SF DPH/CDC: HIV Epidemic Over or Endemic?
Debate on Nov 8
The Centers for Disease Control-mandated but S.F. health department-administered HIV Prevention Planning Council will debate whether HIV is at growing epidemic levels infections or at endemic rates, meaning HIV is stable and contained within a particular group of people.
Item number seven on the November 8 agenda for the HPPC guarantees a provocative discussion will take place:
7. Epidemic/Endemic: What do we think about HIV in San Francisco? (Discussion item)
Objective: To provide HPPC members with an understanding of the difference of the terms endemic and epidemic and to discuss the implications of the terms in San Francisco.
The presenter is Dr. Willi McFarland, SF DPH and UCSF researcher and epidemiologist who gained international infamy in June 2000 when he told the San Francisco Chronicle the city’s HIV infections were at sub-Saharan levels of transmission, an allegation he eventually retracted. At the time, the U.S. Congress was considering funding for San Francisco through the Ryan White CARE Act, millions of dollars were at stake, and McFarland had pretty flimsy data to back up his claims.
In order to help the HPPC members and local gay community in the epidemic versus endemic debate, I’m sharing some recent HIV testing data that must be an integral component to determining where we are in controlling HIV in America’s key city for the disease, with implications for other U.S. cities.
The most comprehensive and largest set of data comes from the Counseling, Testing and Referral (CTR) funded programs across the city, and from diverse health care settings; clinics, private doctor’s offices, community-based organizations, etc.
The latest CTR figures:
The number of tests performed impacts the rate of positive results, which are declining, suggesting San Francisco may have progress from epidemic to endemic five or more years back, and we may be well into a persistent drop of HIV infections.
Bear in mind that some of the people tested are repeat testers, already knew their HIV positive status when they were tested, and may be counted twice. The positive results, well under one thousand annually, in a city with an estimated 55,000 – 60,000 gay and bisexual male community, should be discussed further among sexually active men who have sex with men.
The recently released 2006 annual HIV/AIDS epidemiology report, in Table 1.3 on page 4, provides the following HIV positive test results, without the figures for tests administered. This set of data, not sourced by SF DPH, is probably the CTR numbers, updated by late-reporting laboratories and clinics.
From the new SF DPH HIV/AIDS epi report:
2002
832
2003
843
2004
788
2005
669
2006
406
As with the first set, this set is reinforcing the argument that HIV is really on a continuing downward trend.
Speaking of declining trends, the September 2007 quarterly AIDS surveillance report is out and shows full-blown AIDS cases and deaths still falling.
The current month STD report, through the end of August, in Table 3, testing at only one very important clinic, the STD control and prevention site on 7th Street, illustrates how monthly HIV positive results increases correspond accordingly when there is a jump in number of tests performed.
From the DPH monthly STD stats:
Year to date, August 2007
Tests: 3,392
Positives: 80
Year to date, August 2006
Tests: 2,037
Positives: 67
Putting aside tests administered and its influence, for both years, over eight months, San Francisco’s STD clinic saw less than 100 HIV positive results, which is a significant development.
The HIV and AIDS data must be examined in the larger context of STD numbers, so let’s start with the male rectal gonorrhea data. The 2006 annual STD summary, released last month, on page 2 reported the following:
“Gonorrhea in San Francisco was stable compared to last year with 2,413 cases and 2,469 cases in 2006. […] Male rectal gonorrhea increased by 6 percent from 486 cases in 2005 to 517 cases in 2006. This increase in rectal gonorrhea was due, in part, to increasing screening at Magnet, the gay men’s health center.”
Nice of DPH to admit testing rates, at least for male rectal gonorrhea, when increased, can drive up the number of infections detected.
The August monthly STD summary gives these numbers:
Year to date, 2006
389
Year to date, 2007
339
Fifty fewer rectal gonorrhea infections equals a 12% drop. I’d say, between the annual figures and the monthly stats, this STD, a prime marker for guessing safer sex practices among gay and bisexual men, safer sex is widely practiced.
Now, what about the syphilis rate? The annual STD report says this: “Syphilis cases of less than one year’s duration (including primary, secondary, and early latent cases) were stable with 427 cases in 2005 to 420 cases in 2006.”
So far, the monthly year to date syphilis rate is tumbling. Down from 364 cases in 2006 to 303 reported in 2007. This is a decline of 16%.
With HIV, gay gonorrhea and syphilis all dropping, the last thing I want to look at is the meth-related emergency room visits at SF General Hospital, from the monthly STD numbers.
There’s been a 13% decrease in such year to date ER visits. In 2006 through August there were 326 visits, compared to 284 in 2007.
All these drops, or increases that are attributable to more testing, are signs that San Francisco HIV/AIDS/STD/meth ER visits point to effective control and prevention of serious public health problems.
Will the HPPC discussion this Thursday acknowledge these facts and offer positive reinforcement to the gay and bisexual male community for this, as it debates whether we’re in an epidemic or endemic phase?
Show up at 3:00 p.m. on November 8 at the Quaker Meeting House, 65 Ninth Street, near Mission, and participate in the debate.
93% of all domestic STD infections, excluding HIV, are among those who have MSM. We all know that STDs increase the risk of HIV infection. However, many STDs seem to be between seroconcordant individuals, but the operative term is "seems."
ReplyDeleteEpidemiology, all other facts aside, suggests that safe sex is not being practiced and anecdotal experience validates that impression. Within the last year, men in their 20s have had multiple STDs, while claiming no seroconversion. This can and does happen, but probability suggests quite the opposite.
Meanwhile, those who work with PWA have noticed a significant increase in inquiries from outside the area looking for section eight housing and other social welfare perks under the assumption that queer San Francisco offers unlimited benefits to those who are seropositive. The impression left is that some individuals believe HIV is a disability card to a life without work, responsibility, and state support.
Finally, many within the "mental health" professions and services are recommending service groups provide "nonjudgmental" approbation for those who engage in high risk behavior, under the theory that structural homophobia is the cause of such aberrant behavior and must not be seen as anyway judgmental. So, a meth-using, unsafe-sex individual who presents him/herself to community support should not receive any advice, only nurture of their risky behavior as "understandable" with such oppressive social structures and systematic homophobia. They point to the idea that "injection rooms" for serious drug users creates a healthy and positive response in light of obvious homophobia.
Unfortunately, such perceptions are leading some on the right, and even in the center, to collect evidence that MSM are deliberately using the "system" for victimhood 101. That may wash with the Twisted Sisters and their Lap Boy enablers, but outside the queer oasis it presents serious adverse publicity of deliberate and massive irresponsibility in order to live-off the dole, get laid, and spread contagion. Coddling self-destructive behavior by some of our "community programs" with their "nonjudgmental" approach to harmful and injurious behavior does not "sell" outside queercity.
Like all vicious stereotypes, this one may be vicious, but it seems to have gone beyond "stereotype" into "typical" of S.F.'s MSM. We might all do well to remember not everyone -- including GLBT -- is tolerant of deliberately destructive behavior, and with the wellspring of it occurring in Pelosi's own playground, not to mention her Lap Boy's inducement of "transgressive" pornographers, may get her re-elected, ply her constituents with hand-outs, and our Ted Haggard of a mess mayor kept in office, but operatives see a golden opportunity to "tie together" a community that cannot even help itself, and in many instances, promotes the worse in our ideals of human nature.
As a pioneer in Gay Liberation who lives now in NYC observed to me personally: San Francisco's indulgence of drug-crazed, lazy-ass, sex-a-holics, with all the open transgressive porn this city's major is proud to hold he brought up from the sewers of Los Angeles, may sell in queerdom, but it will be used against the gay community, democrats, and the extremist political class that sent them to congress -- and voted to confirm Bush's torture-ambiguous nominee: That the Twisted Sisters tipped their hat in Bush's favor, vis-a-vis detainee torture and rendition, will coalesce and come back to haunt whoever the Democrats nominate as the rankest hypocrisy. And the Sisters exploitation of queer exploitation of the public dole is right along with it.
If I were at all politically savvy, I would urge our community to "duck and cover," but our community has already been captured in the Michael Powers, Gavin Newsom, and Kink Haven slice of life. Don't be surprised to "see" it used against us. Don't be surprised to see Ryan White funds evaporate.
HIV in its nascent days has public empathy; anyone can be vulnerable to an accident; but the stats suggest MSM are bilking the "system" with their politicians' knowledge, and there is NOTHING the Twisted Sisters won't do to keep their political base. As you may have noticed, Democrats' control of Congress has not had a SINGLE effect on any significant policy matter -- and outside the Bay Area, people are as pissed at Nancy and her Twisted Sisters as they are at Bush. Didn't Feinstein join her AIPAC devotees to confirm Bush's attorney general -- against their party, against their country, and with Feinstein's equivocation -- against self-interest. The Twisted Sisters will figure prominently in the country's election of a Republican to succeed the most failed presidency in U.S. history. Wait for the caricature that won't look overdrawn.