SF sees slight uptick in HIV cases as advocates fear funding cuts

New HIV diagnoses saw a slight uptick in San Francisco in 2024 and rose by about 1,000 cases nationwide in 2023, according to the latest surveillance reports from the San Francisco Department of Public Health and the Centers for Disease Control and Prevention.

These data, however, do not yet reflect the effects of the Trump administration’s recent cuts to federal health funding and staffing or proposed reductions in President Donald Trump’s so-called skinny budget released May 2. Advocates fear these cuts will soon lead to rising numbers for all sexually transmitted diseases.

“The drastic cuts to HIV public health and research programs proposed in the president’s budget would leave America’s HIV response in peril if enacted by Congress,” HIVMA chair Dr. Colleen Kelley said in a statement. “From small towns to big cities, every state across the country may lose lifesaving HIV prevention, testing, and research programs. The result will be more HIV infections nationwide, taking a devastating toll on health and the health care system.”  

San Francisco HIV trends
According to DPH’s 2024 Preliminary HIV Annual Surveillance Report, 145 new HIV diagnoses were reported through December 31, 2024. Despite a slight uptick from 139 cases in 2023, the numbers reflect a declining trend over the past two decades. These data are provisional, and a full analysis will be published in the final HIV Epidemiology Annual Report this fall.

Latinos accounted for the largest share of new cases in 2024 (32%), followed by Black people (28%) and white people (26%). These proportions have varied somewhat in recent years, but it is difficult to draw conclusions about racial/ethnic trends from small numbers. Perhaps more worrisome is a near doubling of diagnoses among cisgender women, from 13 to 25 cases. Still, cisgender men accounted for more than 75% of new diagnoses, compared with 17% for cisgender women and 6% for trans women.

“While new diagnoses have declined by 53% over the past 10 years, the pace of progress has slowed over the last several years, and challenges persist,” DPH said in a statement. “The rise in new diagnoses in cis women, the majority of whom are Black/African American, is a concerning trend.”

According to the preliminary report, 95% of people newly diagnosed with HIV in the first half of 2024 were linked to care within one month, and 81% achieved viral suppression on antiretroviral treatment within six months.

However, 82 people were diagnosed with AIDS in 2024 – including some who already had advanced disease when they first tested positive for HIV – showing that some are still not getting tested and starting treatment soon enough. People who inject drugs accounted for about 14% of all new HIV diagnoses but 28% of new AIDS diagnoses, according to the preliminary report.

The report notes that 15,395 people in the city were living with HIV and 226 people with diagnosed HIV died in 2024. Thanks to effective treatment, people with HIV are living longer, and around three-quarters of HIV-positive people in San Francisco are aged 50 or older, making them increasingly prone to death from other causes. Nonetheless, the number of deaths was the lowest recorded since the early years of the epidemic.

National numbers
Given recent disruptions at the CDC – including staff layoffs and communications blocks – the fate of this year’s national HIV surveillance update was uncertain, but the agency did release key findings on April 29.

According to the new data, 39,201 people were diagnosed with HIV in 2023, up from 37,981 in 2022. (CDC has a longer lag time than SF DPH, so 2023 data is the most recent available.)

Men accounted for more than 80% of new HIV cases, over half of newly diagnosed people lived in the South, 38% were Black, and more than a third were Latino. Two-thirds of the cases were attributed to male-to-male sexual contact and 6% to injection drug use. Women accounted for 19% of all new diagnoses. There is no mention of transgender people anywhere in the key findings, apparently in keeping with the federal government’s new mandate to root out “gender ideology.”

According to the report, nearly 1,133,000 adolescents and adults were living with diagnosed HIV in 2023, of whom 77% were men. Some 4,500 people died of HIV-related causes in 2023. (This is not comparable to the DPH mortality data, which includes deaths of HIV-positive people due to any cause.)

The CDC noted that publication of its full Surveillance Supplemental Report on estimated HIV incidence and prevalence has been delayed, and this year’s companion monitoring report on prevention and care objectives does not include PrEP coverage.

In 2024, the CDC paused PrEP reporting for a year to account for newly available data and to determine how best to present PrEP coverage, but the agency now says it is unable to resume PrEP coverage reporting at this time due to a reduction in force affecting the Division of HIV Prevention.

“As part of this staffing reduction, the DPH branches that produced HIV incidence estimates and provided the statistical expertise needed to assess PrEP coverage were eliminated,” according to a note accompanying the data summary. “CDC is currently evaluating plans and capacity to resume this work.”

Budget cuts feared
Advocates fear that the CDC’s inability to estimate HIV incidence and monitor PrEP coverage is just the tip of the iceberg, as Trump’s skinny budget proposal includes deep cuts to HIV and related programs.

As summarized by the HIV+Hepatitis Policy Institute, domestic HIV care and treatment programs appear to be largely preserved, but HIV prevention is left out. Most treatment-related components of the Ryan White HIV/AIDS Program would remain intact, but it could lose ancillary services such as dental care. AIDS housing programs are slated to take a hit. The fate of the Ending the HIV Epidemic initiative, launched during Trump’s first term, remains unclear. The budget proposal does not include CDC funding for HIV prevention, and it is not yet known whether this will be eliminated or moved to another part of the Department of Health and Human Services.

The budget also proposes to cut CDC funding for viral hepatitis, sexually transmitted infections and tuberculosis and shift responsibility to the states.

“We have already seen a dismantling of many domestic HIV programs with staff cuts, grant terminations, and offices shut down, and [the May 2] budget confirms the dangerous direction we are headed in,” HIV+Hepatitis Policy Institute Executive Director Carl Schmid, a gay man, stated. “We look forward to explaining to the Congress the critical federal role in addressing infectious diseases, such as HIV and hepatitis, and the serious implications and consequences to the health of our country if these programs are not adequately supported.”

In California, health officials in Los Angeles County last week terminated all 27 of its HIV and STD prevention contracts as of May 31 amid the federal funding cuts. They also have declared a community-wide outbreak of hepatitis A as there have been 165 cases since 2024, three times the number of cases reported in 2023.

As for the funding cuts to HIV service providers, it is estimated it will result in an average increase of 1,800 new HIV diagnoses per year over the next five years, more than doubling the diagnosis rate, noted APLA Health in an emailed policy update seeking support to save its funding. The HIV service provider noted that the county’s Division of HIV & STD Programs currently reports 1,400 new HIV diagnoses each year, down from 1,700 in 2020.

“If California’s prevention programs are shuttered, efforts to end the HIV epidemic in California will be stymied and the infrastructure that supports HIV prevention will be decimated. Any increase in new HIV infections will only cost the State of California more in the long run,” stressed APLA Health Chief Executive Officer Craig E. Thompson.

The service provider is part of a statewide coalition of more than 120 community-based organizations, including the San Francisco AIDS Foundation, calling on Governor Gavin Newsom and the state Legislature to allocate $60 million in state funding to cover HIV prevention cuts at the federal level.

“We are in an unprecedented situation with the drastic cuts to HIV, STI, and LGBTQ+ funding coming from the Trump administration,” said Jonathan Frochtzwajg, SFAF’s director of health justice policy. “We have made incredible progress in working towards ending the HIV epidemic in California, and we risk losing the fragile progress we have made over more than 40 years by dismantling and defunding our systems of prevention and care.”