Following a massive drop-off in HIV services during the pandemic, city health care workers are now playing catch-up to find and engage San Franciscans living with the virus.
“For a while, we couldn’t provide any HIV tests. We had to make sure we weren’t putting any participants at risk, especially if they were HIV positive,” said Juliana DePietro, director of harm reduction services at Glide, a nonprofit that provides homeless services in San Francisco, including free HIV testing.
In 2020, San Francisco saw an overall 18% decrease in the average number of monthly HIV tests, according to a report released Monday by The City’s health department. The largest drop-off occurred between March and May 2020, when California was under a shelter-in-place order, but testing still has not recovered to pre-pandemic levels.
Community testing sites were particularly hard-hit, hurting one of San Francisco’s primary vehicles for getting HIV care to people experiencing homelessness. The average number of monthly HIV screenings at smaller hyper-local clinics in 2020 was 44% lower than the 2019 monthly average.
Glide, based in the Tenderloin, has been slowly working to resume its HIV testing services since employees and clients were able to get vaccinated against COVID-19. But reopening doors is only half the struggle — especially for smaller resource-strapped clinics across The City.
Now the task is extending HIV health care to those who did not receive proper services during the pandemic, a fate that fell primarily fell on individuals experiencing homelessness.
So far, that’s required a mixture of resuming pre-pandemic practices, like sending health care workers on the streets of San Francisco to do direct outreach, DePietro said. It’s also involved parsing through old records of patients who have lost touch since the pandemic, cold-calling and even snail mailing people with addresses on file to let them know that services are back.
Some community health clinics are also working with the San Francisco Department of Public Health to bring HIV testing on-site to individuals living in shelter-in-place hotels. Advocates say it’s been a crucial lifeline to reach some of The City’s most vulnerable populations and keep up with HIV care during the COVID-19 crisis.
But even that option is now facing threats. San Francisco has already closed four of its 25 emergency shelter-in-place hotels, and officials have said more closures could come in the following weeks despite the ongoing delta variant surge.
“The shelter-in-place hotels are imperfect, but they have provided crucial housing especially for those living with HIV, or are at risk of HIV. Having a safe place for them to stay allows us to connect with them,” said DePietro.
Even as schools, stadiums and other businesses have reopened, HIV testing still yet to rebound. Compared to 2019, the monthly average number of HIV tests was 45% lower in March 2021, the report shows.
“This means that some San Franciscans may have had a delay in finding out their HIV status or may not yet be aware that they are living with HIV,” said San Francisco’s Director of Health Dr. Grant Colfax.
One solution the health department has offered is free HIV testing through a program called Take Me Home, which sends testing kits to an individual’s house. The program was piloted from March to December 2020, during which 204 people conducted 324 home tests, according to the department’s report.
But aside from April 2020, which had 81 participants using the at-home kits, overall use plunged after July 2020 while HIV services at most community-based clinics were limited and telemedicine remained out of reach for those without access to computers.
“I was really concerned when we started to see massive decreases in HIV testing. All these doctors I know were talking about it, but no one did much to get it back to pre-pandemic levels, even though we couldn’t ignore other public health problems,” said Monica Gandhi, who heads up the Division of HIV, Infectious Diseases and Global Medicine at UCSF.
At the Mission Neighborhood Health Center, HIV testing decreased by 44% in 2020. The center is now preparing to resume outreach efforts, such as going into local bars and spreading the word about nearby HIV testing and care options.
But a full recovery will take some time, as HIV prevention staff at the clinic who were deputized to work on COVID-19 testing and treatment are focused on the delta variant.
“Those staff members do both jobs now, but their focus is still really COVID. We have had a big demand for vaccines and tests. In the Mission, we are the epicenter of the COVID pandemic in San Francisco,” said Fernando Gomez-Benitez, deputy director and chief administrative officer at Mission Neighborhood Health.
For a city that has made major strides in combating HIV, San Francisco health care workers are now navigating how to continue that progress while also prioritizing labor and resources for COVID-19 testing and vaccinations.
“As of right now, a lot of smaller clinics are still closed,” said Reina Hernandez, associate director at the San Francisco AIDS Foundation. The San Francisco AIDS Foundation’s mobile health testing services provide outreach in communities hard-hit during the pandemic. “We have seen people completely fall out of care because the clinic they were connected to couldn’t see them.”
Providing The City’s hyper-local HIV testing and treatment programs with more resources to continue to fight COVID and pre-existing health issues will be essential to San Francisco’s pandemic recovery, Gandhi said.
“There are people with HIV in this city who are not diagnosed last year,” she said. “I hope we can find them by increasing our community-based programs.”