SF HIV cases fell by 19% in 2019
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New HIV diagnoses in San Francisco continue to fall but disparities remain, according to the latest HIV epidemiology report from the San Francisco Department of Public Health. While acknowledging last year's good news, health officials are concerned that the COVID-19 crisis could compromise the city's progress going forward.
"We're seeing declines in new diagnoses across most groups, and that means we're moving in the right direction," Health Director Dr. Grant Colfax, a gay man hired by Mayor London Breed last year, told the Bay Area Reporter in a Zoom interview. "But just like almost everything else in society, COVID-19 has disrupted our system of HIV prevention and care."
The new report, released September 10, summarizes new HIV diagnoses during 2019 and care metrics for 2018. The data show a 19% decline in new cases, from 204 in 2018 to 166 in 2019. This follows a 13% decline between 2017 and 2018.
"We think the decline in new infections is likely a result of improved linkage of people living with HIV into care and getting them virally suppressed," Dr. Susan Buchbinder, director of Bridge HIV at DPH, told the B.A.R. "Once someone is fully virally suppressed, they cannot transmit HIV to their sexual partners. Pre-exposure prophylaxis [PrEP] is also likely playing a role in driving down new infections."
As usual, gay and bisexual men account for a majority of new cases, at 62%. Cisgender women made up 8% of new cases. Transgender women accounted for 7% of new diagnoses, compared with 3% the previous year, but this may be attributable in part to increased testing. Trans men accounted for 1% of new cases both years.
New diagnoses have fallen across population groups, including Black and Latino men, who had seen increases in recent years. But still, African American men and women continue to have higher rates than any other racial/ethnic group.
"We're heartened to see that the total number of new diagnoses has declined, so that we're at the lowest level we've ever seen," Buchbinder said. "We're also pleased that there was a decline among both Black and Latinx men, because we were concerned about the trajectory the last couple of years. But the numbers are still way too high."
Indicators of HIV care have also improved, with 95% of newly diagnosed people being linked to care within a month and 81% of those diagnosed the previous year achieving viral suppression within 12 months. The median time from diagnosis to the first care visit dropped to two days and the median time to viral suppression fell to 46 days in 2018.
But some notable disparities remain, the report reveals. The number of new HIV diagnoses among people who inject drugs and people experiencing homelessness has fallen, but remains higher than those for all other groups.
Viral suppression rates were lower for women (71%), Black people (70%), and injection drug users (66%) compared with the HIV population as a whole. Of greatest concern, less than half of homeless people (39%) had an undetectable viral load, up slightly from 33% the previous year.
Effect of COVID-19
The new data show that San Francisco continues to make progress toward achieving the goals of the Getting to Zero initiative: zero new infections, zero deaths due to HIV/AIDS, and zero stigma against people living with HIV.
The city is also doing well with regard to the UNAIDS 90-90-90 goals, which call for 90% of all people living with HIV to know their status, 90% of people with diagnosed HIV to be on antiretroviral therapy, and 90% of people on treatment having viral suppression.
San Francisco's numbers are hard to match against the UNAIDS goals because they are based on people diagnosed with HIV, not everyone living with the virus, Buchbinder explained. Health officials estimate that in 2019, 94% of all people living with HIV were aware of their status, 76% had received care, and 71% had achieved viral suppression.
But COVID-19 threatens to derail this progress. The city has seen substantial drops in the use of PrEP services, HIV testing and viral load testing, though this is starting to rebound, according to Buchbinder.
DPH is now working with community-based organizations and care providers to develop alternative ways for people to access PrEP, HIV testing, and ongoing HIV care and treatment.
"We're working with our providers to ensure that the proper safety measures are put into place so people can still get the care they need," said Colfax. "I think San Francisco is showing that it's up to the task of being able to continue our HIV prevention and care efforts in the midst of another epidemic."
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