Editor's note: It is curious that among all the horrid news reports this past World AIDS Day, of a pandemic gone wild the world over, this bright spot at ground zero of the AIDS era has gone unnoticed.

Executive Summary

2005 Annual Report • HIV/AIDS Epidemiology • San Francisco

The HIV epidemic is complex and we cannot rely on a single piece of research to determine infection rates. After reviewing trends from multiple data sources, following a resurgence in HIV incidence beginning in 1995, we see little evidence of continued increases from 2001 to the present. Limited evidence suggests that HIV infection rates have decreased, albeit to a modest degree, from an estimated 1,084 five years ago to 977 this year.

While this decrease may be within measurement error, the good news is that the HIV epidemic does not appear to be accelerating in San Francisco. This assessment is based on over 50 data sources and the input of over 75 AIDS researchers, service providers, community members, and epidemiologists.

This periodic synthesis of available information on the epidemic, a process we call the "HIV Consensus," was done in 1992, 1997, 2001, and 2006. Results of the 2006 HIV Consensus are presented in Table 1.5 of this report.

Our revised estimates take into account apparent growth in the size of some populations at risk. For example,
consider men who have sex with men (MSM). Nine studies converge on an estimated 63,577 MSM (including 5,234 MSM-injection drug users [IDU]) in San Francisco. Yet, growth in the number of MSM has not translated to increased new HIV infections.

The projected HIV incidence rate is 21% lower than estimated in 2001. Estimated HIV incidence rates also appear to be lower in MSM-IDU (by 44%), heterosexual
male IDU (by 9%), female IDU (by 54%), and very low among heterosexual men and women. Estimates also account for persons living longer with HIV. Among persons in care, we see relative stability in current rates of new AIDS diagnoses and deaths, use of antiretroviral therapy, and among patients with respect to gender, race/ethnicity, age, and risk category.

Skeptics of these estimates can correctly point out uncertainties in our data. We must also distinguish a reversal in trend from correction of a wrong conclusion made previously. Most likely, we overshot the estimated number of male-to-female transgendered persons (MTF) and the number of MTF infected in 2001.

New data estimate number of MTF at 1,883 (including 449 MTF-IDU), with HIV incidence rates 59% lower for MTF and 61% lower for MTF-IDU. With our epidemic concentrated in hard to reach segments of society, we may be at the limits of our ability to make accurate projections. Nonetheless, with the high concentration of AIDS research in San Francisco, we feel our estimates are as robust as anywhere in the world.

In summary, the current HIV/AIDS epidemic is characterized by no apparent increases in HIV infection rates over the past five years, and with considerable decreases in some populations.

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