Before there was Getting to Zero, which aims to dramatically reduce HIV transmission, HIV-related deaths, and stigma by 2020, San Francisco joined Fast-Track Cities, which attempts to do the same thing in cities around the world.
This week, gay District 8 Supervisor Jeff Sheehy and Amsterdam deputy mayor Eric van der Burg met in San Francisco to discuss how each city is meeting its Fast-Track Cities goals.
They also urged cities that are not yet part of the program to join them.
The goal of Fast-Track Cities is threefold: ensuring that 90 percent of people with HIV/AIDS know their status; improving access to antiretroviral therapy for people living with HIV/AIDS to 90 percent; and increasing to 90 percent the proportion of people with HIV/AIDS with undetectable viral load.
Eliminating stigma and discrimination is also part of the effort.
Sheehy and van der Burg held a news conference on the sunny deck of historic tall ship Clipper "Stad Amsterdam" (City of Amsterdam) Monday, March 12. Both cities joined Fast-Track Cities when it was launched in Paris on World AID Day 2014.
San Francisco started its Getting to Zero program in 2015.
Sheehy said San Francisco has met or exceeded the 90-90-90 goal (status, ART, undetectable viral load) already, and his staff said that the current San Francisco numbers are 90-93-96. Amsterdam is also moving past the 90-90-90 targets, according to van der Burg.
According to Sheehy, the goals will ensure every HIV-positive person in San Francisco will know their status and be treated.
"We're aiming at zero new infections and zero stigma for HIV," Sheehy said. The issue has special resonance for Sheehy, who is the first known person living with HIV to serve on the San Francisco Board of Supervisors.
"We will follow San Francisco in getting to zero," van der Burg predicted.
Fast-Track Cities was started by the International Association of Providers of AIDS Care and is funded in part by the Joint United Nations Programme on HIV/AIDS. IAPAC designed the initiative to optimize HIV care through technical assistance to clinics, local health departments, other service providers, and affected communities.
Each Fast-Track city is encouraged to define its own metrics for success but is required to operate within the 90-90-90 and zero discrimination and stigma framework.
"We are concerned that as we move, other places in the world are not moving together," Sheehy said. "We need to share with other cities with fewer resources because we have seen so much success in Fast-Track Cities where NGOs [non-governmental organizations] and the government work together.
"No one should be left behind," he added.
The ultimate goal is to end AIDS as a public health threat by 2030, though San Francisco's Getting to Zero initiative has a deadline of before 2020. As of January 10, 77 cities on five continents were enrolled in Fast-Track Cities, with the largest number in Africa.
Sheehy said that one of the tools helping in San Francisco's Fast-Track efforts is the HIV-prevention medication PrEP, which has been shown to be successful for many people if taken as prescribed.
"PrEP can be used without the consent of sexual partners, unlike condoms, so I feel it gives a woman a better tool to protect herself against HIV," he explained, adding that Healthy San Francisco, the city's health access program, subsidizes PrEP for youth and adolescents, so clients can obtain the medication without parental permission.
"If someone with HIV is treated successfully, it's almost impossible to transmit the virus to partners," Sheehy said. "With PrEP, we have seen more than a 45 percent reduction in HIV infections in San Francisco. The next step is to drive the epidemic down to zero. The biggest problem in San Francisco is the huge disparity in health care quality."
Information sharing
One area of information sharing is how Amsterdam treats injection drug users. San Francisco is studying the methods used in Amsterdam because, Sheehy said, "Amsterdam has achieved zero new infections due to needle use because of how drugs are handled."
San Francisco has long had syringe exchange programs, and last month the Health Commission voted unanimously to back a resolution supporting supervised injection sites.
In Amsterdam, syringe exchange has proved successful, van der Burg said.
"We don't have anyone transmitting HIV because we have needle programs," van der Burg explained. "We believe it's good to have principles but it's better to solve problems."
Sheehy pointed out that the policies of President Donald Trump and his administration have not helped HIV programs.
"Attacks on the Affordable Care Act have caused delays in getting programs operational, and doing away with the insurance mandate has created new problems," he said, referring to the requirement that people purchase health insurance that was repealed when Congress passed tax reform last year.
In response to a question about how Fast-Track Cities impacts San Francisco's transgender community, Sheehy said, "The trans community is one of our targeted groups and we've been working with the API Wellness clinic in the Tenderloin." (The Asian and Pacific Islander Wellness Center changed its name last month to the San Francisco Community Health Center.)
Sheehy discussed another underserved community, youth and adolescents, and said, "One of the problems I've identified is that one in five of our homeless population are youths but they are getting only 7 percent of the (overall) funding for the homeless. Ten to 15 percent are HIV-positive and half of those are LGBTQ."
Sheehy talked about his efforts to increase funding for homeless youth programs and said he is sponsoring a June ballot measure to provide additional funding. Proposition D, Additional Tax on Commercial Rents Mostly to Fund Housing and Homelessness Services, will levy a 1.7 percent tax on commercial landlords to fund low- and middle-income housing and homelessness services for four years. It requires two-thirds passage by voters.
Van der Burg acknowledged the Fast-Track Cities goal is not without risks and uncertainties.
"Our challenge now is how we reach out to the last group of people," he said. "Our goal is to achieve 100 percent sooner than the U.N. goal of 2030 but making 2020 will be hard, so probably between 2020 and 2025."
Both Sheehy and van der Burg expressed cautious optimism.
"Fast-Track started in San Francisco in 2013 with just a few people," Sheehy noted, "and now over 200 are working on the Fast-Track goals. We now have the tools."
Added van der Burg, "With this initiative, both cities work will join forces to actually get to zero and share our knowledge and expertise with other partners. Cities cannot always wait for solutions."