Wednesday, December 01, 2004

December 1, 2004

Marin Independent Journal
Marin, CA

Dear Editor:

I applaud your Dec. 1 story about an AIDS patient battling to stay healthy and alive in Marin and current HIV and AIDS statistics.

Of particular interest to me were the following statements from a San Francisco health official, Randy Allgaier.

He said, "The number of people being diagnosed with HIV and AIDS in San Francisco and Marin has decreased over recent years . . . [b]ut increases in sexually transmitted diseases, such as syphilis, cast an ominous shadow over the future . . . [t]hat is because such increases usually coincide with increases in HIV infection."

The 2003 HIV epidemiology report from San Francisco not only clearly backs up Allgaier on the decreases, it spells out a stable rate: "New data suggest HIV incidence has leveled off in the past few years. Application of the Serological Testing Algorithm for Recent HIV Seroconversion (STARHS) to specimens collected at the anonymous and the STD clinic testing sites finds that recent infection peaked in 1999. From 1999 to 2003, HIV incidence has stabilized." (Source: DPH HIV report, Page 11.)

However, Allgaier's contention that rising syphilis rates equals surging HIV infections is not borne out by a large-scale study on this supposed connection between the infections.

A study published in August 2004 in JAMA, the Journal of the American Medical Association, found that in two epicenters of the AIDS crisis in the United States, San Francisco and Los Angeles, there was no increase in HIV incidence at several testing sites, over a four-year period.

"Despite the high HIV incidence in men with P&S [primary and secondary] syphilis, HIV incidence rates among MSM [men who have sex with men] tested at large public sites in San Francisco and Los Angeles did not increase during 1999-2002." (Source: JAMA HIV Syphilis Study.)

Let's hope the stable HIV transmission rate in San Francisco and Marin remains steady and soon decreases, while doing everything to promote safer sex practices to bring about declines.

Michael Petrelis
2215-R Market Street, #413
San Francisco, CA 94114
Ph: 415-621-6267

Marin Independent Journal

Dec. 1, 2004

The fight goes on for survivors

Improved drugs help San Rafael woman outlive prognosis

By Richard Halstead, IJ reporter

Three times a day, Julie Dowling swallows about a dozen pills that keep her alive.
The San Rafael resident is one of 603 Marin residents living with AIDS or an HIV diagnosis. Many of them will march in a candlelight vigil through San Rafael's Canal Area tonight to commemorate World AIDS Day.

They're the lucky ones - of the 1,018 Marin residents who have contracted AIDS over the years, 649 are dead, county health officials say.

Improved medicines have allowed Dowling and thousands like her to cheat death so far. Dowling worries that the general public may assume the war has been won and forget how tenuous the lifeline is for AIDS survivors. Federal and state funding for AIDS programs in Marin decreased this year.

Dowling, 41, subsists on government disability payments. She doesn't feel well enough to work. She has learned to live with the constant pain in her feet, caused by her medicine, the protease inhibitors.

"It's better than the alternative," Dowling said.

She stopped taking the drugs recently to give her body a rest. She lost weight immediately. She often has flu-like symptoms, feeling nauseous and tired. Due to a condition brought on by AIDS she will never bear children.

Nonetheless, Dowling smiles as she tells her story. She wants people to know that AIDS is no one's fault. Anyone can catch it. That includes middle-class people, who aren't gay and don't use intravenous drugs - people like her.

Dowling was working as a public health nurse in San Diego when she was diagnosed in 1991. She was tested after she accidentally stuck herself with a needle while drawing blood from a patient. The test revealed that she already had advanced AIDS. She would later learn that a former lover slept with men without telling her. He has since died of AIDS.

"I was 28 years old," Dowling said. "Most people were starting their lives. I was ending mine."

Treatments for AIDS then were far less effective. Her doctors told Dowling she could expect to live another four years.

The first few years, Dowling was plagued by opportunistic viruses and bacteria to which her depressed immune system left her vulnerable. She contracted cytomegalovirus, which usually causes blindness and death. It disappeared without treatment.

"That's the grace of God," Dowling said. "I believe I was healed by a miracle."

The AIDS remained, however. She returned to San Rafael, where her parents live, in 1994. Soon after, she moved into a residential home in Santa Rosa, which she shared with five gay men.

"They told me I was Snow White and they were the dwarfs," Dowling said.

During the more than two years she lived there, dozens of men died and were replaced by other AIDS sufferers. Dowling nursed them the best she could, even though she herself was wasting away.

"It was like a dress rehearsal for me," Dowling said. "I'm watching these people die - when is it going to be my turn?"

Then in 1997, Dowling began taking protease inhibitors.

"Within days -it was like this cloud had lifted," Dowling said.

Dowling has been taking the protease inhibitors for eight years now. She lives with the knowledge that her body could develop a tolerance to the drug at any time.

"When is it going to stop working?" she asks herself. "How much longer do I have?"

For Dowling and others like her, nonprofits, such as the Marin AIDS Project and Community Action Marin, are nearly as essential as her medicine.

The Marin AIDS Project advises Dowling on how to apply for government assistance and serves as her advocate. It has also matched her with a volunteer, who gives her emotional support. Community Action Marin operates the HIV Pantry, which supplies food to people living with HIV and AIDS.

Government funding for such services in Marin declined this year. The amount of federal money was cut 15 percent to about $1 million, said Sparkie Spaeth, a manager in the county's Health and Human Services Department. State funding for AIDS prevention was reduced by about 33,000 to $131,645.

The legislation that authorized federal outlays to care for AIDS sufferers is up for renewal next year, said Randy Allgaier, a San Francisco official in charge of allocating Marin its share of the funds. There is concern that Congress will alter the Ryan White CARE Act so that federal money can no longer be spent on ancillary services such as case management, mental health and transportation, Allgaier said.

The number of people being diagnosed with HIV and AIDS in San Francisco and Marin has decreased over recent years, Allgaier said. But increases in sexually transmitted diseases, such as syphilis, cast a ominous shadow over the future, Allgaier said. That is because such increases usually coincide with increases in HIV infection, he said.

And the while the numbers are encouraging in Marin, the disease continues to rage throughout the rest of the world.

According to the United Nations, there were 35.7 million adults and 2.1 million children living with HIV at the end of 2003. During 2003, 4.8 million new people became infected with the virus. By the end of October, AIDS had killed 78,000 Californians.

Contact Richard Halstead via e-mail at RHalstead@MarinIJ .com

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