Public health officials stress the importance of testing because treatment with antiretroviral drugs may prevent new infections by reducing the amount of virus in the body. (Credit: Jenny Oh)

Reported for KQEDnews.org

Nearly one fourth of men who have sex with men in San Francisco are HIV positive, and one fifth of those infected are unaware of their status, according to new data released by the federal Centers for Disease Control on Thursday. Among several cities where surveys were conducted, San Francisco had one of the lowest rates of HIV-positive men who were ignorant of their status.

“This speaks well to our ability to get HIV testing broadly into the community,” said Henry Raymond, director of HIV behavioral surveillance at the San Francisco Department of Public Health, who was in charge of collecting the city’s data for the CDC.

The department estimates that the city of San Francisco is home to close to 66,000 men who have sex with men. The public health term includes men who identify as gay or bisexual, as well as those who identify as heterosexual but also have sex with men. As part of the survey, 474 men who have sex with men were tested for HIV in San Francisco.

Of the 21 cities where public health workers conducted surveys and HIV tests in bars, clubs and social organizations, Baltimore had the highest percentage of HIV-positive men who didn’t know they were infected: 73 percent. And Seattle had the lowest: 15 percent. By comparison, San Francisco had 19 percent.

Although Raymond said that public health officials don’t know what explains the disparities, he speculated that stigma around HIV infection might keep people from testing.

“We’re lucky to have a pretty good environment,” he said. “People see a benefit to knowing their status and then move to seek treatment.”

Treatment is beneficial not only to those who have found out they’re HIV positive. The powerful antiretroviral drugs used to treat HIV infection since 1995 have also been found to reduce the amount of virus in some patients’ bodies to the point where they no longer can transmit it to other people.

Research also shows that people who don’t know that they’re HIV-positive are more likely to contribute to new cases than those who do know their status.

“One estimate is that men with an unrecognized infection may be responsible for up to 3.5 times more infections than men who know they’re positive,” said Raymond.

The overall trend of HIV infection in San Francisco is encouraging, he said. The percentage of HIV-positive men has remained roughly the same since the last time the CDC conducted its survey, in 2004. The number of new infections in the city fell from 975 in 2006 to 621 in 2008, and the number of deaths of HIV-positive people has been decreasing too. In 2009, 138 HIV-positive San Francisco residents died, according to the city's public health department, down from 288 in 2006, and a peak of 1,820 in 1992.

However, the nationwide results of the CDC survey show that disparities remain between different groups. The survey found that nationwide, 28 percent of African-American men who have sex with men are HIV-positive, while the same was true of 18 percent of the Latino group and 16 percent of the white group.

Among African-American HIV-positive men, 59 percent didn’t know their status, and 46 percent of Latino men were unaware of theirs. This is compared to 26 percent of white HIV-positive men. San Francisco hasn’t broken down the city’s numbers by ethnicity yet.

Eduardo Morales, executive director of AGUILAS, a San Francisco nonprofit that works with some 1,500 Latino men who have sex with men, said that preventing HIV infection requires more than testing.

“When it comes to the actual situation you’re confronted with, using the condom and protecting yourself becomes a challenge,” he said. “You could be under the influence, or you could be depressed. These co-factors affect people’s judgment.”

AGUILAS provides individual counseling and discussion groups to help men reduce their risk of becoming infected.

But Morales warned that CDC funding for his organization and groups doing similar work has all but dried up, even though Latinos, which make up 15 percent of the national population, suffer from 20 percent of HIV infections.

“They (the CDC) said their top priority is Latino men, but they didn’t fund us,” he said.

Video:
Watch QUEST TV's segment HIV Research: Beyond the Vaccine

QUEST on KQED Public Media.

Radio:
Listen to KQED's Health Dialogues episode about HIV/AIDS in California

Listen to QUEST's story about The Graying of HIV

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H1N1 flu

The vulnerability translated to substantial number of deaths, estimated to be between 2,500 and 6,100 according to the CDC. There is good news on the horizon, as week to week indicators show both a decline in national doctor visits for the flu and there has been a substantial decline n number of states reporting widespread H1N1 activity.

This may be sign of the H1N1 outbreak peak, a figure Art Reingold has been closely monitoring for the past few months. He'll be discussing the epidemiology of the pandemic and the controversy over the vaccine.

To learn more about the H1N1 virus, call: (800) CDC-INFO (800 232-4636) or visit the CDC's website.

H1N1 Update with Dr. Art Reingold
When: Wednesday, December 9th, 7-9 PM
Where: Cafe Valparaiso at La Pena Cultural Center
Cost: Free
Details: Experts are predicting a substantial resurgence of swine flu cases this coming winter. Art Reingold will provide an update concerning the global pandemic of novel H1N1(swine) influenza; the current state of affairs in the US and California; and options for prevention, including a pandemic influenza vaccine.

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The last time we reported on Swine flu, or 2009 H1N1 virus, the Centers for Disease Control and Prevention was considering whether or not to invest in a vaccine for the new influenza strain.

Now, after several delays, the first batches of vaccines — first, a nasal spray version, then an injectible vaccine — is due to hit hospitals and clinics across the country (and around the world) in the first weeks of October. It's up to each state to decide which groups to prioritize, but pregnant women, young children, and those with certain preexisting conditions such as asthma may be considered priorities. Over the following weeks, the flow of vaccines, produced at five different labs across the country, will steadily increase until, officials hope, any American who chooses to be vaccinated has access to a dose.

To learn more about where to get the vaccine, call: (800) CDC-INFO (800 232-4636) or visit www.cdc.gov/flu.

Here's another good resource for basic H1N1 vaccine info.

In this piece, we profile work taking place at the University of California, San Francisco's Viral Diagnostics and Discovery Center. This lab is home to the ViroChip – a powerful viral diagnostic tool that won its inventor, Joseph DeRisi, a MacArthur "Genius" Grant back in 2004. TheViroChip and other tools are critical to the fight against 2009 H1N1 . Among other things, they may be the first to alert us should the virus mutate into a form that's resistant to the leading antiviral drug, Tamiflu. (Several cases of Tamiflu-resistant 2009 H1N1 have already been reported, but so far they appear to be isolated incidents.)

They'll be looking out for another important mutation too: That's if 2009 H1N1 changes enough so that the current vaccine for it — the one coming out in October — no longer works. (This kind of subtle virus mutation is the reason we need new flu vaccines every year.) So far, this does not seem to be the case.

Listen to the Predicting Swine Flu radio report online.

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Animal viruses can be more deadly than their human
counterparts

Over those two years, at least three waves of flu struck killing over 600,000 people in the U.S. and a staggering 30-50 million people worldwide.  People died at such a high rate that cities ran out of caskets and dead bodies were stacked on porches and in the streets.

Governments have been concerned that history might repeat itself because the two flues share one thing in common–they both started out as animal viruses.  And our bodies are not particularly good at fighting off viruses new to humans.

Each year a new flock of flu strains kicks off the flu season.  Almost always these strains are variations of human flues from previous years.  What this means is that we have seen cousins of these viruses in the past and so have a leg up on mounting an attack and defeating them.

We do not have this same leg up on animal viruses.  Our immune systems haven't seen anything like them and so can't mount a quick attack.  The end result is that the percentage of people who die from animal flues tends to be much higher than from run of the mill human flues.

In any flu season, the CDC estimates that 5-20% of the U.S. population ends up with the flu.  And that 36,000 of these people die.  The numbers of deaths would be much higher if a truly deadly animal flu virus like the bird flu from a few years back were to emerge and gain the ability to spread from person to person.  (The bird flu was never more than a few isolated cases since it never gained this ability.)

At first blush, this is what the swine flu looked like.  The disease spread easily among people and, in Mexico at least, appeared to be more deadly than normal flues.  So governments around the world sprang into action.  Since flu is spread through contact, governments tried to keep people away from each other.

They closed schools at the fist sign of trouble.  Mexico closed restaurants, theaters and museums too.  All of this was done in an attempt to prevent the spread of a disease like the flu of 1918.

At least outside of Mexico, this flu does not seem to be too much worse than other flues.  So it may be that governments overreacted this time.  But I would prefer that they overreact like this as opposed to ignoring a deadly pandemic.  We don't want another 1918 on our hands.

More info on The 1918 Flu in San Francisco

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