HIV diagnoses hit historic low in SF but continue to rise in vulnerable groups

City struggles to stop new infections among homeless, African Americans, Latinos, drug users

While new HIV diagnoses dropped below 200 last year for the first time in The City’s history, at-risk and underserved populations — including San Franciscans who are homeless, African American, Latino and those who use injection drugs — continue to suffer disproportionately from HIV infections and deaths, according to a report released Tuesday.

The City’s overall new HIV infection rate has dropped by 13 percent, down to 197 last year from 227 in 2017. There have been no new infections among children under age 13 since 2005, and in 2018 94 percent of people living with HIV were aware of their diagnosis and were virally suppressed in 2017.

However, new infections are steadily climbing among those who are homeless, increasing from 14 percent in 2017 to 20 percent this year, as well as in The City’s Black and Latino communities, according to the San Francisco Department of Public Health’s annual HIV report.

City and Public Health officials who gathered at Zuckerberg San Francisco General Hospital’s Ward 86 — the nation’s oldest HIV clinic — to discuss the report’s findings acknowledged that while The City as a whole is inching toward its stated goal of “zero new HIV infections,” gaps across race, age, gender and housing status not only continue to exist, but are widening.

“We are pleased but not satisfied,” said Dr. Diane Havlier, co-founder of the citywide “Getting to Zero” consortium. “For an African American HIV infected male, his mortality is twice that of his counterparts, and [in terms of] new infections, 39 percent were from the Latinx community. We have to double down on these gaps we are seeing.”

Mayor London Breed agreed that “ending these disparities must be our focus.”

“These disparities highlight the work we have to do to continue to get to zero,’” she said.

In 2018, African American men had the highest HIV diagnosis rate, followed by Latino men, at 145 and 89 per 100,000, respectively. With a diagnosis rate of 35 per 100,000, African American women were diagnosed with HIV at a much higher rate than women of any other race or ethnicity last year.

While the viral suppression rate for the overall number of people living with HIV at 74 percent remained unchanged in 2018, it continues to be much lower for homeless individuals, who per the report showed a 33 percent viral suppression rate in 2018, up slightly from 32 percent in 2017. Viral suppression refers to suppressing the HIV virus to an undetectable level through treatment.

People who inject drugs in 2018 had a viral suppression rate of 65 percent, while the number of new infections in this group continued to rise. According to the report, there were 27 new diagnoses in 2018 compared to 21 in 2016.

In 2017, African American women had a mortality rate of 43 deaths per 100,000, which was 4.3 times higher than Latina women and 7.2 times higher than white women, per the report.

The causes behind the widening disparities in regard to race and housing status of HIV patients were not identified in the report.

However, The City’s focus on ending HIV infections and deaths must include “ensuring systems in which people receive care are affirming places and that we address some structural issues, including structural racism that a lot of San Franciscans experience in the health system,” said Dr. Hyman Scott, a UCSF clinician in Ward 86.

As part of that work, Breed announced Tuesday the the pbulic health department this week will launch “a competitive bid process” for a $8 million funding allocation for community organizations “primarily serving African Aermican, Latino, transgender and substance use communities.”

Breed also plans on closing some of the gaps highlighted by the report with a mental health reform initiative she introduced last week that includes a plan to help the nearly 4,000 homeless San Franciscans who have serious mental illness and substance use disorders by streamlining housing and healthcare services.

“[This] initiative will help us to serve, treat and house those living with HIV and prevent new HIV infections,” she said.

To reach The City’s homeless population, Ward 86 launched a flexible program focused on patient-centered care in January, called The POP-UP. The program provides low-barrier care for patients who are not virally suppressed and are homeless, and does not require appointments.

Since its launch, the program has enrolled 65 people, according to Dr. Monica Gandhi, medical director at Ward 86.

Gandhi said that people who are living with HIV who are homeless are 27 times more likely to die than those who are not.

“We know that many elements that are key to sucess for people living with HIV are challenging when you dont have a place to live – making and keeping appointments, storing medications, maintaining safe sex, healthy eating — all of these barriers to taking your meds every day are amplified 100 fold if you don’t have a home,” said Gandhi.

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