San Francisco: Without Fear Factor, AIDS Won't Stop

San Francisco health officials and many in the AIDS community fear that HIV-prevention strategies are not working and that the growing number of infections means that more men are having unsafe sex. They are looking for solutions.

The latest estimated figures from the San Francisco Department of Public Health put new HIV infections in the gay community last year at 800, double the reported 400 per year in the late 1990s. A recent study by the CDC also found that 14 percent of gay men intentionally engaged in sex without a condom in the past two years.

"Only fear made [HIV prevention] work in the first place," says Marcus Conant, head of the Conant Foundation, and one of the first doctors to work with AIDS patients. Some urgency did decrease after 1996 when AIDS drugs began to make a real difference in the disease, prevention specialists say.

But there also seems to be a shift in sexual practices. According to Steven Gibson, Stop AIDS Project spokesperson, finding an increase in risky behavior, Stop AIDS began to target its messages to the most at-risk communities. Still, Gibson maintains, a small number of infections should be expected.

Tom Coates, director for the Center of AIDS Prevention Studies at the University of California-San Francisco, disagrees. "We have all these programs and HIV prevention people are scratching their heads saying, 'How can we help people with HIV?' "When it is all said and done it's up to the community to say 'we just don't want HIV to spread.'"

Currently, what is hurting the HIV prevention community the most is pressure from the federal government. Reverberations from the investigation that found the Stop AIDS Project workshops obscene are being felt across the country. Nationwide, AIDS groups are double-checking their materials and engaging in self-censorship, afraid of funding cuts. According to many AIDS organizations, HIV prevention campaigns have to be sexually explicit in order to speak to specific practices and habits that put people at risk.

House Whip Nancy Pelosi defended that position recently at a March meeting at the American Foundation for AIDS Research in San Francisco. "Anything that has to do with sex, they have a problem with," Pelosi said of the Bush administration's sex-education policies.

In agreement with Coates' suggestion to involve the community more directly, as was the practice in the early days of the epidemic, one new program is doing just that. Castroguys -- a "grass-roots" project funded by Bristol-Myers Squibb and the city, works directly in the Castro, the city's gayest neighborhood. "AIDS prevention has gotten so professional, so slick," said Michael Siever, adviser to the project. "We need to grab people's attention and get them involved."

"How do you get people to care in a short period?" Michael Shriver, Mayor Willie Brown's AIDS adviser asks. "It's not rocket science. Someone in the community is going to figure it out."

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