AIDS cases in San Francisco are down – at least right now. That's the good news. The bad news is that the number of cases in San Francisco very likely will increase over the next six months, and that's because there is a significant reporting delay by hospitals, doctors, and clinics that submit their case information to the Department of Public Health. Nevertheless, as we report this week, the latest Quarterly AIDS Surveillance Report released by the health department through June indicates that there have been only 205 reported cases of AIDS so far this year, and that of those, only 43 were diagnosed this year.
Yet it's been a challenge to get officials from AIDS service organizations and HIV prevention agencies to comment on these latest AIDS statistics. We certainly understand – and reported – that these new numbers DO NOT mean that AIDS is over, or that AIDS cases will dramatically decrease this year. You cannot simply double 205 to predict AIDS cases for the rest of the year, for example. And that is not what we're saying and it's not what the health department report is saying. What these quarterly reports represent, however, is a snapshot of the epidemic at certain periods throughout the year. We know that numbers will continue to come in that will be added to the 2006 figures, and even the 2005 figures because of the reporting delay. But why the skittishness on the part of AIDS and HIV prevention agencies? Aren't they happy the numbers are down? Don't they want the epidemic to end?
That point may be somewhat debatable. Longtime AIDS activist Michael Petrelis stumbled across minutes from a July 13 meeting of the HIV Prevention Planning Council, in which "some members expressed concern that as numbers go down, we lose funding accordingly." We were somewhat dumbstruck by that comment. Aren't lower numbers of HIV infections and lower numbers of AIDS cases what we all want? Isn't the goal of AIDS service organizations to actually go out of business once their services are no longer needed? We hope that day comes, but we fully understand it's a long way off. Until there's a cure for HIV, there will always be a need for prevention agencies.
There's another angle to this news. Jeff Sheehy, the mayor's AIDS policy adviser, told us that these days, with the current HIV medications available, most people shouldn't be progressing to full-blown AIDS. It's a "failure of the system," he said, when someone is diagnosed with AIDS. "We ought to look at each AIDS case as a failure," he said, meaning that people aren't being treated, perhaps because they lack health insurance, do not have stable housing, or other factors.
"Any number of AIDS cases is something to worry about," he said. "We have a good arsenal of antiretrovirals if people have access."
And there's the medications themselves. HIV medications require that patients take them consistently. While a few missed does of current drugs may be tolerable but is not desirable, the new once-a-day medication Atripla may mean that if someone misses one dose, it can dramatically reduce the adherence percentage. That's something else to consider as patients begin the new medication.
In the meantime, the trend in San Francisco is encouraging. The lower number of AIDS cases, combined with what officials believe will be a decrease in HIV infections, is an indication that work at some prevention agencies, such as the Stop AIDS Project, is paying off. Executive Director Robert McMullin told us that the surveys and other work Stop AIDS is doing may be helping gay and bi men reduce their use of crystal meth, which has been shown to increase the likelihood of acquiring HIV.
Years ago, when we started looking at "AIDS Inc." and made it a policy to report the annual salaries of executive directors when they were hired at an agency, it was because we firmly believed that our readers, many of whom are living with AIDS, as well as donors to these causes, had a right to know how the millions of dollars these organizations received were spent. We still believe that. So instead of fretting about decreasing public and private funds if HIV cases decrease, we suggest that those in HIV prevention and AIDS work continue to reduce administrative overhead so that more funds can be spent on programs that so far, at least, have begun to show results in San Francisco.
Instead of reluctance on the part of officials to talk about these numbers, why not hold a town hall meeting to put the figures into context for people? It seems to us that knowledge is power, and the community would definitely benefit from informed discussion.