The San Francisco Examiner - June 30, 2000
Ryan Kim, Examiner Staff

The percentage of new HIV cases in The City has almost tripled from 1997 to 1999, according to studies by the San Francisco Public Health Department. There were about 900 new cases of the virus in 1999 compared to about 500 the year before.

The rise, which reverses a trend dating to back to the '80s, has health officials sounding the alarm.

"It's dismaying," said Willi McFarland, an epidemiologist with Health Department. "We went from a stable baseline rate, where we wanted to extinguish it, and now it's going up."

Observers blame the increase on such factors as new confidence brought on by powerful drugs that can keep HIV in check.

Tom Coates, director of the UCSF Aids Research Institute, said the drugs are keeping patients alive longer and thus prompting a false sense of security. "People aren't dying off like they used to," said Coates, a gay man infected with HIV. "People are living pretty well and we have this image that AIDS is here, but it's not as bad as it used to be."

Pat Christen, executive director of the San Francisco AIDS Foundation said there is a certain amount of fatigue that has also set in among gays. People are tired of keeping up their guard, she said.

"People talk about the fatigue of safe behavior and living within the epidemic all these years," said Christen. "It's comparable to being on the front lines of a war only they don't get rotated out."

The situation is also made worse by the fact that since so many people are infected with HIV, the virus pool has grown, increasing the chance of infection.

The findings were culled from a dozen indicators monitored in The City. The most potent data came recently from five city clinics that perform anonymous HIV testing,

considered the front line of HIV detection. The study found that new rates of HIV had risen from 1.3 percent in 1997 to 3.7 percent in 1999 at the five clinics.

While the figures don't approach the 8 percent infection rate reached during the height of the epidemic in the 1980s, the numbers are headed in the wrong direction, said AIDS workers.

Part of the increase in HIV infection may be attributed to other Health Department findings.

The study found that gay men who reported always using a condom fell from 70 percent in 1994 to 54 percent in 1999.

The number of gay men who reported having unprotected anal sex with multiple partners increased to 43 percent in 1999 from 23 percent in 1994.

The data also show that incidents of rectal gonorrhea, another harbinger of HIV infections, has also grown from 20 per 100,000 in 1994 to 45 per 100,000 in 1999.

Those findings echo a 1999 survey conducted by UCSF, which reported the number of gay men who performed unprotected anal sex rose from 31 percent in 1994 to 41 percent in 1997.

The study also found that the percentage of men who reported having more than one episode of unprotected anal sex per year rose to 50 percent from 37 percent during the same period.

Coates said the findings should be a wake-up call. He said increased prevention efforts need to come from gays and those infected with HIV, much as they did in the '80s.

"We have to take a deep breath and start over again and say we can't let our guard down," said Coates.

McFarland said new efforts should be made to educate gays, among whom the new HIV cases are concentrated.

He said the education should also target people who are HIV positive, to encourage them to take measures to prevent the spread of the virus.

The study comes at a time when worldwide attention is being focused on the skyrocketing rate of HIV and AIDS in Africa.

World health leaders will convene in July at an International AIDS Conference in Durban, South Africa, to talk about the epidemic.

According to a 130-page report released by the United Nations in preparation for the conference, nearly 19 million people have died from AIDS worldwide and more than 34 million people are infected with HIV. In addition, some 13 million children have been orphaned, according to the U.N. report.

While the rates are growing in San Francisco, nationwide the number of HIV cases has stabilized at about 40,000 new cases a year for the last several years, according to the Centers for Disease Control and Prevention.

Ronald Valdiserri, an AIDS official with the CDC, said he's seen an increase across the country in risky sexual behavior, a precursor to higher rates of sexually transmitted disease. It may not be long before San Francisco's rise in HIV cases is mirrored in other parts of the country.
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