PHONY HIV STATISTICS

HOW THE SAN FRANCISCO DEPARTMENT OF HEALTH TURNED A DECLINE IN HIV INFECTIONS AMONG GAY MEN INTO A TWO-FOLD INCREASE

By David Rasnick, Ph.d

David Rasnick is a visiting scientist in the Department of Molecular and Cell Biology at the University of California at Berkeley

 

April 25, 2002 - 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 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 has been a decline in newer HIV infections. Unfortunately, the abuse of statistics at the department 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 from 4.2% in 1999 to 3.0% in 2000. But if you only relied on the study by Katz and his colleagues 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 study. In print (at Gay.com) the only community comment came from the CDC-funded, Stop AIDS Project, headlined: "Study: Drug advances propel unsafe sex." And what evidence does Gay.com share with readers to back up the claim by Katz that unsafe sex is rising? Gay.com offers this:

"At 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.

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 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 meeting on December 18, 2001. The head of the health department’s AIDS Office presented an annual report to the commission. According to the minutes, the AIDS Office budget is more than $78 million, coming from 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 decline in HIV infection among gay men into a two-fold increase.


References:

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: CTR/PCRS Reports,Data for 1999 by Behavioral Risk Population, page 11
3. Source: CTR/PCRS Reports,Data for 2000 by Behavioral Risk Population, page 11
4. Source: San Francisco Transmitted Disease Annual Summary, 2000
5. Source: www.dph.sf.ca.us/HCMinutes/HCMin01/HCMin121801.htm