San Francisco Chronicle - Thursday, May 31, 2001
Sabin Russell, Chronicle Medical Writer

The warning is based on preliminary results of a six-city study of gay men using new blood tests that can separate recent infections from older ones.

Rates were highest -- extraordinarily high -- among a relatively small group of 500 gay and bisexual African American men, where the study showed an incidence of 14.7 percent. That means that almost 15 out of every 100 men aged 23-29 are becoming infected each year.

"These are explosive HIV rates," said CDC epidemiologist Linda Valleroy, director of the agency's Young Men's Study, which has been tracking AIDS in seven U.S. cities, including San Francisco, since 1994. "It is comparable to rates in South Africa."

With 4.7 million people infected -- roughly one in five adults -- South Africa has more HIV positive people than any nation on earth.

Among all 3,000 gay men in the survey, the annual infection rate was 4.4 percent, a figure Valleroy compared to U.S. infection rates in the mid-1980s, when gays were just coming to grips with a mysterious new disease that to date has killed 450,000 Americans.

She also compared that infection rate to the rate prevalent in southern and East Africa in the early 1990s.

The annual infection rate among the largest group in the study, white gay men, was 2.5 percent -- in line with earlier reports from San Francisco. Among gay Latino men, the rate was 3.5 percent.

The disturbing new numbers were released just days before the 20th anniversary of the first published report of a mysterious outbreak of rare pneumonia in five gay men in Los Angeles. That report by UCLA immunologist Dr. Michael Gottlieb and colleagues in the CDC's weekly bulletin June 5, 1981, marks the discovery of the AIDS epidemic.

Today's findings are published in the same bulletin, the CDC's Morbidity and Mortality Weekly Report.

In February, the Young Men's Study showed that 30 percent of gay and bisexual black men in the survey were already infected -- triple the percentage of HIV positive men in the sample as a whole.

Despite these data, the CDC has not yet increased its long-running estimate that 40,000 Americans are newly infected with HIV each year. Dr. Helene Gayle, director of the CDC's AIDS prevention program, said the estimates are now under review.

The magnitude of the new infection rates stunned longtime observers of AIDS statistical trends.

"I have never seen incidence rates as high as 15 percent. It's off the charts," said Tom Coates, director of the UC San Francisco AIDS Research Institute.

"This is a public health emergency," Coates said. "Why are they publishing these without announcing a crash program?"

Phill Wilson, executive director of the African American AIDS Policy and Training Institute at the University of Southern California, said people no longer perceive that "you get infected and you die in two months anymore."

"There's all these posters around that say you can climb mountains and do whatever with HIV and AIDS. There's not enough messages about the price you have to pay," he said.

In Washington, Surgeon General David Satcher hailed the nation's HIV and AIDS prevention efforts, but he called the anniversary a solemn milestone.

"Twenty years into the AIDS epidemic, as a nation and as individuals, we may need a stark reminder that the best way to stop AIDS is to prevent HIV infection in the first place," he said today.

Gayle said yesterday that the CDC is moving aggressively to bring prevention programs to young gay men.

The CDC spends $400 million a year on such programs, and Gayle said she was adding $12 million in funding to community organizations that serve gay black men.

The newly published estimates do not include data from San Francisco, which last year was the first city to report signs of an increase in infection rates, described by public health officials as "sub-Saharan" at some surveillance sites.

But because annual infection rates among gay black men are substantially lower in San Francisco -- as low as 1 percent -- those numbers are likely to reduce the overall CDC findings when the study is completed.

According to San Francisco epidemiologist Dr. Willi McFarland, city researchers participating in the Young Men's Study are concentrating their efforts on a survey of infection rates among Asians and Pacific Islanders.

Earlier studies that looked at stored samples of blood show annual infection rates among gay white men ranging from 6.4 percent at sexually transmitted disease clinics to 1.9 percent at sites that provide anonymous testing.

CDC officials cautioned that the new data are preliminary and represent a relatively small sampling of gay men who may be more sexually active than their peers.

But combined with numerous other studies showing increases in sexually transmitted diseases and a decrease in regular condom use, the data suggest that a dangerous new phase of the epidemic may be under way.

Wilson said prejudice against homosexuality among blacks compounds the stigma of being a black man in the United States.

Gay black men are "shamed into silence, so they stay in their marriages, putting their wives and their children at risk. All of us, black or white, openly gay or not, pay a price for that silence," he said. The Associated Press contributed to this report.

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