Providing intravenous drug users with safe injection sites could play a critical role in San Francisco’s goal to eliminate HIV transmissions and related deaths, but whether such a plan will move forward remains unknown after a state bill legalizing the sites failed last week.
In the past decade, The City has achieved a nearly 60 percent decrease in diagnosed HIV transmissions, according to the Department of Public Health’s annual HIV Epidemiology 2016 report, which was released Friday.
“The number of new HIV diagnoses declined from 530 in 2006 to 223 in 2016,” the report said. In 2015 there were 265 new cases diagnosed.
There are also fewer people dying from HIV. “The number of deaths declined from 327 in 2006 to 257 in 2015, the last year that death reporting is complete,” the report said. There were 16,010 people in San Francisco living with HIV last year.
But for San Francisco to achieve the near-term “Getting to Zero” goal of a 90 percent reduction in new HIV cases by 2020, city officials say new strategies focusing on the most vulnerable populations are paramount.
Safe injection sites, for instance, can reduce the spread of the disease among intravenous drug users and reduce overdose deaths, according to studies of existing facilities in other countries.
The sites provide new hypodermic needles and can offer a number of services like education, counseling and possibly lockers for medications for HIV or Hepatitis. They could help make inroads in the homeless population where drug use is high and HIV infections are on the rise.
Supervisor Jeff Sheehy, the first openly HIV positive member of the Board of Supervisors who held a news conference Friday to discuss the report’s findings, said he supports safe injection sites.
“I think they are actually very critical,” Sheehy said. “I think they can play a very important role.”
But San Francisco’s effort to become the first city in the nation to open safe injection sites suffered a setback Friday when Assembly Bill 186, which would have legalized the sites under state law, didn’t make it out of the California Senate Friday, the deadline to do so.
Assemblywoman Susan Eggman, D-Stockton, who introduced AB 186, and co-author state Sen. Scott Wiener, D-San Francisco, have vowed to try again and pass it next year.
Not everyone, however, wants San Francisco to wait for that possibility.
In the 1990s, San Francisco’s decision makers declared a state of emergency to fund underground needle exchange programs to combat the spread of AIDS. The state of emergency was supported by then Mayor Frank Jordan and backed by then City Attorney Louise Renne, who argued The City had the legal authority to declare an emergency and exempt itself from state law that had banned distribution of hypodermic needles without a prescription.
That’s exactly what Joe Hollendoner, chief executive officer with the San Francisco AIDS Foundation, has suggested The City do to open safe injection sites.
“We know that if you are going to get to zero, we have to develop new and unique interventions,” Hollendoner said.
He also highlighted the drug overdose deaths among those living with HIV. “Within the top five causes of death of people living with HIV, overdose is one of them,” Hollendoner said. “Safer injection facilities are going to prevent overdoses as they have in other countries.”
Fatal drug overdoses accounted for 88 of the 973 deaths of those living with HIV between 2012 and 2015, the report said.
Of the 223 who were diagnosed with HIV in 2016, 21 were those who inject drugs and another 21 were those who inject drugs and are also gay or bisexual men, according to the report.
Of those living with HIV in San Francisco, 6 percent, or 913, are those who inject drugs — about 400 are female — and 15 percent, or 2,370, are those who inject drugs and are also gay or bisexual men.
Dr. Tomas Aragon, DPH’s director of the Population Health Division, told the San Francisco Examiner Friday morning that “obviously The City will prefer to have” AB 186 as law, but “if it doesn’t come through, I think people are going to put their heads together and try and figure out what we can do.”
There are stark disparities in the fight against HIV.
In 2016, the rates of newly diagnosed HIV cases was 43 per 100,000 for black women whereas it was 39 per 100,000 for white men. For black men it was even higher at 96 per 100,000.
Sheehy highlighted the needs of the homeless population, where the cases of new HIV transmissions are rising, specifically noting that only a third of cases were virally suppressed. For those living in homes it was 74 percent.
Part of the challenge in suppressing the viral load among homeless residents is ensuring they remain on their medication.
Dan Bernal, who sits on the Health Commission and is HIV positive, said, “I take six or seven different HIV medications and I have a hard time keeping track of them myself. So imagine being homeless, not knowing where you are going to sleep every night, not having a place for your belongings.”
Those infected by HIV and who are homeless are most likely to be female or transgender, black, people who inject drugs or people who inject drugs and who are also homosexual or bisexual men, according to the report.
Fifty-eight percent, or 293, of those those homeless diagnosed with HIV in the past decade were people who inject drugs or people who inject drugs and are also homosexual or bisexual men.
“The homeless population, which has been relatively stable, is increasing in HIV infections,” Sheehy said. “We are not going to get [to zero] unless we address all the disparities that drive this.”
The goal of zero new HIV cases is within reach, Sheehy said, but “as a city we have to redouble our efforts.”
Lance Toma, chief executive office of the Asian and Pacific Islander Wellness Center, provides HIV services for those living in homeless encampments.
“The last piece of this puzzle is to truly reach those most vulnerable,” Toma said. “These are the folks that we have yet to reach in our 30-plus years in fighting this epidemic.”
The Health Commission will hold a hearing Tuesday on the 2016 HIV report.