SF gay male Viagra studies questioned

Dear friends:

I am sharing this public letter from Patrick Monette-Shaw with you because he raises many important issues of concern to me.

--Michael Petrelis

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August 11, 2002

Cynthia Laird
Bay Area Reporter
395 Ninth Street
San Francisco, CA 94103

Letter to the Editor,

Once again, the B.A.R. has fallen hook, line, and stinker for a media
story planted by the San Francisco Department of Public Health without
prior release to the citizenry of San Francisco (“Viagra usage remains
high among gay men, survey says,” Aug. 8). DPH and UCSF have been
roundly criticized for planting media stories and not informing the
local public beforehand. Before the Barcelona conference, DPH employee
Steven Tierney, Director of HIV Prevention, noted in his report to the
HIV Prevention Planning Council on May 9 that UCSF, and by extension
DPH, were committed to releasing information locally before presenting
it in Barcelona.

Your front-page coverage last Thursday shows DPH is not as committed as
it would like the Prevention Planning Council to believe, given that the
Viagra study was released in Barcelona July 11 and we are just now
getting wind of it locally. Fully 30 days later, DPH is just getting
around to presenting the information to U.S. audiences for the first
time. Such is their commitment to “…not repeating previous
experience[s] of information being presented and quoted in the media
prior to informing the HIV Prevention and Services Community,” per
Tierney's remarks in the minutes of the May 9 Council meeting!

As for the community not heeding the prevention messages, there are
clearly mixed signals being presented in San Francisco. On the one
hand, DPH comes to the table late, announcing an August 15 community
forum to discuss Viagra use. On the other hand, we have the Gay Pride
organizing committee issuing Pfizer a permit for a Viagra booth at the
Parade held at the end of June. How are gay men to uncross these mixed
messages? The booth tells us it’s OK to have Viagra in our lives; now
DPH is saying something different entirely.

Bajko cites the Stop AIDS study of having interviewed 884 people, yet
the abstract on the Barcelona web site lists only 644 survey
participants. Did the Stop AIDS project actually interview another 240
people in the 30 days between Barcelona and now, and if they did, how
did DPH manage such a fast analysis, when they usually take far longer
to analyze anything? Nor does Bajko report on any of the demographics
of the abstract, which reveals that 66% of the survey pool included
white men and 65% of the survey pool included men with at least one, and
possibly more, college degrees. This is not a cross-sectional,
representative sample of gay men in San Francisco; once again, this is
convenience sampling targeting particular venues like sex clubs and bars
in the Castro. Notably, neither the abstract nor DPH’s
recently-released annual HIV/AIDS report for 2001 presents a zip code
distribution of survey respondents, so we have no clue as to whether
this sample was drawn from all locations of the City, or whether the
data is simply that much further skewed by over-sampling in one area.

Disturbingly, this study, like so many other of DPH’s studies, is based
on “ever use”; it does not reflect current usage of Viagra. The data is
artificially inflated by including anyone who has ever used it and who
may have already stopped using Viagra due to adverse reactions. “Ever
use” is a dead ringer that something is dead wrong with this study
design; “current” vs. “ever” use is the biggest confounding factor DPH
allows its data collection to be skewed by. Neither the major media nor
the B.A.R. have yet to catch on to how this inherent bias invalidates
DPH's wild conclusions. Just what we don’t need: More flawed data
being touted as fact! From my perspective (and I am just expressing an
opinion and not making an allegation), it is just this sort of flawed
data that skates dangerously close to being criminal.

Finally, Bajko does not report on a second Viagra study DPH presented in
Barcelona which was conducted at the City’s STD clinics. The second
abstract concluded that “Viagra use was less frequent in our study than
suggested by previous surveys,” but we hear not one word of
qualification by Bajko, the Stop AIDS Project, or DPH sources in your
coverage, nor is it likely DPH will circle back and correct their
planted story that Viagra use is not as frequent as it may have once
been.

Appallingly, DPH has now waited a full month to get around to releasing
this information locally. What impact will its 30-day foot dragging
have on increased seroconversion rates in SF, and how much additional
needless human suffering will ensue owing to foot-dragging?

Patrick Monette-Shaw
ICO/AARI (Independent Community Observer/AIDS Accountability Research
Investigator)