S.F. Paper's Brief Headline Signals a Moment to Rejoice

TIMES STAFF WRITER

"No obits," announced the profoundly simple banner headline on the front page of the Bay Area Reporter.

Some smiled when they saw the stark notice Thursday in the city's largest gay and lesbian newspaper, long the bellwether for the community's battle with AIDS. Others wept with joy. Still others just stared in disbelief.

For the first time in 17 years, in a city long considered America's ground zero in the epidemic, a week had passed without a single obituary arriving at the editorial offices of the BAR, as the paper is known.

"Wow," said Paul Wisotzky, a gay man with AIDS who has lived in San Francisco since 1989. Chairman of the San Francisco AIDS Foundation's board of directors, Wisotzky said he followed the obituaries meticulously until a few years ago, when he stopped because "my circle of friends had died." Just three years ago, he noted, a week without death notices was inconceivable.

That was before the introduction of combination therapy for HIV infection. The therapy involves treatment with at least three AIDS drugs, one of which is called a protease inhibitor.

Combination therapy reduces the virus below detectable levels in as many as 80% of those receiving it. It also produces at least a partial restoration of the immune system. That boosting of immune function, in turn, sharply limits the opportunistic infections that are the sign of full-blown AIDS and that are usually the cause of death.

The new drugs are widely believed to be responsible for the dramatic decline in AIDS deaths over the past two years.

"After 17 years of struggle and death, and some weeks with as many as 31 obituaries printed in the BAR, it seems a new reality may be taking hold, and the community may be on the verge of a new era of the epidemic. Perhaps," wrote Timothy Rodrigues in the article that the headline topped.

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Editor Mike Salinas said the decision to run the headline and story sparked a lively debate in the newsroom, where some feared that it would create the false impression that the AIDS epidemic was over.

Salinas said that by Tuesday, when no obituaries had arrived for 10 days, he decided it was time for a little rejoicing.

"We said in our article, and we all know, that this is not in any way a scientific measure, that it doesn't mean people didn't die of AIDS in this country last week, aren't still dying of AIDS," he said Friday.

"But it is a canary in a coal mine. We've reached a new level. People are living longer with the virus."

At the height of the AIDS epidemic in San Francisco, Salinas dreaded the weeks when his obituary writer was on vacation, because then he and other staffers would have to wade through the often heartbreaking testimonials to lost loved ones that poured in. Many times, obituaries consumed the bulk of the paper's weekly news hole.

By the late 1980s, reading the BAR's death notices had become a morbid ritual for the city's gay community.

"It used to be the first thing that everybody would look at, a way of tracking your own history in the epidemic," recalled Martin Delaney, founding director of the San Francisco AIDS Foundation. "Everybody would look at it and look for old friends and acquaintances."

The tabloid's death notices began to lose their grip on the community's imagination several years ago, as infection and death rates began to fall in the face of prevention efforts and advances in drug therapies. Two years ago, after the introduction of combination therapy, the number fell dramatically, to an average of five obituaries weekly.

But never before had a week passed without a single death notice.

Reaction to the headline, Salinas said, was instant. "It was wonderful this morning, taking the streetcar and seeing people with the BAR, reading the headline, and other people catching sight of the headline and doing a double take and smiling. I saw people with tears."

Some of the city's AIDS activists fretted that the headline sent the wrong message, that readers would take it to mean the epidemic was over.

"The BAR represents mostly the white, middle-class gay community," said Ronnie Burk, an activist with ACT UP San Francisco, a militant group born of the AIDS epidemic that often is at odds with the mainstream gay community. "Even in the article, they said that a homeless man had died of AIDS in the Tenderloin last week and nobody wrote an obituary for him.

"The BAR is not really a gauge of how many people died of AIDS in San Francisco. It is a gauge of how many white, middle-class men died."

Allen White, on the staff at the Metropolitan Community Church of San Francisco, counts himself among those middle-class white males. The headline shocked and thrilled him, White said.

"There have been more memorial services for people who have died of AIDS at this church than at any other church in America," he said. "My reaction was a very selfish reaction, it's true. Twenty minutes after I saw that headline, tears started to well up in my eyes."

White estimates that he has lost at least 200 friends, business associates, lovers and acquaintances to the epidemic in the past 17 years.

"After a period of time, just to simply exist you have to build up a barrier to your emotions. Then you see something like this and just for a moment say, 'Maybe it will be over.' Just for a moment, we could say, 'Maybe there's some hope.' It was like being in a rainstorm and suddenly seeing sunshine."

It is indisputable that the number of AIDS deaths has dropped dramatically over the past two years, in California and the nation as a whole.

According to the San Francisco Department of Health, the number of reported deaths because of AIDS in the city last month was 35.

The number of such deaths so far this year is 134. For all of 1997, the number was 347. The peak year was 1992, with 1,816 deaths.

In California, according to the state Department of Health Services, there were 2,674 AIDS deaths from July 1997 to July 1998, compared to 4,307 in the previous 12 months--a 38% drop.

Nationwide, the number of AIDS deaths dropped from 21,460 in the first six months of 1996 to 12,040 in the first six months of 1997, according to the most recent figures available from the National Institute of Allergy and Infectious Diseases. That represents a 44% decline.

But Ron Stall, an epidemiologist and biostatistician at UC San Francisco Medical Center, said he is in no mood to celebrate.

"What concerns me is that people will take this headline to mean that the war is over. I see no evidence of that," Stall said. "As far as I'm concerned, this is a very dangerous time for gay men."

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Studies in San Francisco show that the rates of high-risk sex among gay men--meaning anal intercourse without the protection of a condom--have gone up, Stall said. The rate of young men practicing unsafe sex has risen nearly 50% in the past two years, he said.

The increase in unsafe sex practices comes at a time when it has been demonstrated that it is possible to sexually transmit HIV that is resistant to combination therapy, Stall said.

"If there is enough transmission of treatment-resistant virus out there, we could be back to the situation of 1984 before we know it--when there was no known treatment," he said.

If he needed any reminder that the war rages on, Stall said, he got it Friday morning. The mail brought the first obituary for the paper's next edition. It was for a man who had died of AIDS.

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Times medical writer Thomas H. Maugh II contributed to this story.

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