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>From http://www.washingtonpost.com/wp-dyn/articles/A5756-2002May11.html
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washingtonpost.com
A City Combats AIDS Complacency
As Rates of Sexual Diseases Climb, San Francisco Preaches Risk to Gay Men
By Rene Sanchez
Washington Post Staff Writer
Sunday, May 12, 2002; Page A03
SAN FRANCISCO -- On the streets of the Castro district, news of funerals for gay
men who had AIDS is scarce. Cafes are no longer filled with gaunt, sickly customers.
And some days, when the city sends a van out to offer free tests for sexually
transmitted diseases, it finds few takers. The worst of the plague has passed.
But health officials here say that as new drugs continue to tame, if not solve, the
AIDS crisis, they are struggling with another predicament: More gay men are
engaging in risky sex. Cases of venereal disease and HIV infection are soaring. And
pleas for caution are being ignored.
All of which is why San Francisco, an epicenter of the national AIDS fight for two
decades, is taking a desperate new step to persuade gay men to stay vigilant about
their health. It has just begun offering them discounts all over town if they show
proof
they were checked this spring for sexually transmitted diseases.
Local sex clubs, which the city regulates, are waiving $15 cover charges for patrons
who get tested. A leather store is knocking $5 off any purchase. A florist is offering
free flowers. Coffeehouses are pouring complimentary drinks. Bookstores and
restaurants are offering 15 percent discounts.
City officials hope the deals are too good to pass up -- because they say too many
residents still at risk of getting AIDS have become too sanguine about it.
"There's much less fear," said Michael Siever, director of the Stonewall Project, a
local advocacy group for gay men. "Even here, the disease isn't in your face
anymore, so people aren't as careful. They're tired of getting tested and they're tired
of hearing the same old campaigns to scare them about sex."
At its peak here a decade ago, more than 1,800 people with AIDS died annually. Last
year, that figure was 218. The sharp decline is a profound relief, but San Francisco is
still far from winning its long battle with the disease and others that can lead to it.
In fact, some of the troubles the city thought were over are returning. Cases of
syphilis, a disease that significantly increases the risk of being infected with the
AIDS
virus, have quadrupled in the past three years. Cases of HIV infection, which causes
AIDS, have doubled in the past five years.
The same trends are apparent in other cities with large numbers of gay men. Last
year, a federal study concluded that young gay men across the country were
contracting HIV at a rate not seen in more than a decade. Last week, the federal
Centers for Disease Control and Prevention recommended for the first time that all
gay and bisexual men be tested for HIV exposure at least once a year. Previously,
the CDC had recommended screening only for patients with risky lifestyles.
Health officials say the new statistics reflect a striking change in mind-set among gay
men: Many apparently are so confident now that HIV can be managed with the help
of new drug treatments that they are taking fewer precautions to avoid becoming
infected with it. Many also have no memory of the deadlier early days of the
epidemic.
Only a few years ago here in the Castro, the heart of San Francisco's large gay
community, it would have been almost impossible to hear a refrain now common in
the neighborhood. "I don't know anyone who has died of AIDS," said Nick Lazarou,
33, as he sat outside a neighborhood cafe, "but I hear it happens."
Doug Weaver, another Castro resident, said that many gay men have grown
complacent about AIDS and HIV infection. "I think people are sick of worrying and
are just deciding to live it up a little bit," Weaver said. "They really have reached a
saturation point with a lot of the negative messages about sex, and they don't bother
as much with testing, because now they know there's a much better chance they are
not going to feel as ill anymore."
San Francisco is rushing to change that attitude by changing its tactics. Last year,
public health officials began accusing pharmaceutical companies of promoting AIDS
drugs with misleading advertising messages that glamorized life on the treatments by
showing vigorous men climbing mountains and riding bikes.
Health officials took action after a survey of local gay men showed that those who
saw such ads often were more likely to have unsafe sex. The city is pressuring drug
companies to change their ads at bus stops and on billboards and has threatened to
ban them. Last year, the Food and Drug Administration also ordered companies
promoting drug treatment for AIDS to tone down their advertising.
San Francisco's latest initiative is an attempt to entice gay men to be tested
regularly
for sexually transmitted diseases. Those who show up for the free tests also will
receive new warnings that HIV infection is a serious, chronic medical problem, not a
minor ailment that drugs easily suppress or cure. Some AIDS drugs have serious
side effects and pose health risks, and there are still unanswered questions about
when and how often some should be taken.
City clinics and the health department's mobile van are giving gay men who get
tested stamped cards to present to local businesses for an assortment of perks or
freebies. The special offers are not exclusively for gay men; they are just the group
that city officials are targeting most in their campaign.
"I don't know how effective this will be," said Larry Hanbrook, a city health worker
who leads a gay community group called Castroguys. "But we've got to get people's
attention, or things could get terrible again."
Since 1981, more than 1 million Americans have been infected with the virus that
causes AIDS, and about 450,000 have died. About 323,000 people are living with
AIDS, which significantly damages the immune system. The number of people
reaching that stage of infection peaked in the mid-1990s.
Jeffrey Klausner, deputy director of San Francisco's health department, said that
when the AIDS crisis was raging, most local gay men were tested every few months.
Now, he said, surveys show that fewer gay men in the city are practicing safe sex
and more are having sex with multiple partners.
"When you're burying one of your friends every few weeks, you're not thinking about
having sex," he said. "But the landscape here has really changed."
So, too, have the consequences of unsafe sex. Klausner said that four years ago,
reports of syphilis in the city were rare. This year, he is bracing for 400 new cases.
In
recent years, cases of rectal gonorrhea among local men have nearly doubled.
The news on HIV infection is worse. Health officials say that the city had more than
1,000 new cases last year. They also have an extraordinary new suspicion: that
some men are hoping to get the disease because they trust drugs will keep them fit
and they want to join the growing community coping with it.
"When a lot of obviously sick people were walking along the streets, it made quite a
different impression on younger guys who had not tested positive," Hanbrook said.
"The possible horrors of this have dropped off people's radar."
In the Castro these days, gay men say it is easier than it has been in decades to hide
a sexually transmitted disease. Or to forget to ask sexual partners whether they have
any illnesses. Or to stop wearing condoms.
"Everybody around here looks so good now," Lazarou said, "that nobody thinks
they're going to catch anything bad."
� 2002 The Washington Post Company
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