Petrelis Files

The Latest HIV Rate For San Francisco

The San Francisco health department normally releases the latest HIV rate for the city in January, but not this year. Why? The answer can be found in the minutes of the January 2006 HIV Prevention Planning Council meeting:

> "Tracey Packer [head of HIV prevention for DPH] explained that at the first meeting of each year Willi McFarland, MD, PhD, usually reports on the most recent epidemiology data. This year, however, he is updating the consensus report through consultations with a number of people working on HIV/AIDS. The consensus report is used to prioritize populations for HIV prevention. Willi McFarland will present consensus estimates to the HPPC for its response and finalize the numbers after this meeting." (HPPC 01/06 minutes, page 2.)

Previous epidemiology updates can be found here: 2005, 2004, 2003.

Now you may think the DPH is only starting the 2005 HIV consensus report process, but it actually began seven months ago. From the San Francisco Chronicle story of July 20, 2005, about a big drop in HIV infections:

> City officials therefore are expected to convene within a month a panel of experts to consider lowering San Francisco's official estimate of annual HIV infections -- which would signal that the feared second wave of the epidemic detected in 2000 has crested without a return to the ghastly infection rates of 8.5 percent in the early 1980s. [...]

> At the forthcoming HIV "consensus conference" in San Francisco, experts will consider at least 11 different indicators that the city regularly uses to track the course of the epidemic.

The question arises of why San Francisco is taking a rather long time to develop the latest HIV infection rate consensus report. One possibility is that DPH fears officially reporting the current rate because it's decreasing or stable, and that means less federal funds coming here through the Ryan White CARE Act.

Starting in FY 2007, new regulations for Ryan White funds will allocate funds based on valid HIV infection data, instead of only using full-blown AIDS caseload stats, as has been the case in the 1990s. California presently lacks an HIV names reporting law, but that is expected to change very soon in order for the state to qualify for Ryan White grants at or near current funding levels.

Frankly, San Francisco's DPH and AIDS service organizations have much to worry about with new federal requirements demanding better HIV and AIDS stats, which, honestly, have been shamefully manipulated by the health department over the years to artificially inflate the numbers for increased funding.

For example, up until last July, San Francisco quietly counted non-residents of the city in its AIDS data. Last year's annual HIV/AIDS report contained a letter explaining that the city had included people with AIDS from surrounding areas in the stats, but this practice was ending to give a more accurate picture of actual caseloads for San Francisco. (2004 S.F. HIV/AIDS Report, page 12.)

Another example of how cities like San Francisco and states like California have pumped up federal grants in by double counting stats, something that should be eliminated in the Ryan White legislation. A press release last year from the Department of Health and Human Services, while not specifically citing this city or state, clearly laid out the problem:

> Currently, in major metropolitan cities, AIDS cases are counted once as part of a city count and a second time in the overall state count. Therefore, HIV/AIDS cases in major metropolitan cities are counted twice. In an effort to ensure that every AIDS case is counted equally and to make sure that Federal funds are distributed fairly to those most in need of assistance, we must eliminate this double counting.

We all know Congress is gearing up for reauthorizing the Ryan White CARE Act in the coming weeks and with billions of dollars at stake, many local and state health departments, along with AIDS groups, are going to fierce fight for pieces of the funding pie.

My one bit of advice for members of Congress to bear in mind when evaluating San Francisco's HIV and AIDS stats is that they demand independent verification of whatever numbers are presented. San Francisco and our health department should not be allowed to again get away with false claims of "sub-Saharan levels of [HIV] transmission" just to keep federal dollars flowing here, while other harder-hit parts of the country are denied their fair share of AIDS funds.