There was a time when AIDS dominated the city's headlines and political discussions. But 30 years into the country's AIDS epidemic, the issue has largely receded from the front pages and as a top concern.
In this year's mayoral race, HIV and AIDS issues have largely gone overlooked. Few candidates bother to mention it on their campaign websites and it has rarely come up during debates.
"I think the headline is accurate. HIV is largely ignored," said Jeff Sheehy, who served for a time as an unpaid adviser on HIV and AIDS policies under former Mayor Gavin Newsom.
AIDS activists have taken it upon themselves to bring attention to HIV and AIDS issues amid the mayoral race. Similar to a forum they held last year with candidates running for supervisor, they are hosting an HIV policy discussion with the mayoral candidates on Wednesday, October 19.
"The needs of the HIV community are not going away. They are only intensifying," said AIDS Housing Alliance Director Brian Basinger, one of the organizers of the forum.
The issues range from ensuring people have access to their medications and health care services to how to maintain San Francisco's status as a leader in the fight against HIV.
Although commemorations of the country's AIDS epidemic turning 30 this year were marked with renewed hope of finding a cure for the devastating disease, at the same time federal funding continues to lag behind the needs of those living with HIV and AIDS. Fears are growing that the ongoing economic problems will mean more cuts in state funding that could have devastating consequences for people living with HIV and AIDS.
Talk of co-pays for Medi-Cal recipients will be destabilizing if enacted, warned Basinger.
"The state is talking about implementing these co-pays for medical beneficiaries, which are going to destabilize those people with HIV who have not fallen off the cliff," said Basinger. "People with significant illnesses are going to have serious expenses."
In San Francisco the picture is similarly mixed. The city continues to experience stagnating HIV transmission rates despite dwindling resources. In an effort to push rates lower, and ultimately bring an end to HIV in the city, last month local health officials instituted a radical shift in how they allocate HIV prevention dollars to focus more on testing people and treating those who are HIV-positive.
Last week the health department broke ground on an expansion and renovation of its AIDS Office. The $9.5 million project, funded by a grant through the National Center for Research Resources at the National Institutes of Health that is part of the American Recovery and Reinvestment Act, will provide 17,000 square feet of newly renovated space for the HIV/AIDS Research Center located at 25 Van Ness Avenue.
"The San Francisco AIDS Office will continue to conduct cutting edge research that will improve the quality of life for those living with HIV/AIDS and aid in finding a cure for the disease," noted interim Mayor Ed Lee, who attended the groundbreaking ceremony for the project last week.
In January the city will roll out a pilot project, the first in the nation, examining if a daily pill can keep gay and bisexual men HIV-negative. Should it prove promising, the city's next mayor could become embroiled in a funding fight over how to allocate resources between keeping people HIV negative and keeping those with HIV and AIDS healthy and alive.
"It's very important to know where they stand" on HIV/AIDS issues, said Matthew Pawlowski, 48, a San Francisco resident who's living with HIV.
Pawlowski was asked about this year's mayoral race by the Bay Area Reporter while attending a recent forum at City Hall about the federal rollout of a national AIDS strategy.
"Historically, San Francisco has been a bellwether of AIDS funding and research," said Pawlowski, who wants to know whether City Hall will continue to support that.
Weihaur Lau, 33, a gay, HIV-negative San Francisco resident, said it's important to him "because it's an issue that impacts many, many diverse residents of San Francisco."
Lau, who sits on the city's HIV Prevention Planning Council, said among his biggest concerns are making sure HIV services are "friendly and open to the public." Testing should be "easy to access, not shameful," he said.
During editorial board meetings with the B.A.R. several mayoral candidates touted their support for AIDS services. District 11 Supervisor John Avalos was a social worker when he first came to the city and worked at Clinica Esperanza, an HIV clinic that offers services to HIV-positive individuals in the Mission.
As chair of the Board of Supervisor's Budget Committee, Avalos noted he championed funding for HIV prevention and AIDS health care and met with leaders of various HIV and AIDS agencies.
Asked if he would appoint an AIDS czar in his administration, Avalos said having such a position is "important" as there is a need to have someone "looking holistically at services."
City Attorney Dennis Herrera also expressed support for having a paid, full-time AIDS czar position once again at City Hall. It is part of his HIV/AIDS policy position his campaign recently posted onto its website.
He also calls for increasing funding for HIV prevention services, though his plan doesn't specify how much money he would allocate. Herrera also states he will make housing and employment opportunities for people living with HIV and AIDS "a major focus" should he become mayor.
In addition Herrera pledges to fight for more federal funding, and should that fail, calls for providing additional money "through the city's budgeting process so that all of the gains made over the 30 years of the epidemic in San Francisco are not lost due to inadequate resources."
Beyond HIV and AIDS, Herrera's policy paper calls for more services for LGBT seniors and culturally competent health care services in general for gay men, lesbians and transgender people.
"In addition, while Healthy San Francisco offers all residents access to care, not all communities in San Francisco have been fully enrolled in Healthy San Francisco and that should be addressed," states Herrera's proposal.
Gay former Supervisor Bevan Dufty also outlines several proposals for addressing HIV on his campaign website. In addition to expressing support for continued city funding and pledging to advocate nationally on the issue, Dufty also pledges as mayor to work with health officials in ensuring the new HIV policies are culturally competent.
"For the new DPH 'Test and Treat' strategy to be effective, we must fund culturally sensitive outreach that understands how to assess the risk levels amongst communities that may be less willing to discuss sex and share risky behaviors," wrote Dufty.
He, too, told the B.A.R. he would hire a paid AIDS adviser and would push to see that health officials reach their goal of reducing new HIV infections by 50 percent by 2015.
"I would be an AIDS activist mayor both in San Francisco and at the national level for stronger policies and funding, particularly around AIDS housing," said Dufty.
Basinger, who has yet to decide on who to support for mayor, said he was pleased to see both Dufty and Herrera address HIV and AIDS on their websites and is hopeful more candidates will follow suit.
"With so many of the nonprofits that we need to stay alive being under pressure, we need to insure this new crop of leaders really gets what we are going through and prioritizes us properly in relation to all of these competing priorities," he said.
The HIV forum next week is being co-sponsored by a number of agencies, including Project Inform, the San Francisco AIDS Foundation, Shanti, and the Castro Country Club. A panel of HIV-positive leaders will take turns questioning the candidates and audience members will also be able to submit their own questions.
Due to the potential for major breakthroughs in HIV prevention in coming years, this year's mayoral race could prove to be crucial, said Sheehy, who is backing Herrera as his first choice but has yet to decide on second or third picks.
"This is a time when leadership in City Hall could make a dramatic difference in the course of the epidemic in this city," he said.
And with speculation that voter turnout could be particularly low this year �" some estimates of late have suggested as few as 75,000 people may cast ballots for mayor �" Basinger said the HIV community could play an important role in deciding who will be mayor.
He noted the city estimates 18,000 people are living with HIV and AIDS in San Francisco. It is a large enough block that it could help sway the election, he said.
"If the HIV community organizes itself, we have the opportunity to have a significant impact on who becomes mayor," he said.
The debate next week will be one of the last times people have a chance to hear from the candidates prior to Election Day and is one of the few forums to focus on one topic. Basinger hopes the HIV community and its supporters will come out for it and flex its political muscle.
"This next year is going to be a critical time in painting the picture of what HIV services looks like in San Francisco. And we have a unique opportunity to educate all of these leaders about our lives and we need to take it," said Basinger.
The forum will take place from 5:30 to 7:30 p.m. Wednesday, October 19 in the auditorium of the State Building at 455 Golden Gate Avenue in San Francisco's Civic Center.
Seth Hemmelgarn contributed to this report.