HIV and STD report: new HIV diagnoses fall but COVID-19 sharply cut testing; congenital syphilis cases rose

San Francisco's HIV surveillance and STD teams told the Health Commission that long-term gains against HIV continue but COVID-19 threatens progress by constraining testing and prevention services. Ling Su, director of HIV surveillance, said the 2019 epidemiology report recorded 166 new HIV diagnoses in 2019, a 19% decline from 2018 and a 65% decline since 2010. She said an estimated 16,000 people are living with diagnosed HIV historically, and roughly 13,000 currently reside in San Francisco based on latest address data.

The report highlighted persistent disparities: Black residents and people experiencing homelessness remain overrepresented among new diagnoses and have worse care outcomes. Linkage-to-care within one month improved (to about 95% for those diagnosed in recent years) and rapid ART initiation rose, but viral suppression rates remain lower for several groups and particularly for people who inject drugs and people experiencing homelessness.

Dr. Scott (Getting to Zero) told commissioners COVID-19 has sharply disrupted testing and prevention: laboratory-based HIV testing across reporting labs fell sharply in April (about a 54% drop year-over-year) and community point-of-care testing experienced a peak decline of about 91% in April compared with 2019. Viral-load testing and clinic visits also dropped and have not fully rebounded; Ward 86 data showed the odds of being unsuppressed were about 30% higher post-shelter-in-place, with homelessness associated with larger declines in suppression.

Officials described mitigation steps. The department is expanding home-test pilots (Take Me Home), promoting low-barrier and pop-up testing targeted to neighborhoods with higher positivity, extending PrEP refills where clinically appropriate and piloting hospital-based PrEP initiation on discharge. Dr. Scott also described a new CDC five-year planning grant (Components A and C) worth roughly $2.7 million to support diagnosing, treating, tracing and scaling PrEP and other prevention efforts.

City Clinic and STD staff warned of testing-supply constraints: nucleic acid amplification test (NAAT) reagents for chlamydia and gonorrhea are in short supply nationally, so the public-health lab is prioritizing testing for high-risk groups and symptomatic people. That shortage, paired with reduced clinic visits, contributed to drops in reported STI testing.

The department flagged congenital syphilis as a rising concern. City presenters said congenital syphilis cases rose from zero in 2018 to four in 2019, and three additional cases occurred in the third quarter of the later reporting period. City STD teams have activated targeted responses including Team Lilly (a UCSF-linked prenatal outreach program), rapid syphilis testing in street-medicine settings, multidisciplinary case conferences to link pregnant people to care and penicillin treatment, and community outreach to at-risk populations.

Commissioners asked for more granular denominators for race/ethnicity testing rates and for follow-up reporting on reopening of youth CHPS clinics and progress on PrEP and testing recovery. Officials said they will return with updated analyses and timelines.