THE HIV NON-SURGE

The San Francisco Public Health Department study which alleges a sharp increase in HIV infection in that city among gay men has just been released. I’m grateful to the researchers for getting me a copy. What that means, of course, is that all those news stories written last week were written by reporters with no access to the actual data! Go figure. What’s my read? There are six mini-studies of men seeking sex with men (gay and bisexual) that lead the researchers to their conclusion of soaring infection rates. I have to say that I’m unconvinced. It’s possible, but nothing in the report proves it. Only one study has a reasonably representative sample of young gay men between the ages of 21 and 29, randomly selected from neighborhoods where AIDS infection is highest in the city. But the sample size varies considerably over time. In 1994 – 95, for example, there were 660 men in the sample. In 1998 – 99, there were 322. In 1993 – 94, there were a mere 261. Unsurprisingly, the smallest samples show the greatest variation from the mean. In 1993, at the height of the safe-sex era, HIV-transmission is calculated as 2.7 percent. The next year, the rate plummeted to 1.4 percent. The researchers provide no reason for this shift, and it’s almost certainly a function of sample size. Last year’s incidence rate of 1.8 percent is certainly within the realm of the average of the last several years which is around 1.4 percent. The “doubling” scare is more a function of the freak low figure for 1997 – 98, for which again there is no explanation. And the numbers themselves are tiny – a mere three HIV seroconversions in 1997; a mere 9 in 1998 – 99. You’d be statistically right if you declared a tripling in HIV rates from such numbers. But you’d also be really silly to draw such a conclusion from a total of 12 cases.

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WAIT, THERE’S MORE

The other studies are just as weak. One looks at men who get anonymous HIV testing at public clinics. This, as the study’s authors delicately put it, “may not be representative of the community” as a whole. No kidding. The sample sizes are also all over the place. The number seeking testing in 1996 was 3,488. In 1998 that number was 2,910. In 1999, the number fell again to 1,826 – a vast difference in sample size, and one that should set off alarm bells in drawing easy conclusions from one year to the next. The inference that transmission rates have increased is based on a new sort of biological analysis that can tell whether HIV infection is recent or not. Sure enough, more recently infected people are showing up at STD clinics. But what do these numbers tell us? They tell us that many fewer men are being tested than in the past and many more of them have been infected recently. One obvious conclusion from this is not an increase in HIV-transmission. It is that most gay men in San Francisco have already been tested for HIV and know their status. But those who may recently have had an unsafe incident or accident are the ones most likely to get tested. This is certainly just as plausible an explanation for the increase in incidence of HIV and a shrinking number of testers as an alleged outbreak of new HIV transmission. In the only study where the sample size seems to be increasing – for gay men showing up at STD clinics – the rate of HIV transmission is basically stable. In 1995, with a sample of 634 men, 5.8 percent showed up HIV-positive. In 1999, with a sample of 1,071 men, the rate had dropped to 4.7 percent. I’m sorry, but that isn’t an explosion. To my mind, the only truly worrying sign in all the data is the number of rectal gonorrhea cases. This is a real number, since, unlike HIV, gonorrhea infections must be recorded by law. These are clearly rising, suggesting a declining use of condoms. The number has risen from 97 cases in 1995 to 160 cases in 1999 and 93 cases in the first six months of 2000. But this may not be evidence of HIV-transmission. Why? Because two HIV-positive men could transmit gonorrhea through unsafe sex, but not transmit HIV – because they both already have it. Another study shows that the rate of STDs among people with AIDS has doubled in five years, suggesting that unsafe sex may indeed be primarily an issue between HIV-positive people, not a means of HIV-transmission. The bottom line is: the case for a doubling in HIV-rates in San Francisco is simply not proven. If it’s happening, these studies don’t prove it. And journalists who trumpet the fact would do well to read the studies before broadcasting the executive summary.

NEO-NEPOTISM WATCH

Two words: Andrew Cuomo. Just a pity he didn’t have his launch party at Denise Rich’s, as planned.

FEINGOLD GETS IT

“The Senate has nearly uniformly sought to avoid disapproving nominees because of their philosophy alone, and I believe we should not begin to do so now,” – Senator Russell Feingold. Amen, brother. The point here is not whether Ashcroft is a bad pick for AG. He is. The point is whether a new president should be allowed lee-way in picking who will be in his cabinet. Yes, the Senate can and has barred candidates for cronyism, corruption, scandal or drink. But only ideology stood in the way of Ashcroft. Russ Feingold is proof that someone on the Democratic side has the smarts to see where the wind is blowing. It makes sense for Democrats to respond to Bush in good faith and with restraint. The public will flush out divisive partisanship quickly enough. My prediction: more Dems will follow the Feingold approach. And they’ll benefit from it.

OOPS, I DID IT AGAIN

Mary Eberstadt, in her endless reply to the letters criticizing her “Pedophilia Chic” piece in the Weekly Standard, smears another person. This time it’s Wendy Kaminer, who wrote a piece in the American Prospect recently defending NAMBLA members’ right to free speech. Eberstadt claims in her response to the letters that, “just recently, writer Wendy Kaminer penned a classic example for American Prospect magazine called, casually enough, ‘Speaking of Man-Boy Love.’ Does anyone really believe that the same magazine would have licensed any writer to weigh the pros and cons of men having sex with little girls?” This is a good test of Eberstadt’s intellectual honesty since you all can read the Kaminer piece for yourself. Kaminer extends no sympathy whatsoever for “consensual man-boy love,” whatever that can possibly mean. Indeed, she puts it in quotation marks, which Eberstadt slyly removes. (For some reason, the title of the piece has been changed to “Speaking Of.”) Kaminer even finds consensual man-boy sex to be “absurd.” There is no discussion of the pros and cons of it in the piece, merely an examination of a lawsuit designed to prove that the very airing of such views should make NAMBLA legally responsible for a child rape and murder. Yet Eberstadt is able to imply that Kaminer basically endorses pedophilia or is anti-anti-pedophilia, when the sole point of Kaminer’s piece is pro-free speech. Another point. In her reply, Eberstadt argues that “there are plenty of [pro-pedophilia] books on the gay studies shelf [of any book store], as none of my critics deny.” Well, I do deny it. Perhaps if you looked really hard, you might find a reference or two somewhere. But pro-pedophile books or journals are simply a minuscule portion of gay fiction and non-fiction and I’ve never seen one in a gay bookstore. If any reader cares, let me know what your perusal of such a shelf shows up. I bet you: nada.

SHE ASKED FOR IT

Finally, a self-defense. In my letter, I wrote that “child abuse is always and everywhere an evil of extraordinary gravity.” Eberstadt has the gall to thank me for this “clarification.” Clarification of what? She has no, repeat no, evidence that I have ever said anything even faintly different. Her only source is a piece I wrote in the New York Times Magazine about our cultural resistance to good news. It started with an account of the discrepancy between falling crime and pregnancy rates and our continued belief that we are still somehow in cultural decline. It went on to discuss Bill Bennett’s Cultural Indicators, as well as a much-reviled study that suggested that legalizing abortion in the 1970s had reduced crime in the 1990s, and a largely ignored paper that argued that post-Vietnam suicide rates were far lower than previously thought. For good measure, I threw in the APA paper on child sexual abuse. Here’s what I wrote: “An equally sour reception greeted a study published by the American Psychological Association. Assessing data on effects of child-molestation, the paper found that lasting psychological trauma among adult survivors of abuse, particularly for men, was much less than feared. The results from 36 peer-reviewed studies and 23 dissertations showed that victims of child abuse seemed on average only slightly less well adjusted by the time they got to college than their peers. A reason for relief? Of course not. Outraged members of the religious right accused the A.P.A. of tolerating pedophilia and launched a crusade to punish the organization. The authors stressed that their findings ”do not imply that moral or legal definitions of or views on the behaviors currently classified as [child sexual abuse] should be abandoned or even altered,” but the House of Representatives voted 355-0 to condemn the article anyway. That’ll teach them to look on the bright side.” So it’s your call. Was that a subtle endorsement of pedophilia? Was it even anti-anti-pedophilia? There’s only one fair conclusion, I think. Eberstadt defiles the noble cause of opposing child-abuse by tactics outside the realm of civilized discourse. I’m sorry to go on. But the record should be set straight.

WHAT’S BOB KUTTNER SMOKING?

“Now Bush has abandoned all pretense of governing from the center, and congressional Democrats are uncertain whether to muster wall-to-wall opposition.” – Robert Kuttner in The American Prospect. Bush has even abandoned the pretense of governing from the center? It’s statements like that that make you wonder whether the man has lost touch with reality. My favorite Kuttner moment, however, was a cover-story he did for The New Republic while I was deputy editor. It was written just as the last recession was ending and predicted the future of the economy in the 1990s. It was called: “The Abyss.” Doesn’t get any more prescient than that. Maybe he should get a job at the Economist.