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Drop in new San Francisco AIDS cases gives hope in prevention battle
November 26, 2005
San Francisco is the only US city to report a drop in new AIDS cases this year, prompting hopes that it signals a decline in risky, drug-induced gay sex.
"San Francisco and California led the way in the epidemic, so our leading the way in the reduction is a good thing," Steven Tierney, director of HIV prevention for the city of San Francisco, told AFP.
"I think people are hopeful."
Statistics indicate that half as many new HIV infections were reported among San Francisco gay men in 2004 as compared to the previous year, according to Jason Riggs of the STOP AIDS Project in San Francisco.
The ratio of HIV infected gay men in San Francisco has dropped from one-in-three to one-in-four for the first time on record.
"We are the only (US) city reporting a downward trend in the country," Riggs said as World AIDS Day neared.
New cases of syphilis, seen as a strong indicator of unprotected sex, dropped about 27 percent among gays, Riggs said.
A key factor in the turn-around has been a drop in the use of methamphetamine as an "aphrodisiac" by gay men, prevention experts agreed.
"We went from being one of the top cities for seeing crystal meth abuse among gay and bisexual men to being on par with Chicago and Los Angeles," Riggs said.
"We are still not out of the woods yet, but the trend is pointing in the right direction."
Statistics indicated that a gay man in San Francisco using methamphetamine was four times as likely to get infected with HIV as a drug-free peer, according to STOP AIDS.
Methamphetamine relaxes gay men and banishes inhibitions that sap pleasure from sex, Riggs said.
"Imagine never in your life being able to have sex without guilt or shame, or fear of infection, and then having a magic potion you could take that makes you absolutely free," Riggs said. "That is what you have."
"The problem is that magic potion is more addictive than crack cocaine or heroin, and you burn out all the pleasure centers in your brain. It's a lot quicker and cheaper than therapy, but much more destructive."
Gay men that use methamphetamine tend not to be natural risk-takers, and would likely avoid unprotected sex if they weren't using drugs, according to Riggs.
Methamphetamine has been in the gay community for at least 40 years, but it seems to be going out of vogue, some prevention experts said. One reason, experts said, is gays have seen friends destroyed by the drug.
"It definitely helps that crystal meth is really cycling out," Tierney said. "The combination of crystal and Viagra made you very horny and able to perform for a long time, it cycling out is a good thing."
San Francisco has thrown financial and political support behind education and medical programs aimed at promoting safe sex practices and convincing those who inject methamphetamine or other drugs not to share needles.
"I don't think we are lucky," Tierney said. "I think we have done a lot of community-based work to get people to thing about personal responsibility."
More gay men are "serosorting," having sex only with men with matching HIV status, according to Tierney.
HIV-positive men are also savvier about using "retroviral" medicines that suppress virus levels in their blood and reduce the potential to spread it to partners, prevention experts said.
Friends are being encouraged to watch out for each other in ways that include thwarting stoned pals from having dangerous sex, just as people might stop intoxicated friends from driving, Riggs said.
"The whole act of safe sex is a moving target at best," said Doctor Eric Goosby, head of Pangaea Global AIDS Foundation. "It is a sustained battle."
"In San Francisco, the convergence of treatment and prevention is the winning strategy."