Much to do to keep SF's edge in fighting HIV
by Bill Hirsh and Lance Toma
Our city is a national leader when it comes to effective and high-quality HIV programs and services. There are many responsible for our city's vigilant responsiveness and positive impact for people living with and at-risk for HIV, but one person stands out – longtime HIV advocate Mike Smith.
We want to publicly acknowledge Smith as he steps down from his position as the longtime executive director of the AIDS Emergency Fund/Breast Cancer Emergency Fund and president of the HIV/AIDS Provider Network. HAPN is the association of the many HIV organizations in San Francisco providing essential services ranging from primary care and mental health services to emergency financial and legal assistance to HIV prevention and education. As the new co-chairs of HAPN, we share Smith's commitment to the San Francisco Model of Care that is a model for our nation and the world. We have big shoes to fill and a lot of work ahead, but we remain committed and inspired by the prospect of an imminent future where HIV transmission is eliminated.
Over the past 11 years, the number of people living with HIV in San Francisco has increased by 45 percent. Currently, almost 16,000 San Franciscans are living with HIV, with approximately 1,000 of them unaware of their HIV-positive status. Over this same period, San Francisco lost $14 million in federal and state funding for essential HIV prevention and care services. Roughly one of every four gay men in San Francisco is HIV-positive. African Americans in our city are infected with HIV at a rate three times higher than their proportion of the population. Homeless residents are four times more likely than people in stable housing to be HIV-positive, and persons 50-plus years of age now comprise over 50 percent of people living with HIV.
These statistics reflect a reality in San Francisco that is unacceptable and requires action. Our priorities are clear.
Funding and resources must increase. We applaud the efforts of the mayor and the Board of Supervisors to backfill continuous and relentless reductions in federal funding. Our city's ongoing efforts to sustain funding levels is unprecedented, but flat funding in real-time means service reductions as organizations face increased costs and service demand. We must reverse this downward curve. We must identify ways to increase investment in our current HIV infrastructure to reach our goal of "getting to zero" – zero infections, zero deaths, and zero stigma.
Accessible and affordable housing must increase. San Francisco's most recent HIV/AIDS Housing Plan states that over 77.6 percent of people living with HIV are at risk of becoming homeless, due to being very low income. Currently, only 998 government-subsidized slots are available. This is an impending crisis. We know that housing is health care and prevents HIV, as people are much less likely to transmit the virus when they are stably housed and viral loads are suppressed. Many of those who are newly diagnosed with HIV are homeless.
Access to HIV medications is game-changing and necessary. HIV testing followed by immediate access to HIV medication if one tests positive has made this impact. Treatment is preventing HIV transmission because most who are on medications have undetectable levels of HIV in their system. They are healthier and they are not transmitting the virus to others. What many still don't know is that individuals who are at-risk for HIV should also be taking HIV medications to prevent contracting HIV. This one pill a day regimen for HIV-negative individuals is known as PrEP (pre-exposure prophylaxis). We need to get the word out and address the stigma that we know comes with this clinically effective prevention option. We must target PrEP education, support, and access to those at highest risk – HIV-negative gay men of color and transgender women and men.
Communities we can no longer ignore include our older adults, our transgender community, and our youth. The lives of long-term survivors of the HIV epidemic need to be a clear focus in our service delivery system. Many will soon be losing long-term disability benefits, which will drastically reduce their income and place many at-risk for losing their housing. The transgender community must be a priority. If we know that over 40 percent of transgender women are HIV-positive, we must be doing more for our transgender sisters. If we know that the transgender community was not involved in PrEP research, we must correct this so that there is equal access to PrEP. And finally, our youth. For the past several years, HIV prevention efforts have shifted away from youth. Young people are still testing positive for HIV at high numbers. We must bring back targeted HIV prevention education to young people – particularly youth of color at highest risk for HIV.
Despite all these challenges, San Francisco is ahead of our nation in preventing, testing, and treating HIV. Nationally, of the more than 1.2 million individuals living with HIV, only 30 percent have an undetectable HIV viral load. In San Francisco, 68 percent of those living with HIV are in this category because of our robust system of prevention and care. More than 30 years into the epidemic, the San Francisco community still turns out committed armies of volunteers, donors, and service providers in a sustained response to the epidemic that still inspires the nation. This is what makes San Francisco so special. Let's continue to roll up our sleeves and keep fighting.
Bill Hirsh and Lance Toma are the new co-chairs of the San Francisco HIV Providers Network. Hirsh serves as executive director of the AIDS Legal Referral Panel; Toma serves as executive director of the Asian and Pacific Islander Wellness Center.