Petrelis Files

S.F. HIV STATS: WHERE ARE THE 1000 POSITIVE TEST RESULTS?

For two years running, San Francisco has had less than one hundred HIV positive test results annually from antibody tests performed at the city’s sexually transmitted disease clinic, where the bulk of all such tests are performed on city residents.

The year-end STD report from the Department of Public Health for 2002 shows there were only 99 HIV positive test results, out of 2,419 tests administered, for a seroprevalence of 4.09%. During the previous year, 4,925 HIV tests were performed and total number of positives was just 88. The seroprevalence in 2001 was 1.79%. So even though the number of tests fell, the seroprevalence rose by more than double. [1]

Department of Public Health AIDS epidemiologists have repeatedly declared that in both 2001 and 2002 there were an estimated 1,100 new HIV infections among city residents. The San Francisco Chronicle has twice recently duly noted the projected number of infections. Let’s accept the loosely projected DPH numbers, just for argument’s sake, so I can make a point that needs to be considered. [2, 3]

The DPH claims the probable number of annual new infections is well over one thousand, but the year-end STD report shows less than one hundred HIV positive test results.

So where, exactly, are the test results for the other alleged one thousand new infections?

How can DPH officials maintain their allegations of sub-Saharan levels of HIV transmission when evidence from the STD control unit reveals there aren’t even a hundred positive test results in each of the last two years?

It boggles my mind that no reporters have tried to confirm and prove the DPH claims of almost 1,100 new HIV infections annually.

The 2002 annual report for the SF DPH AIDS Office explains that the research division received slightly more than $3.3 million for HIV and AIDS epidemiology and statistics. With that large sum of funding, DPH should be able to produce hard evidence showing where the other one thousand HIV positive test results are.

There’s other important news in the year-end report that I think deserves attention.

When comparing the total number of tests performed, 4,925 in 2001 and 2,419 the following year, we see a dramatic 49.11% drop.

This enormous decline comes amid saturation social marketing campaigns targeting gay and bisexual men, and others at risk for HIV, to take an HIV antibody test. The biggest such campaign last year was the “HIV. THE TRUTH WILL SET YOU FREE” effort, which blanketed the city with bus shelter ads, post cards in cafes, TV commercials, radio spots, plus ads splashed inside and out on Muni transit vehicles. Is the constant bombardment of the gay community with these messages to get an HIV test is having a reverse effect, one in which the social marketing drives at-risk men away from getting tested? Have we reached a saturation point with such testing campaigns?

I think the answer is yes, in light of the nearly 50% plunge.

A precipitous decline like this speaks volumes about what is wrong with current social marketing campaigns, which need to be evaluated for effectiveness at achieving stated goals. Before we can design and implement social marketing campaigns that reduce new HIV and STD transmissions, and increase the number of people getting an HIV antibody test, we must first critically examine what is presently failing.

San Francisco Supervisor Bevan Dufty is organizing two upcoming town hall meetings on HIV prevention related concerns. The first will be on speed use and STD prevention, while the second forum will be about HIV prevention for the gay male community. These are excellent first steps towards a rethinking of HIV prevention, gay sexuality, and overall healthcare issues for gay men.

I’ve written to Dufty to suggest that he specifically address the failure of HIV prevention programs to decrease or at least stabilize new HIV infections and STD transmission. As DPH dutifully reports on a monthly basis, syphilis, rectal gonorrhea, hepatitis and oral gonorrhea are surging upward, with no decreases in sight. Added to the sexually transmitted diseases on the upswing is a new drug resistant staph infection. Plenty of evidence exists proving current prevention programs aren’t working, and are in need of much scrutiny.

One additional point I wish to make about the number of positive HIV antibody test results is that not all of the 88 positive results in 2001 and the 99 in 2002 represent new HIV infections. Some of these results are for repeat testers previously identified as HIV positive.

Absent any data from SF DPH about how many of the results in these two years were for people with a prior positive HIV test result, I’ve looked to annual HIV testing numbers for Wisconsin as a guide for trying to figure out what percentage of HIV positive test results were among repeat testers.

The most current annual report, for 2001, for publicly funded HIV tests in the Dairy State said:

“Of the 18,716 tests, 128 were HIV positive – equal to a seroprevalence of 0.7%. Of these positive tests, 45 were from persons previously identified as HIV positive. Therefore, 83 clients were newly identified with HIV infection. The seroprevalence for the program based on newly identified HIV positive clients was 0.4%.” [4]

Using those numbers, I’ve constructed a mathematical model and applied it to San Francisco’s HIV tests. The rate of repeat testers in Wisconsin was 35%, so I took figure and applied it to the San Francisco positive test results.

Thirty-five percent of eighty-eight tests in 2001 would equal 31 repeat testers, making 57 the number for newly identified HIV positives that year.

For the ninety-nine positive results in 2002, thirty-five percent would equal 35 repeat testers, reducing the number of newly identified HIV positive to 64 during last year.

If we accept that the already rather low number of positive test results over the last two years is probably actually lower, when repeat testers are taken into account, then the question I posed above is even more urgent and demanding of an answer from DPH:

Where are the thousands of other HIV positive test results for the past two years in San Francisco?


1. Source: http://www.dph.sf.ca.us/Reports/STD/STD0212.pdf

2. Source: http://sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2003/02/12/MN219202.DTL

3. Source: http://sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2003/01/27/BA65228.DTL

4. Source: Wisconsin AIDS/HIV Update, Summer 2002