Saturday, September 04, 2010

SF Clinic's HIV Poz Rate Fell 46%

The 2009 annual Sexually Transmitted Disease report from the San Francisco Department of Public Health was released last week and it's full of good news, about controlling, and obviously preventing all kinds of new infections, with disease rates continuing to drop. Where increases are seen, the DPH summary spells out the rise is due to expanded testing.

Let's go over key findings, starting with HIV testing and results information from just City Clinic, where most municipal HIV and STD testing takes place. For 2009, the summary notes, on page 108:

Change in HIV seropositivity from 2005 t0 2009 = 45.9% decrease

Change in HIV testing volume from 2005 to 2009 = 36.6% increase

Over a five-year period, when the number of tests skyrocketed, the figure for antibody positive results dramatically plunged. Clearly an indication of much serious good prevention behavior by people with AIDS, and associated factors including sero-sorting, low infectivity of treatment-adherent persons, and social marketing.

Even though the almost 46% fall in HIV seropositivity at this major testing site, in America's AIDS Model City, is not the rate for the city, City Clinic's testing services are a damn fine surrogate marker to be included in the municipal HIV rate.

For the one-year 2008 to 2009 trend (page 108), the HIV seroposivity went up 11.1%, while there was a 17.6% increase in testing volume. DPH does not explain what's led to the jump, and it is of concern to me, but I also know that one-year comparisons might not reflect a genuine trend in new infections. The five-year figures above, I believe, are the chief things to bear in mind.

What about other diseases? The report's executive summary (page 2), shows one-year jump of 1.2% and five-year rise of 12.5% in chlamydia, and the increases are explained later on as due to more testing.

For gonorrhea the one-year figure fell 10%, and the five-year rate dropped almost 25%. Syphilis figures for one-year saw a 5.1% decrease, while the five-year rate soared 21.2%, because of additional testing programs.

The rates for rectal infection in gay men, come from page 69, ahem. Male butt chlamydia from 2008 to 2009 increased 12.1%, and for rectal gonorrhea the one-year rate fell 1.3%.

Why is the butt chlamydia rate up? DPH says:

Rectal and pharyngeal screening for gonorrhea and chlamydia for men who have sex with men began in 2003 and has expanded beyond [City Clinic, to such sites as the Magnet gay health center in the Castro] and other local providers serving MSM populations. As a result, increases in case detection may be a function of increased screening for these often asymptomatic infections.

In 2009, cases of rectal chylamydia increased while cases of rectal gonorrhea declined. This trend has been consistent since 2006.

My translation of that last part is that more chlamydia tests are detecting the easy-to-transmit infection among anally active gay men, while gonorrhea numbers remain on the wane.

Overall, the 2009 SF DPH STD Report demonstrates remarkable and healthy trends for gay men, and the report should be held up as prime example of how this city is doing much right to control STDs and HIV.

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