The record-breaking decline in new HIV diagnoses and improvements in HIV care outcomes are encouraging and show a positive trend towards achieving San Francisco's goal of zero new HIV infections. In 2018, new diagnoses dropped below 200 to 197, which is a 13 percent decrease from 227 new diagnoses in 2017. There has also been progress on reducing disparities among populations, with three groups seeing significant improvement—the number of new diagnoses declined among Asians, women, and men who have sex with men (MSM).
"The results of the Annual HIV report are encouraging and show that we are on our way to Getting to Zero new infections," said Mayor Breed. "That said, we know that some San Franciscans need additional care and outreach in order to receive the treatment they need. Our health care professionals and community partners will continue working to reduce disparities among populations and improve HIV care for everyone in our City."
Disparities by race and ethnicity, age, gender, housing status, and risk group remain. The number of new diagnoses increased among four populations: people who inject drugs, people experiencing homelessness, African Americans and Latinx people. In 2014, San Francisco City agencies and organizations came together in a collective impact initiative known as Getting to Zero. This initiative brings together people and resources from throughout the city with three goals in mind: zero new HIV infections, zero HIV-related deaths and zero stigma and discrimination. These disparities highlight the need to address and achieve the Getting to Zero goals.
To strengthen San Francisco's ability to tackle these disparities, the San Francisco Department of Public Health (DPH) this week will launch a competitive process to allocate $8 million in funding to community organizations primarily serving African Americans, Latinx, transgender people and people who inject drugs. With grant funding, organizations will be able to develop new Health Access Points and strengthen their work on HIV prevention and care in their respective communities. The new Health Access Points will address the social determinants of health through a whole person care approach. This approach will help people with their basic needs, such as food and mental health, and also providing HIV, Hepatitis C, and sexually transmitted disease testing and treatment.
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"As the record-breaking decline in this year's Annual HIV Epidemiology Report shows, we've made enormous strides towards our Getting to Zero goals," said Supervisor Rafael Mandelman. "But the increase in new diagnoses among injection drug users, African Americans, Latinx, and unhoused people is deeply troubling. This is not a moment for complacency or self‑congratulation. Innovative models like Ward 86's POP-UP Clinic, which provides accessible and low barrier care to homeless and unstably housed HIV positive San Franciscans, are essential to ensuring the health of our most marginalized communities. We need more of that, and fast."
"We began as a world leader in care for AIDS patients more than 30 years ago," said Dr. Grant Colfax, Director of Health. "Together with our community partners, scientists, academics, providers and the City's leaders, we are confident in our pledge to be the first city to Get to Zero. But we can't get there until we close the disparities gaps and focus on equity to ensure that all San Francisco communities have access to HIV prevention and care that works for them."
"We know Getting To Zero's strategy of expanding PrEP, treatment upon diagnosis, and re-engagement in care is working," said Dr. Diane Havlir, co-founder of Getting To Zero. "We are now doubling down to ensure we reach those affected by the gaps in housing, mental health and substance use services."
There are several efforts underway to address the disparities facing people who are experiencing homelessness. In January 2019, Ward 86 at San Francisco General Hospital launched a new medical program that provides flexible, comprehensive and patient-centered care. The POP-UP (Positive-health Onsite Program for Unstably-housed Populations) program specifically aims to reduce health disparities among homeless and unstably housed individuals living with HIV in San Francisco. The POP-UP clinic provides low-barrier care for patients who are not virally suppressed and require urgent care or other drop-in needs. The team consists of physicians, nurses, and a social worker. POP-UP is open in the afternoons five days a week. No appointment is necessary and patients in this program can come any time for care. POP-UP provides incentives for linkage and retention in care, enhanced patient outreach, and referrals for emergency and permanent HIV housing in coordination with the Department of Homelessness and Supportive Housing.
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DPH also has a $2 million grant from the Centers for Disease Control and Prevention (CDC) to focus on HIV and Hepatitis C prevention and care among people experiencing homelessness, and people who inject drugs. The grant, called OPT-IN, supports the provision of medical and social services to this population. A highlight of OPT-IN is DPH's team of street outreach workers that not only link people to health services daily, but also set up stationary health services in neighborhoods. The team develops relationships with people in the Bayview, Hunters Point, SOMA, and the Tenderloin, enabling them to link to the services they need.
San Francisco's existing efforts to reduce disparities in the African American and Latinx populations have focused on increasing PrEP access for African American and Latinx men who have sex with men. PrEP, or pre-exposure prophylaxis, is medication that is proven to prevent the transmission of HIV. These efforts include lowering barriers to PrEP, social marketing campaigns, provider education, and partnering with community. Since 2014, the uptake of PrEP has been steadily increasing among all ethnic groups. For example, at San Francisco City Clinic, the municipal STD clinic, the proportion of MSM who reported using PrEP increased from 2017 to 2018. PrEP among Latino and White MSM increased from 47-48 percent to 53 percent, while PrEP among African American MSM increased from 41 percent to 49 percent. Racial and ethnic disparities are lessening, but more work remains.
On September 30, 2019, San Francisco will be awarded a planning grant from the CDC to partner with existing initiatives, including the HIV Community Planning Council, the Getting to Zero Consortium, and End Hep C SF. The City and partnering initiatives will engage with all communities—especially the African American and Latinx communities, people who use drugs and people who are experiencing homelessness—to strengthen successful methods and devise additional ones to help these populations get to zero. The one-year plan will address overlapping vulnerabilities, health disparities and inequities. Racial and social justice will be at the forefront of the planning process, which will inform the new Health Access Points mentioned above.
The Annual Report is the first in a series of announcements that the City will be making regarding HIV/AIDS initiatives over the next year. San Francisco and Oakland will be hosting the AIDS 2020 Conference in July next year.
Read the full 2018 Annual HIV Epidemiology Report here.
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