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Thursday, January 25, 2001 | Print this story

HIV Rate Rising Among Gay Men in S.F.
Health: The figure has more than doubled since 1997. Data indicate safe-sex practices are being abandoned, officials say.

By JOHN M. GLIONNA, Times Staff Writer

     SAN FRANCISCO--The rate of HIV infection among gay men in San Francisco has more than doubled since 1997, alarming local and national health experts by suggesting a breakdown in safe-sex practices that for years had helped stabilize the city's HIV rate, officials said Wednesday.
     According to preliminary data collected by a panel of two dozen researchers and AIDS experts here, the rate of new HIV infection among gay and bisexual men is 2.2%, up from 1.04% in 1997. The infection rate among gays who use drugs is even higher at 4.6%, up from 1.99% in 1997.
     Experts believe the upswing coincides with the increased use of such highly effective drugs as protease inhibitors, whose success may have had the unintended effect of encouraging both infected and uninfected men to engage in more high-risk sexual behavior.
     "With people living longer lives under new therapies, the risk pool for infection is increasing," said Sandy Schwarcz, director of AIDS surveillance for the San Francisco Department of Public Health.
     "But what makes the problem worse is there seems to be less concern of acquiring HIV among people who don't already have it--they're not as fearful as they once were when getting AIDS was clearly a death sentence. They see people with the disease living what appear to be normal lives, and many may be letting their guard down when it comes to safe sex."
     Since 1996 and the increased use of such drug cocktails as highly active anti-retroviral therapy, HIV-infected men once confined to home are feeling well enough to resume normal lives. Many are becoming more sexually active, returning to such risky behavior as unprotected sex.
     "People are lowering their guard," said Willi McFarland, director of the HIV seroepidemiology unit of the San Francisco health department. "They're telling researchers they're having more sex with people they know have HIV and with those [whose status] they don't know."
     Since San Francisco is often regarded as a guidepost to gay practices nationwide, officials are paying special heed to the findings. "Things happen here first," said McFarland. "We're a bellwether for sexual activity among gay men."
     The San Francisco researchers were surprised to find that HIV infections had increased among men between 25 and 35.
     "We thought we'd find the rise in young men who are just learning, those who hadn't gotten an effective enough message about safe sex," said Steven Tierney, director of HIV prevention for the city's health department. "But these new HIV sufferers have been around a while. Many probably came out some time ago. They're people who practiced safe sex for a while and grew tired of it."
     Another ominous sign, the researchers said, is that gay men are contracting more sexually transmitted diseases.
     Between 1997 and 2000, the number of male rectal gonorrhea cases in San Francisco rose 44%, from 129 to 186, statistics show.
     "When an HIV-infected person gets an STD, they're going to shed more of the virus, which makes them much more dangerous," said Schwarcz. "We're also seeing STD infections in the general population in San Francisco going up."
     Federal health officials said the rise in the number of sexually transmitted diseases among gay men in San Francisco mirrors a disturbing national trend. Rates of sexually transmitted diseases among gay and bisexual men are on the rise in such cities as Los Angeles, New York, Chicago, Seattle and Miami.
     "We're all concerned about what's going on in San Francisco," said Robert Janssen, director of the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention in Atlanta.
     "The data from San Francisco is compelling evidence that there are increases in risk behavior among gay men that seem to be going on in other cities as well. And this could ultimately lead to higher rates of HIV incidence, which we're all concerned about."
     In Los Angeles, new syphilis cases among gay and bisexual men soared more than 1,680% from 1999 to 2000, rising from only five cases to 89. During 2000, an outbreak of cases occurred in Hollywood and West Hollywood, possibly originating during the millennium celebrations.
     In the same period, rectal gonorrhea cases among gay men rose 71%, going from 58 to 99 cases, statistics show.
     Health officials said 70% of the new syphilis patients among gay men were being treated for HIV infection when they contracted the disease. "These are people who should have known better--this is a marker for the rise in unprotected sex," said Peter Kerdt, director of the STD control program at the Los Angeles County Department of Health Services.
     "These numbers suggest a breakdown in prevention efforts for people who are HIV-positive. Why are they going out and having unprotected sex and exposing themselves to syphilis? Why the sudden rise in this destructive behavior, such as engaging in sex with anonymous partners?"
     San Francisco health officials have reorganized their prevention efforts with a new advertising campaign--"HIV Stops With Me"--that they hope will reach a new generation of gay men living with hyper-effective AIDS therapy.
     "We're searching for a message that's more [relevant] for the current environment," said McFarland. "It's no longer enough just to say 'use a condom.' Now we're telling people to think about who you're having sex with. Know your status. Know your partner's status."
     This year, San Francisco health experts estimate that there will be 892 new HIV infections among gay men, far fewer than in the 1970s and '80s, when several thousand people each year were becoming infected.
     "Still, we're really, really concerned by this," Schwarcz said. "We want to see HIV infections go down, not up."
     The infection statistics, part of a draft report scheduled to be released in several weeks, are the result of of more than two dozen San Francisco-based studies conducted by researchers into such areas of sexual risk behaviors as condom use and unprotected anal sex.
     "I think it's safe to say that things are not going in the direction we'd like them to go in," said McFarland.
     In 1997, he said, officials had achieved probably the lowest rate of HIV transmission in years. "Then, as an unfortunate byproduct of these new treatments, we've had some serious new risk behavior that is apparently undoing any benefit of the new treatments," he said.
     "Are we worried? Absolutely."

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