We are extraordinarily fortunate in San Francisco to be making strides in ending the HIV epidemic that has ravaged our communities for over four decades. With every new annual HIV report from the San Francisco Department of Public Health, we let out a collective exhale as the number of new HIV diagnoses continues its downward trajectory. What an incredible victory for our community and what great promise the future holds.
But as we welcome this hopeful shift in the epidemic, I must urge you to remember: We are NOT there yet.
Now is not the time to turn your back on HIV or to forget the decades of activism, resilience, and heartbreak that have shaped this movement. We have immense collective passion and power, but we're facing unprecedented challenges as individuals and as organizations fighting every day to bring this epidemic to an end. Each year, the gulf between the resources we desperately need and the resources we have only widens — especially for Black and Brown communities, transgender folx, and all those traditionally furthest from access and opportunity. These communities continue to face disproportionate impacts of HIV, and without a united commitment to equity, we risk further leaving them behind.
Each year, I find myself asking, "Will we have the strength — and the resources — to stay the course until we bring this epidemic to an end?" And each year, my answer is unwavering: "Yes, we will." San Francisco can and will be the first city to reach zero new HIV diagnoses. But it will take all of us united in community, our funders standing strong, and a refusal to step back now when we're so close.
This month and earlier this year, SFAF was forced to make some difficult decisions: laying off staff, eliminating open roles, reducing some full-time employees to part-time, and cutting direct expenses for program materials and supplies agency-wide. These steps were essential to address a nearly $3 million budget deficit in order for SFAF to remain financially stable amid an uncertain economic and political climate. This was not easy — and it reflects just a fraction of the challenges our movement is facing.
Perhaps you've noticed a shift. Public support for AIDS-related causes has waned as advancements like PrEP and effective treatments make HIV and AIDS "feel" like a crisis of the past. But the battle isn't over. HIV continues to impact lives every single day, including my own, and we need your continued commitment to end this epidemic, not just manage it.
This year, we announced that 2025 would mark the final year of the AIDS/LifeCycle fundraising event that we produce with the Los Angeles LGBT Center. While this 545-mile bicycle ride has been a lifeline to our community — raising over $300 million over the years, spreading joy, and bringing visibility to the queer and HIV and AIDS communities — it has reached its natural end. Rising costs and declining participation mean it's no longer sustainable or financially responsible. This shift represents not just the end of a beloved tradition, but the reminder of the larger decline in support that threatens the very future of HIV and AIDS organizations.
Similar events like AIDS Walk San Francisco (an event that does not benefit SFAF) have also seen declines in participation, while long-standing corporate funders, including Levi Strauss, have ended their HIV grantmaking after more than four decades. Although we agree with the Levi Strauss Foundation's assessment that both the crisis itself and the funding landscape around it have evolved, we worry about grantmakers stepping back just when we're within sight of the epidemic's end.
We're also seeing decreased benefits from the federal 340B pharmacy program, which has resulted in nationwide losses for safety-net clinics, estimated at $100 million in HIV prevention funds since 2022 — primarily in the U.S. South. (The program allows certain health care organizations to purchase drugs at a discount.) At the same time, rising costs of programming, staffing, and events stretch our budgets thin. Perhaps our biggest continued threat comes from our government funding — at the local, state, and federal levels. Every year, we find ourselves coming up short in federal Centers for Disease Control and Prevention funds, and in the position of urging city officials to backfill federal cuts from city revenues. Funding from sources like the CDC penalizes places like San Francisco that have made significant strides in reducing HIV transmission.
As we look toward the uncertain political landscape ahead, we are deeply concerned about the potential for federal cuts to HIV and AIDS services under a new administration. Cuts to federal and state funding make pieces of the "pie" smaller for all of us competing for public health funds (and I should note: we don't want to compete with other providers!).
On the local front, while leaders and mayoral candidates are currently committed to sustaining quality HIV and AIDS programs, this support may not last if federal funds shrink and public interest fades. Locally, much of our funding comes from the San Francisco Department of Public Health — and those dollars are dependent upon the health of the local economy and how much can be collected from city taxes. We all know the impacts that the pandemic and remote work have had on our city's economy, the effects of which trickle down to service providers and city nonprofits.
We stand at a critical juncture: the end of the epidemic is within reach, but we need every supporter, donor, and community member with us to close the final gap. The stakes have never been higher, and we can't afford to take our foot off the pedal now.
What can you do?
Join us! We have a lineup of social and fundraising events coming up, including Santa Skivvies, a holiday fun run through the Castro set for Sunday, December 8. Show up and show your support.
Come on the ride. AIDS/LifeCycle will make its last journey next year. Registration is currently closed to cyclists, but we are still in need of volunteer roadies June 1-7.
Advocate alongside us. Through our HIV Advocacy Network, we're fighting to end the HIV epidemic and improve the lives of those most impacted. Join an upcoming meeting and discover how you can make a difference.
San Francisco can be the first city to reach zero new HIV diagnoses. But we won't get there without you. Together, we can make history — once again.
Tyler TerMeer, Ph.D., is CEO of San Francisco AIDS Foundation and co-chair of the AIDS United Public Policy Council. He is passionate about improving the health of people living with HIV, ensuring that LGBTQ+ people have access to affirming care, and supporting and empowering Black-led organizations and BIPOC leaders. Dr. TerMeer has been honored by the White House as one of the "Nation's Emerging LGBTQ+ Leaders," and as part of the "Nation's Emerging Black Leadership."
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