New cases of HIV in San Francisco dipped nearly 10 percent in the last five years, marking the first drop in infections since the late 1980s, according to preliminary estimates from the city’s Department of Public Health.
“It looks like we’re on the waning side” of this wave in the epidemic, said department epidemiologist Willi McFarland. “Certainly, the job is not done.”
The findings, issued last week by a city often considered a bellwether for HIV trends among gay males, came as somewhat of a surprise.
Although the change in absolute numbers, from an estimated 1,084 cases in 2001 to 976 in 2006, isn’t huge, San Francisco’s gay male population has increased 25 percent in that period, McFarland said. Also, increases in syphilis – often transmitted through unprotected sex – and studies showing high-risk behavior among young men seemed to predict a resurgence in HIV.
The department was forecasting an increase by perhaps as much as 33 percent, McFarland said.
“This is great news. We’re making progress,” said Mark Cloutier, executive director of the San Francisco AIDS Foundation. “But I think it is both bad planning and bad public policy to look toward the future based on a (short-term) trend. We don’t know how long this will last.”
He and others cautioned that the estimated decrease was moderate, especially compared with the plunge in cases two decades ago. And although overall rates seem to have dropped, nonprofit workers and health officials say rates for black and Hispanic men who have sex with men continue to rise.
The reasons for the apparent decline in San Francisco are unknown, but many are pointing to a relatively new community-based effort known as “sero-sorting” – a practice of engaging in sexual activity only with partners sharing the same HIV status. The practice can be informal but is becoming more common on gay-oriented Web sites such as Poz.com, which offers personal ads for HIV positive men and women.
Some AIDS activists said the old approaches to prevention weren’t working. The message the nonprofits were sending – “Don’t ever, ever have unprotected sex” – were met with a certain amount of fatigue in the community, said Robert McMullen, director of the nonprofit Stop AIDS Project.
“We are now telling people, ‘Whatever you do, you have to have an effective strategy,’ ” McMullen said. “That strategy would include things such as sero-sorting.”
Medications that substantially reduce viral load and needle-exchange programs for drug users at risk for the disease, could also help explain the decrease, McMullen said.