A longtime San Francisco Latino HIV/AIDS nonprofit is hanging on by a thread and has stopped providing direct services after losing city funding at the end of the last budget year. Meanwhile, preliminary data from city health officials shows the number of new HIV diagnoses among Latino men was down in 2023 in contrast to rising rates nationally.
Due to its funding loss AGUILAS has had to lay off all its employees except Executive Director Eduardo Morales, Ph.D., a gay man, and one other person, Morales told the Bay Area Reporter. It comes as recent public health reports show Latinos represent an outsize share of new federal HIV diagnoses but, in San Francisco, the community saw a dramatic decrease of 46% in new cases last year over 2022 figures.
San Francisco Department of Public Health funds stopped going to AGUILAS in 2023, as the B.A.R. previously reported, and earlier this year the city did not renew $200,000 the agency had received in Fiscal Year 2023-24 through the Mayor's Office of Housing and Community Development. AGUILAS has been involved in HIV prevention for 30 years, and is the only agency that offered all its services in English, Spanish, and Portuguese.
Morales said that he's applied for three grants — a one-year NBCUniversal Impact Grant, a federal Substance Abuse and Mental Health Services Administration grant, and a ViiV Health Care Foundation grant. He hasn't heard back regarding the first two grants, and a decision regarding the third will be rendered in October.
Morales stated August 30 AGUILAS will be vacating its office at the San Francisco LGBT Community Center. (The lease ends August 31 and the nonprofit can no longer afford to rent it.)
The agency is currently operating based on a UCSF subcontract, Morales said, and the good news is he heard August 28 that a UCSF study will provide $60,000 to AGUILAS from September 1 to August 31, 2025. Morales stated that "the study is targeting Latinx gay men in SF and Alameda counties since CDC have noted these are hot spots for HIV and will investigate the quality of the relationships study participants have with their primary provider."
Morales had stated August 27 that "AGUILAS is not providing any services."
"The subcontract from UCSF for their research project is totaled $49,500, which ends August 31, 2024," he stated, referring to the abovementioned funds. "That includes expenses for the steering committee, training, and consulting about sampling strategies for SF and Alameda counties. We expect a continued subcontract but I do not know the amount for after September 1."
Nationwide, new HIV diagnoses stayed roughly the same between 2018 and 2022 but increased 19% among Latinos, according to statistics from the Centers for Disease Control and Prevention. The data also showed that though Latinos and Hispanics make up less than 20% of Americans, they comprised about a third of new diagnoses in 2022. Black Americans, who comprise 14% of the U.S. population, had the most new diagnoses, though those numbers have decreased since 2018.
In San Francisco, the B.A.R. ran two special reports earlier this year on the fact that 2022 was the first time Latino men made up the highest rate of new HIV diagnoses in the city. Latinos were the only racial or ethnic group to see an increase in new cases, and among cis men the rate of diagnoses surpassed all other racial or ethnic groups measured — even as AGUILAS received cuts in 2023.
But the city is touting that 2023 seems to have been a better year, according to an HIV semi-annual surveillance report issued earlier this month, which saw the number of Latinos in San Francisco testing positive for HIV decline 46% from 2022 to 2023, from 74 to 40. (The health department stated these numbers are preliminary and may increase due to reporting delays. It is expected to release the annual HIV surveillance report for 2023 later this year.)
According to the report, as of the end of 2023, there were 3,042 Latino cisgender men living with HIV in San Francisco. An additional 219 Latina cis women and 161 Latina transgender women were also living with HIV per the city data.
National numbers up in 2022
Carl Schmid, a gay man who is executive director of the Washington, D.C.-based HIV+Hepatitis Policy Institute, told the B.A.R. in a phone interview that nationally "it's gay men and younger people in particular" who are being affected, and that "you have to look at how funding is allocated in each jurisdiction" to see if it's being effective.
The Ryan White Comprehensive AIDS Resources Emergency Act is the federal program to provide funds to the states and local municipalities for uninsured, under-insured, and low-income people with HIV. These block grants are intended to give jurisdictions the ability to be more flexible.
Schmid pointed out something advocates had in the B.A.R.'s reports earlier this year — lack of access to insurance and, thus, lower PrEP uptake.
PrEP, or pre-exposure prophylaxis, refers to the use of antiviral drugs to prevent people exposed to HIV from becoming infected. The pill Truvada was first approved for PrEP use in 2012 by the U.S. Food and Drug Administration; since then the FDA has also approved the pill Descovy for some groups and the drug Apretude as an injectable treatment. As the B.A.R. previously reported, there are large disparities of usage between whites, on the one hand, and Blacks and Latinos, on the other.
"You need to look at PrEP stats, too: that they are lower for Latinos as well," Schmid said. "Among all Latino gay men, 46% of all new infections were ages 25-34; 19% were ages 13-24. ... There's a lot of barriers to PrEP, insurance barriers, but we really need to be focusing more outreach for our PrEP programs in the Latino community. This is, I feel, an overlooked problem."
Jorge Zepeda, director of Latine Health Services for the San Francisco AIDS Foundation, stated to the B.A.R. that the CDC findings "underscore the critical need for intensified efforts to address the disproportionate inequities in HIV prevention, treatment, and care that disproportionately impact Latine individuals."
(In Latin America, "Latine" has been lifted up as an alternative to "Latinx" as a gender-neutral alternative to Latino. "Latinx" has been criticized, in part, because the Spanish language does not have an "x" suffix.)
"At San Francisco AIDS Foundation, we are dedicated to supporting Latine individuals, regardless of their immigration status, income level, or cultural background," Zepeda stated. "Our programs and services are thoughtfully tailored to meet the unique needs of this diverse community. We offer practical support, culturally centered and linguistically inclusive spaces for accessing services, and targeted interventions that directly address the health challenges faced by Latine individuals living with or affected by HIV."
A 'snapshot'
Morales said in a phone interview that the lower numbers among Latinos in San Francisco isn't necessarily indicative of a change in tide.
"I don't know; that's just one snapshot," he said, adding that the health department "doesn't break out" the population into smaller populations, which would be helpful for health experts to figure out why the numbers went down.
"The change might be an anomaly," he said. "It could be a lot of people have left the city. The numbers are very small."
Morales also pointed out that before coming down, the numbers had risen.
"If it goes up for 10 years and there's a snapshot where it goes down ... the next time it could go up again," he said.
Asked about Morales' comments, the San Francisco Department of Public Health stated that it doesn't see eye-to-eye with his doubts.
"We believe that our comprehensive HIV prevention, testing and treatment services, along with the combined efforts of academic, health system and community partners, has contributed to these declines," a spokesperson stated August 30. "SFDPH is currently evaluating the data, and a full analysis will be published as part of the 2023 HIV annual report this fall."
Earlier, on August 23, the department had given a more general statement about the preliminary report.
"The decline among Latinx individuals is [a] notable change from the prior year, which saw a 17% increase in HIV diagnoses among Latinx individuals from 63 in 2021 to 74 in 2022," a spokesperson stated. "While the decline in HIV diagnoses is encouraging, we still have work to do to address the ongoing disparities in HIV rates among Black/African Americans and Latinx individuals."
Tyler TerMeer, Ph.D., a gay man living with HIV who is the CEO of the AIDS foundation, stated to the B.A.R. that "the decline in new HIV cases among Latine people in San Francisco is an encouraging sign that our prevention and treatment efforts are having a positive impact."
TerMeer noted that "there has been no decline in new HIV cases among Black and African American individuals from 2022 to 2023, underscoring the persistent inequities that disproportionately impact Black communities."
He continued that "while this local progress is promising," the federal numbers are cause for concern.
"While we are encouraged by the strides made in reducing new HIV cases among Latine people locally, we remain committed to ensuring that these advancements extend to all communities, particularly those that are most at risk," he stated. "We must continue to address the systemic barriers that contribute to these disparities and invest in comprehensive strategies that provide equitable access to prevention, care, and support services for everyone in San Francisco. We are dedicated to achieving a future where HIV transmission is eliminated for all San Franciscans."
Updated, 9/3/24: This article has been updated with additional comments from the health department.
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