SAN FRANCISCO — Alarming health officials, the rate of new HIV infections among gay and bisexual men in San Francisco nearly tripled over the past two years.
Health experts said that powerful AIDS drugs are making people complacent and that the safe-sex message is no longer getting through.
"We think this needs to be a wake-up call for the rest of the nation," said Dr. Ronald Valdiserri, deputy director of the National Center for HIV, STD and TB Prevention at the Centers for Disease Control and Prevention.
In 1997, 1.3 percent of all gay and bisexual men who were anonymously tested at San Francisco clinics that year were diagnosed as HIV positive. That rose to 2.6 percent in 1998 and 3.7 percent last year, according to the San Francisco Department of Public Health. In 1996, it was 2.0 percent.
Powerful AIDS drug cocktails that can knock the virus down to almost undetectable levels and make AIDS a manageable disease went into wide use in the mid-1990s.
"I think there's a sense that the drugs have taken care of the problem," said Dr. Tom Coates, director of the AIDS Research Institute at the University of California at San Francisco. "Second, I think people believe the disease is slowing. I used to go to a memorial service every week. I've only been to two in the last year.
"And I think within the community itself there has been an erosion of the safe-sex norm. I think all of that has eroded the community's resolve for prevention."
San Francisco has generally been ground-zero for trends in the AIDS epidemic, so experts worry that that they may soon start seeing the same phenomenon among gay and bisexual men elsewhere around the country.
"Obviously we want to be careful about extrapolating what's happening in one city. But the CDC considers this an important and serious finding," Valdiserri said.
The figures come from a network of sites around San Francisco that provide free, anonymous HIV testing. They were released in advance of the International AIDS Conference, set for July 9-14 in Durban, South Africa.
Dr. Willi McFarland, an epidemiologist with the city's Public Health Department, said the research involved only gay and bisexual men, and "we really haven't seen a change in other groups."
Researchers were tipped to a possible rise in infection rates when they started seeing a number of well-recognized warning signs, including a higher incidence of rectal gonorrhea and increases in high-risk sexual behavior with multiple partners.
For example, the proportion of gay men reporting that they always use a condom fell from 70 percent in 1994 to 54 percent last year.
"We've been waiting for the other shoe to drop," Coates said.
The researchers went back to blood samples they have kept for the past four years to determine with much more accuracy the trend in infections.
They used new technology that can show from a blood test whether a person has been infected within the last 120 days. That enabled researchers to say with precision whether patients were in fact recently infected.
The Stop AIDS Project, a nonprofit group serving gay and bisexual men in the city, has seen a disturbing trend toward complacency, spokesman James Nguyen said.
"I think if you walk around San Francisco, you see signs of health. Fifteen years ago, you would see skeletons walking down the street — it was easy to identify who had AIDS," he said. "The fact that most everyone you see looks healthy — people don't equate that with an epidemic."
About 40,000 new HIV infections are reported each year nationally, with gays and bisexuals accounting for 40 percent of that, Valdiserri said. As of December 1998, there were an estimated 325,000 to 475,000 gay and bisexual men in the United States with HIV, including 135,000 with AIDS.
Jeff Getty, an activist for the group Survive AIDS whose own, epic struggle with the disease involved getting a bone marrow transplant from a baboon, called the research "devastating."
"This is among people who should know better!" Getty said. "Should I scream and rant and rave about how angry I am about this? The very thing that makes this happen is stupidity, ignorance and arrogance."