Important note: Information in this article was accurate in 2000. The state of the art may have changed since the publication date.
The Los Angeles Times - Saturday, July 1, 2000
Thomas H. Maugh II, Times Medical Writer
New infections had run at about 500 cases a year during most of the last decade, but the number jumped to more than 800 last year, according to the department's Dr. Willi McFarland.
Reports of an increase in unprotected sex among gay and bisexual men have been circulating for several years, but the new data are the first to show the harrowing impact of that activity. Gay men accounted for about 575 of the new cases.
"This verifies a fear that we have had for quite some time," said Steven Gibson of STOP AIDS in San Francisco, a community-based action group.
"It's not the increase itself that surprises us, but that the increase was greater than we expected," added Gustavo Suarez of the San Francisco AIDS Foundation.
"This should sound a warning bell for the rest of the country," said Dr. Thomas Coates of the AIDS Research Institute at UC San Francisco. "We see in San Francisco what is going to happen next in the epidemic [elsewhere]."
Researchers were particularly alarmed by the number of new cases showing up at anonymous testing centers run by the city. From 1997 to 1999, the proportion of tested people who were found to have HIV nearly tripled--from 1.3% to 3.7%.
"We're very concerned and we're very worried," McFarland said.
That rise has also been accompanied by sharp increases in other sexually transmitted diseases. The rate of rectal gonorrhea in the city, for example, grew from 20 cases per 100,000 residents in 1994 to 45 per 100,000 in 1999, the health department said.
Although it is hard to pin the rise exclusively on gay and bisexual men, behavioral information garnered through continuing surveys presents a disturbing picture.
The proportion of gay men who say they have unprotected anal sex with more than one partner grew from 23% in 1994 to 43% in 1999. The proportion who said they always used a condom, meanwhile, dropped from 70% to 54% during the same period.
The data indicate a clear regression toward unsafe behavior in the San Francisco gay community, one of the largest in the country.
Health officials worry that a sharp drop in the death rate from AIDS produced by cocktails of drugs led to the perception of HIV infection as a manageable disease rather than a fatal one. And by keeping HIV-positive men alive, the drugs enlarged the pool of people who could transmit the disease. In 1996, there were an estimated 6,400 HIV-positive San Franciscans. Today, there are more than 10,000, according to the health department.
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