HIV Infections in SF May Be Dropping but More Must Be Done

On Wednesday, July 20, readers of the San Francisco Chronicle were greeted with good news on HIV infection rates in San Francisco. The front page headline read: "Large drop reported in HIV cases in S.F. -- Feared second wave of infections appears to have crested." As we approach the 25th year of the first documented AIDS case, we at the San Francisco AIDS Foundation are heartened by indications that infection levels may have stabilized and possibly dropped. But we have also urged caution because even if this proves to be accurate and ongoing, infection levels still remain unacceptably high.

The impetus for this news report was a study conducted by the U.S. Centers for Disease Control and Prevention (CDC) on the infection status of gay and bisexual men in five U.S. cities. This study found that among the men sampled and tested in San Francisco, only 1.2% had been recently infected, a significant drop from rates previously found in past studies of this population in which new infection rates were found to be more than 2%. If the 1.2% proves to be accurate and the rate stays at that level, we will have reached endemic infection levels, meaning that there is a consistent and stable rate of new infections. The upside of this phenomenon is that the number of people infected with HIV is not increasing exponentially. However, new infections at any rate will continue to impact our community negatively.

So, what does all of this mean for our community and for our work here at the San Francisco AIDS Foundation? First, this suggests that our efforts to prevent new infections are having an impact. Gay and bisexual men in San Francisco are clearly taking many steps to protect themselves and others from HIV. Public health and prevention leaders speculate that these lower infection levels are partly the result of men of similar sero-status selecting each other as partners, also known as sero-sorting (e.g., HIV-positive men choosing other positive men). These particular strategies have evolved from men developing their own "harm reduction" strategies to reduce risk. We applaud efforts by all individuals to reduce or eliminate risk behavior that would cause the transmission of HIV.

Despite these positive trends, we do appear to have a constant stream of men who are becoming infected. We must, therefore, re-think our approaches to the care of people with HIV disease as well as the prevention strategies to reduce new infections. This includes the need for an enhanced focus on the factors that are driving new HIV infections, such as the use of crystal methamphetamines and mental health issues among gay men, including isolation and depression. As described in our front page feature, the AIDS Foundation's prevention programs are changing and growing to address these issues. And we are continuing to assess these issues internally to develop even more cutting-edge approaches to help reduce infection rates in our community.

At the same time that we are retooling our prevention efforts, we must also recognize that HIV has evolved increasingly into a chronic disease, and that a growing number of people are living longer lives with the disease. Advocating to protect the rights of those living with HIV/AIDS and to maintain funding for critical, supportive services continues to be a top priority for the AIDS Foundation. Unfortunately, some of the proposals released by the Bush Administration on the reauthorization of the Ryan White CARE Act could have a disastrous impact on San Francisco's system of care. Our policy staff are working tirelessly to ensure that the CARE Act is reauthorized in a manner that does not decimate San Francisco's capacity to serve those in need in our community.

I extend my deepest thanks to those of you who have supported the San Francisco AIDS Foundation in our work. Please join us in our continued efforts to re-think, innovate and provide leadership to contain and end the HIV pandemic. I invite you to send me your thoughts on this subject. You can reach me at feedback@sfaf.org or at the San Francisco AIDS Foundation, 995 Market Street, Suite 200, SF, CA 94103.