Tuesday, July 01, 2003


Three years ago this week, San Francisco Department of Public Health HIV experts exclaimed with alarm to the New York Times that the AIDS plague was resurgent, not just here, but possibly in many other urban areas, and all the fears were based on slender increases in HIV antibody testing, especially the rates involving a new test to detect recent HIV transmissions.

On July 1, 2000, Lawrence K. Altman reported in a page one, above-the-fold story that a
“small but sharp rise in new infections with the virus that causes AIDS has been detected among gay men in San Francisco over the last three years . . . [and that 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.”

Altman explained to readers that the new test “strategy involves testing the infected blood twice, using both a sensitive and less sensitive method . . . [and that the] test is becoming a powerful new tool for epidemiologists tracking the AIDS epidemic, health officials said.” [1]

Three years on, that “powerful new tool” shows incredibly low levels of recent HIV infections in America’s AIDS model city, and Altman and editors at the Times yawn. If Altman were to revisit the story he wrote in 2000, particularly his first sentence about the “sharp rise,” his opening this year might be, “A small but sharp drop in new infections with the virus that causes AIDS has been detected among gay men in San Francisco over the last two years.”

By the way, the test Altman refers to is known as STARHS, the Serologic Testing Algorithm for Recent HIV Seroconversions, and when the SF DPH monthly STD reports cite recent new HIV infections, the department is referring to this testing method.


The latest monthly sexually transmitted disease summary from the SF DPH, for May, reports essentially flat or slightly declining rates of new HIV infections.

Let’s start with what I consider to be the most noteworthy numbers, for the two categories of HIV tests performed.

Total number of regular HIV antibody positive test results at City Clinic at the end of May 2002 was 48, while for this year the figure thus far is 45. I consider this a minor decrease, while many statisticians would characterize it as stable. In any case, it’s good news.

The statistics for recent HIV positive infections, using the STARHS method, are even better. Last May there were 20 for the year; while so far this year the number has gone up to only 16. [2]

And bear in mind that these drops come at a time when the number of HIV tests performed is going up. Last year for this period, 1047 tests were administered, while so far for this year there have been 1072 performed.

Furthermore, if you want to look at the monthly HIV infection rates in a larger context, take a gander at this slide, http://hivinsite.ucsf.edu/InSite?page=md-rr-17-sl&ss=xsl/sl-doc&slide=7, which is from the SF DPH, and presented on a University of California at San Francisco web site.

You’ll see that at anonymous testing sites, for gay males, the incidence rate was at a high of 4.2% in 1999, and fell to 3.9% during 2000, the year San Francisco was allegedly going through sub-Saharan levels of new HIV transmissions.

So we have hints of declines of overall HIV tests results and recent HIV infections detected with STAHRS, in a city supposedly in the throes of sub-Saharan levels of new HIV transmissions, and what do health advocacy groups have to say? Literally nothing.

The SF DPH and HIV/AIDS organizations have a responsibility to analyze the monthly STD reports and offer reasons why there appears to be a small, but sustained decline underway, but no one in the AIDS industry in this town is speaking about the most recent summaries and what they may mean for controlling and preventing new infections.

The silence from SF DPH and AIDS groups is, I believe, an indication of how they don’t use epidemiologic reports and data in more honestly communicating with the public, and they should utilize such data with a wide audience concerns about sexually transmitted infections.

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