- The Observer,
- Sunday July 2 2000
News that the city now has the same infection levels as sub-Saharan Africa has sparked fears across America and Europe that years of safe-sex education are being undermined by complacency.
It is the first reported rise in infection rate in any US city since the HIV epidemic started being brought under control.
San Francisco public health officials estimate that the number of new HIV infections - which can lead to Aids - has doubled in the past year to 900. 'This is a harbinger of what is going to happen all over the country. What happens in the HIV epidemic usually happens here first,' warned Tom Coates, director of the University of California at San Francisco Aids Research Institute.
Anonymous testing at clinics across San Francisco - where high-risk groups serve as an early warning system - show the proportion of HIV positive cases has nearly tripled in three years, from 1.3 per cent in 1997 to 3.7 per cent in 1999. 'We are very concerned, very worried. These are sub-Saharan African levels of transmissions' said Dr Willi McFarland, the city's Department of Public Health Epidemiologist.
Aids workers said that there was no evidence the new wave of infection had hit the UK, but that the figures served as a warning against unsafe sex. 'It's worrying. We've got to make sure we stay ahead of the game. It shows that in an epidemic like HIV, you can't afford to take your eye off the ball,' said Derek Bodell, head of the National Aids Trust, 'We've got to be aware of the risks of complacency, or it can all go pear-shaped.'
In both the US and the UK, there are increasing signs that those at risk are reverting to unsafe practices, lulled into a false sense of security by powerful drugs and - until now - falling infection rates.
In Britain, the number of recorded infections rose last year to 2,500, the highest for a decade, although researchers insist that was caused by more people coming forward for testing, rather than the actual rate of infection rising.
However, Aids prevention workers worry that people are letting down their guard, with all the early-warning signals all pointing the wrong way:
• The number of gay men having unprotected anal intercourse has risen, according to research just completed by the Terrence Higgins Trust - although more men know the HIV status of their partner.
• Hepatitis infection rates among injecting drug users have risen, suggesting there is more sharing of needles.
• Gonorrhoea cases rose by 26 per cent in men and 30 per cent in women last year - and jumped by more than 50 per cent in young men, suggesting fewer people practise safe sex.
The rise in infections in San Francisco was preceded by similar signs of less than safe sex in high-risk groups.
Marie Ennis, assistant director of the Terrence Higgins Trust said: 'HIV doesn't have the profile it once had, so people don't think it's as relevant as it once was.
'People are getting complacent because they are not getting enough information.'
