay Windows. The level of HIV infections have remained constant in Massachusetts, she reported. Noting that the state implemented a tracing program on Jan. 1, 1999, it has no long-term statistics on infection rates. ôBecause itÆs both retrospective and current reporting, the state has no way of determining when a case occurred. What weÆve heard anecdotally they think the infection rate is steady.ö

This spring the state reported that 31.5 percent of total HIV cases are among gay men, a figure quite close to the number of those living with an AIDS diagnosis ù about 30.5 percent. ôIncreasingly itÆs injection drug use that is driving the epidemic in Massachusetts,ö Rosenberg pointed out.

The San Francisco AIDS community is anxious to have the SFDPH provide more particulars. ôItÆs very hard to tell what all of this means without seeing the actual [SF]DPH report,ö Gustavo Suarez, communications director at the San Francisco AIDS Foundation, said in an interview.

ôWeÆre not quite sure what this report says, but it could well be a tempest in a teapot. The fact that thereÆs been an increase in HIV transmission does not surprise anyone. There have been a number of markers saying that an increase was likely under way. They include an increase in sexually transmitted disease, such as higher rates of rectal gonorrhea among gay and bisexual men. These data indicate a greater amount of unprotected sex is occurring.ö

Suarez believes it is important to see how the SFDPH is analyzing its data, but how the community addresses any increase in new infections is even more so.

ôIt certainly underlines for people working in the field that this battle is not over and is not even contained,ö he asserted. ôWe have to evaluate what prevention work is going on, basing education prevention on hard data, analyzing who is getting infected and how they are getting infected. For government officials who can be easily swayed and lulled into feeling that the epidemic is under control, this may show that it is not.ö

He acknowledged that it is hard to estimate what effect the new data will have on the general public: ôIf it causes gay and bisexual men, who remain the largest population impacted in San Francisco, to stop and think and be reminded that this epidemic is ongoing and we cannot let our guard down, it will be very important.ö

The data the AIDS Foundation has gathered indicate that unprotected sex is being practiced not because people are choosing to ignore the epidemic but rather as a result of people lapsing because of mistaken assumptions. People assume, Suarez contends, they are being intimate with someone of the same serostatus so they donÆt have to be worried about HIV transmission. The assumptions usually are made without talking about it with their sex partner.

The assumptions are based on a range of reasons, he says: ôHIV negative men will say their sex partners are too young to have HIV, they are too old, they look too healthy, they are a professional. Not one is based on anything concrete.ö

HIV-positive men want to make sure they are not passing the virus on, so many have decided they will not have sex with someone who is HIV-negative. ôThese men assume no one would practice unprotected sex with someone unless they, too, are HIV-positive.ö

The organization has conducted an educational poster campaign for nine months that addresses the issue. The posterÆs main text asks, ôHow do you know what you know?ö The subhead on one version is targeted at HIV-positive men: ôIÆm positive. I assumed he was, too.ö Another is aimed at HIV-negative men: ôIÆm negative. I assumed he was, too.ö

The idea that gay men are not acting responsibly rankles some.San Francisco activist Michael Petrelis is offended that AIDS educators believe gay men are complacent about HIV. ôWe see them continually demonizing us,ö he said in an interview. ôWe havenÆt done anything good in the last 20 years. All of a sudden youÆre suffering complacency syndrome.ö

Petrelis also is among those who believe there is a connection between the timing of the leak of the SFDPH data and congressional reauthorization of AIDS funds. They suspect San Francisco wants to show an increase in HIV infections as a matter of self-interest.

Gay journalist Andrew Sullivan told Bay Windows: ôI have no knowledge of the motives of [the DPH], but the report didnÆt just come out before the Ryan White reauthorization, but a week before the departmentÆs own budget was up for consideration. But these questions of motive are unknowables.

ôWhatÆs knowable is that the report is factually extremely misleading. If you ask the DPH for figures for rates of actual seroconversion, you find that the percentage of people testing positive at anonymous testing sites has stayed almost the same for five years. The higher figure they came up with was a reflection of people newly infected ù but a higher proportion of these people could be a reflection of any number of factors (more people hearing that early treatment works best, fewer untested people in the pool of possible testers, etc.) and not necessarily an increase in unsafe sex.

ôItÆs also possible that increases in unsafe sex may be happening but are not leading to higher infection rates, if the barebacking is restricted to HIV-positive people. In other words, the stories were almost universally bogus.ö

John Strausbaugh, a columnist for the New York Press, a conservative alternative weekly, wrote in its July 17 edition that the figures were leaked just after Congress announced plans for a cutback in federal AIDS funds to San Francisco, in response to the cityÆs reduced number of AIDS cases. ôAn alarming jump in the HIV rate in San Francisco, with frightening implications for the rest of the nation and the world, makes better copy ù and a better fit with the mediaÆs self-appointed role as social welfare programmers ù than does a group of public health bureaucrats fudging numbers in an effort to save their budget,ö Strausbaugh wrote.
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