HIV Cases Up For Fifth Straight Year,
Alarming City's Health Officials

SAN FRANCISCO -- HIV infection rates are up for the fifth year in a row and reported cases of syphilis have risen from just 20 two years ago to 249 this year, San Francisco public health officials announced today. Officials estimate that more than 1,000 San Franciscans will contract HIV this year, joining nearly 9,000 residents living with the virus.

In an annual report to the city's Commission on Public Health today, the San Francisco AIDS Office outlined the statistics behind the AIDS epidemic, the prevention strategies and services the public health department has employed to stem the spread of HIV and the health services available for those living with HIV.

While AIDS cases have been on the decline in San Francisco since they peaked in 1992, the HIV infection rate has been increasing, particularly among gay men in their late 20s to early 30s who also inject drugs, the report says.

This data contradicts conventional wisdom that very young gay men -- those in their late teens and early 20s - are largely responsible for the increase in HIV infections, said Dr. Sandra K. Schwarcz, an epidemiologist with the AIDS Office.

City health officials are unable to say with certainty why the HIV infection rate has climbed steadily since 1997. Yet, they believe an increase in unsafe sex between gay men, complacency with the decades-old safe-sex message, and the availability and success of anti-retroviral drugs to treat HIV positive patients have had an impact.

An increase in sexually transmitted diseases often occurs with a rise in the HIV rate, city health officials said. Most of the syphilis cases are among gay men and that is a "good indicator of unsafe sexual behavior," said Dr. Schwarcz.

The data reveal another troubling trend with respect to AIDS, HIV and race. African-Americans are disproportionately represented among those with HIV and AIDS in San Francisco. In 2001, the HIV rate among African-American women was four times higher than it was among women on any other racial group.

African-Americans with AIDS are less likely to survive than other ethnicities and the predominantly African-American Bay View-Hunters Point neighborhood has the lowest rate of anti-retroviral drug therapy use of any neighborhood in the city.

The statistics have prompted the city AIDS Office to devote more prevention resources to the African-American community, including $180,000 in the current fiscal year to fund two new prevention programs targeted at young gay men and an additional $90,000 for a program operating within the San Francisco jails and state prisons.

James Loyce Jr., Deputy Director of Health for AIDS Programs, said his office has to craft new messages to reach this population of young men who don't identify as gay or bisexual although they have sex with men. The "Miss Ellie" campaign, the first of its kind in San Francisco, features a poster of a middle-aged African-American woman dressed in her Sunday best. Her message is simple: "Honey, your secrets will kill you."

Loyce hopes that by avoiding overt references to homosexual behavior and by using the image of a benevolent mother figure, the campaign will help change behavior with regard to condom use and HIV testing.

In October Mayor Willie Brown convened a regional summit of public health departments, community organizations and AIDS activists from San Francisco, Alameda, Contra Costa and San Mateo counties to develop strategies to address the AIDS epidemic in the African-American community. The group will hold it's third meeting on December 17.

The report did contain some good news. New AIDS diagnoses and deaths continue to decline across all racial, gender and behavioral risk groups. HIV transmission among heterosexual drug users remained stable, infection among pregnant women is low and transmission between heterosexuals is rare, the report said.

However, officials said that cuts in federal funding along with projected state and local budget shortfalls will hamper the AIDS office's prevention efforts and health services, just as the growing number of people living with HIV in San Francisco increases the need for such services.

"The pot is getting smaller all over and that's the scary part," said Health Commissioner Lee Ann Monfredini.