HOW THE SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH TURNS A 30 PERCENT DECLINE IN HIV INFECTIONS AMONG GAY MEN INTO A TWO-FOLD INCREASE
By David Rasnick
I have examined a relatively minor study from the San Francisco Department of Public Health, which was carried out in collaboration with the UCSF AIDS Health Project and the Stop AIDS Project (1), to see if one of its conclusions is consistent with the evidence contained in the Department’s own statistics. The March 2002 study states that the fraction of gay men who have antibodies to HIV doubled since 1996 (from 2.1% to 4.2%) (1). However, the Health Department’s own statistics show that there was actually a decline in new HIV infections. Unfortunately, the abuse of statistics by Katz et al. is not unique. It is just the latest example of researchers, health officials and community representatives manipulating their own data to make alarming points.
The 4.2% HIV infection rate for gay men at anonymous testing sites in 1999 cited by the researchers is indeed true and can be located in the HIV testing and counseling document, which is compiled and published by the SF DPH, with funding provided by the Centers for Disease Control and Prevention (2). The HIV Counseling, Testing, Referral and Partner Counseling and Referral Services (CTR/PCRS) report for 1999 noted that there were 4,118 anonymous visits, and that a total of 2,439 HIV tests were performed of which 102 were HIV positive (4.2%) (2). However, in the CTR/PCRS report for 2000 the researchers state that there were 4,526 anonymous visits, and 2,791 tests for antibodies to HIV were administered of which 83 were HIV positive ( 3.0%) (3).
So even though there was a surge in the number of visits (up 10%) and the number of tests (up 14%) in 2000, the HIV rate in fact fell significantly, plummeting from 4.2% in 1999 to 3.0% in 2000, while at the same time the blinded HIV rate was not going up. But if you only relied on the Katz et al. study or news accounts you would never learn about the drop of the HIV infection rate. Why isn't the drop of the rate of HIV infections acknowledged and discussed?
The release of the SF DPH study generated fairly typical stories at gay online media sites. There were no challenges to the allegations being put forward by the Katz et al. study. The only “community” voice in print is from the CDC-funded Stop AIDS Project under the headline: “Study: Drug advances propel unsafe sex,” that appeared on Gay.com February 27, 2002. What evidence does Gay.com share with readers to back up the claim by Katz et al. that “unsafe sex” is rising? Gay.com offers this: “[A]t least one other sexually transmitted disease is on the rise. According to the study, the number of cases of rectal gonorrhea in the city rose from 72 in 1994 to 160 in 1999. The disease generally hits “bottoms” -- men who are on the receiving end of anal sex."
Annual STD statistics are among the easiest things to locate at the SF DPH web site, and should be read by all reporters who cover AIDS issues, if only because the health department’s HIV programs are constantly making news. One would expect Gay.com to check out the latest annual STD report for San Francisco (4) and either verify or debunk the increases of male rectal gonorrhea, and to inform readers of any mitigating reasons behind the upsurge in cases.
These critical facts and numbers from the SF DPH annual STD report for 2000 were left out of the Gay.com story: “In response to the city-wide increases seen in 1996, we began testing more men who have sex with men (MSM) seen at City Clinic for rectal gonorrhea. Much of the increase in cases since 1996 is due to this increased screening: the number of cultures increased from 571 to 1399, while the proportion of cases found decreased from 8.9 percent to 8.4 percent” (4). There was actually a slight reduction in gonorrhea among gay men in San Francisco.
The online gay press is also guilty of failing to tell readers its one person quoted as a community representative, Steven Gibson of the Stop AIDS Project, is an author of the Katz et al. study, which makes him a guilty party to this faulty research on the sex lives of gay men and HIV rates. Gibson, as expected, does not raise any doubts about the research.
San Francisco health officials have an extra special responsibility to be accurate and fully informative on the latest statistics, when they present their numbers in a study, which may have far reaching influence beyond the city’s borders. And gay news outlets, online and in print, should look upon it as a duty to look at every study from the San Francisco health department in the larger context of all available data from the department that is at one’s fingertips on the agency’s web site.
What legitimate reasons could the health department have for concealing a significant drop in HIV infections in gay men at select testing sites? The answer may lie in the minutes from the San Francisco Health Commission’s December 18, 2001, meeting. The head of the health department’s AIDS Office presented an annual report to the commission. According to the minutes, “[t]he AIDS Office budget is more than $78 million, and sources are the General Fund, Federal funds and grants, State funds and private foundation grants.” (5)
Thus, there are at least 78 million reasons why the health department may need to be creative with its studies and findings. While it is understandable that the city wants to keep up its AIDS and healthcare budget, the desire for that funding should not be a license to turn a substantial decline in HIV infection among gay men into a two-fold increase.
David Rasnick, Ph.D.
Dept. Molecular & Cell Biology
University of California at Berkeley
Berkeley, CA 94720
1. Katz MH, Schwarcz SK, Kellogg TA, Klausner JD, Dilley JW, Gibson S, McFarland W (2002): Impact of highly active antiretroviral treatment on HIV seroincidence among men who have sex with men: San Francisco. Am J Public Health 92: 388-94.
2. Source: www.dph.sf.ca.us, CTR/PCRS Reports,Data for 1999 by Behavioral Risk Population, page 11
3. Source: www.dph.sf.ca.us, CTR/PCRS Reports,Data for 2000 by Behavioral Risk Population, page 11
4. Source: San Francisco Transmitted Disease Annual Summary, 2000
5. Source: http://www.dph.sf.ca.us/HCMinutes/HCMin01/HCMin121801.htm