Subject: SF DPH minutes: People less frightened of HIV, infection rates
From: [email-masked]
Date: Mon, 17 Jul 2000 13:19:15 EDT

Web link:
<A HREF="http://www.dph.sf.ca.us/">SF health department</A> 

http://www.dph.sf.ca.us/HCMinutes/HCMin00/HCMin070500.htm 
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Minutes of the Health Commission Meeting
   --[Excerpt]--

Wednesday, July 5, 2000
3:00 p.m.

101 Grove Street, Room #300
San Francisco, CA 94102

POPULATION HEALTH AND PREVENTION

Last week both local and national press attention was focused on a study 
conducted by the Seroepidemiology & Surveillance Branch of the San Francisco 
Department of Public Health AIDS Office. The study was based on using a new 
technique called detuning to identify HIV antibody positive blood samples 
from persons who have recently seroconverted. 

The testing from the anonymous testing sites (ATS) showed that the HIV 
incidence among men who have sex with men (MSM) increased from 1.3 in 1997 to 
2.6 in 1998 to 3.7 in 1999. This is an almost tripling in the HIV incidence 
rate. 

The data are important because we and other health departments have reported 
for some time now increases in the rate of male rectal gonorrhea and 
increases in reports of unsafe sex. 

There are limitations of the data. Although we saw significant increases in 
HIV incidence among the HIV counseling and testing participants we did not 
see similar increases among MSMs seen at the STD clinic during the same time 
period. 

The STD sample was smaller and we are currently investigating differences in 
the sampling that may explain these differences.

There are many hypotheses as to why there is more unsafe sex behavior. These 
hypotheses include people are less frightened of contracting HIV/AIDS because 
of the improved treatment; people are fatigued from several years of HIV 
prevention efforts; increases in substance use among MSM are fueling the 
epidemic; and, younger MSMs have not fully heard the HIV prevention message.

The problem with all of these explanations and others offered is that sexual 
behavior is an extremely complex issue. No one thing determines why people 
have safe or unsafe sex. 

Two immediate risks from such data are that people will blame men who have 
sex with men for being irresponsible or they will blame HIV prevention 
efforts for not being effective. Neither is an appropriate response.

Gay men have been hard hit by the epidemic, psychologically, socially, and 
spiritually, by the loss of so many persons. Were it not for the existing HIV 
prevention efforts it is quite possible that infection rates would be even 
higher in San Francisco. 

Nonetheless, because the advent of protease inhibitors and triple combination 
therapy have profoundly changed the HIV/AIDS landscape we do need to think 
more about what are the most effective methods of prevention in these times. 
I expect that there will be more releases of data like this one at the Durban 
International Conference and subsequently. 

I will be working with researchers like Drs. McFarland, Schwarcz, Buchbinder 
and our HIV Prevention Section headed by Steve Tierney to forge an 
appropriate response to this data. I will keep the Commission fully apprised.

Dr. Mitch Katz, Director
SF DPH
                                                         *   *   *

AGENDA
HEALTH COMMISSION MEETING

July 18, 2000
3:00 P.M.

at
101 Grove Street, Room #300
San Francisco, CA 94102

THE CONSENT CALENDAR ON THIS AGENDA WILL BE CONSIDERED BY THE BUDGET 
COMMITTEE OF THE COMMISSION AT 2:00 P.M. THE HEALTH COMMISSION WILL ACT ON 
THOSE ITEMS OF THE CONSENT CALENDAR, WHICH HAVE BEEN RECOMMENDED FOR APPROVAL 
BY THE BUDGET COMMITTEE.

PUBLIC COMMENTS WILL BE TAKEN FOR EACH AGENDA ITEM.

[Ok, I will be there. And I my three minutes of public comment will be 
devoted to asking that a seat on the HIV Prevention Planning Council be set 
aside for proponents and practioners of barebacking. The HPPC is a $10 
million CDC funded enterprise, encompassing many agendas and agencies, 
including the Sisters of Perpetual Indulgence.
I hope to see you at the SF Health Commission meeting on Tuesday. --MP]

================

Michael Petrelis
 <A HREF="http://www.aids-statistics.com/">Welcome to AIDS-STATISTICS</A>
www.AIDS-statistics.com 
2215-R Market Street, #413
San Francisco, CA 94114