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San Francisco Making Gains in ‘Getting to Zero’ New HIV Infections

Martha Kempner

San Francisco Supervisors David Weiner and Scott Campos last week held a hearing to discuss the efforts of a coalition formed to end HIV in a city that was once seen as a center of the epidemic in this country.

San Francisco Supervisors David Weiner and Scott Campos last week held a hearing to discuss the efforts of a coalition formed to end HIV in a city that was once seen as a center of the epidemic in this country.

The ultimate goal of the Getting to Zero program is for San Francisco to be the first jurisdiction in the United States to have no new HIV infections, deaths, and stigma. Advocates and public health experts believe this could be possible based in large part on the success the city has already had in fighting HIV.

The hearing reviewed the coalition’s three-pronged strategic plan, which was originally announced on World AIDS Day in December. As Weiner and Campos explained, the first part of the plan is a 90 percent reduction in new infections, which the coalition hopes to achieve by increasing the number of at-risk San Franciscans who are using Pre-Exposure Prophylaxis (PrEP).

The Food and Drug Administration in 2012 approved Truvada, a once-daily pill recommended for HIV-negative people who are at high risk of contracting the virus. The drug is highly effective—some studies have found that it is 99 percent effective in those who use it correctly—but very expensive, with a price tag of about $1,300 a month.

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Last September, Weiner made news when he announced that he takes Truvada every morning.

The second strategy is to get those who are newly diagnosed with HIV into treatment as soon as possible. A program at San Francisco General Hospital, called RAPID, provides counseling and anti-retroviral (ART) drug therapy to patients as soon as they are diagnosed. So far, about 50 participants have gone through the RAPID program, but the coalition plans to expand RAPID so anyone diagnosed with HIV can start treatment within five days.

Getting treatment for people quickly is not only good for their own health—it also works as a prevention method.

ART can reduce an HIV-positive person’s viral load, which in turn makes them less infectious. Of course, ART only works for as long as person continues taking the medication. That’s why the final part of Getting to Zero’s plan focuses on retention and filling the gaps in treatment that can happen when a person faces challenges such as losing health insurance, employment, or housing.

San Francisco officials dedicate a lot of resources toward fighting the HIV epidemic—in the current fiscal year, the city is set to spend $57 million on services, prevention, and research—and this investment has paid off. For instance, the number of new HIV cases dropped by 30 percent from 2006 to 2013, and deaths from the disease dropped by 50 percent during the same period.

San Francisco, when compared to the United States as a whole, is having much more success in identifying and treating those who are HIV-positive. In 2012, 94 percent of HIV-positive people in the city knew their status, compared to 82 percent nationwide. About seven in ten HIV-positive people were linked to health care in the city, compared with 66 percent nationwide. And perhaps most notably, 66 percent of HIV-positive San Franciscans were virally suppressed, compared to just 25 percent nationwide.

The strategy proposed by the coalition will require an additional investment of more than $2 million.

“We do have a path to ending new HIV infections,” Weiner said at the hearing. “If we can do it here, it will spread to other parts of the country, it will spread to other parts of the world. In order to make this successful, we have to put the resources behind the effort.”

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