Ward 86, the first dedicated HIV clinic in the United States, recently marked its 40th anniversary with a commemoration at Zuckerberg San Francisco General Hospital.
Since its inception, Ward 86 has been a key element of the "San Francisco model" of comprehensive community-based HIV care. Over the years, the clinic has pioneered innovations in HIV treatment and prevention that have been adopted nationwide and around the world.
"Treatment has dramatically changed the lives of our patients. But let me tell you what has not changed. Number one, [Ward 86] is patient-centered. And secondly, we are constantly figuring out better ways to deliver scientific advances in HIV to our patients," said Dr. Diane Havlir, SFGH's chief of HIV, infectious diseases, and global medicine. "Ward 86 is the Silicon Valley of innovation for AIDS care, and what we do here is transferred both locally and globally."
During last week's gathering, gay state Senator Scott Wiener (D-San Francisco) presented a resolution from the state celebrating the anniversary, gay District 8 Supervisor Rafael Mandelman offered congratulations from the Board of Supervisors, and Mayor London Breed declared January 25 "Ward 86 HIV Clinic Day." In addition, Dan Bernal, a gay man living with HIV who is a president of the San Francisco Health Commission, presented a commendation on behalf of Congressmember Nancy Pelosi (D-San Francisco). For the past 21 years Bernal has been chief of staff for her district office in San Francisco.
Wiener recalled how Ward 86 and other local providers cared for the community in the darkest days of the AIDS epidemic.
"Our city government and our health care institutions stood up at a time when the federal government abandoned us ... when they considered people like me and so many others in this room to be human garbage," he said. "San Francisco built this amazing infrastructure that is a model for the world, not just for HIV, but for so many public health epidemics. We saw it again with monkeypox. We said we're going to treat health problems as health problems. We're not going to rely on prohibition and moralism."
During last year's mpox outbreak, SFGH became a primary location for people to get inoculated against the virus, though there were long lines due to the short supply of the vaccine, which was distributed by the federal government.
Today, Ward 86 serves some of the city's most disadvantaged people living with or at risk for HIV. Many are living in poverty, 96% rely on Medi-Cal or Medicare, a third lack stable housing and rates of mental illness and substance use are high, officials noted.
"The model of HIV care at Ward 86 evolved as the epidemic unfolded and has continued to adapt to the many changes seen in more recent years," Dr. Paul Volberding, who founded the clinic with Dr. Donald Abrams and the late Dr. Constance Wofsy, told the Bay Area Reporter. "From the start, it brought needed services of many forms to a single site in a coordinated, compassionate and effective manner that is truly responsive to patient needs. It has had a community-informed and participatory philosophy and remains a vital model emulated worldwide."
Four decades of innovation
The Ward 86 outpatient clinic opened its doors in January 1983, followed by the opening of Ward 5A, SFGH's designated inpatient ward for people with AIDS, that July — two years after the Centers for Disease Control and Prevention published the first medical reports about the disease that would come to be known as AIDS.
"Between the outpatient and the inpatient units, we launched a number of research initiatives and clinical care programs to improve the care of those living with HIV, not just in San Francisco but to provide models for HIV care around the country and internationally," Ward 86 medical director Dr. Monica Gandhi told the B.A.R.
In the early years, SFGH helped lead the first clinical trials of investigational HIV drugs. In 2008, Ward 86 opened a women's clinic. In 2010, Ward 86 and other San Francisco providers were the first to recommend antiretroviral treatment for all people diagnosed with HIV, regardless of their CD4 T-cell count, two years before national guidelines adopted this approach.
In 2013, Ward 86 created a RAPID ART program that helps people start antiretroviral therapy the same day they are diagnosed — or as soon as possible thereafter — to avoid people falling through cracks while they wait for test results or follow-up appointments. But Ward 86 does not limit itself to HIV treatment: It also runs a PrEP clinic that provides HIV prevention medications to people at risk.
Ward 86 also plays a role in HIV cure research. Dr. Steven Deeks and colleagues have been studying a cohort of elite controllers, people who manage to naturally control the virus and remain healthy without medications, in an effort to learn how to achieve long-term remission.
Ward 86 launched its SALUD clinic for Spanish-speaking clients in 2016. The following year saw the debut of the Golden Compass program, which provides one-stop comprehensive care for HIV-positive people over age 50. According to the San Francisco Department of Public Health's annual HIV epidemiology report, 73% of the 15,631 city residents living with HIV are 50 or older.
Two years later, Ward 86 launched the POP-UP program to provide specialized HIV care for homeless and marginally housed people. According to the DPH report, 24% of people newly diagnosed with HIV in 2021 were homeless, and HIV-positive people experiencing homelessness are least likely to have an undetectable viral load, at just 27%.
The latest initiative is SPLASH (Special Program on Long-Acting Antiretrovirals to Stop HIV), which aims to broaden use of long-acting injectable treatment. The federal Food and Drug Administration approved the first injectable regimen, Cabenuva (cabotegravir plus rilpivirine), in 2021, but it is only indicated for people with an undetectable viral load who wish to switch to a long-acting regimen. However, a recent pilot study showed that it may also be a viable option for people who are unable to achieve and maintain viral suppression due to challenges with treatment adherence.
"By trying to use these novel agents in patients with concomitant life challenges, we hope to get individuals suppressed on therapy who have never been suppressed before and change the trajectory of the HIV epidemic," Gandhi told the B.A.R.
Updated, 2/3/23: The headline of this story was changed; "celebrates" was the wrong word to use.
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