Subject: CDC's Intelligence Arrives in San Francisco
From: [email-masked]
Date: Wed, 1 Sep 1999 14:28:45 EDT

The CDC's Intelligence Arrives in San Francisco
By Michael Petrelis
Phone: 415-621-6267

Presented to the SF Health Commission
August 31, 1999

I never thought a one-line warning from Bette Davis in "All About Eve" would
give me perspective over an alleged syphilis outbreak among San Francisco gay
men cruising AOL chatrooms, but it has.  Davis advises guests at her party to
"Buckle your seatbelts, it's going to be a bumpy night."  She then proceeds
to ensure the evening is funereal.

My updating of that movie classic would cast Gwenn Hammer, PhD, in the title
role and she could utter the immortal line, that would apply to the events in
July 1999 leading up to an alert issued to health care providers and the
media about syphilis among gays.  Who's Hammer, anyway?

The answer begins on July 29 when Dr. Jeff Klausner, director of the SF health
department's sexually transmitted disease control branch, began distributing
a one-page alert.  "In the past four weeks, we have identified four cases of
early syphilis among white gay male residents of SF who report meeting the
majority of their sexual contacts through internet chat rooms," the statement
claimed.  It seemed strange Klausner was rushing this alert out to the press
and public without offering an ounce of scientific proof to prove his
assertions.

    As I perused gay city health chief Dr. Mitch Katz's report included in
the minutes of the August 3 SF health commission meeting the following
paragraph sharply caught my attention.  "A Centers for Disease Control (CDC)
Epidemic Intelligence Service (EIS) Officer Gwenn Hammer, PhD, has been
assigned to the San Francisco STD program for a two year period, from July 1,
1999 to June 30, 2001.  She is an epidemiology, occupational health and safety policy
expert, who will be working with the STD, HIV and CD Sections on outbreak
evaluation and response, and long term primary prevention studies."

Hmmmm.  Hammer arrived in town at the start of July and before the month was
over, a syphilis alert had been declared.  A mere coincidence?  Probably.  No
need to get suspicious, but skepticism was certainly called for in wondering
why the CDC would assign an EIS officer to San Francisco right before an
outbreak.

I was more intrigued by the Epidemic Intelligence Service reference, which
brought to mind Cold War spy novels.  In all of my years as an AIDS activist
I had never come across the EIS acronym before.  Every reporter and colleague
I asked if they knew about this program said no.  Except members of ACT
UP/San Francisco, who knew about the EIS and had grave concerns.

Klausner happily sent me a twelve page memorandum of understanding between
him and Dr. Laura J. Fehrs, chief of the epidemiology program office of the
EIS.  Fehrs wrote that Hammer, among other duties, was responsible for
sending monthly reports to her superiors, without any personal identifiers to
better protect the confidentiality of ill persons Hammer was coming in
contact with in the field.

Convinced Hammer's July report would have substantial data about the syphilis
cluster alert, I phoned Fehrs in Atlanta to request a copy.  She declined to
speak with me, but her aide told me to call Doug Hamilton, MD, director of
the EIS.

During a 30 minute telephone interview Hamilton gave me much background on
the EIS training program within the CDC.

    "The EIS was established in 1951 as the eyes and ears of the CDC.  EIS
provides the opportunity for officers to learn practical applied epidemiology
in a structured two-year program," he said.

"Dr. Klausner, head of your STD control branch out there is an EIS graduate,"
Hamilton said.  "In December, Dr. Klausner submitted a single page request
for an EIS graduate to train with him.  That request was shared with all
members of last year's EIS class for their consideration.  Obviously, Gwenn
Hammer read and liked the proposal."

But how and when did Klausner and Hammer meet to agree on her assignment to
SF, I asked.

"We hold a session in April at the CDC that's akin to a campus pledge week.
Health officials from around the country travel to Atlanta to meet EIS
graduates.  This year's session is where Klausner met Hammer, and they must
have liked each other because she is now in the field out there under
Klausner's supervision.  Hammer takes orders from Klausner, not the EIS back
at CDC," explained Hamilton.

In conclusion, Hamilton claimed Hammer's July monthly report "would be dry,
technical and probably not have any data about the syphilis outbreak in it.
You'll have to file a FOIA [Freedom of Information Act] request for that,
anyway."  He gave me the CDC's FOIA officer's name and phone number, I called
her and await a reply.

Hamilton mailed me an EIS promotional brochure touting the importance of EIS
related to the discovery of AIDS in America.  "In 1981, an EIS Office
assigned to the Los Angeles county Department of Health Services was involved
in the identification of the first cluster of cases of the acquired immune
deficiency syndrome (AIDS)," the pamphlet notes.  How is it the EIS has never
come across my AIDS radar screen before?

I found all this background fascinating, but it wasn't bringing me any closer to the
definitive data I sought about the syphilis cases.  Hammer phoned me last
week to say Klausner was considering my request that he publicly present his
data.  She said she couldn't mail me any proof about the syphilis cases.

While all of the news stories were circulating about the syphilis outbreak, I
inquired again with the health commission about the three-month delay in
releasing the comprehensive annual STD report for 1998.  In the first week of
June 1998 Klausner distributed the 1997 annual report on time.  The HIV
Prevention Planning Council (HPPC) asked Klausner at their August meeting
when the new report would be ready.  According to the minutes "Jeff responded
that the annual report should be available in October of 1999."  Note the use
of the word "should."  I won't be holding
my breath Klausner will have the report available then.

The importance of the annual STD report can't be overstated, in my opinion,
because it is a feature length movie in terms of data collected, analyzed and
then used to set public health policies.  Versus a monthly STD report, equal
to a snapshot really.  Heck, the monthly STD reports always conspicuously
features a bolded box with the proceeding caveat.  "Note: All statistics are
provisional until the annual report is released for the year."  Unless, you
have a syphilis outbreak and you need to shift resources and personnel away
from preparing the annual
report and instead focus on an alleged outbreak of syphilis, right?

The problem with thinking the annual STD report is tardy because the health
department was stretched thin handling the syphilis outbreak is that the
report should have been available in June, a full month before the outbreak.
What valid reason is there for delaying release of the annual report?

This juncture seems an ideal spot to point out confusing policies seemingly
at odds here.  On one hand, the STD branch wants all monthly data to be
"provisional" until they have had adequate time to evaluate it over the
course of a calendar year.  However, the STD officials on the other hand
believe their new syphilis cluster data warrants breaking that "provisional"
rule.  Why bother loudly repeating the warning monthly only to ignore it at
whim?

And what is one to make of this epilogue from Sir Josiah Stamp cited at the
very end of the annual summary for 1997, authorized by Klausner?  Is Klausner
the watchman putting down only what he wants to see?

"The government [is] extremely fond of amassing great quantities of
statistics.  These are raised to the nth degree, the cube roots are
extracted, and the results are arranged into elaborate and impressive
displays.  What must be kept ever in mind, however, is that in every case,
the figures are first put down by a village watchman, and he puts down
anything he damn well pleases."

If the STD branch indeed can prove this gay cluster of syphilis cases was
contracted from sex partners met over the Internet, it may demand
extraordinary precautions and warnings be adhered to.  But where is the
scientific evidence that launched this never before seen type of STD warning?

To further confuse the situation, the week after the syphilis alert was
issued, results from a statistical model study were printed in a scientific
journal, comparing unsafe oral sex against unsafe anal sex between gay males.
 The SF health department's AIDS Office, specifically Dr. Susan Buchbinder,
designed the study.  I called her assistant Paul O'Malley not to ask for a
copy of the study, since it had been actually conducted years ago, but to
request a copy of the protocol for a current similar study, Project Explore.

This new multi-city cohort study is recruiting HIV negative gay men to
compare different behavioral interventions and how well HIV prevention
counseling works today.  The protocol for Project Explore contained this
nugget that sent my mouth south to the floor.  "Syphilis is not included as
an endpoint in this trial due to its current low prevalence among MSM [Men
who have Sex with Men]. . . Tabet, S.; Krone, M.; Paradise, M.; et al.
Herpes, the most common STD in a cohort of high-risk HIV negative men who
have sex with men.  Abstract, XI International Conference on AIDS, Vancouver,
1996."

Needless to say, I had to read this citation in full, so I looked it up in
Abstracts, Vol. 1, Vancouver, July 7 -12, 1996.  It's on page 164, column
one.

This study researched gay men from the Seattle area, no year given.  "The
median age of the . . . participants was 32 years, and 85.9 percent were
caucasian," the abstract reads.  "Of 499 results available . . . four
participants were seropositive to syphilis, of whom three had been previously
tested."  The four men with syphilis in this trial didn't register even as
one percent when compared with how many had positive results for herpes.

Even though this study was presented more than three years ago, it is the
exclusive argument made to exclude syphilis testing from the Project Explore
study, launched in 1999.

If the researchers behind Project Explore wish to expand their trial to now include
syphilis testing, because of the alleged outbreak, they will first have to
convince the Institutional Review Board (IRB) overseeing the study, then also
convince the Community Advisory Board (CAB) to revise the protocol.  If that
happens, I will insist both the IRB and CAB first hold public meetings to
share their definitive data to amend the protocol and began testing
participants for syphilis, at additional cost.

We must require these boards show actual clinical proof this syphilis
outbreak has been real and is the basis for syphilis testing during the
course of Project Explore.  Vague one-page alerts and hysterical
advertisements from Klausner should not be considered valid scientific
evidence.

The primary reason why Project Explore is happening can best be summed up in a
statement from Michael Ahearn, the Clinical Coordinator of the trial, in the
April 29 Bay Area Reporter.  Ahearn believes "this study is crucially
important since Explore could provide a potent case for funding of more and
enhanced prevention counseling."  Gee, I bet just like the prevention we get
in studies like Project Explore, right?  Or do I get three guesses?

The results of the study won't matter much in the end.  The researchers and
prevention workers will say the same three little words they always say after
one of these studies hits the papers, "Use a condom."  Or their other three
favorite words:"Give us funding."

Which brings me back to AIDS, the number one reason why we have all of these
issues to confuse us.  Practically every aspect of AIDS and gay sexuality in
San Francisco is seen through a prism constructed in a crisis mentality no
longer pertinent today.  Yet, one fundamental building block in this
makeshift crisis structure is the bathhouse issue and it incredibly can
explain an enormous amount about what is wrong with our approaches to AIDS
and STDs among gays in SF today.

The draconian prohibition against private spaces for gay men in public
bathhouses has been unconscionably maintained for fifteen years and was
reaffirmed by Katz in a July 28 letter to the HPPC.  "I appreciate that there
is no definitive data to support or refute my position.  It is not unusual in
public health to lack definitive data," Katz again boasted.  In other words,
no science is no problem when designing policy related to gay sex.

For fifteen years San Francisco has not been required to produce science to
explain the bathhouse ban.  The health department simply feels it would be
best to deny gay men sexual privacy in public bathhouses.  With that in mind
is it any wonder I am highly skeptical of the alleged syphilis cluster?
Certainly not.  Under the framework of bogus argumentation for restricting
the civil liberties and sexual expression of gay males, it is a sacred duty
to demand full honest scientific proof a syphilis outbreak among gays may
have occurred.

Keep in mind, the day after Katz reminded the HPPC of his data deficiency,
Klausner issued his first syphilis warning, perhaps also deficient in the
data department.  It doesn't take a master's degree in public health to
theorize Katz's scientific and intellectual laziness may have found a match
in Klausner and how he deals with gay sex.

In the end, I think the bureaucrats ensconced within all branches of the SF health
department, especially the gay ones, are incapable of even forming a cabal,
never mind carry out some grand conspiracy to demonize gay sex.  However,
just stirring up fear about gay sex virtually guarantees funding flows from
many sources and money drives the health department tank in this city.  It
also makes sense in a Keystone Kops clumsiness that a heterosexual, Klausner,
would aid the gay bureaucrats and lead the syphilis scare.

Finally, I plan to keep my seatbelt securely fastened during the remaining 22
months of EIS officer Hammer's tenure here.  If her first two months in town
are any indication of what to expect, it will be a barrage of conflicting
statistics, ugly ads in the B.A.R., few facts, buckets of ink, further
demonization of gay sexuality, increased HIV and STD prevention and testing
dollars from the CDC, and a huge magnifying glass examining every orifice of
any sexually active gay man in this town.

It may be a bumpy two-year night for us under the EIS's prying eyes, but one
day a new assertive gay skepticism will dawn.  And health officials of all
stripes won't know what hit 'em when it does.  We also should have the
definitive data by then, finally explaining this alleged syphilis cluster.

---------------------------------------------------------------------------

From: [email-masked]
Date: Thu, 9 Sep 1999 13:14:47 EDT
Subject: Re: CDC's Intelligence Arrives in San Francisco

REPLY FROM MICHAEL AHERN AT S.F. DPH:

Date:   99-09-08 15:14:13 EDT
From:   [email-masked]
To: [email-masked]

     Michael:

     Changes in the Explore protocol since December, 1998 include  a change
     in the age of eligibility from 18 down to 16.  A minor change was made
     to the provisions we have for remote HIV-Ab testing:  The test was
     changed from one brand to another.

     There are no changes in the
     protocol related to syphilis or syphilis testing at all.  In San
     Francisco, participants can elect, at their option, to get a test for
     syphilis.  This is a public health service and not part of the Explore
     study.

     Mike Ahern