From: MPetrelis@aol.com Date: Fri, 30 Jun 2000 19:18:49 EDT Subject: AIDS is endemic in SF; CDC informed of downsizing from epidemic Dear friends: On Thursday, June 29, I entered a copy of the full minutes from the SF Ryan White council into the public record during the proceedings of the Centers for Disease Control and Prevention's Advisory Committee on HIV and STD Prevention. Copies were also provided to all members of the committee and the thirty people sitting in the audience. I also read aloud choice excerpts from the minutes and asked committee members to call Willi McFarland, MD, chief HIV/AIDS epidemiologist for the SF Department of Public Health, and ask him for his evidence proving HIV/AIDS is no longer at epidemic proportions, and that AIDS is now endemic in San Francisco. BTW, here is the Merriam Webster on line definition of the word endemic. "en*dem*ic [1] (adjective) [French endemique, from endemie endemic disease, from Greek endemia action of dwelling, from endemos endemic, from en in + demos people, populace -- more at DEMAGOGUE] First appeared 1759 1 a : belonging or native to a particular people or country b : characteristic of or prevalent in a particular field, area, or environment 2 : restricted or peculiar to a locality or region <~ diseases> synonym see NATIVE -- en*dem*i*cal*ly (adverb) -- en*de*mic*i*ty (noun) -- en*de*mism (noun)." --MP] ================ Minutes of April 24, 2000 San Francisco HIV Services Planning Council (Ryan White CARE Act Council) 1540 Market Street San Francisco, CA 94102 Ph: 415-556-9000 [Excerpt] SF DPH Epidemiology Report Willie McFarland made a presentation entitled "Status of the HIV/AIDS Endemic in the HAART Era: San Francisco 1995-2000." The purpose was to characterize who is now living with AIDS, living with HIV, and newly infected with HIV in order to present an accurate current snapshot of the HIV crisis. The presentation gave information on how the era of new treatments has impacted the epidemiology of HIV. The number of new infections has been remaining approximately the same each year. The peak of HIV infection was in the early 1980s, and the period from infection to AIDS diagnosis was then calculated to be about 10 years, therefore the peak of AIDS incidence figures was in the early 1990s. He noted that the decline in AIDS incidence started in 1993, even before the time period identified by HAART. The number of new diagnoses is now leveling off at close to 500 per year. Next, he noted deaths from AIDS reaching a plateau in the early 90s, followed by a drop in deaths from 1995 on. This corresponds with an increase in use of HAART, which went up sharply in '95. At least four to five years of survival time have been added as a result of using HAART. Whites have achieved these gains before African Americans and Latinos. There are now greater numbers of San Francisco residents living with AIDS than at any prior point in the epidemic. Of the people with HIV, about half of them have an AIDS diagnosis and half do not. Therefore, the best way to get an estimate of the overall numbers of HIV infected people at this point in time is to double the numbers of diagnosed AIDS cases. That formula leads health planners to an estimate of 17,196 people living with HIV or AIDS in San Francisco; up from the 1997 figure of 15,000. The epidemic here is overwhelmingly male, with 94%. He used maps of San Francisco to portray the distribution of cases by census tract for each population group and transmission category. Finally, he analyzed the statistics for HIV seroconversion by race/ethnicity, gender and transmission category. The highest rates of conversion now are for men who have sex with men and use injection drugs, for men age 25 to 35, and for Latinos using anonymous testing sites. He presented the following conclusions: HIV/AIDS is endemic in San Francisco. That is, a balance exists among the factors of prevention, treatment, survival, behavior, immigration and other social/demographic factors. HIV/AIDS will persist in San Francisco's severely affected communities for some time to come. This dynamic balance may not last because there are indicators of increasing risk. The studies show definite benefits from treatment. On the individual level, survival time continues to improve. On the community level, treatment probably suppresses transmission. Brief questions and comments followed the presentation.