Though Latino cisgender men now make up the highest rate of new HIV diagnoses in San Francisco, more funding toward organizations that serve the community may not be forthcoming due to the city's projected budget deficit.
Indeed, the struggle this year will be maintaining current levels of funding to fight HIV, according to the co-chairs of the HIV/AIDS Provider Network, or HAPN, which advocates with city officials for funding.
As the Bay Area Reporter previously reported, San Francisco's HIV Epidemiology Annual Report for 2022, released December 5, 2023, showed that Latinos were the only group to see an increase in new cases (67 of 157 cases, or 43% of new diagnoses, up from 36% in 2021). Among cis men the rate of diagnoses surpassed all other racial or ethnic groups measured.
"It's going be a challenging budget year, so our top priority is preventing cuts and keeping everyone's heads above water," Laura Thomas, senior director of HIV and harm reduction policy at the San Francisco AIDS Foundation and one of the HAPN co-chairs, told the Bay Area Reporter. "I think it is obvious, when you look at the report, that the city needs to be doing more in the Latinx community and that this needs to be a priority in terms of preventing new HIV transmission."
Unfortunately, however, the need comes as the city stares down a budget deficit that could be as large as $1 billion — and some programs have already seen huge cuts and don't have funding stability.
The city's two-year budget process for fiscal years 2024-25 and 2025-26 is now getting started. Thomas and Lance Toma, CEO of the San Francisco Community Health Center and the other HAPN co-chair, said that just keeping funding at current levels will be difficult considering the budget crunch.
Last year's budget included $1.25 million for housing subsidies for people living with HIV for 2023-24 and $500,000 for 2024-25. The budget also included $500,000 to help HIV/AIDS nonprofits with rising costs, as the B.A.R. previously reported. The funding was far short of the $7 million requested by HIV advocates.
In December, Mayor London Breed asked city departments for 10% cuts across the board. A deficit of about $800 million is expected over the next two fiscal years, and Breed has said it could reach $1 billion by Fiscal Year 2028.
"So we're doing everything we can to meet with the mayor's office, the health department, with our champions on the Board of Supervisors, to ensure we do everything we can to protect and preserve the current safety net," Toma said.
DPH figures show HIV increased among Latino cis men
The health department's epidemiology report was a wake-up call for many HIV/AIDS leaders.
"Since 2018, the largest number of new HIV diagnoses have been among Latinx, and the annual rate of new diagnoses among Latino cis men surpassed all other racial/ethnic groups in 2022," the report stated. "Compared to other racial/ethnic groups, Latinx San Francisco residents were the least likely to have any evidence of HIV care, and both Latinx and Black/African American San Franciscans were virally suppressed at a rate lower than White San Franciscans."
This was the first time Latino men made up the highest rate of new diagnoses.
According to the 2020 U.S. census, 15.6% of the city's population is Hispanic or Latino. That's 136,761 people, about 20,000 of whom lived in the Mission neighborhood at the time of the census.
Asked why this is happening, Dr. Stephanie Cohen, a straight ally who is the section director for HIV/STI prevention with the health department, told the B.A.R., "I think lack of access to health insurance is an important driver, but certainly not the only driver."
Indeed, the report did find Latinos were the largest group without insurance at the time of diagnosis, with 34% reporting no insurance and 7% missing insurance.
"There's social determinants of health that drive the risk of HIV, STIs, and other communicable diseases, like COVID, which had a disproportionate impact on the Latinx community in San Francisco: things like poverty, access to housing, racial and ethnic discrimination, and in the context of the Latino community, acculturation, stress, and fears of deportation in seeking safety net services," Cohen said.
Funding a priority
The priority, those whose HIV prevention and education work targets the city's Hispanic and Latino communities say, is that they need more funding and culturally competent services now as the population sees higher numbers of diagnoses even as other groups see declines.
There are several agencies in the city that work specifically with the city's diverse Hispanic and Latino communities. One of those is Instituto Familiar de la Raza, which the city awarded a $2 million request for proposal to run a Latina/o/x Health Access Point at 1663 Mission Street, in partnership with the AIDS foundation and the Mission Neighborhood Health Center.
In addition, the AIDS foundation has its own Programa Latino/Latine, and AGUILAS is run out of the San Francisco LGBT Community Center at 1800 Market Street. One of those who participates in AGUILAS' programs is Mario Flores, a gay HIV-positive Mission neighborhood resident who has been involved with the nonprofit for three years. He goes to a Tuesday night support group and has participated in some of the aforementioned training programs.
"It has, definitely, created a sense of community building and I became aware of the resources in the community as an LGBT person," Flores said. "AGUILAS is one of the groups supporting the Latino community but there is not much visibility, because of its funding limitations. It can do so much."
Thomas said, "It's going to be a very challenging budget year where we have to focus on existing services. I'd love to be in the position of advocating for expanded services, but I don't think that's going to be possible this year, which is a problem."
District 9 Supervisor Hillary Ronen, a straight ally who represents the Mission neighborhood on the board, told the B.A.R. that "we will absolutely bring this up with the mayor when she's finalized her budget."
"Obviously, her budget director will talk to all of the supervisors about what their priorities are, and this will be up there as a priority for our office. But that said, it was a horrendous budget year, since they just started with the IFR RFP, I'd imagine they will want to see how that impacts things. Us, the gay members of the Board of Supervisors and me, are advocating for HIV funding. I can't imagine this year will be any different given the real need the Latino community is having."
Gay District 8 Supervisor Rafael Mandelman, who represents the Castro neighborhood on the board and is a member of its budget committee, told the B.A.R., "Although encouraging to see that HIV cases are down slightly from the 2021 numbers, the rise in HIV cases within the Latino community is alarming."
There were 157 new HIV diagnoses in the city in 2022, down slightly from 166 in 2021, according to the DPH report.
"Plainly we need additional resources in education, preventative care, and treatment to combat this trend," Mandelman said. "At a time when Republicans in Congress are threatening cuts to federal HIV funding, it will be all the more important for San Francisco to prioritize getting all our communities to zero new infections in the upcoming budget cycle."
The city's Getting to Zero program aims to reduce new HIV transmissions and HIV deaths by 90% by 2025, in addition to reducing stigma.
Gay District 6 Supervisor Matt Dorsey, who is HIV-positive, told the B.A.R. February 27 that "it's going to be a slog to get to zero, but we can."
"I'm going to be committed to anything I can to make sure we are reaching the highest risk populations for HIV transmission," Dorsey said. "My hope is that we can make sure people are aware they have access to PrEP. That will be helpful. I have talked to [gay health director] Dr. [Grant] Colfax about this and expressed my willingness for any solution that would be beneficial toward this."
When asked for comment, gay District 4 Supervisor Joel Engardio, who represents the Outer Sunset on the board, stated, "I haven't had a chance to look into that so don't have comment beyond we need to do what we can to lower HIV rates."
Other concerns for Latinos
As the B.A.R. previously reported, Latino men in the city were disproportionately affected by the mpox outbreak in 2022, and around that time U.S. Senator Alex Padilla (D-California) called out the racial and ethnic disparity of the government's response. While they were less at risk, it was white Americans who received a disproportionate number of vaccinations.
Cohen said that the city has a "robust safety net that ensures there is access to HIV prevention and sexual health services, including for those who are uninsured, at places like San Francisco City Clinic and Magnet at the San Francisco AIDS Foundation in the Castro."
But Cohen added that the framework for communicating with people who need to be reached might not be so strong.
"I think those who are uninsured are not necessarily aware those services exist, and therefore may not be seeking them out," she said. "I think it's important to add that these disparities are of great concern for all of us at the San Francisco Department of Public Health, and working to ensure we are getting to zero for all communities is a priority for the health department."
To that end, Cohen said that the department is "working to ensure we are providing culturally affirming, language concordant, low barrier services to all individuals, including those who are Latinx."
These include the above mentioned access point, which is one of seven DPH health access points.
"That is one of our many strategies aimed at improving low-barrier access to services, HIV prevention and sexual health services," Cohen said.
Editor's note: This story is one of two focusing on HIV prevention efforts in San Francisco's Latino community in the aftermath of the city's annual HIV report for 2022.
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