Petrelis Files

January 20, 2005
Bay Area Reporter
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San Francisco HIV cases continue to plateau
by Matthew S. Bajko

San Francisco's HIV epidemic has stabilized, and health officials reported this month they expect the trend to continue through at least 2007, if not longer. The leveling off is a turnaround from the late 1990s through 2001, when HIV incidence had a resurgence.

It also makes San Francisco unique, in that the country as a whole saw new HIV/AIDS diagnoses increase by 3.2 percent between 2001 and 2002. While health officials reported a slight increase among heterosexual cases and a decrease among injection 2002 numbers, San Francisco ranked 12th, falling behind Washington D.C. and Memphis.

"San Francisco has gone from being one of the most severely affected cities in terms of AIDS incidence to population to now having fallen to 12th. The leading cities have more injection drug users and heterosexual infections," explained Dr. Willi McFarland, director of the HIV/AIDS statistics, epidemiology, and intervention research section at the city's Department of Public Health. "It's not all good news, it's mixed. HIV incidence has leveled off, but at a rate that will continue to increase the number of MSM living with HIV."

As the city prepares to conduct its HIV consensus estimate this year ñ the last one was conducted in 2001 ñ the number of people living with HIV or AIDS is expected to stay about the same at 12,786. The number of new annual HIV infections, which had been 748, is expected to be "a little lower" said McFarland.

The numbers are a double-edged sword for the numerous AIDS agencies that work to maintain the successes San Francisco has achieved in battling the disease over the last two decades. Federal dollars that support AIDS and HIV care follow the epidemic, meaning San Francisco's piece of the funding pie is likely to continue to shrink.
America's AIDS epidemic is moving into the South, what some health officials are dubbing the "AIDS belt."

Among the top 10 cities for AIDS incidence in 2002, Miami ranked second, Baton Rouge ranked third, West Palm Beach came in fifth, Fort Lauderdale sixth, New Orleans seventh, and Columbia, South Carolina placed eighth.
Sitting in first place was New York City, an 800-pound gorilla when it comes to federal AIDS funds. Last spring, when San Francisco lost nearly $4 million in Ryan White CARE Act funding, local health officials said the drop was partly due to New York securing more funds than in years past.

In what has become a yearly report for the city's HIV Prevention Planning Council, McFarland presented the latest data and his predictions for where the city's AIDS epidemic is headed at the group's first meeting of the new year on January 13. He offered several reasons as to why health officials' fears in recent years of a resurgence in HIV have not panned out.

Their fears stemmed from rises in other sexually transmitted diseases, including syphilis and male rectal gonorrhea, both of which spiked upwards in 2000 and have continued to climb ever since. Both STDs can be a predictor for rises in HIV, for carriers are more susceptible to contracting the virus. But McFarland said that has yet to happen in San Francisco due to serosorting.

"We have seen an increase in STDs and unprotected anal sex and not have had HIV go up. This is due to networks of only positive men having sex with positive men and negative men only being with negative men," said McFarland. "If you separate out positive men, risk behavior has gone down since 2001."

The number of both positive and negative MSM reporting unprotected anal sex with a partner of the opposite serostatus has fallen in the last three years. But among men of the same HIV status, the number reporting unprotected anal sex has shot up since 2002. However, McFarland cautioned that serosorting might not be a viable HIV prevention strategy.

"It may not be a strategy over the long term that may be stable. How long will people choose someone of the same status?" he said.