Petrelis Files

SF DPH: Gay STDs Down, Stable; STR8 Gonorrhea up 51%

As we scrutinize the preliminary STD stats for last year, let's keep in mind that due to reporting delays, the numbers may increase slightly by the time the definitive final STD report for 2005 is released in the summer.

One other factor to be mindful of while analyzing STD rates is the larger picture of HIV, because there has been a drop in HIV infections that began at least 2-3 years ago and Dr. Mitch Katz, head of the S.F. health department on February 14 was quoted in the S.F. Chronicle saying that new HIV transmissions have flattened.

The Dec. 2005 monthly STD report, published a month ago, presents much good data about declining infections for gay men, but there is an alarming rise in heterosexual female gonorrhea cases.

> Summary of Provisional 2005 San Francisco STD Data

> Reported cases of early syphilis (primary, secondary and early latent syphilis) declined 23% between 204 and 2005, the first decrease since syphilis started rapidly increasing in 1999.

Such a tremendous drop should be heralded, especially in the gay community because when we talk about syphilis in San Francisco, we are essentially talking about gay syphilis rates and if gay men in the 25th year of the AIDS crisis are undeniably reducing syphilis infections, public health authorities and private-funded gay health groups should offer positive reinforcement for the behaviors behind the decline.

Unfortunately, the DPH and community-based organizations have not made statements about the drop, nor have they articulated plans to keep the numbers going downward.

> Gonorrhea increased by 11% between 2004 and 2005. As reported previously, this increase disproportionately affected heterosexuals.

This is troubling and outrageous. Troubling because it may reflect DPH policies of ignoring STDs among sexually active heterosexuals because the department is exclusively focused on curbing gay STD infections, and outrageous because the DPH and the Board of Supervisors were asked in 2004, by yours truly, to pay attention and react to the then-rising figures of heterosexual female gonorrhea infections, but they chose not to.

City Hall and DPH workers laughed in May 2004 when I spoke at the Board of Supervisors, giving them copies of DPH's then-most current annual STD report showing a rise in female gonorrhea. While they didn't laugh at the stats, they giggled in embarrassment as I, a gay man, spoke about the need for a "Healthy Vagina" campaign, comparable to the "Health Penis" effort.

Now, more than a year later, without any DPH-funded social marketing campaign educating straight people about gonorrhea and urging them to get tested, we're witnessing a tragic spike in new cases for female.

Let's break away for a moment from the Dec. 2005 preliminary STD report and look at the editorial note about gonorrhea in women in the Jan. 2006 report from DPH.

> In 2005, reflecting an increase seen throughout the Western United States, gonorrhea cases among women in San Francisco rose 51% compared with 2004 (from 234 cases to 353 cases). [...] black women had the largest increase 69% from 93 cases to 157 cases [...], Hispanic women and white women had increases of 39% and 40%, respectively.

> Gonorrhea puts women at increased risk for infertility, pelvic inflammatory disease, chronic pelvic pain, tubal pregnancy (a surgical emergency), and HIV. [...]

A 51% surge of any STD in any community, in my opinion, should be noted by the press, but so far, no reporter has touched this story. Have we become so used to only being concerned about gay male STD rates and health penises that we can't give a damn when women of all races in San Francisco are experiencing frightening increases of vaginal gonorrhea and there isn't a single prevention campaign or group targeting sexually active women at-risk for STDs?

You can be sure, if this 51% spike were happening in the gay community, it'd be front-page news and health experts would be pounding their chests berating gay men for not practicing safe sex rules. Pleas would be issued from local politicians, the Centers for Disease Control and AIDS groups for more money for expanded STD/HIV prevention messages targeting gay men.

But when the increase occurs in the women's community, silence and shrugs of the shoulder are the order of the day from the pols and health officials. Now back to the Dec. 2005 report.

> Chlamydia remained stable between 2004 and 2005.

We like good news about any flat STD rate, don't we?

> Between 2004 and 2005, reported rectal infections increased 9% for rectal chlamydia and 11% for rectal gonorrhea. These increases might be the result of increased rectal screening at Magnet, the gay men's health center.

Since California presently lacks HIV names reporting laws and our HIV stats can at times be unreliable and not totally indicative of actual HIV rates, S.F. DPH leaders over the years have used the male rectal gonorrhea rate as a surrogate marker for HIV infections.

The basically stable gay male gonorrhea figures add further credence to the flattening, possibly declining, HIV infection caseload.

Starting with the 1999 annual STD report, DPH has noted every year that increases in male rectal gonorrhea were due to more testing, not necessarily more unsafe gay anal sex.

Even though the Dec. 2005 preliminary numbers are up, and the DPH is hedging on the reason by using the word "might" when describing what may be the reason for the increase, more tests performed, if you look at the annual reports on this issue, you will find that earlier climbing rates were related to the rising number of tests performed.

You can find those previous annual stats at these links: 1999, 2000, 2001, 2002 and 2003. (Rectal rates are general found on page 71 or 73 of the reports.)

What's the bottom line on all the stats and reports from San Francisco? Except for the rise of female gonorrhea, the city is witnessing a great thing: effective control and prevention of gay STD and HIV rates. However, the disturbing fact remains, DPH and AIDS groups can't bring themselves to acknowledge this positive development, and build on its success. It's almost as if there's something fundamentally wrong or embarrassing about what so many have longed for over the past two-and-a-half decades--containment of infections.

Remember the alarms sounded in June 2000 by DPH, AIDS experts and the media when provisional data for STD and HIV in San Francisco were supposedly at sub-Saharan levels? The experts couldn't wait to call reporters and offer scary quotes, gleefully included in front-page news articles, declaring their fears not just for San Francisco, but indeed for all of America.

Here's what one researcher had to say to the S.F. Chronicle:

> ``This is a harbinger of what is going to happen all over the country,'' warned Tom Coates, director of the University of California at San Francisco AIDS Research Institute. ``What happens in the HIV epidemic usually happens here first.''

Well, if what this AIDS expert applies when the numbers are allegedly on an upswing, it seems to me reasonable to say that if San Francisco's numbers are falling, the same could also be occurring all over the country.

Six years on, with gay infections falling faster than Bush's approval ratings, the silence from DPH, AIDS groups, the CDC and the press, is not only deafening, it's something the gay community should immediately demand an end to.