Featuring Our Faculty: HIV Infections in SF Hit Low, but Drive Misses African Americans
New HIV infections dropped to historic lows in San Francisco last year as the city amped up an aggressive campaign to essentially end the AIDS epidemic by 2020, but those efforts are not reaching everyone in equal measure, according to an annual report set to be released Thursday.
The city recorded 255 new infections in 2015, according to the Department of Public Health report. That was a 17 percent drop from the previous year — and roughly a 10th of the total new infections reported at the peak of the epidemic in the early 1990s.
However, infections increased among black men and women. And other indicators of progress toward ending the epidemic — such as getting people diagnosed early and into care quickly — also aren’t as robust among minority men and women as white men.
“We’ve made tremendous strides. The problem is that we’re not doing better for everyone,” said Dr. Susan Buchbinder, director of HIV research for the San Francisco Department of Public Health. “There are populations we’re not reaching. We need to do more outreach, more services, more education.”
In 2014, San Francisco launched its “Getting to Zero” campaign, which aimed to cut new infections and deaths from AIDS by 90 percent by 2020, to a few dozen a year at most. That would largely signal the end of widespread transmission of HIV, which has been at epidemic levels in the city since the early 1980s.
To that end, the city has invested roughly $2 million toward curtailing new infections. Those efforts largely focus on two areas: getting people onto drugs, a procedure known as pre-exposure prophylaxis, or PrEP, to protect them from contracting HIV; and getting the newly infected into care immediately.
PrEP can cut the chances of contracting HIV by more than 90 percent when taken appropriately, studies have shown. Over the past several years, San Francisco has pushed to get people who are most at risk of HIV on the regimen, an effort that likely has played some role in the drop in new infections, public health officials said.
Repeated studies also have found that when people who are newly infected are treated early with anti-HIV drugs, the amount of virus in their blood can be kept at undetectable levels, making it almost impossible for them to infect others.
San Francisco’s focus on early, aggressive treatment of HIV patients appears to be paying off, according to the new report. In 2014, the most recent year for which treatment protocols are available, 84 percent of people newly infected with HIV were in medical care within a month of diagnosis, and 72 percent had undetectable levels within a year. Those rates are much higher than national averages.
Patric Ian, 37, is not newly infected, but he was introduced to San Francisco’s aggressive treatment programs within a week of moving to the city this month, when he went for a checkup at Ward 86, the outpatient HIV clinic at San Francisco General Hospital. He learned that he had become resistant to his HIV drugs and would have to switch to new medication. From there, he was swept up in a whirlwind of care.
“It was kind of breathtaking. I’m still trying to figure out the difference between Muni and BART and suddenly it’s like life or death,” said Ian, just after wrapping up an appointment at the clinic on Wednesday. “San Francisco just seems to have this network of very capable people who know what to do if you just shut up and let them.”
But, as with the rate of new infections, access to care is not equal among all groups.
Only 67 percent of infected black people were receiving treatment within a month of diagnosis, and only 65 percent had undetectable virus levels within a year. Black men and women also were more likely than others to be diagnosed with late-stage HIV infection, in many cases when the disease had already progressed to AIDS.
If San Francisco is going to become the first city in the United States to end the AIDS epidemic — and, ultimately, that is the goal — there’s a lot more work to be done in reaching communities that are not yet seeing the benefits of the city’s aggressive approach, public health experts said.
“We really have to figure out how we can prevent those disparities,” said Dr. Diane Havlir, chief of the division of HIV/AIDS at San Francisco General Hospital. “We’re looking at some stubborn problems now. They’re not going to be solved unless we put more effort and resources into them.”
The annual report also looks at San Francisco’s growing population of long-term survivors of AIDS. Among the city’s 16,000 residents living with HIV, 60 percent are now age 50 and older, and a quarter are 60 or older.
Increasingly, the city is recognizing that older survivors have needs beyond just treating HIV infection. Long-term survivors are dealing with other effects of aging, including heart disease, diabetes, liver disease and cancer. They’re also facing problems with mental health, social isolation, and housing and food instability.
Their needs are, in many ways, emblematic of larger barriers in the fight to end the epidemic. Many groups that continue to have higher risk of HIV infection and less access to care are also struggling with mental health problems and a lack of safe, stable housing.
As San Francisco continues to slow down new infections, public health officials say they’re going to have to keep pushing resources into communities that need the most help — including, at one end of the epidemic, long-term survivors, and at the other end, minority and low-income groups who are at greatest risk of infection.
“We have so many structural issues that people face that need to be addressed and that make it difficult to get all the way to zero,” Buchbinder said. “But we’re at the turning point in the history of the epidemic. San Francisco has always been a leader, so if anyone can get to zero, it should be us.”