Petrelis Files

SF DPH: HIV, AIDS Deaths,
Gay STDS = 'Hyperendemic'

A friend who used to work in AIDS Inc recently called my attention to the pubication in November last year of an important study, strangely unheralded by the Department of Public Health, showing that not just HIV infections, but AIDS mortality, saturation of cocktails on the infected population, gay syphilis and gay anal gonorrhea have been at hyperendemic level for a decade. The DPH study says these crucial surrogate markers for the state of the HIV/AIDS problem in San Francisco, from 1998 through 2007, have been endemic, meaning, flat and contained. WTF?

I thought there was a raging surge of new HIV infections in 2000, when one of the authors of the new study told the SF Chronicle that an alleged uptick in HIV was happening. Dr. Willi McFarland's infamous quote was: "These are sub-Saharan African levels of transmission."

The NY Times also sounded an alarmist tone about the 2000 HIV rate:

The estimated number of new infections in San Francisco nearly doubled to 900 last year from about 500 three years ago after having stabilized following aggressive prevention campaigns.

I'm happy to report that San Francisco was actually in the third year of endemic levels of HIV and other indicators, according to the new SF DPH study, published in the November 2008 edition of the Sexually Transmitted Infections journal.

The bottom line of the abstract is that HIV, AIDS deaths and gay STDs have been flat/contained for a decade and will remain so. While the researchers are displeased with the hyperendemic status, I say such a thing is very good because it means HIV and other indicators are not rising, and that the cocktails are doing much to prevention new infections.

Who can be against fewer HIV and STDs among gays, and people with AIDS living longer?

Click here to read the STI journal abstract, and go here to read the full six-page study. If you give a damn about AIDS, read the full study.

Here's part of the abstract, emphasis mine:

HIV is hyperendemic among men who have sex with men in San Francisco: 10-year trends in HIV incidence, HIV prevalence, sexually transmitted infections and sexual risk behaviour

[Authors]
S Scheer1, T Kellogg1, J D Klausner1, S Schwarcz1, G Colfax1, K Bernstein1, B Louie1, J W Dilley2, J Hecht3, H-H M Truong4, M H Katz1, W McFarland1

[Affiliations]
1 San Francisco Department of Public Health, San Francisco, California, USA
2 AIDS Health Project, University of California, San Francisco, California, USA
3 The STOP AIDS Project, San Francisco, California, USA
4 Center for AIDS Prevention Studies, University of California, San Francisco, California, USA

Objectives: To evaluate trends in the HIV epidemic among men who have sex with men (MSM) in San Francisco and the implications for HIV prevention.

Methods: An ecological approach assessed temporal trends in sexual risk behaviour, sexually transmitted infections (STI), HIV incidence and prevalence from multiple data sources between 1998 and 2007.

Results: By 2007, there were over 13 000 HIV-infected MSM living in San Francisco. No consistent upward or downward temporal trends were found in HIV incidence, newly reported HIV cases, AIDS deaths, proportion of AIDS cases using antiretroviral therapy, rectal gonorrhoea or primary and secondary syphilis cases among MSM during the study period. ...

Conclusions: Temporal trends in multiple biological and behavioural indicators over the past decade describe a hyperendemic state of HIV infection among MSM in San Francisco, whereby prevalence has stabilised at a very high level. In the absence of new, effective prevention strategies this state will persist.