Petrelis Files

HHS Must Audit S.F.'s AIDS Stats

Daniel R. Levinson
Inspector General
Dept. of Health and Human Services
Room 5541 Cohen Building
330 Independence Avenue, S.W.
Washington, D.C. 20201

Re: Audit request of San Francisco's AIDS statistics

Dear Mr. Levinson:

Millions of federal dollars flow to San Francisco thanks to the Ryan White CARE Act, which is administered through the Health Resources and Services Administration for the care and treatment of people with AIDS. The HRSA allocations are primarily based on the AIDS caseload and number of deaths recorded by AIDS epidemiologists at the city's Department of Public Health, but serious questions about the validity of AIDS numbers here must be addressed by a federal investigation by your office.

There are several reasons why I request that you audit San Francisco's AIDS statistics, which I list here.

1.
The executive summary for San Francisco's 2004 AIDS epidemiology report states that the "cumulative total of 29,056 AIDS cases were reported through 2003 last year; the new count of resident-only cases through 2004 is 26,110." [1]

The DPH has reduced the AIDS caseload by almost 11% because it is ending the practice of counting non-residents of the city in the number of AIDS cases diagnosed here.

This reduction raises two important questions. Has San Francisco been receiving a disproportionate amount of HRSA funds, based on DPH's padding of the AIDS caseload? And, will HRSA decrease the city's allocation of Ryan White CARE Act money because of the reduced caseload, and instead shift the dollars to a city where AIDS cases are rising?

2.
The city's 2004 AIDS report shows the following declining figures for AIDS deaths over the past ten years, for which data are available:

1994
1584

1995
1475

1996
982

1997
413

1998
395

1999
352

2000
340

2001
319

2002
311

2003
215

2004
203
[2]

To many people, the downward numbers reveal a steadily decreasing rate of AIDS mortality. However, the executive summary says, "The stability we are witnessing in this phase of the epidemic is not good news; 500 new cases and 400 deaths each year translate to considerable morbidity and mortality in our city."

We're witnessing declines, not stability, which is characterized as bad news, and the city has thankfully not seen close to 400 AIDS deaths since 1998, according the DPH data. The rhetorical claims are not matched by the figures.

3.
Without explanation, the cumulative number of AIDS deaths for San Francisco has mysteriously fallen.

The DPH's 2003 annual AIDS report said a total of 19,616 people had died of the disease in the city since the epidemic began. But the 2004 surveillance report lists 17,610 cumulative deaths from AIDS for the city. [3, 4]

Frankly, I've never heard of any local health department lowering its cumulative AIDS death statistics, by nearly 10%, without a full and detailed explanation why.

My biggest fear is that San Francisco's AIDS epidemiologists have been cooking the statistics to artificially raise the numbers in order to win more in federal grants, to the detriment of other cities with more AIDS cases and deaths, not to mention better and more genuine AIDS epidemiology.

I've enclosed a copy of Michelle's Cochrane's new book, "When AIDS Began: San Francisco and the Making of an Epidemic," for your consideration in deciding how to audit the city's AIDS figures. [5]

"When AIDS Began" is a detailed account of how AIDS epidemiology for the city was developed, the political and financial machinations behind the surveillance, the suppression of data showing HIV and AIDS declines over the years stretching back to at least 1990 by DPH, and the deliberate skewing of data to increase government grants to the city's coffers.

After reading the 2004 DPH surveillance data and executive summary, in addition to "When AIDS Began," I believe you, as Inspector General for Health and Human Services, must carry out an audit of San Francisco's AIDS diagnoses and mortality figures to determine how valid and accurate they are, before Congress and HRSA use the statistics in awarding San Francisco federal dollars for AIDS programs here.

In closing, I ask that you immediately launch a federal audit into the ways in which San Francisco counts AIDS cases and deaths, evaluate the honesty and integrity of the epidemiology, and ask if any city officials have knowingly manipulated data for purposes of federal funding streams.

Sincerely,
Michael Petrelis

Sources:
1. SF's 2004 AIDS report , page viii.
2. SF'S 2004 AIDS report , page 62
3. SF'S 2003 AIDS report , page 13
4. SF's 2004 AIDS report , page 16
5. SF Public Library catalogue listing for "When Aids Began"