San Francisco's HIV sex revolution comes with a catch

SAN FRANCISCO (KGO) -- One out of four gay men in San Francisco take a blue pill every day to help prevent HIV and it is working even better than many doctors hoped.

It's so effective, the San Francisco Department of Health is calling it a sexual revolution. "We do hear from many people that now for the first time they can have sex without anxiety and fear and we think that's worth celebrating," said Stephanie Cohen, Medical Director of San Francisco City Clinic.

There are signs of the 'revolution' all around San Francisco. At bus stops and outside a corner store, a black-and-white image shows a group of young people laughing and dancing. In a corner of the ad, an image of the pill called PrEP, which stands for pre-exposure prophylaxis.

PrEP, made by Foster City-based Gilead under the brand name Truvada, reduces the risk of contracting HIV by at least 90 percent when used correctly.

Some have seen even better results. Kaiser Permanente San Francisco is a national leader in PrEP care. None of its patients on the pill has contracted HIV.

So what's the catch? "I think one of the risks of PrEP that we are seeing is the rise of other sexually transmitted infections," said Dr. Brad Hare, director of HIV care and prevention at Kaiser Permanente San Francisco.

The Department of Health says new HIV cases in San Francisco have decreased by 60 percent in the past 13 years. At the same time, other STDs have skyrocketed. For example, gonorrhea has doubled and syphilis is up 180 percent.

PrEP can't take the entire credit nor the entire blame for any of those numbers. It wasn't even approved for use until 2012. Still, doctors in the city are watching what is happening to condom use in the age of PrEP.

A year before PrEP was approved, the CDC says about 30 percent of gay men in San Francisco consistently used condoms. By 2014, that number plummeted to just about 18 percent. Cohen at San Francisco City Clinic stresses to her clients that PrEP only protects against HIV. "Small changes in rates of condom use can actually lead to pretty big changes in rates of STDs", Cohen said.

You can see those changes in the Castro just about every morning where a line forms outside a free STD clinic an hour before the doors open.

It's where ABC7 News met Eric. "I know what I can get myself into and still get treated and be okay at the end of the day," Eric said.

He was candid with ABC7 News and said he always communicates with his partners about sexual risk and doesn't always use condoms. Sometimes, that leaves him there looking for treatment. "It's risky, but it is what it is," he said.

For Eric, the number one priority is avoiding HIV. It's a strategy the city and many health professionals have also adopted in this "sexual revolution. In somebody with a high risk for HIV, the importance of protecting that person and averting new HIV infections really outweighs the other consequences that we are seeing," said Dr. Hare at Kaiser Permanente. Although we have to mindful of those consequences," he said.