Petrelis Files

SF DPH: New HIV cases peaked in '99; NYT/Sullivan's "When Plagues End"

Not sure how I missed this crucial abstract that was presented a few months back at the global AIDS conference and the incredible admission by our local health officials that new HIV infections hit their summit seven years ago:

2006 Toronto AIDS Conference
Published: August 13, 2006
Title: HIV serosorting? Increases in sexually transmitted infections and risk behavior without concurrent increase in HIV incidence among men who have sex with men in San Francisco
Lead Author: Mitch Katz, MD, SF Department of Public Health

HIV incidence using the serological testing algorithm for recent HIV seroconversion (STARHS) peaked in 1999 at anonymous testing sites (4.1%) and the STI clinic confidential testing program (4.8%), with rates leveling off through 2004.

For those who may have forgotten, the importance of the HIV rate gleaned from such testing programs with this novel test, made the front-page of the New York Times on July 1, 2000, when the paper reported an alleged surge of HIV:

The rise was detected by using a new test developed by the C.D.C. that allows health workers to distinguish between recent H.I.V. infections and those that were acquired months to years ago, [...] When San Francisco health officials learned about the new testing strategy, they moved quickly to apply it in a number of testing sites, [...] known as anonymous testing sites because they provide testing without identifying individuals.

Even though I'm not an HIV/AIDS expert with medical degrees, I still say it is very significant that this city, one of hardest-hit metropolitan areas in the world and one that saw devastation to the gay community in the early days of the crisis, has seen new infections hit their top level, and a relatively long while ago too. But don't expect the NY Times to informed readers of this HIV peak.

Sure, I'd think all the gays and our allies working at the DPH, the many AIDS institutes at UCSF and at the dozens and dozens of AIDS service and HIV prevention groups would herald the peak as not only a public health success, but one that forces all those agencies to give gay men some credit for a remarkable achievement -- containing a plague.

But I can't locate one news releases or reference to the DPH abstract showing the HIV peak on any San Francisco AIDS group's web site.

Let's move on to a larger context, that of AIDS rates, because some of the same researchers who wrote the Toronto abstract also said in 1997 that full-blown AIDS cases here hit a high in 1992:

Journal of Acquired Immune Deficiency Syndrome
Published: November 1, 1997
Title: Projected incidence of AIDS in San Francisco: the peak and decline of the epidemic
Lead Author: Mitch Katz, MD, SF Department of Public Health

The annual number of new AIDS cases is estimated to have peaked at 3332 in 1992, and is projected to decline to 1196 annually by 1998.

My point is that whether I'm examining new HIV infections or AIDS diagnoses for the city, the health department's own studies and epidemiology clearly document that we hit the peak years ago and that over all control and prevention of the plague continues, yet AIDS experts and nonprofit executives do nothing to talk about these peak and decline of a plague.

Not only are Toronto and JAIDS abstract vital to look at when assessing the state of HIV and AIDS here, there is also the latest annual HIV/AIDS statistical report for the city, which sums up the situation nicely:

2005 HIV/AIDS Epidemiology Report
Published: August 28, 2006
Lead Author: Mitch Katz, MD, SF Department of Public Health

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.

Like the abstract presented in Toronto, this new annual report was greeted with yawns and silence by the AIDS groups and the local media. Who wants to talk about any sustained good turns in this 25-year-old plague? Certainly no one yet in what is sometimes derisively called AIDS Inc, shorthand for all of the private groups, DPH and UCSF entities. Folks who work in AIDS Inc may fear breaking the silence about HIV/AIDS peaks and declines could end their lucrative careers, or that gays would get the message that we've loving in ways that don't transmit the virus.

At the same time, AIDS Inc, as it has so often in the past, may try to use male rectal gonorrhea rates to undermine reports of HIV drops. The line of reasoning is that because California only recently launched valid HIV tracking with a name-based system, HIV stats for the state and San Francisco may not be the best indicators of true infection rates for the past eight or nine years, so AIDS Inc cites rising male rectal infections to say the rates may equal rising HIV infections.

I must admit seeing the logic of using the rectal gonorrhea rate as a surrogate marker for an HIV rate, however, AIDS Inc often conveniently fails to mention why this rate is up. If you didn't read the minutes of SF Health Commission meetings, you wouldn't know the steep growth of this infection wasn't due just to condom-less sexual activities.

It's because more tests = more cases:

2006 Minutes of the Health Commission
Meeting date: September 25, 2006
Chief of Public Health: Mitch Katz, MD

An analysis of rectal gonorrhea trends in San Francisco revealed that between 2001 and 2005, reported cases of rectal gonorrhea increased more than two-fold, from 213 cases to 461 cases. STD Prevention and Control believes that a large part of this increase can be explained by its expanded rectal screening program and improvements in testing methodologies.

During this time period, the number of rectal GC screening tests supported by the STD Program increased 250%. The percentage of tests submitted by screening program providers other than the STD Clinic increased from 2% (45/2132) of tests in 2001 to 54% (4026/7395) of tests in 2005.

So what does all of this have to do with Andrew Sullivan? A lot, considering his influential November 10, 1996, New York Times Sunday Magazine cover story, "When Plagues End," caused a ruckus among people with AIDS, streets activists, executive directors and public health workers across the USA, all because Andrew believed with the advent of protease inhibitors and other leaps forward in treating AIDS, that he was witnessing the beginning of the end of the American AIDS plague.

To my surprise, the piece lacked enough stats, and this is the most Andrew wrote citing numbers:

Almost overnight, toward the end of 1996, the obituary pages in the gay press began to dwindle. Soon after, the official statistics followed. Within a year, AIDS deaths had plummeted 60 percent in California, 44 percent across the country as a whole.

And he went on to say something that is as true today about AIDS Inc and stats as it was a decade ago, maybe more so:

It was still taboo, of course, to mention this hope [of new drugs] -- for fear it might encourage a return to unsafe sex and new outburst of promiscuity. But, after a while, the numbers began to speak for themselves.

Yes, the numbers from the San Francisco health department speak loudly, if you're listening, and even if you are, it is practically against the law to mention HIV peaks and decline in public.

A decade after "When Plagues End," it's time to revisit such an occurrence happening in San Francisco and to use available hard stats from DPH researchers to consider this idea -- the plague peaked and we need to discuss it to ensure numbers continue declining.

Would that be so terrible?