Huzzah!!!

Well, you’re forgiven if you think it’s time to celebrate.

Speaking at the San Francisco AIDS Foundation gala in May, the agency’s executive director did not mince words. Two sentences into his speech that night, Mark Cloutier made a startling announcement.

“The HIV epidemic is over. Yes. The HIV epidemic in San Francisco is over,” said Cloutier, according to a copy of his prepared remarks.

A closer look at the definition tells the story:

epidemic: An outbreak of a disease or illness that spreads rapidly among individuals in an area or population at the same time.

HIV in San Francisco is no longer the out-of-control scourge it once was in the 1980s and 1990s. Since 2001, infection rates in the city have leveled off, with new HIV cases remaining fairly stable at between 800 and 1,000 a year.

Thus, HIV no longer fits the definition of an epidemic, which city health officials define as meaning the spread of a disease is increasing.

“My own personal opinion would be, from a technical point of view, we have an AIDS endemic, not an epidemic, based on what the words mean. Epidemic means an exponential growth in new cases,” said Health Director Dr. Mitch Katz. “All the data still shows it is stabilized. Endemic is the more correct term.”

While it may be the more medically correct term, folks who man the prevention barricades wonder at the wisdom of dropping the word epidemic. My former colleagues at the Stop AIDS Project have doubts.

Stop AIDS Project deputy director Jason Riggs also expressed concerns about how a shift in words would be interpreted by gay men and others. Using endemic not only overlooks those parts of the community where HIV continues to spread, such as among African American men, said Riggs, but also implies that HIV will be a part of the gay community for years to come.

“What’s in a name? It doesn’t change the facts of HIV transmission. The fact is almost 1,000 people are getting infected in San Francisco and that is still too high,” said Riggs. “Three hundred men a year die of AIDS in San Francisco. It is like a plane crashing each year in San Francisco. We need to remain vigilant.”

This in a city with a total population of less than three-quarters of a million. Twenty-five years into this epidemic, are we ready to call it endemic — and does that mean a plane crash every year in San Francisco? Does that mean one thousand new HIV cases every year — forever?

Cloutier said in an interview last week that referring to an HIV endemic would result in changes to how health providers and AIDS agencies address the disease.

“If it is endemic, meaning it has become stable, you need a different set of responses from a prevention perspective and a services perspective. You need new tools to break that cycle,” he said. “An endemic framework leads you to ask questions, such as what can we do further to work with the HIV positive population to reduce new infections in addition to the HIV-negative population.”

Some of our heroes have always told inconvenient truths about this disease:

“There is no doubt in my mind that if the same disease had appeared among Americans of Norwegian descent, or among tennis players, rather than among gay males, the response of both the government and the medical community would have been different.”

That’s four-term Congressman Henry Waxman, in 1982.

Does San Francisco’s HIV/AIDS endemic mean that every other locality will face the same decision — at whatever point the disease is brought under control? As communities rein in their epidemic – if they do, a big if — will endemic HIV/AIDS then become the norm everywhere in America? Will Americans completely discard the notion that we can win against HIV/AIDS, and accept an endemic level of this killer disease?

How many AIDS deaths are in your state every year? Is that number acceptable to you? Are you prepared for your public health officials to declare the epidemic over?

Over half a million Americans have died with AIDS. At some point, will American AIDS deaths be a normal part of twenty-first century public health?

(video projection by Jason Riggs and Stuart Goldstein, Stop AIDS Project. This was projected on three-story screens installed at 18th and Castro the Friday and Saturday night of Pride 2005)

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