Diseases Soar Among San Fransisco 'Gays'

A City Combats AIDS Complacency As Rates of Sexual Diseases Climb, San Francisco Preaches Risk to Gay Men

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."

Context is important: the article stated that the above was "suspicion" amongst some, not a statement of fact... I've heard the claim that AIDS is considered by some homosexuals as a "badge of honor" by both pro and anti homosexual sources .. but I've never seen any solid evidence that it's really the case

Well, I too have not "heard" any homosexual make this claim directly, but the author of this article is from the Wash Post, which is hardly a "homophobic" newspaper. Quite the opposite, actually..Also, this is not the first place I've heard this from, and it is fact that the AIDS cocktail is paid for by most med. insurance companies and so on.

The fact that AIDS cases are rising quickly as well as HIV infections,would seem to support, at least indirectly, most of the arguments made in this column ( as well as my subjective conclusion ?)

Well, I too have not "heard" any homosexual make this claim directly, but the author of this article is from the Wash Post, which is hardly a "homophobic" newspaper.

I've seen it in The Advocate. I've not seen any solid documentation that it's the case, however, I've not seen any quotes from people who actually espouse such a philosophy and I've not seen any real reason to believe that homosexuals engage in risky sexual behaviour for any reason other than self-destructive denial of the consequences. They go out and do what "feels good" without considering the consequences. That they don't see anyone "suffering" from AIDS might make the consequences less real but I don't think that they see AIDS as some kind of status symbol and I think that it's mostly an arrogant sense of invincibility where AIDS happens to "other people" that leads to their behaviour. That kind of arrogant denial is common amongst people engaging in all kinds of self-destructive behaviour, it's one way of rationalizing what is known to be a dangerous activity.

Why don't we force them to pay higher premiums for their habits??

Would you want this applied to all homosexuals or just those who engage in high-risk sexual behaviour?

I'd not have much problem with the latter, but I would disagree with the former, however I don't see how you can easily determine either without serious privacy invasion issues. A smoker's habits can be easily discerned through some specific medical tests, but I'm not sure that the same holds for promiscuity.

I've not seen any real reason to believe that homosexuals engage in risky sexual behaviour for any reason other than self-destructive denial of the consequences

Well, that might be the full explanation. But why does the WP make this contention? I personally do not see a bright side to the allegation; certainly those few people who believe taking the AIDS cocktail 8 times a day is a good thing, are sick individuals indeed.

But why does the WP make this contention? I personally do not see a bright side to the allegation; certainly those few people who believe taking the AIDS cocktail 8 times a day is a good thing, are sick individuals indeed.

I don't think that there is a "bright side" to the allegation, I think that it's a rumour or urban legend that's starting to take form fueled by its shocking nature.

I think that you'd be hard pressed to find real people who think of HIV as a "badge of honour". It's being reported by the WP (and other organizations) because it's a current rumour and it's very disturbing.

One of the worst things possible is this partial cure. Sooner or later one or both of two things will happen: It will become able to be easily spread through non-sexual contact; or it will simply become omnipresent so that everyone will have to have a constant supply of the drugs to stay alive. That will be the effective end of our species as a viable lifeform.

It's being reported by the WP (and other organizations) because it's a current rumour and it's very disturbing.

Really? But the WP does not always report "disturbing rumors", especially if it is adverse to current editorial thinking on a subject, or unhelpful as far as propagating misunderstanding and bias, etc. Somebody, somewhere, thinks this is "cool" thinking. You know, Solidarity, Brotherhood, Victimhood and all that.

Then why report something so disturbing at all? I've never seen the "AIDS as a badge of honour" rumour printed anywhere in anything remotely resembling a positive tone, even in The Advocate. It's always printed as one possible explanation for why large groups of homosexuals in specific locales have high infection rates. Perhaps it's an attempt to quell the fears of those whose high-risk behaviour is motivated by arrognace: they aren't seeking to get AIDS, so they should be okay.

Regardless of the WP's editorial bias, I think you're looking for a liberal slant where there might not be one.

Perhaps it's an attempt to quell the fears of those whose high-risk behaviour is motivated by arrognace: they aren't seeking to get AIDS, so they should be okay.... Regardless of the WP's editorial bias, I think you're looking for a liberal slant where there might not be one.

Okay, maybe. Maybe the author's just trying to push buttons

OTOH, when I read this..

. 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. ... . The city is pressuring drug companies to change their ads at bus stops ..and has threatened to ban them

Thats a very leftist reponse, isn't it? The pharmaceuticals want to show that their product is good, so the city is going to take legal action because it "makes" people do bad things. And this is reported neutrally, of course..

Sorry, most of us here know how "biased" the WP is; sometimes its hard to know whether the rumors they report are really based on truth, or leftist propaganda, or just plain propaganda.

"Or, under the famous last words column "may I push your stool in for you Kevin"

Reminds me of a joke-

Q: How do you get 4 fags on 1 bar stool?

A: Turn it upside down.

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