San Francisco Chronicle - December 1, 2005
Sabin Russell, Sabin Russell at srussell@sfchronicle.com.

The study calculated that 151,000 California residents were infected with the virus that causes AIDS, compared with 108,000 in 1998. It is a change driven not so much by an increase in infection rates, but by rising numbers of AIDS patients who are living longer because of drug therapies introduced a decade ago that are keeping the virus in check.

"The consequence of improved survival among persons with AIDS is a rapid and sustained increase in the number of persons living with AIDS," said George Lemp, an epidemiologist who directs the university's AIDS Research Program in Oakland.

An estimated 57,200 Californians have HIV infections that have progressed to AIDS, a diagnosis made when the virus has so weakened the immune system that a patient becomes vulnerable to common viruses and bacteria. That is double the number of diagnosed AIDS cases in the state from a decade ago.

California's numbers are merely a statistical speck in a global pandemic -- worldwide, an estimated 40.3 million people are living with HIV -- but the figures nonetheless reflect the complexity and the challenge posed by the disease in the state where it was first discovered nearly 25 years ago.

As a consequence of having more people surviving the disease, the annual cost of treating it continues to climb. Outlays for the state's AIDS Drug Assistance Program, which uses state and federal money to buy medicines for those who cannot afford them, nearly doubled to $275 million this year from $145 million in 2001.

Meanwhile, government support for AIDS prevention in the state has stalled. The report found that spending of state and federal dollars on prevention by the state Office of AIDS peaked in 2001 at $429 per person infected with HIV in California. The total declined to $351 in the current fiscal year.

Precise numbers on new HIV infections are difficult to come by, but there are worrisome signs that an increase in infections is likely.

"We look at 39 different indicators, and most of them -- two-thirds -- are going in the wrong direction," Lemp said.

Within the statewide HIV Counseling and Testing Program, for example, the number of clients reporting sex with more than five partners in the previous two years rose to 24 percent in 2003 from 10 percent in 1995.

Although the dangerous practice of needle-sharing among injection drug users has declined slightly, several surveys used as indicators in the study show that unprotected anal intercourse among gay men has been increasing. Among sexually active gay men with an AIDS diagnosis in Los Angeles, for example, 26 percent reported not using a condom in 2003, compared with 11 percent in 2000.

The study also cited San Francisco surveys showing that rates of unprotected anal sex rose to 67 percent in 2003, compared with 42 percent in 1997.

Lemp conceded that the state survey did not take into account a trend that disease trackers with the San Francisco Department of Public Health have noted: the practice of "sero-sorting," where men who are HIV-positive limit their unprotected sex to those who are also HIV-positive, and those who are HIV-negative have unprotected sex only with partners who are negative.

Several indicators in San Francisco suggest that the rates of new HIV infections in the city may be in decline, and sero-sorting is the likely explanation.

But Lemp, who was chief epidemiologist for the city's Office of AIDS during the darkest days of the epidemic -- when there were no drugs available to treat it and when most of San Francisco's 18,000 AIDS deaths occurred -- is wary of the sero-sorting trend.

"We know sero-sorting is occurring, but I don't think it is a good strategy in the long term, especially for younger persons at risk," Lemp said. Young people in particular, he said, are vulnerable in situations where they think they are in a monogamous relationship, but their partner may be having other unprotected sexual encounters.

"It would be safer if people were to reduce their number of partners and practice safe sex," Lemp said.

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On the Web

The report, "California HIV Prevention Indicators," is online at uarp.ucop.edu.

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