Issue:  Vol. 47 / No. 50 / 14 December 2017
 

SF report shows 16 percent drop in HIV infections

by Liz Highleyman
liz@black-rose.com

The San Francisco Department of Public Health released its latest HIV epidemiology report this week, showing that the number of new infections has declined 16 percent, with decreases seen across demographic groups. Homeless people, however, have higher rates of infection and poorer treatment outcomes.

(Health department HIV Epidemiology Section Director Susan Scheer discusses the latest HIV numbers at a Friday news conference as Dr. Tomas Aragon, left, Health Commissioner Dan Bernal, and Supervisor Jeff Sheehy look on. Photo: Liz Highleyman)

(Health department HIV Epidemiology Section Director Susan Scheer discusses the latest HIV numbers at a Friday news conference as Dr. Tomas Aragon, left, Health Commissioner Dan Bernal, and Supervisor Jeff Sheehy look on. Photo: Liz Highleyman)

The HIV Epidemiology Annual Report for 2016 was released at a news conference at the San Francisco AIDS Foundation Friday, September 15 and will be presented in more detail at a Health Commission meeting September 19 and a meeting of the San Francisco Getting to Zero Consortium September 28.

“Highlights of this year’s HIV annual report include at 16 percent decline in new diagnoses to 223 – the lowest number ever reported in San Francisco,” Susan Scheer, director of the DPH’s HIV Epidemiology Section, told the Bay Area Reporter. “This means we have cut new diagnoses by over half since 2006.”

While new HIV infections nationwide decreased by 18 percent over six years (2008 to 2014), according to the Centers for Disease Control and Prevention, San Francisco saw a similar 16 percent drop last year alone, and a 49 percent reduction over the past four years, Dan Bernal, a gay man who sits on the city’s health commission, noted at the press conference.

The latest findings indicate that San Francisco is making progress toward achieving the goals of its Getting to Zero initiative: zero new HIV infections, zero deaths due to HIV/AIDS, and zero stigma against people living with HIV.

“New HIV infections in San Francisco are declining at a faster rate than ever, and the city continues to do better than the nation in reducing new infections,” said Health Director Barbara Garcia, who is a lesbian. “Better yet, new infections are dropping among all groups, including African-American and Latino men, and we are starting to close the disparity gap. It is essential that we focus on disparities in order to get to zero.”

New and total HIV cases

The report, which covers data through the end of 2016, shows that the number of new HIV diagnoses in San Francisco fell from 265 in 2015 to 223 in 2016. This continues a decade-long drop, with a steeper decline starting around 2012.

Experts attribute the decline to a combination of factors including increased testing, the advent of PrEP for HIV prevention, and widespread adoption of early antiretroviral therapy. Studies conclusively show that people on effective treatment that suppresses HIV to an undetectable level do not transmit the virus.

Among newly diagnosed individuals, 87 percent are men, 11 percent are women, and around 2 percent are transgender. Trans women accounted for almost all of the 144 newly diagnosed cases in the transgender category.

By transmission category, 70 percent are men who have sex with men, 9 percent are people who inject drugs, another 9 percent fall into both these groups, and 6 percent are heterosexual. Among gay and bisexual men in particular, the report also noted an increase in sexually transmitted diseases, especially gonorrhea.

By race and ethnicity, 39 percent of newly diagnosed people are white, 28 percent are Latino, 15 percent are African-American, and 15 percent are Asian or Pacific Islander. New diagnoses declined for all groups except Asians-Pacific Islanders, for whom they held steady.

White people and Asians account for a smaller proportion of newly diagnosed individuals compared with their share of the city’s population (about 54 and 36 percent, respectively, according to the U.S. Census Bureau), while Latinos and black people accounted for disproportionately more new cases relative to their share of population (about 15 and 6 percent, respectively).

The HIV diagnosis rate among black men in 2016 was 96 per 100,000 people – more than double the rate of 39 per 100,000 among white men. But this was a substantial drop from 140 per 100,000 in 2015. Nationwide, the disparity is even greater: African-Americans account for 45 percent of all new HIV cases while making up about 12 percent of the U.S. population.

One-third of newly diagnosed people in San Francisco were in the 30-39 year age range, followed by those ages 25-29 (24 percent). Young adults age 18-24 accounted for 14 percent of new HIV diagnoses. The 40-49 year age group and people over 50 each accounted for 15 percent of new cases. No adolescents age 13-17 were found to be HIV-positive in 2016, and no infants or children under 13 have been diagnosed with HIV in San Francisco since 2005.

The number of deaths among people with HIV declined even more steeply than new infections, from 257 in 2015 to 165 in 2016. However, the report cautions that the latest number is likely an underestimate due to delayed reporting. Deaths from direct HIV- or AIDS-related causes continue to fall, while deaths due to other causes are rising, the most common being non-AIDS cancers, accidents (including drug overdoses), and heart disease.

As the death rate goes down, the number of people living with HIV goes up. At the end of 2016 there were 16,010 HIV-positive San Francisco residents, accounting for 2 percent of all people known to be living with HIV in the United States, according to the report.

The vast majority of people with HIV in San Francisco – 92 percent – are men, while 6 percent are women and 2 percent are transgender. More than half (59 percent) are white, 19 percent are Latino, 12 percent are black, 6 percent are Asian/Pacific Islander, and fewer than 1 percent are Native American.

As a consequence of improved survival, the HIV-positive population in San Francisco people is aging. Currently 63 percent are over age 50, while 26 percent are over age 60 and 5 percent are over 70. Only around 5 percent of people living with HIV in the city are under age 30.

“It’s great news that we’re seeing fewer new HIV diagnoses, better survival, and a lessening of racial/ethnic disparities, likely as a result of a whole suite of initiatives rolled out by the health department, community-based organizations, clinics, and individual providers,” Dr. Susan Buchbinder, director of DPH’s Bridge HIV program told the B.A.R. “Now is the time to double down on these efforts, not pull back. The only way to prevent new infections and ensure the health and well-being of people with HIV is through these comprehensive services, with a focus on our most vulnerable populations.”

Disparities in care

San Francisco continues to do a better job than the U.S. a whole in moving people through the HIV continuum of care from testing to initiation of treatment to achieving viral suppression.

Overall, an estimated 93 percent of people living with HIV know they are positive. In 2015 (the last year with complete data), 78 percent of newly diagnosed people were linked to care within a month of diagnosis and 64 percent remained in care for three to nine months.

That year 77 percent of newly diagnosed people – or 73 percent of all people currently living with HIV in San Francisco – achieved viral suppression within a year. It took a median of 13 days from HIV diagnosis to treatment initiation and 76 days to reach an undetectable viral load.

“Deaths from HIV-related causes have continued to decline and overall linkage to HIV care and viral suppression have improved at the population level,” Scheer told the B.A.R. “Even more impressive, the amount of time it takes people who are newly diagnosed with HIV to link to care and to achieve viral suppression has become much faster. Time to viral suppression has been cut in half since 2012 from five months to two and a half months.”

Yet all groups are not benefitting equally from improvements in care. Looking at all HIV-positive people living in San Francisco, men were more likely to achieve viral suppression than cisgender or transgender women (73 percent versus 66 and 67 percent, respectively). White and Asian people (both 75 percent) were more likely than black people (67 percent) or Latinos (69 percent) to become undetectable within a year.

Some advocates have suggested that San Francisco’s overall good progress in preventing and treating HIV is in part related to its small and dwindling black population, as well as the fact that many people at risk for and living with HIV are being displaced from the city due to high housing costs.

Underscoring the effect of socioeconomic risk factors, 13 percent of newly diagnosed people were homeless at the time of their diagnosis. This represents a total of 28 homeless individuals found to be HIV-positive in 2016. Homeless people currently living with HIV in San Francisco were the least likely to reach an undetectable viral load within a year, at 31 percent.

“We can’t look at these numbers and not realize that we’re not going to get to zero unless we address housing issues,” Jeff Sheehy, San Francisco’s first openly gay and HIV-positive supervisor and a co-founder of the Getting to Zero Consortium, told the B.A.R. “We need to prioritize people with HIV for housing. We need to get people off the streets, but also look at what we can do to help people who are still on the streets.”

One such effort is DPH’s Linkage Integration Navigation Comprehensive Services (LINCS) program, which does outreach to help vulnerable groups re-engage in care, including people living in homeless encampments and clients of harm reduction programs. Among homeless people participating in LINCS, the proportion achieving viral suppression rose to 77 percent.

But HIV services in San Francisco could be at risk due to coming federal budget cuts. Sheehy told the B.A.R. that the city can expect up to $1.6 million in cuts to CDC grants over the next year as federal funding is reallocated to jurisdictions with more new infections. He said that he would work with the mayor and Board of Supervisors to backfill the cuts with city funds, as has been done in the past.

“We’re demonstrating with the numbers that we have the tools to dramatically change the course of the epidemic, but we need to keep our momentum going.” Sheehy said.

— Cynthia Laird, September 15, 2017 @ 2:16 pm PST
Filed under: Uncategorized


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