December 4, 2003
DPH Study Finds Poppers Strongly Linked to HIV
Also Length of Life with HIV Depends on Where You Live
By Joe Dignan
A new analysis of HIV infection data by the San Francisco Department of Public Health's Susan Buchbinder shows that there is a strong correlation between popper use and HIV infection. She said that poppers, which are nitrite inhalants were an were an independent risk for HIV infection with an attributable risk of 28 percent. Buchbinder, the director of the Department's HIV research section said that the mechanism of infection is still unclear; but she guessed that one of the reasons might be that poppers cause a dilation of blood vessels and allow white blood cells, which are cells directly attacked by the HIV virus, to race to the infection site - and become infected with HIV. Poppers also suppress the effectiveness of the body's immune system.
Buchbinder presented her data at the third annual AIDS Office Report to the Health Commission on Dec. 2. The commission also heard from activist Hank Wilson, who asked the Commission to send a letter of inquiry to the producers of the Folsom Street Fair, which donates most of the proceeds from their annual event to AIDS charities, asking why in this year's program, they carried an ad for the inhalants.
The distribution and sale of poppers was banned by federal law in 1991 but there has been only one prosecution since that time according to Wilson who has been crusading against the drugs for many years. San Francisco passed a point of sale warning law in 1982, when poppers were suspected of being a primary cause of AIDS. When they were crossed off the list of major causes, said Wilson, they fell off of people's radar. "Now they're back on," he said.
The head of the Department's AIDS office, Jimmy Loyce, said that popper use combined with methamphetamines, alcohol and multiple sex partners are a lethal combination. "They'll make you do stupid things," he said. Methamphetamine use in San Francisco is three times the national average, Loyce said.
Loyce presented data which showed that your chance of surviving with HIV and AIDS in San Francisco depends a lot on where you live. If you're white and live in the northern part of the city, Cow Hollow, the Marina, or Pacific Heights, you have a vastly better chance of living with the disease than if you're black, poor and live in the Bayview or Hunters Point. Survival rates five years after an AIDS diagnosis were a minimum of 15 percent higher in the largely white affluent districts of the city than in the poor heavily black ones.
Loyce said that that's because men in the Bayview come to treatment much later than those in other communities. "If you have a list of issues," Loyce said, "housing, getting food, racism, poverty, HIV may be low on the list until you become ill, symptomatic, then you have to do something about it. Often when people get tested - they're not just carrying the virus, they have AIDS."
Loyce also said that there is a lingering distrust of institutional health car in San Francisco's black community - perhaps with roots as far back as the infamous Tuskegee studies conducted by the now defunct US Department of Public Health in the 1940s and 50s, when black men were intentionally infected with syphilis and then denied treatment to study to devastating progress of the disease.
Loyce also said that homophobia in this city's black community is also a factor. "Homophobia does exist in the African-American community, there is absolutely no question," he said. "Homophobia presents itself as a fear of getting tested, a fear of getting a diagnosis, and a fear of losing family and respect in the community," he said.
Loyce said that many African-American men who have sex with men don't identify their actions as gay sex, "They just identify it as sex," he said, "You have people who are engaging in sex acts in public places, it's about getting off. Those men are getting off more with men than women, but they're not saying they're gay."
African American women get AIDS at a much higher rate than others, approximately three to four times more often than the general population.
So, Loyce said the Department is going to have to shift its prevention messages for these people away from gay themes to messages that emphasize protecting your partner - never mind what sex they are, and protecting the black community from assaults by the disease.
Generally HIV infection rates appear to be leveling off, according to Buchbinder - but at a higher rate than at the low point of a few years ago. But cumulatively, 28,830 people have been diagnosed with AIDS in San Francisco through September 2003. Of those almost 22,000 are gay men. The Department spends of $66 million annually fighting the epidemic, over $9 million of that direct from the city's general fund, with the balance coming from other grants, mainly from the state and federal governments.
The presenters said that only with a vaccine will the disease be controlled. The recent VaxGen trail was a complete failure, with even a hoped-for efficacy among blacks now disproved. The Department will help in preliminary safety trials for a new Merck product starting in January 2004 but they will not begin efficacy studies until 2005. According to Buchbinder it has now been 20 years since the etiologic agent for HIV was discovered. A vaccine for hepatitis B took 16 years to develop. Hepatitis A took 22 years. But it wasn't until 1955, 47 years after the isolation of the agent for polio, that Jonas Salk developed a vaccine for the disease. "I hope it won't take that long," said Buchbinder.
The Department will be starting a new study in December to evaluate the possible correlations between herpes and HIV infections. People who have Herpes but are HIV negative and want to participate in the study can call 415-554-9068 to sign up.
SAN FRANCISCO BAY TIMES DECEMBER 4, 2003