When the Centers for Disease Control and Prevention this month awarded San Francisco an $8 million-four year grant to help eliminate HIV, the mayor’s office announced it would dedicate the extra funds to the city’s most vulnerable populations – focusing on those without homes.

Though the city has drastically reduced the number of new HIV infections each year, healthcare workers say the scarcity of housing in the city is aggravating the problem.

San Francisco will use the grant to finance Project OPT-IN, which focuses its services on people often neglected by the health care system.

Of the nearly 16,000 people living with HIV in San Francisco, fewer than 300 (about 2 percent), are homeless. But the clinics who serve those patients describe an urgent picture for this small but growing group. In 2017, according to the mayor’s office, 14 percent of people newly diagnosed with HIV were homeless.

“Approximately a third of our patients are marginally housed,” said Monica Gandhi, the Medical Director of Ward 86, the largest clinic in San Francisco serving people with HIV who are uninsured or covered by public insurance plans.

The clinic, located on the border of Mission District and Potrero Hill, is visited by roughly 2,600 patients a year, a third of whom are “massively affected by housing instability,” said Gandhi. Their living conditions range from “living on the streets to being in and out of shelters, to being in transitional housing, to couch surfing or living with others,” she said.

Gandhi, who said her clinic will not benefit from the CDC funding, said that using the funds to address the housing crisis within the HIV-infected community would be valuable.

“It is very obvious,” she said, “that patients with HIV who are homeless experience poorer outcomes than those who are housed.”

Even though the number of new cases has been on the decline across the board, according to the city’s public health data, homeless people who are HIV-positive have a lower rate of viral suppression, which occurs when medication is taken to lower virus levels in a person’s blood. Viral suppression is needed to prevent transmission of the virus to others.

“You cannot get to zero,” said Gandhi, “you cannot get to helping people with HIV if you don’t address this.”

Darpun Sachdev, Clinical Prevention Specialist at the San Francisco Department of Public Health, said the city will use the grant money to create “one-stop shops,” where people can get tested and treated for HIV, along with hepatitis C and other infectious diseases. They can also receive mental health services, charge their phones, and meet with friends, all in an environment that is “stigma-free.”

To do so, the city will partner with community-based organizations including the San Francisco AIDS Foundation and Glide.

Sachdev said they hope to identify opportunities for education, outreach, and delivery of treatment to those “who inject drugs but aren’t linked into primary care.”

Since the city received funding notification from the CDC in July, they have been training staff to prepare for the work to come.

“The world really wants to see San Francisco get to zero, and we do have a good chance given all the advances we made in the last five years,” said Sachdev, “but once we get to zero, we need to also stay at zero.” In 2017, the city made a pledge of “getting to zero” by 2020, which means no new infections, zero HIV deaths, and zero stigma by 2020.

The CDC says the funding — granted to 20 jurisdictions, with San Francisco and New York State receiving the largest awards — represents the agency’s “largest single investment in HIV surveillance and prevention and will be the cornerstone of national prevention efforts for the next five years.”