Effective HIV/AIDS prevention treatment could be boosting other STDs in SF 

Victory in the war on HIV and AIDS is coming with a cost: more gonorrhea, syphilis and other STDs.

Pharmaceutical HIV/AIDS prevention treatments are so effective that condoms are becoming an afterthought for some sexually active gay men, according to local public-health officials.

Thanks in part to pills like HIV pre-exposure prophylaxis -- known as PrEP and sold under the brand name Truvada -- new HIV/AIDS cases in San Francisco have dropped by nearly 50 percent over the past decade to near-all-time lows, according to the Department of Public Health. In 2013, for example, 332 people were diagnosed with new HIV infections, down from 532 as recently as 2007.

New drug cocktails for HIV/AIDS patients are so effective that the time required for the virus to be suppressed in new diagnoses dropped from nearly three years in 2004 to under a year today. HIV/AIDS-related deaths also dropped by half in that time.

With that confidence comes some risky behavior -- and a spike in other sexually transmitted diseases in The City.

Among men who have sex with men, since 2007 the syphilis rate has tripled and the rate of gonorrhea has increased by 50 percent, according to data presented to the Health Commission on Tuesday.

Chlamydia is also on the rise, with a 20 percent increase in new cases since 2009.

This is the HIV-prevention paradox, according to Dr. Susan Philip, the health department's point person on STDs. Other STDs don't have the same stigma as HIV, she noted, which may lead some people to consider a gonorrhea infection an acceptable trade-off for an active sex life.

"It's hard to use a condom 100 percent of the time" for both oral and anal sex, Philip noted. Some effective HIV-prevention strategies, like relying on Truvada and picking partners based on HIV status -- such as having sex with other positive people if a person is positive -- "can also lead to more sex without condoms," she added.

STD infection rates are highest among San Francisco's gay men. That means that if a sexually active gay man is having unprotected sex with other sexually active gay men, the STD infection risk rises.

"It's a little bit of a cycle that has to do with sexual networks," Philip said.

The City's successes with AIDS make it a worldwide leader, but the other STDs' resurgence has public-health officials concerned, as lax condom use could lead to serious consequences down the road.

Other STD infections make HIV transmission more likely. And San Francisco is "likely" to be one of the first American cities to see the strain of gonorrhea resistant to all antibiotics, Philip said.

That superbug is for now present in Asia, but could wreak havoc here if condom use is casual.

Condom use is decreasing, said Steve Gibson, director of HIV- and STD-testing clinic Magnet. He noted that condomless oral sex is an "efficient" way to transmit STDs, "and we have to figure out what we're going to do about that."

Most new HIV diagnoses are among men who have sex with men, according to the health department.

Out of the 332 new diagnoses in 2013, 250 were sexually active gay and bisexual men.

There are about 15,867 people living with AIDS in San Francisco, according to the health department.

About The Author

Chris Roberts

Chris Roberts

Chris Roberts has worked as a reporter in San Francisco since 2008, with an emphasis on city governance and politics, The City’s neighborhoods, race, poverty and the drug war.
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