WAIT, THERE’S MORE

The other studies are just as weak. One looks at men who get anonymous HIV testing at public clinics. This, as the study’s authors delicately put it, “may not be representative of the community” as a whole. No kidding. The sample sizes are also all over the place. The number seeking testing in 1996 was 3,488. In 1998 that number was 2,910. In 1999, the number fell again to 1,826 – a vast difference in sample size, and one that should set off alarm bells in drawing easy conclusions from one year to the next. The inference that transmission rates have increased is based on a new sort of biological analysis that can tell whether HIV infection is recent or not. Sure enough, more recently infected people are showing up at STD clinics. But what do these numbers tell us? They tell us that many fewer men are being tested than in the past and many more of them have been infected recently. One obvious conclusion from this is not an increase in HIV-transmission. It is that most gay men in San Francisco have already been tested for HIV and know their status. But those who may recently have had an unsafe incident or accident are the ones most likely to get tested. This is certainly just as plausible an explanation for the increase in incidence of HIV and a shrinking number of testers as an alleged outbreak of new HIV transmission. In the only study where the sample size seems to be increasing – for gay men showing up at STD clinics – the rate of HIV transmission is basically stable. In 1995, with a sample of 634 men, 5.8 percent showed up HIV-positive. In 1999, with a sample of 1,071 men, the rate had dropped to 4.7 percent. I’m sorry, but that isn’t an explosion. To my mind, the only truly worrying sign in all the data is the number of rectal gonorrhea cases. This is a real number, since, unlike HIV, gonorrhea infections must be recorded by law. These are clearly rising, suggesting a declining use of condoms. The number has risen from 97 cases in 1995 to 160 cases in 1999 and 93 cases in the first six months of 2000. But this may not be evidence of HIV-transmission. Why? Because two HIV-positive men could transmit gonorrhea through unsafe sex, but not transmit HIV – because they both already have it. Another study shows that the rate of STDs among people with AIDS has doubled in five years, suggesting that unsafe sex may indeed be primarily an issue between HIV-positive people, not a means of HIV-transmission. The bottom line is: the case for a doubling in HIV-rates in San Francisco is simply not proven. If it’s happening, these studies don’t prove it. And journalists who trumpet the fact would do well to read the studies before broadcasting the executive summary.