Tuesday, April 29, 2003


Thanks to an April 18 news article by Charles Ornstein in the Los Angeles Times about the Centers for Disease Control and Prevention announcing their decision to shift gears with current HIV prevention programs and end workshops designed to avert new transmissions, I’ve experienced a profound feeling of happiness as a homosexual.

My happiness stems from the tone of the story and from a quote Ornstein got from the executive director of the National Association of People With AIDS, Terje Anderson, about the CDC shift.

"There ain't going to be any more safe-sex workshops. There ain't going to be any more public attitude campaigns around this,” he said. [1]

The San Francisco AIDS Foundation had a similar reaction to the CDC’s announcement. In their news release, the foundation stated: “Under this initiative, community-based organizations that are directly funded by the CDC will have to conduct programs from a list of specified activities related to this initiative. Some activities currently funded by the CDC, such as social marketing campaigns and workshops focused on risk reduction among those who are not infected, will be excluded from the list of activities.” [2]

To a small degree, Anderson and the foundation are overstating their argument. The CDC has not killed all safe sex workshops, just some of the more ineffective and offensive to gay men, in my opinions, workshops targeting men who have sex with men. But any move on the federal agency’s part to curtail HIV prevention efforts, such as those operated by the Stop AIDS Project of San Francisco, is a development I wholeheartedly endorse.

Shortly after the LA Times article ran, a San Francisco gay newspaper reported that while “the Stop AIDS Project has been participating for several years in a demonstration project funded by the federal government, the agency had been told funding for its Positive Force program would run out at the end of this year.” [3]

I don’t believe this is the death knell either for the Stop AIDS Project or such CDC demonstration projects, but the decision to no longer fund Positive Force nevertheless must be causing great consternation and worry for all HIV prevention organizations receiving federal grants.

For more than I decade I have scrutinized the federally funded community based organizations and efforts in San Francisco targeting gay and bisexual men and found them unappealing, sometimes appallingly derogatory to gay sensibilities, not to mention largely incapable of controlling and reducing new HIV infections. Friends who have attended Stop AIDS Project events and forums report that, on average, less than two dozen men show up to participate.

Seems to me the programs are predicated on two central themes: the male homosexual is diseased, or soon will be. Therefore, national and local public health officials believe they must create and maintain an HIV prevention industry, with no comparable such effort mounted for other preventable diseases that kill thousands of San Franciscans annually. The officials think without HIV bowling leagues, flirting and erotic writing seminars offered by several community based groups, social trips to the zoo, museums and cafes, classes in how to fist the anus, ballroom dance opportunities, continuous social marketing campaigns that flood bus shelters, appear in ads in gay rags, or hit the television and radio airwaves, and too many other ways of trying to halt HIV infections, then homosexuals will be gathering for sex and potentially spreading HIV and assorted other sexually transmitted diseases.

To me, such prevention silliness is not reaching those men at highest risk, nor has it reduced the level of infections significantly. Precious little research and data exists proving federally funded activities in San Francisco targeting the men who have sex with men community are meeting their intended goals.

But what offends me most is how the basic premise off these activities equates all homosexuals as either ill with infections, or has the potential of sharing and spreading diseases. The victimization of the modern homosexual in San Francisco gets a shot in the arm by the HIV prevention workshops, and the social marketing campaigns accompanying them.

It is impossible to avoid the social marketing campaigns that saturate every venue for gay men in San Francisco, not just the sex establishments, and I see these campaigns as intruding on gay spaces and our individual and collective lives. The dissenting justices in the Supreme Court’s Bowers vs. Hardwick ruling upholding sodomy statutes, said “this case is about ‘the most comprehensive of rights and the right most valued by civilized men,’ namely, ‘the right to be left alone.’” A right that is sorely lacking for gay men in San Francisco who are subjected to never-ending social marketing campaigns and sexually transmitted disease prevention.

The absence of the right to be left alone, especially for gay men cruising for sex, was gleefully reported in a November 9, 2000, article in the New York Times headlined, Group Roams Chat Room to Talk to Gay Men About AIDS.

This was the opening sentence: “Where men meet men for sex, health agencies are sure to follow.” [4]

I guess it was too much for the NY Times that just maybe, that all spaces where men gather to find other men for sex, including on the Web, should be respected and that health agencies might consider leaving us alone.

Every aspect of gay sexuality and queer culture has been co-opted by the CDC and their partners in the HIV prevention industry, for the purposes of disease prevention. Our lives and sexual fulfillment are viewed only through the prism of how to modify homosexual conduct, ostensibly for valid reasons, to avoid contracting or spreading diseases. However, the notion that gay is good, a slogan and philosophy promulgated by gay liberationists is not an integral component of CDC funded programs.

The first step on the long road to a resurgence of gay liberation and sexual fulfillment without the snooping eyes of the federal and local health authorities, is to end HIV prevention workshops that have not been shown as ineffective at halting new infections among men who have sex with men.

Let’s put the sex back in homosexuality, without massive spying and intrusive programming singling out gay men for federally subsidized anti-sex campaigns that are infected with a virulent strain of negativity towards gay sexuality and pleasure.

The happiness I feel regarding the changes in CDC funding decisions will only increase over the coming months, because I believe other additional changes from the federal government are on the horizon. I will do everything in my limited power as an AIDS activist to minimize CDC funded HIV prevention efforts directed at gay men, and help to restore abundant pride in our sexuality and sexual culture.


1. www.latimes.com
2. http://www.sfaf.org/aboutsfaf/newsroom/cdc_testing.html
3. Bay Area Reporter, April 24, 2003; print edition
4. http://www.nytimes.com/2000/11/09/technology/09AIDS.html

Tuesday, April 22, 2003


April 17, 2003

Michael Petrelis
2215-R Market Street, #413
San Francisco, CA 94114

Dear Mr. Petrelis:

This letter is in final response to your April 1, 2003, letter to Dr. Julie Gerberding, Director, CDC, pertaining to a Stop AIDS Project report. Your letter was processed as a Freedom of Information Act (FOIA) request.

We are withholding the draft Stop AIDS Project report. Release of this type of predecisional internal material would interfere with the agency's deliberative process. This decision is based upon the Freedom of Information Act at 5 U.S.C. 552(b)(5) and the Department's implementing regulation at 45 CFR 5.66(a).

To appeal this decision to deny you full access to agency records, send your appeal, within 30 days from the date you receive this letter, to the Deputy Assistant Secretary for Public Affairs (Media), U.S. Department of Health and Human Services, Room 17A-46, 5600 Fishers Lane, Rockville, Maryland 20857. Please mark both your appeal letter and envelope "FOIA Appeal."

Sincerely yours,
Lynn Armstrong
Office of Communication
Fax: 404-639-7395


April 22, 2003

Julie Gerberding, MD
Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333

Dear Dr. Gerberding:

To put it mildly, I am enormously dismayed that the Centers for Disease Control and Prevention is withholding the draft Stop AIDS Project report.

You'll recall I previously asked you to answer one very basic question in relation to CDC funds directed to the San Francisco based Stop AIDS Project: Is the organization effectively using federal dollars to halt transmission of HIV and other sexually transmitted diseases?

Earlier this month, I sent you a Freedom of Information Act request for the report, and today I received a letter from Lynn Armstrong, CDC/ACTSDR FOIA Officer, informing me that the agency is denying me full access to the records, based on sections of FOIA and the agency's implementation regulations of meeting FOIA requests. As per the directions of Ms. Armstrong, I have sent an appeal regarding the CDC decision to the deputy assistant secretary for public affairs at Health and Human Services.

At your direction, four CDC investigators last August were dispatched here to determine if Stop AIDS is successful at meeting its stated goal of stopping the disease. An August 14, 2002, story in the San Francisco Examiner stated, "CDC officials will report their findings in 10 days." The story ran on the CDC daily HIV/AIDS news summary, so I know the agency was more than well aware that is had been reported CDC would issue a report within two weeks after leaving town. Eight months later, there still is no document from the CDC answering my question. Nor do we know what the four investigators did exactly during their two-day visit, other than chatting with officials at the Department of Public Health and Stop AIDS, and what findings, if any, they conveyed to you about their investigation.

The CDC's inability to adequately respond to my query of proof backing up allegations that Stop AIDS is averting new HIV transmission is perplexing. I would expect the agency, after providing $18 million annually to the San Francisco Department of Public Health for programs such as HIV prevention workshops, surveillance data and epidemiology, that the agency would readily be capable to explain to the public if that money is wisely spent to actually stop HIV infections.

Since CDC is unable to provide me with the Stop AIDS Project report, and the CDC's grantee agency, the San Francisco Department of Public Health, is almost one year late in releasing the annual HIV Counseling, Testing, Referral and Partner Counseling and Referral Services report for the city, I will soon formally ask members of Congress and the Department of Health and Human Services Office of the Inspector General to audit all CDC HIV prevention, surveillance and epidemiological grants to the local health department over the past five years.

The CDC must treat HIV as a preventable illness, not an industry. Two simple ways to bring this about is to convince the agency to release the Stop AIDS Project report, and to have HHS's Office of the Inspector General audit how the San Francisco Department of Public Health spends its federal HIV prevention dollars.

Michael Petrelis
2215-R Market Street, #413
San Francisco, CA 94114

Dr. Bill Frist, U.S. Senate
Dr. David Weldon, U.S. House of Representatives
Inspector General, Health and Human Services


April 22, 2003

Deputy Assistant Secretary for Public Affairs (Media)
U.S. Department of Health and Human Services
Room 17A-46
5600 Fishers Lane
Rockville, MD 20857

RE: FOIA Appeal

Dear Sir or Madam:

This letter is an appeal in response to an April 17, 2003, letter from the Centers for Disease Control and Prevention denying me full access to agency public records, specifically a report on the Stop AIDS Project of San Francisco, California.

I sent a Freedom of Information Act request to the CDC on April 1, 2003, formally requesting release of the Stop AIDS Project report, which was to determine if the nonprofit organization was effectively using federal funds to stop new HIV transmissions through workshops and other programs targeting gay men.

The CDC is withholding the Stop AIDS Project report under the provisions of subsection 5 U.S.C. 552(b)(5) of FOIA and the Department's own implementing regulation at 45 CFR 5.66 (a).

As you know, the FOIA subsection exemption cited by CDC says:

"Sec. 5.66 Exemption five: Internal memoranda.

"This exemption covers internal government communications and notes that fall within a generally recognized evidentiary privilege. Internal government communications include an agency's communications with an outside consultant or other outside person, with a court, or with Congress, when those communications are for a purpose similar to the purpose of privileged intra-agency communications. Some of the most-commonly applicable privileges are described in the following paragraphs.

"Deliberative process privilege.

"This privilege protects predecisional deliberative communications. A communication is protected under this privilege if it was made before a final decision was reached on some question of policy and if it expressed recommendations or opinions on that question. The purpose of the privilege is to prevent injury to the quality of the agency decision making process encouraging open and frank internal policy discussions, by avoiding premature disclosure of policies not yet adopted, and by avoiding the public confusion that might result from disclosing reasons that were not in fact the ultimate grounds for an agency's decision. Purely factual material in a deliberative document is within this privilege only if it is inextricably intertwined with the deliberative portions so that it cannot reasonably be segregated, if it would reveal the nature of the deliberative portions, or if its disclosure would in some other way make possible an intrusion into the decisionmaking process. We will release purely factual material in a deliberative document unless that material is otherwise exempt. The privilege continues to protect predecisional documents even after a decision is made."

In my opinion, this exemption does not apply to my request and the Stop AIDS Project report because I have not requested internal memoranda or internal communications. The document I requested is a final report, which was written after the CDC dispatched four investigators to San Francisco last August to see if the Stop AIDS Project was properly utilizing federal HIV prevention grants.

Also, the Department's CFR 5.66 (a) regulations state:

"(b) This section does not apply to matters that are--

"(5) inter-agency or intra-agency memorandums or letters which would not be available by law to a party other than an agency in litigation with the agency."

Since there is no litigation between the CDC and its grantee agency, the Stop AIDS Project, as far I know, this regulation does not apply to my original FOIA request.

Therefore, I hereby formally request that the Department of Health and Human Services immediately force the CDC to comply with my FOIA request and release the Stop AIDS Project report.

Michael Petrelis
2215-R Market Street, #413
San Francisco, CA 94114

Dr. Bill Frist, U.S. Senate
Dr. David Weldon, U.S. House of Representatives
Inspector General, Health and Human Services

April 1, 2003, FOIA request to CDC
April 17, 2003, CDC letter rejecting the FOIA request

Friday, April 18, 2003


[This letter has been sent to the CDC via snail mail, email and fax.]

April 18, 2003

Julie Gerberding, MD
Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333

Dear Dr. Gerberding:

As you know, the Centers for Disease Control and Prevention provides more than $18 million annually to the San Francisco Department of Public Health for HIV prevention, testing and surveillance, with a significant portion of that amount going toward HIV Counseling, Testing, Referral and Partner Counseling and Referral Services (CTR/PCRS).

The DPH web site erroneously claims that CTR/PCRS “[r]eports are published yearly by the San Francisco Department of Public Health, AIDS Office, Epidemiology and Evaluation Section and HIV Prevention Section. They contain all HIV counseling and testing data from participating San Francisco Counseling and Testing sites that report their data to the San Francisco Department of Public Health, AIDS Office.” [1]

The error in this claim pertains to annual published reports. The DPH released the CTR/PCRS for 2000 on June 4, 2001, and since then, no other annual reports have been forthcoming. I expected the DPH to share the CTR/PCRS data for 2001 in the first week of June 2002, but they didn’t, and almost a full year later, the 2001 data is still missing. Surely it can’t be because of lack of funding to prepare and publish that year’s data.

Since the state of California lacks an HIV names reporting law, it is impossible to determine an accurate and verifiable number of new HIV infections. One of the best tools available to help gauge whether the HIV rate in San Francisco is climbing, stabilizing or going down is the CTR/PCRS report.

I therefore am formally requesting under the provisions of the federal Freedom of Information Act the following information from the CDC, pertaining to CTR/PCRS activities in San Francisco during 2001:

1. Number of visits to clinic and other health care settings for HIV antibody testing;
2. Number of HIV antibody tests performed;
3. Number of positive, negative and indeterminate HIV antibody test results;
4. All available demographic information on patients who took an HIV antibody test;
5. A breakdown by behavioral risk populations.

Last year, I wrote an essay that cited data from the 1999 and 2000 CTR/PCRS reports for San Francisco, to call attention to the importance of these reports.

Here’s what I said: “The report for 1999 noted that there were 4,118 anonymous visits, and that a total of 2,439 HIV tests were performed, of which 102 were HIV positive (4.2 percent). However, in the CTR/PCRS report for 2000, the researchers state that there were 4,526 anonymous visits, and 2,791 tests for antibodies to HIV were administered, of which 83 were HIV positive (3.0 percent). So even though there was a surge in the number of visits (up 10 percent) and the number of tests (up 14 percent) in 2000, the HIV rate in fact fell significantly, plummeting from 4.2 percent in 1999 to 3.0 percent in 2000, while at the same time the blinded HIV rate was not going up.”

Of course, I wonder if the CTR/PCRS report for 2001 will show if new HIV infections identified through this service were up, down or steady.

I look forward to CDC promptly replying to this FOIA request.


Michael Petrelis
2215-R Market Street, #413
San Francisco, CA 94114
Ph: 415-621-6267

Secretary Tommy Thompson, Health and Human Services
Dr. David Weldon, U.S. House of Representatives
Lynn Armstrong, CDC FOIA Officer

1. http://www.dph.sf.ca.us/Reports/HlthAssess.htm

Thursday, April 17, 2003


Minutes from the San Francisco health commission’s Population Health and Prevention committee reveal a new plan is in the works to deal with the syphilis crisis in the city.

The secretary of the committee, Jimmy Loyce, director of the health department’s AIDS Office, made the following presentation at the committee’s February 25 meeting.

“On January 8, 2003, an all day meeting was held to develop a ‘syphilis reduction plan’. The Group [sic] suggested that the STD program focus on the following priority areas over the next year:

“- Enhancing STD surveillance and expanding clinical/lab services in both clinical and community based settings;

“- Increasing health promotion activities, including targeting health providers, creating messages that focus on prevention and standards of care for gay men’s health and expanding our internet [sic] outreach in gay chat rooms;

“- Developing a gay men’s Health Bill of Rights; and

“- Creating a Community Advocacy/Press Committee.

“The STD Program is planning to release a Plan [sic], as a collaborative endeavor between the STD Program and various community groups prior to STD Awareness Month in April.” [1]

While it is great to learn that such an all day planning session was held back in January, there’s been effort to inform the community that it took place and provide community members with more information about what was on the agenda, who was invited and lots more details about what was discussed. If the health department made a better effort to keep the community up to date about such things, I bet the gay and mainstream press would report on the efforts, thereby increasing awareness, and community involvement in fighting syphilis transmissions.

Regarding the expansion of the department’s invasion of gay chat rooms, I’d like to know what scientific evidence the department has in hand to prove that such outreach effectively reduces unsafe sex practices and syphilis rates. I acknowledge not supporting such outreach to gay men cruising the web for sexual partners, funded by the Centers for Disease Control and Prevention and the city. Gay men deserve private sexual spaces, including on the web, that are not subjected to the preying eyes of health officials who are doing a terrible job of controlling and preventing HIV and STDs.

I wholly support the notion of a gay men’s Health Bill of Rights, but I wonder why such a bill is necessary in San Francisco at this point in time. Is the health department admitting gay men are not respected in the local health care system and that our medical and civil rights need protecting with such a bill? I wish the minutes provided more background information about this basically good idea.

If the health department is establishing another community advocacy committee related to syphilis and gay men, can we be sure the usual suspects from AIDS Inc and the HIV prevention mafia won’t be in charge and/or dominating it? There have been far too many community advisory boards and panels that are nothing more than front groups for powerbrokers already in control of disease prevention, and operating ineffective programs. We need community members who aren’t on the AIDS Inc payroll running advisory committees, if the health department is serious about getting more citizens to own syphilis prevention campaigns.

The promise to release the plan before the start of STD Awareness Month is another broken commitment from the department. If the plan does exist, why hasn’t the department posted it on their web site?

The health department has its work cut for it, especially in light of this letter appearing in today’s edition of the Bay Area Reporter.

“I’m now certain that it’s not just my taste, and the ‘Healthy Penis’ campaign really is stupid. Math is not a matter of opinion. The campaign’s ad in the March 27 B.A.R. proclaims, ‘The number of syphilis cases has increased 1000 percent from 55 cases in 1999 to 494 cases in 2002.’ That would be 798 percent, not 1000 percent.

“Would be. The actual figures from the S.F. Public Health Department’s Web site www.dph.sf.ca.us/Reports/HlthAssess.htm show 122 syphilis cases for 1999, and 595 cases for 2002.

“That 388 percent increase is frightening enough without exaggerating or lying about it. But what can you expect from the team that expensively plastered those artless, amateurish, adolescent cartoons all over town?

“This growing health crisis requires accurate, smart, sex-affirming public education. It’s time for the health department to ditch the dumb cartoons and allocate whatever scarce funding remains to a new and wiser team of health educators.” [2]

The letter is from Randy Alfred, and bully for him for stating what I and many other gay sex activist think about the current syphilis control and prevention social marketing campaigns saturating the gay community and our sexual venues.

Alfred’s letter reminds me of a column a few years ago by Patricia Nell Warren in Arts & Understanding AIDS magazine. Warren questioned some alarming statistics from CDC HIV epidemiologists that were generating scary stories in the press. She called up Dr. Ron Valdiserri, a top HIV prevention expert at the CDC in Atlanta, to get his views about the questions being raised about the HIV statistics. He dismissed the questions as mere quibbles, but Warren rightly pointed out that gay men know how to use calculators and will try to make sense of alarming HIV statistics from the CDC. Just as Alfred has done with San Francisco’s syphilis numbers.

It will be interesting to see if and how the health responds to Alfred’s letter and valid concerns.

1. http://www.dph.sf.ca.us/Meetings/PHP/Minutes/JCCPHPM02252003.pdf, Page 2
2. Bay Area Reporter, April 17, 2003. BAR does not have a web site.

Monday, April 14, 2003


[The following letter has been sent via snail mail to the San Francisco Human Rights Commission.]

April 14, 2003

Virginia Harmon, Executive Director
Human Rights Commission
25 Van Ness Avenue, 8th Floor
San Francisco, CA 94102

Dear Ms. Harmon:

In Roman Polanski’s Oscar-winning film “The Pianist,” there is a scene that deeply affected me when I recently saw it. The protagonist and a woman friend want to eat in a restaurant, but can’t because of the prominent sign at the entrance, for all to see. It said: No Jews Allowed. Just one of myriad ways the Nazis subjugated the Jews and conferred less than-human status on them.

This scene resonated inside my gut because of how I am treated by the Stop AIDS Project and their demonizing campaigns against me, all because I want answers about their failing HIV prevention programs and workshops, paid for with millions in federal and city funding.

At a recent gay community forum, paid for with grants from the federal Centers for Disease Control and Prevention, held at the gay and lesbian Community Center on Market Street, the Stop AIDS Project debated the merits, or lack thereof, of their “HIV is no picnic” social marketing campaign. My friend Rick Gerharter, a noted gay photojournalist, attended the January 22 forum and took a photo of the sign, which was hung notably at eye level so no attendee could miss it.

This is the full text of the offensive sign:


“Because of history of violent acts against people in our community and their harassment and disruption of Stop AIDS Project events, [t]he following groups and individuals are not welcome at this Positive Force Event.

“ACT UP San Francisco
Queer Nation SF
& Michael Petrelis

“Additionally, any individuals engaging in disruptive, threatening or violent behavior will be asked to leave immediately.

“This is your only notice. If you do not leave the premises – you are trespassing, if the police called charges will be pursued.”

For your information, I have not committed any violent acts against Stop AIDS Project, nor am I a member of either ACT UP San Francisco or Queer Nation SF, and I think I have been libeled by the project and their allegations, for which I would like an apology.

The Human Rights Commission is hereby formally asked to investigate the following matters on my behalf, to determine if my human rights have been in any way jeopardized or violated by the sign and hateful treatment by a government funded HIV prevention group, desperate to hold on to its government money.

Here are my questions for the commission:

1. Since the CDC fully funds the Positive Force division of the Stop AIDS Project, were any federal used to create the sign? If so, how much taxpayer money went into the production, design and copying costs of the sign?
2. The City’s General Fund also contributes to the management and programmatic costs of the project. Were any General Funds used to make the sign, and if yes, how much city money was spent for this purpose?
3. With no restraining orders in place between the Stop AIDS Project and myself, and certainly no convictions or charges of violent behavior on my part toward the agency and its employees, is it legal for the project to preempt my attendance at CDC funded HIV prevention forums for gay men in San Francisco?

Also, I would like the commission to force the Stop AIDS Project to immediately cease and desist from posting the hateful sign at each of their public forums.

I look forward to a prompt reply from you regarding my complaint.


Michael Petrelis
2215-R Market Street, #413
San Francisco, CA 94114

Dr. Julie Gerberding, Centers for Disease Control and Prevention
Dr. Dave Weldon, U.S. House of Representatives
Darlene Weide, Stop AIDS Project

Color photograph of the demonizing Stop AIDS Project sign

Tuesday, April 08, 2003


The following brief letter arrived via snail mail yesterday. I am quite pleased the Centers for Disease Control has responded so quickly to my FOIA request for their report on the investigation conducted last year, at my request, on the Stop AIDS Project of San Francisco.

My question was simple. Is the Stop AIDS Project effective at preventing new HIV infections among gay men in this town?

CDC dispatched four investigators in August to assess how the project uses CDC HIV prevention grants and to determine if the group is successful at meeting its stated objective; to stop AIDS. Yet, eight months later, no report has been issued by CDC.

Let’s hope the agency finally releases its findings on the Stop AIDS Project, under the provisions of FOIA.
- - -

April 4, 2003

Dear Mr. Petrelis:

This letter is an interim response to your April 1, 2003, letter to Dr. Julie Gerberding, Director, CDC, pertaining to the Stop AIDS Project.

Your letter is being handled as a Freedom of Information Act (FOIA) request.

A response will be provided as quickly as possible.

Sincerely yours,
Lynn Armstrong
Office of Communication
Fax: 404-639-7395

Monday, April 07, 2003


Marilyn Chase, a medical reporter for the Wall Street Journal, has a new book out in stores called “The Barbary Plague,” about the bubonic plague that struck San Francisco in the early 1900s. She appeared on April 2 at A Clean Well-Lighted Place for Books on Van Ness Avenue, for a book signing and discussion.

Having read her stories over the years, especially her articles about HIV and STDs, I was keen to meet her and listen to what she had to say about how this city dealt with the bubonic plague, and, in the process, helped create what we now accept as public health and that it is the responsibility of the state to guard it.

After reading brief excerpts from her new book, she opened the floor for questions and turned the seventy-five minute event into an informative discussion with the audience about plagues, old and new, like HIV, and the SARS problem.

When she called on me, I explained that I was an AIDS activist trying to keep track of HIV statistics in San Francisco and had some data to share with her about those numbers. Like any well-trained, curious reporter, she promised to look at the data. I brought Chase a copy of my opinion column about the missing 1,000 HIV positive test results in San Francisco, with the year-end STD report for the city, which was cited in my column.

I asked her to detail how the health authorities during the bubonic plague kept track of how many people were felled by the disease and how were the number of deaths conveyed to the general population. She gave a short answer about the epidemiology of the time, and, of course, promised me she had more information regarding statistics from the plague years in her book, and that I should read it.

Other audience members were doctors and researchers she knew from her day job at the Wall Street Journal. One of them asked her about HIV rates in Africa and the rise of new HIV infections among gays, particularly young gay men, in San Francisco. Chase’s reply raised the hairs on the back of my neck, because the sub-text if what she said is a lament for more victims.

This is a transcript of her response.

“The other point that you made about a certain spike in the cases of infection, is troubling to a lot of doctors.

“I was interviewing [Dr.] Harold Jaffe from the Centers for Disease Control. Last December he came to town for the annual AIDS update [that is organized by the San Francisco Department of Public Health], and he said that there does seem to be sort of a spike in risk behavior and they’re not sure why, but one of the things may be, in a counter-intuitive way you might not expect, that the advent of better drugs, such as the protease inhibitors have made people feel safe and because it’s done so many good things and has turned HIV/AIDS into a treatable illness, a treatable chronic illness, that for so many people that prolongs their lives. They’ve gone back to work. They’ve regained their weight and they can go to the gym. They’re living more normal lives and it’s caused wonderful improvements.

“But, on the other hand, it has made it, by making the City sort of, a healthier place outwardly [for people with HIV], and by ending the bad old days when you saw a lot of, you know, very thin people walking around or very ill. It means that a whole generation of young gay men have not witnessed the kind of violent carnage the early days the epidemic caused. So some people think there’s a certain sense of immortality.

“What Harold Jaffe said was that it’s much, much harder to talk prevention now, because young gay men have not had the same life experience as their older brethren and they may think that as long as you go out with someone who’s young, healthy like you are, healthy looking, that you’re not at risk. That you don’t have the disease to worry about," said Chase. [1]

What I really loathe about how Jaffe and Chase view the lack of lots of sickly gay men with AIDS and obviously ill hobbling around the Castro neighborhood is how they are sub-textually calling for a return to the good, old bad days when thousands of San Francisco’s gay community were ravaged looking and dying quickly from HIV disease.
It is as if they can’t and don’t want to accept all the benefits of the AIDS drugs, because the medications have a side effect on HIV prevention efforts targeting gay men.

Such sentiments regarding a lessening of the AIDS crisis, get internalized by me, to the point where what I hear is, “Why doesn’t Michael fail his latest AIDS cocktail and appear gaunt, or his body and face riddled with Kaposi sarcoma lesions, maybe even have to use a cane or wheelchair to be mobile? It would be the greatest gift to HIV prevention if we could point to him in that declining condition.”

Not only do I apply to myself what Jaffe was expressing, but I extend his thinking to my inner circle of friends, also people living with HIV and AIDS. I don’t want them to turn into rail-thin poster children for HIV prevention social marketing campaigns funded by the CDC.

Where on earth could Jaffe and Chase get such negative notions about the positive developments associated with protease inhibitors, for AIDS patients? Perhaps they think of such ideas on their own. Or maybe, they are assisted to by gay men running HIV prevention programs in San Francisco, that are failing.

In a notorious June 30, 2000, front page article in the San Francisco Chronicle, the one in which the City’s HIV epidemiologists claimed new HIV infections here were at “sub-Saharan levels of transmission,” an extremely offensive quote appeared that gave license to thinking of healthy gay men, and those afflicted with AIDS, in a punitive way for being vibrant and alive.

The Chronicle said: “AIDS prevention educators said the changing portrait of the epidemic has caused many gay men to let down their guard. ‘We don't have the visual reminders of what it can be like to have HIV,’ said Steven Gibson, program director for the Stop AIDS project. ‘We don't see the wasting syndrome. When was the last time you saw someone with KS lesions in the Castro?’ Kaposi's sarcoma lesions were among the first opportunistic infections seen in gay men during the early years of the epidemic.” [2]

Is the only way to conduct effective HIV and STD prevention in San Francisco, with hundreds of millions of city, state and federal funds, most specifically those grants provided by the Centers for Disease Control, to have men with KS lesions strolling about the streets, on display, almost like a circus side-show attraction, for Gibson and others to use for prevention purposes? Apparently they think so, but the larger gay community needs proven methods of HIV prevention that don’t require more patients taking on a gaunt appearance or decline in health.

Another aspect to Gibson’s question is, how should we view the relative handful of gays with AIDS, who do look clearly to have the disease or suffering side effects of the cocktails, and are in the community and out in the public sphere. How are they to be treated? To me, Gibson and his colleagues in the HIV prevention industry want to exploit these men only for political and funding purposes, which is troubling.

As the days have past since Chase’s discussion, I’ve paid acute attention to men in the supermarket and in the bars and coffeehouses with physical aspects of AIDS and the medicines patients take to stay alive. First, there are quite a few of them, and second, I see myself, and my future, in each of their faces. With each man, I’ve tried to go out of my way just to smile with them and find a human link between us. Call it creating good karma for my future when I look as though I beset with facial wasting syndrome. There can’t be too much compassion for AIDS patients in our midst, and their lives should be treated with the utmost respect from CDC bureaucrats, including and particularly Jaffe, who has been handling HIV and AIDS prevention and surveillance matters for the federal agency since before the disease was even called GRID.

The thoughts Gibson conveyed to the Chronicle three years ago, making it seem like ancient history on the AIDS calendar, aren’t restricted to that time and just to San Francisco, as you can see in this April 6 article from Florida’s Key News, an online news service.

“Some young, gay men have been found to desire infection, largely because they are less likely to have seen the ravages of the disease in the beginning of the epidemic, probably haven't lost anyone close to them and keep hearing how much medical progress has been made in treatments,” the Key News said. [3]

To which I respond: And we want these younger men to experience the ravages of AIDS and lose dozens, hundreds of lovers and friends, and to think if they contract HIV that the drugs to fight it aren’t the hope they’re made out to be by Big Pharma and AIDS Inc, right? That is the underlying message to what the Key News wrote.

One phrase from Chase, her comment about “violent carnage,” sticks in my mind because it so precisely captures what it what like for me and far too many gay men in the 1980s, as AIDS began its killing rampage. Bravo to Chase for using the apt “violent carnage” statement, which is a chilling assessment of where we’ve been, and a place I don’t want to visit again.

There’s got to be better way for HIV prevention strategies to reduce or stabilize new infection rates, without bemoaning the healthy benefits of protease inhibitors, and certainly free from exploitation of AIDS patients.

Chase put on an educational forum, which made me taking the time to attend and hear her speak. And I hope to soon read her new book. I’ve got a reserve on it at my public library. Should be a good read.

1. Audiotape of Chase book signing event

2. http://sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2000/06/30/MN105153.DTL

3. http://keysnews.com/335954502191594.bsp.htm

Wednesday, April 02, 2003


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

Tuesday, April 01, 2003

[A hard copy of this letter has been mailed to various officials at both Health and Human Services in Washington and CDC in Atlanta. -MP]
- - -

April 1, 2003

Julie Gerberding, MD
Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333

Dear Dr. Gerberding:

Last year at my request you agreed to investigate the effectiveness of the Stop AIDS Project to prevent new HIV infections and other sexually transmitted diseases among sexually active gay men in San Francisco. As you know, the Stop AIDS Project receives funding from the Centers for Disease Control and Prevention, and the purpose of the investigation was to determine if the project is successful at stopping HIV and STDs.

I hereby request that under the provisions of the federal Freedom of Information Act, you release the CDC report on the effectiveness of Stop AIDS Project HIV prevention efforts.

In August, four CDC investigators came to town to evaluate whether the project's prevention programs were scientifically sound.

Eight months later, you and the CDC have not issued a report about the investigation, and I wonder why it is taking so long for you to release to the public the findings of the investigation.

Now, more than ever, with San Francisco experiencing alarming and skyrocketing rates of new HIV, syphilis, gonorrhea and hepatitis infections, along with the outbreak of a drug-resistant staph infection, the gay community and the public need to know if Stop AIDS Project's CDC-funded efforts are effective means of prevention.

On the surface, it appears to me that the CDC is suppressing its report on the Stop AIDS Project's use of federal funds. I find it hard to believe that CDC needs any more time to write the report or evaluate the project.

If CDC is not suppressing the findings, then I ask that you immediately release the CDC report on the Stop AIDS Project's prevention programs. Issuing the report will also show that you are serious are about providing accountability over CDC's HIV prevention programs at the local level.

The lives of many gay men hang in the balance, as HIV and STD rates surge to alarming levels. Please release the Stop AIDS Project report by the end of the week.

Michael Petrelis

2215-R Market Street, #413
San Francisco, CA 94114
Phone: 415-621-6267
Email: MPetrelis@aol.com

Tommy Thompson, Health and Human Services
Dr. Joseph O'Neill, Office of National AIDS Policies
Dr. Dave Weldon, US House of Representatives
Gaylon Morris, Executive Secretary to Dr. Gerberding