New HIV Infections
Soar In San Francisco
SAN FRANCISCO (Reuters) - San Francisco health authorities are reporting a sharp jump in new HIV infections, marking the start of what many doctors fear is a dangerous new stage in America's AIDS epidemic.
City health officials estimate that, after years of relative stability thanks to aggressive prevention programmes, safer-sex publicity and new drug treatments, new HIV infections in San Francisco doubled to 900 in the past year.
"We see in San Francisco what is going to happen next in the epidemic. We saw the first AIDS infection, and now we're seeing the first rise in new infections," Dr. Thomas Coates, director of the AIDS Research Institute at the University of California-San Francisco, said Friday. "This should sound a warning bell for the rest of the country."
Health officials blame the rise in part on the success of earlier AIDS prevention and treatment efforts, which have combined to make the disease seem less threatening for many gay men.
Doctors said the San Francisco data, derived from city clinics that provide anonymous testing for the virus which causes AIDS, was the first to illustrate a direct link between new HIV infections and an increase in risky behaviour which experts have tracked over the past five years.
San Francisco, known around the world as a gay capital, became one of the first centres of the AIDS epidemic in the early 1980s, when as many as half the gay men in the city were believed to be infected with HIV. Since 1981, more than 18,000 San Franciscans have died of AIDS.
Quick action by the city's gay community and public health officials also made San Francisco a model for the fight against AIDS, pushing new HIV infections down from an estimated high of 6,000 in 1982 to a fairly steady 500 per year throughout most of the 1990s.
The estimated total for 2000, however, is between 800 and 900, with gay men accounting for about 575 of the new HIV infections, according to Dr. Willi McFarland of the city's Department of Public Health.
More alarming still, the percentage of HIV positive cases turning up at anonymous testing centres nearly tripled between 1997 and 1999 to reach 3.7 percent -- a level comparable to some areas of sub-Saharan Africa.
The testing centres are seen as an early warning system for the rest of the city because they serve a higher-risk clientele than in the general population.
Doctors say the soaring rate of HIV infection, while alarming, is no surprise. They have tracked a similar rise in risky behaviour as new AIDS drugs have made the disease seem less threatening.
The proportion of gay men in San Francisco who reported always using a condom during sex fell from 70 percent in 1994 to 54 percent in 1999, and the proportion who said they had unprotected anal sex with more than one partner grew from 23 percent in 1994 to 43 percent in 1999, health officials said.
Rates of rectal gonorrhea in the city have risen from 20 per 100,000 in 1994 to 45 per 100,000 in 1999.
Health policy officials said Friday that the data clearly illustrated the need for continued outreach and AIDS prevention efforts among gay men in San Francisco -- although some cautioned that the city's data could not necessarily be interpreted as marking the future course of the AIDS epidemic in other U.S. cities.
"The statistics very clearly point to a well-defined target population, and a particular behavioural pattern. This is a trend that can certainly be contained," said Rene Durazzo, director of programmes at the San Francisco AIDS Foundation.
Unlike many other U.S. cities, San Francisco has not seen a notable rise in HIV infections among women, and its needle-exchange programme has helped to keep new infections among intravenous drug users relatively low, Durazzo said.
"People have to look at their own individual epidemics and do their homework about what is going on in their own cities," Durazzo said. "But what this tell us is that this epidemic is far from over, and it is not time to shift resources elsewhere. Otherwise, we are setting ourselves up for another wave of infections, and huge loss and death."
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