San Francisco officials set a goal to become the first city ever to halt HIV/AIDS transmissions, part of the “Getting To Zero” initiative announced last week at City Hall and backed by $1.7 million in new funding.
The Get To Zero consortium of local organizations coordinates services to provide a citywide, integrated program addressing the disease through prevention, direct linkage of diagnosis and treatment, and keeping patients engaged through the duration of care.
The increased funds come from an additional city allocation of $1.2 million and a $500,000 donation by MAC Cosmetics. Including the new funding, annual city expenditure on AIDS related programs tops $54 million.
“We want to have zero infections, we want to have zero deaths. We certainly want to have zero stigma,” Mayor Ed Lee said, adding, “We are going to back it up with serious money.”
“This is about San Francisco being a sanctuary from HIV infection,” said Supervisor David Campos. “We want to be the first city not just in the country but in the world to do that.”
With a record low number of new cases at 302 last year, the city now proposes to reach a 90 percent further reduction by 2020. At the height of the epidemic in 1992 annual new infections totaled 2,332. Local leaders say that with proper funding the goal of zero infections in the city could be possible within the next decade.
Johanna Brown, a transgender woman who has been living in San Francisco since 2011, said she was thankful for the city’s programs.
After her HIV diagnosis in 1988 Brown said she lost her job as a nurse, struggled with substance abuse and was disconnected from her family. After moving to San Francisco and receiving appropriate health services her viral load is now undetectable and she is back to work as an outreach nurse. She said the social climate is different here and it makes healing easier.
“We get to learn about who we are in this community,” she said, “We don’t have to worry about being stigmatized or judged. We live a healthier life and we go back out into our community, we are stronger.”
Getting To Zero is a threefold approach to addressing treatment and prevention. The first is pre-exposure prophylaxis, or PrEP, a daily pill for high-risk individuals shown in studies to reduce infection by up to 92 percent, according to the U.S. Centers for Disease Control and Prevention. Last month the San Francisco Department of Public Health began a PrEP training program for primary caregivers. The San Francisco AIDS Foundation currently has more than 500 patients started on PrEP, the mayor’s office said in a statement. Supervisor Campos said that in order to reach the goal of zero transmissions he and other city leaders met last year to discuss options for making PrEP available to anyone in the city who might want it.
The second part of the program, RAPID, pioneered in 2013 by San Francisco General Hospital, closes the gap between diagnosis and treatment by immediately linking wrap-around medical and social service options to a positive test.
The third part is to keep people in treatment by adding patient services and staff across the Health Department’s primary care clinics. HIV clinics such as Ward 86 in San Francisco General Hospital and the Castro-Mission Health Center will see increased resources immediately. Because 10 percent of those living with HIV in the city are homeless, a diverse array of outreach organizations is particularly important, said Campos.
“The reality is that we’re all connected,” he said, “We will be successful only if we are able to target the most vulnerable among us. That is the challenge that we have.”
While global efforts against the disease have grown, federal funding has dropped, said a statement from Lee’s office. The $54 million overall city budget for HIV services is partly an attempt to offset decreases in investment from federal sources in a city where 16,000 people access free services for HIV prevention annually, according to the statement.
“The thing that comes to mind as we’re here talking about this very exciting prospect is all the friends that we’ve lost that couldn’t live to see this day,” Campos said. “All of us have somebody like that. Remember them and in that memory rededicate ourselves to this effort.”