Petrelis Files

Gay SF Syphilis Falls 28%; HIV Also Down

On July 1, 2000, in a front page article for the New York Times, chief medical correspondent Lawrence K. Altman wrote about an alleged surge of new HIV infections in San Francisco. [1]

I say alleged for a few reasons; California lacks HIV names reporting, a new antibody detection test not approved by the FDA was used to estimate the HIV rate, and STD statistics were cherry picked by health experts.

Altman wrote: "Syphilis rates have increased in San Francisco and Los Angeles, and gonorrhea rates have increased in Seattle, the health officials said. 'That is what makes [the rising HIV incidence data] important,' Dr. Katz [of the DPH] said. "It is the first report to link new infections to higher unsafe sexual behavior."

What is being claimed by the DPH officials and not challenged by the Times is that syphilis rates basically equal HIV rates for gay men in San Francisco, a scientific hypothesis I never fully accepted as valid.

In any event, for argument's sake, I will accept the alarm of the Times and the San Francisco health department in order to focus attention on new HIV and STD data from America's gay Mecca and model AIDS city.

Examine the latest STD monthly report from the DPH, with the best news first -- syphilis has fallen 28% for the five months of this year compared to the same period in 2004.

Syphilis
Year to date, Jan-May 2004: 280
Year to date, Jan-May 2005: 202
[2]

Since similar syphilis stats were used by the DPH in the Times story to proclaim yet another "second wave" of HIV was hitting San Francisco, we must remember how these forces used this city's stats to forecast dire predictions for the entire country.

"The [HIV] rise is deeply troubling because it was seen in San Francisco, one of the principal centers of the AIDS epidemic that was first detected in 1981. Thus, the rise could signal a new wave of infections there and elsewhere, San Francisco health officials said," the Times wrote.

The rates of new HIV and syphilis infections were supposed to be equal, reason for alarm and page one attention.

However, the STD monthly report through the end of May 2000 reveals 58 syphilis cases were reported to the city at that point, which compares to 53 such cases in 1999. This means there was a 9% jump in syphilis infections when the Times wrote it's article. [3]

In my estimation it's peculiar San Francisco health officials have been mute since the latest STD monthly data was released.

I would expect the health department to seize upon the 28% decline of syphilis as hard evidence their controversial STD prevention programs and social marketing campaigns are working, that gay men are loving each other without driving up STD infections.

If the rise of HIV in 2000 was determined in large part because of the syphilis rise, then we need to ask if the serious decline of syphilis so far in 2005 mirrors a fall of HIV.

According to the most recent monthly report, the numbers for HIV antibody positive test results at the city's central STD clinic fell in comparison to last year's. Bear in mind this is _not_ the city's HIV rate, just one major clinic's data.

HIV
Year to date, Jan-May 2004: 57
Year to date, Jan-May 2005: 51
[4]

Seems to me that's a 10% drop, while not as high as the city's overall syphilis decline, but nothing to sneeze at either.

Okay, now what about the overall HIV rate for San Francisco? Up, down or stable?

The HIV Counseling, Testing and Referral (CTR) reports encompass all federal and city funded testing sites, at clinics and on the street, and tests performed by private doctors.

HIV CTR rate 2001
Number of tests: 23,648
HIV poz #: 736
% poz: 3.1

HIV CTR rate 2002
Number of tests: 19,091
HIV poz #: 699
% poz: 3.7

HIV CTR rate 2003
Number of tests: 20,376
HIV poz #: 735
% poz: 3.5

HIV CTR rate for 2004
Number of tests: 21,973
HIV poz #: 736
% poz: 3.4
[5, 6, 7, 8]

Extreme caution is necessary in looking at these numbers because many of the people tested have previously tested for HIV and may have already been counted, using the shoddy California Unique Identifier system. For data on repeat testers, see page 2 of the CTR reports.

You may recall the Times story of December 16, 2004, about HIV testing on the streets here that reported, "Of 650 testers at the two sites, 40 people were HIV-positive, but 20 had previously tested positive." The Times said those 20 people, repeat testers really, took another HIV antibody test because they were given a $10 voucher for groceries. [9]

However, the four year's of CTR reports on the surface show a fluctuation in annual tests performed, three of the years were remarkably stable for poz test results, the percentage hit a high in 2002 at 3.7 and dropped to 3.4 during 2004.

To get a fuller picture of the STD rates for gay men in San Francisco, we see the following diseases are also down, as reported in the monthly DPH newsletter:

Male rectal gonorrhea
Year to date, Jan-May 2004: 183
Year to date, Jan-May 2005: 179

Male rectal chlamydia
Year to date, Jan-May 2004: 194
Year to date, Jan-May 2005: 181

Adult male shigellosis
Year to date, Jan-May 2004: 44
Year to date, Jan-May 2005: 41
[10, 11, 12]

All these dropping STD rates come amidst an explosion of speed use among a subculture of sexually active gay men and health experts have at times equated using meth with spreading syphilis and HIV.

The speed use epidemic here is so bad the DPH monthly STD newsletter reveals a sharp increase in number of speed-related visits to San Francisco emergency departments.

Speed-related ER visits
Year to date, Jan-May 2004: 311
Year to date, Jan-May 2005: 343
[13]

A 10% rise in tweakers seeking ER help, but syphilis, other gay male STDs, including HIV, are not climbing as health experts and the Times have predicted.

I wish someone would explain to me how San Francisco can go through declining HIV and STD infections, while speed use is up and not a word is said by the DPH, AIDS groups, the Times, and other newspapers.


Sources:

1. NY Times
2. SF DPH report May 2005
3. SF DPH report May 2000
4. SF DPH report
5. CTR 2001
6. CTR 2002
7. CTR 2003
8. Not available on the web. For a copy of the CTR 2004 report, call Steven Tierney at DPH: 415-554-9000.
9. NYT story
10., 11. & 12. SF DPH report
13. SF DPH report