Sunday, September 17, 2006

New SF HIV Report: No Increases in 5 Years

The new HIV report for the city of San Francisco represents a truly remarkable development in the effort to control and prevent new infections:

"The current HIV/AIDS epidemic is characterized by no apparent increases in HIV infection rates over the past five years, and with considerable decreases in some populations. A number of factors may account for these trends. San Francisco's community-based prevention and treatment responses deserve some credit, bringing our per capita rate of AIDS incidence down from the highest in America to its present rank as number seven." (From the executive summary of the report, page 12.)

When I read this passage, my initial reaction was pride in my gay community for contributing to the decline and stabilization of HIV stats. But when I put the report aside and cruised the web looking for any publicity from the DPH on the new stats, or an acknowledgement from any of the vast array of AIDS groups on the stats, I experienced deep cynicism at the overwhelming silence from DPH and AIDS Inc.

I think when you have a five-year period with flat or dropping HIV, in a city that was allegedly experiencing sub-Saharan levels of new infections, it is something the press should report on and the affected community show know about, if only to keep things stable or decreasing. Also, if we assume for a moment that the sub-Saharan claim was indeed true, it's then incumbent on the DPH to explain how we so quickly went from sub-Saharan levels of infections, to a five-year period of stable rates.

Five years equals a fifth of the entire span of the AIDS epidemic, it also equals a twentieth of a century. Really, it's a significant amount of time no matter how you slice it, yet, AIDS Inc may be ignoring the new report because it could affect federal funding levels for the city. With Congress still grappling with reauthorizing the Ryan White CARE Act for another five years, I can somewhat understand why bureaucrats here are hesitant to promote any HIV stats document that could potentially lead to a reduction in federal grants.

However, the fears of losing funds should not prevent AIDS Inc and DPH officials from keeping the community up to date on HIV infections and sharing proof that prevention messages and sero-sorting are helping to reduce rates. I can think of no legitimate reason why the new HIV report should not be in the news and under debate in the gay community.

If any American city, and perhaps any region in hard-hit Africa or Asia, put out an epidemiology report showing a five-year stretch of time in which HIV is flat or falling considerably for certain populations, it is cause for discussion for many reasons.

First, if San Francisco is seeing stable rates, are there other cities with similar stats? I suspect AIDS experts will say no, because they only like to see this city used as an example that applies to other cities only when infections are climbing, not dropping. Second, after a quarter-century of AIDS in the gay community, our advocates have a profound responsibility to share all data with us, especially when it reveals control of HIV. Informing the gay community of any sustained flat infection rates, I believe, will offer positive strokes to sexually active gay men for their safe sex behaviors and also encourage them to continue practicing sex that doesn't spread infections.

Little more than six years ago, with millions of dollars at stake as Congress considered reauthorizing the Ryan White CARE Act, HIV experts in San Francisco alleged that there were around 900 new infections in 2000 and one expert, Dr. Willi McFarland, told the SF Chronicle, "These are sub-Saharan African levels of transmission."

As is their habit when HIV or STD rates are supposedly rising, San Francisco AIDS officials used the local stats to sow alarm in gay communities across the nation.

Who can forget this quote from UCSF's Tom Coates in the same Chronicle story? "This is a harbinger of what is going to happen all over the country. What happens in the HIV epidemic usually happens here first."

As if to validate the alarm reported in the Chronicle, the New York Times ran a page-one story on the subject the next day. Neither the Chronicle nor the Times stories in 2000 raised any doubts about what the experts claimed, and, of course, no skeptics of the scary HIV stats were quoted by either paper.

Now six years on, comes the latest HIV/AIDS epidemiology report for San Francisco, published on the DPH web site in late August, but not yet reported on by any news outlet nor touted by a single HIV organization. Silence is not golden when the topic is new HIV infections.

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