Petrelis Files

SF DPH Cuts AIDS Cases by 11%

Dr. Mitch Katz
Director
Department of Public Health
101 Grove Street
San Francisco, CA 94102

Dear Dr. Katz:

Your latest annual AIDS epidemiology report, for 2004, was posted to the DPH web site last week and I am very concerned about the way in which you've reduced the number of full-blown AIDS cases by almost 11%.

In the "Dear Colleague" letter of the report, the following caveat is given.

"Beginning in 2005, publications of our data were changed to include only persons who were residents of San Francisco at the time they were diagnosed with AIDS. Prior to this change, our reports also included persons who were diagnosed with AIDS at a San Francisco medical facility, but who were residents elsewhere at the time of their diagnosis.

"We have decided to exclude non-San Francisco residents from the data presentations because AIDS case reporting practices result in our having a complete count of San Francisco resident with AIDS, but an incomplete record of non-San Francisco residents with AIDS. In order to provide consistent AIDS surveillance data, our surveillance quarterly and annual reports will include only reports of persons diagnosed with HIV or AIDS who were residents of San Francisco at the time of their diagnosis." [1]

That is quite a shift in counting AIDS stats and I believe a fuller explanation is needed as to why exactly you've implemented the changes in surveillance now, instead of say last year or ten years ago.

The 2004 report's executive summary states 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." [2]

Literally overnight you have cut the AIDS caseload by nearly 11%, raising many questions.

First, why was the city counting diagnoses for those who live elsewhere in the San Francisco surveillance in the first place?

Was the inclusion of the non-residents legal? I will check with lawyers about this question.

While I applaud you now coming clean about who's counted in local AIDS stats, I still must ask why have you never told the public about how our caseload included non-residents?

Considering millions of federal dollars were directed to San Francisco based on the AIDS caseload, were federal officials aware of the padding DPH did to the AIDS numbers?

As you well know, Congress will reauthorize the Ryan White CARE Act this year, which will bring an estimated $29 million to the city based on our AIDS caseload. How does the 11% reduction factor into the reauthorization process and will the city now lose 11% in CARE Act funding because non-residents are no longer counted in the San Francisco AIDS stats?

Other than publishing information and revised downward AIDS stats in the 2004 report, which many reporters and funders and members of the public will never read, how will you spread the word about the 11% reduction?

Let's expand the questions to include matters related to other AIDS stats, along with figures for other sexually transmitted diseases and the surveillance for them.

Are your AIDS mortality stats also inclusive of non-residents? If they are, what is the percentage of San Francisco AIDS deaths for non-residents?

Because California irrationally rejects HIV names reporting, we both know any attempt to gather, evaluate and interpret HIV infections is not easy.

Nevertheless, given all the limitations of tracking new HIV transmission with the Unique Identifier system, have you in the past and are you now including new infections among non-residents? If yes, can you give the percentage of new HIV infections for folks who live outside San Francisco, but are counted in our stats?

Now, regarding syphilis cases and male rectal gonorrhea diagnoses for the city, which overwhelmingly occur among sexually active gay men, are those numbers for only San Francisco residents, or are gay men from other areas included in those stats? Again, if they are, what is their percentage of the total numbers for these STDs?

Given your disclosure on the 11% reduction of AIDS cases, I feel it is my duty to ask friends to be deeply skeptical of any and all HIV/AIDS/STD data from you and the DPH. Your inability to make it know sooner that the city's AIDS stats weren't just for residents of San Francisco raise another import matter.

What else are you keeping from public knowledge and view about how you count all things related to AIDS?

I respectfully request a prompt reply.

Sincerely,
Michael Petrelis

Sources:
1. SF DPH 2004 AIDS report, page vii.
2. SF DPH 2004 AIDS report, page viii.