Editorial: Communities should lead fight against HIV/AIDS

  • by BAR Editorial Board
  • Tuesday November 21, 2023
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This year's UNAIDS theme for World AIDS Day is "Let Communities Lead." Image: Courtesy UNAIDS
This year's UNAIDS theme for World AIDS Day is "Let Communities Lead." Image: Courtesy UNAIDS

The theme for the 35th annual World AIDS Day coming up on December 1 is "Let Communities Lead." This theme is important for what it represents: the idea that local communities across the world know what works for them. Governments must, of course, continue to provide robust funding, but in a way that really lets communities dictate the goals and outcomes that flow from that funding.

Here are some ideas about how that might work.


We've been reporting for years on what researchers have long seen as major racial and ethnic disparities in PrEP usage. Recently, the federal Centers for Disease Control and Prevention released new research that — surprise — continues to show such disparities, especially among Black and Latino men who have sex with men. As a result, Black and Latino gay and bisexual men are not seeing the same improvements in reducing HIV rates and increasing PrEP usage as their white counterparts. We know that racism and stigma continue to play a part in this puzzle, but there continues to be the need for more outreach, particularly on social media as that's where so many younger people get their information. TV commercials for PrEP — featuring people of color in them — have been seen widely in the Bay Area. These, too, need to be expanded to more markets, particularly in rural parts of the country.

Tatyana Moaton, Ph.D., the director of strategic innovations and partnerships at the San Francisco Community Health Center, told us that a multifaceted approach is needed and that's right. Awareness of PrEP needs to be revitalized in minority communities, along with improving access to health care. To this end, federal and state governments must fund programs that can enable local organizations to ramp up their efforts and amplify their impact, as Moaton noted.

Brian Ragas, director of Black health at the San Francisco AIDS Foundation, pointed to racism and stigma as two major barriers. Carl Schmid, executive director of the Washington, D.C.-based HIV + Hepatitis Policy Institute, concurred, and also noted that protecting federal funding for community health centers is critical. House Republicans want to decimate such federal spending, though there is a slight reprieve now as Congress has passed another continuing resolution to keep the government funded. At some point, however, Congress will need to advance the 12 appropriations bills to keep the government funded. Right now, the Republicans' plan calls for a "laddered" approach whereby four federal agencies are funded through January 19, and eight are funded through February 2.

In our article, we report that the San Francisco Department of Public Health has created media campaigns to reach out to the Black and Latino communities. That's a positive development and one that should continue. These public service announcements need to be seen far and wide — and yes, that will cost money, but it's crucial that non-white men who have sex with men learn how to avail themselves of PrEP.

Expand harm reduction

The politics in San Francisco right now are such that Mayor London Breed, gay District 6 Supervisor Matt Dorsey, and others want to return to the bad old days of stigma and the War on Drugs. Breed wants to make public assistance contingent on someone having a clean drug test. Dorsey this summer floated an idea that would see drug users jailed, getting services for their addictions behind bars. To do this, he proposed reallocating the city's entire budget— $18.9 million over two years — from planned Wellness Hubs to Jail Health Services. That's not progress; that's regression.

These proposals are being bandied about because the public is fed up with ongoing issues of homelessness and mental health crises suffered by many people on the streets — and Breed faces a tough reelection next year. Meanwhile, the Department of Public Health's HIV report for 2021 that was issued last year showed, for the first time, that gay and bisexual men who don't inject drugs accounted for less than half of new HIV cases in San Francisco. According to the report, gay and bisexual men who did not inject drugs accounted for 49% of new HIV cases in 2021. That means disparities exist among those who are unhoused and inject drugs. For some of them, harm reduction — where case workers and other staff meet a drug user where they are and try to determine if they are ready to take steps to curb their addiction — is a valid, well-researched intervention that could help them get on treatment if they test positive, or get them on PrEP if they are negative. This is preferable to seeing people further stigmatized by being cut off from public assistance or jailed for using drugs.

As for the three Wellness Hubs the city has budgeted for this fiscal year — in the South of Market, Mission, and Tenderloin — they still are not up and running and that's an indictment on the bureaucratic mess that is San Francisco government. The bottom line, however, is that these centers need to get operational and provide harm reduction services such as clean needles and counseling. Once that happens, city officials can determine if the outcomes are effective and move forward.

Reducing HIV

San Francisco saw 160 new HIV cases in 2021 (the figures for 2022 are expected in December). That was up from 138 in 2020 and remains too high for a city like San Francisco that pioneered a model of care that has been extremely effective in many ways. The problem now is that there is not enough funding for community HIV/AIDS nonprofits and city health clinics to broaden their services to ease some of these stubborn disparities. We'd add that drug companies, too, bear some of the burden to lower costs so that more people can utilize PrEP in its various forms, including a longer-acting injectable that only needs to be administered every other month that might be a game-changer for those experiencing housing insecurity.

As AIDS enters its 43rd year there is still no cure. But there are excellent preventative medications for which access must be expanded to those who for too long have been unable to get them. The disparities in accessing HIV prevention must be addressed, and community groups are in perhaps the best position to do that. What they need is stable funding to be able to do their work.

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