SAN FRANCISCO: Health Officials Predict New Wave of HIV Infection
After holding steady at roughly 500 new infections each year through the 1990s, San Francisco health officials are predicting that new HIV cases in the city will nearly double this year, to 900, the San Francisco Chronicle reports. "This is a harbinger of what is going to happen all over the country," Tom Coates, director of the University of California-San Francisco's AIDS Research Institute, warned, adding that trends in HIV usually start at the disease's U.S. epicenter. According to officials at the San Francisco Department of Public Health, the estimate is based on the increasing percentage of tests turning up HIV-positive at city clinics, which serve high-risk clients, as well as several "well-recognized warning signals." Data shows that the percentage of HIV-positive tests at these clinics reached 3.7% in 1999, up from 2.6% in 1998 and a low of 1.3% in 1997. "We are very concerned," San Francisco Department of Public Health epidemiologist Dr. Willi McFarland said, adding, "These are sub-Saharan African levels of transmission." McFarland said that in addition to the climbing infection rate, public health officials examined 11 indicators to forecast the "new wave of HIV infection." The researchers found that rectal gonorrhea rates increased from 1994 to 1999, climbing from 20 per 100,000 to 45 per 100,000; the proportion of gay men reporting consistent condom use dropped from 70% in 1994 to 54% in 1999; and the proportion of gay men having unprotected sex with more than one partner increased from 23% in 1994 to 43% in 1999.
Although the reasons for the upswing are complex, health officials point to HIV patients' weariness of lifelong drug regimens and a younger generation that has lost interest in the "safer-sex ethic." The San Francisco Chronicle reports that HIV patients who take "drug holidays," either by choice or as part of a clinical trial, may allow the virus to thrive and increase the chances of infecting someone else. In addition, data indicate that the "safer-sex ethic" has lost favor among young gay men, who have "let their guard down," eschewing condoms and "openly flouting" the safe-sex practices that helped stem the spread of HIV in San Francisco in the mid-1980s. A growing complacency among those at risk may also be fueling the epidemic. "We don't have the visual reminders of what it can be like to have HIV," Stop AIDS Project Program Director Steven Gibson said, adding, "When was the last time you saw someone with [Kaposi's sarcoma] lesions?" In light of mounting evidence that HIV prevention messages are losing their impact, experts said the "discovery of a resurgence in infections is more sad than surprising." According to McFarland, "We may have squandered an opportunity to extinguish this epidemic" (Russell, San Francisco Chronicle, 6/30).