(from 7/1/00 N.Y. Times) H.I.V. Cases Jump in San Francisco

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H.I.V. Cases Jump in San Francisco By LAWRENCE K. ALTMAN

from H.I.V. Article

A small but sharp rise in new infections with the virus that causes AIDS has been detected among gay men in San Francisco over the last three years, San Francisco health officials said yesterday. The estimated number of new infections in San Francisco nearly doubled to 900 last year from about 500 three years ago after having stabilized following aggressive prevention campaigns.

The rise is deeply troubling because it was seen in San Francisco, one of the principal centers of the AIDS epidemic that was first detected in 1981. Thus, the rise could signal a new wave of infections there and elsewhere, San Francisco health officials said. San Francisco, New York and Los Angeles were the three cities where AIDS was first recognized. An estimated 6,000 new infections with H.I.V., the virus that causes AIDS, occurred in San Francisco at the peak of the epidemic there in 1982.

San Francisco health officials linked the rise to a trend toward riskier sexual behavior that has been noted in a number of cities over recent years.

Dr. Michael H. Katz, the director of the San Francisco Department of Public Health, said his was the first city to make such a link directly. "One might have assumed it," Dr. Katz said, "but until this report, it was not documented by data."

Dr. Ronald O. Valdiserri, an AIDS expert at the federal Centers for Disease Control and Prevention in Atlanta, said his agency had not reviewed the San Francisco findings. But, if confirmed, the findings "are very serious and important," Dr. Valdiserri said in an interview.

Dr. Valdiserri said he did not "want to be alarmist about a national resurgence" of H.I.V. But, he went on, "we have been trying to sound the alarm about the misperception that the AIDS epidemic is over and not an issue any more."

The Atlanta diseases centers, which are responsible for tracking AIDS nationally, estimate that about 40,000 new infections with H.I.V. will occur this year in the United States.

The new information from San Francisco "is very sobering and I hope it gets the attention of policy makers," Dr. Valdiserri said.

The rise was detected by using a new test developed by the C.D.C. that allows health workers to distinguish between recent H.I.V. infections and those that were acquired months to years ago, San Francisco health officials said in interviews.

When San Francisco health officials learned about the new testing strategy, they moved quickly to apply it in a number of testing sites, said Dr. Willi McFarland, the head of infection surveillance for the San Francisco Department of Public Health. They are known as anonymous testing sites because they provide testing without identifying individuals. Dr. McFarland said that his team used the new test among individuals found to be infected at these sites each year.

The strategy involves testing the infected blood twice, using both a sensitive and less sensitive method. The body forms antibodies against H.I.V. and other infectious agents, and such antibodies tend to be elevated in the blood during the first few months after infection. Thus, individuals infected recently are likely to test as positive on a sensitive test but negative on a less sensitive test.

The test is becoming a powerful new tool for epidemiologists tracking the AIDS epidemic, health officials said.

Other cities are using the test in various ways. San Francisco apparently is the only city that has applied the testing strategy in a series of years so as to detect trends, Dr. Katz said.

Last year, the San Francisco team published an article in the Journal of Acquired Immune Deficiency Syndromes showing the validity of the method for such purposes. Those tests of infections detected from 1996 through 1998 did not show a worrisome trend, however.

It was only when the team tested the 1999 cases and analyzed the information to focus on gay men that the researchers saw the trend toward higher H.It.V. incidence, Dr. Katz said.

Infection rates from earlier than 1996 could not be obtained because samples had not been stored for such purposes, Dr. Katz said.

The H.I.V. incidence among gay men at the anonymous testing sites nearly tripled to 3.7 percent per year in 1999 from a low of 1.3 percent in 1996.

The rise was seen only among gay men, Dr. McFarland said, noting that his department has not detected a single new H.I.V. infection in a male heterosexual who is not a drug user, only one in a female and a small number of injecting drug users.

Health officials have noted a number of signs that early warning signs for H.I.V. were going in the wrong direction. They included a decline in reported use of condoms on a consistent basis; an increase in reported unprotected anal sex; and an increase in sex with multiple partners.

Although the rates of other sexually transmitted infections like gonorrhea and syphilis are at or near record lows, they have risen in certain areas. Syphilis rates have increased in San Francisco and Los Angeles, and gonorrhea rates have increased in Seattle, the health officials said.

"That is what makes this important," Dr. Katz said. "it is the first report to link new infections to higher unsafe sexual behavior."

The new information is to be presented at the 13th International AIDS Conference in Durban, South Africa, on July 11. It was announced yesterday after an embargo against releasing the data prematurely had been broken, Dr. Katz said.

-- eve (eve_rebekah@yahoo.com), July 01, 2000


Same topic, different news source posted two threads down: Health experts say the safe-sex message is no longer getting through - Surprize, Surprize!

-- Ain't Gonna Happen (Not Here Not@ever.com), July 01, 2000.

Sorry about the duplication.

-- eve (eve_rebekah@yahoo.com), July 01, 2000.

Oh hurry, lets get those same sex marriages legalized so we can all help pay for the new explosion of AIDS cases. Im sure the rump rangers will be thrilled with the HMO version of treating AIDS. I know, I'm such a bigot. Who but a bigot would be upset about financing the medical costs created by two 'men' butt-fuckin' each other. I'll try to do better, NOT!!

-- Ra (tion@l.1), July 01, 2000.


-- al-d. (dogs@zianet.com), July 02, 2000.

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