SFDPH reports steady HIV declines but persistent disparities; announces $2M/year CDC grant and rapid STD-testing pilot

San Francisco Department of Public Health staff told the Health Commission that while overall HIV indicators have improved, several groups are not seeing comparable declines and require targeted efforts.

"Ninety-four percent of people living with HIV in San Francisco are aware of their infection," said Susan Shearer, director of HIV epidemiology, citing the latest surveillance data and noting that the figure compares with roughly 86 percent nationally. Shearer reported a continuing decline in new diagnoses to a reported 221 cases, the lowest number on record, and roughly 16,000 people living with HIV in the city. She detailed improvements along the care cascade: linkage to care has risen to about 83 percent, retention around 71 percent, and 85 percent of those newly diagnosed achieve viral suppression within a year.

But the improvements are uneven. Shearer and colleagues highlighted six populations with flat or rising diagnoses in recent years: African Americans, Asians, women, people who inject drugs, men who have sex with men (MSM) who inject drugs, and people experiencing homelessness. "The homeless population has a very, very poor rate of viral suppression at 32 percent," Shearer said, and noted that homeless cases are disproportionately young and have intersecting vulnerabilities.

Susan Buckbinder of the Getting to 0 steering committee described the programs four pillars: expand PrEP, rapid same-day treatment (RAPID), reengagement and retention in care, and stigma reduction through campaigns such as U=U (undetectable equals untransmittable). Tracy Packer announced that San Francisco won a competitive CDC grant (Project OPT IN) that will provide $2,000,000 annually for four years to reach people who are homeless or disconnected and to integrate HIV, hepatitis C and STD services.

Nicole Trainer described expanded PrEP delivery strategies, including pharmacy-provided same-day PrEP at Mission Wellness Pharmacy. Launched in February, the pharmacy reported 12 PrEP starts to date, seven of them among priority populations. Trainer also reported that the PrEP network recorded over 1,300 starts (513 from community-based sites and 879 from clinical sites), with priority-population counts including 133 Black MSM, 376 Latino MSM, 214 young MSM and 53 trans women.

On STDs, Dr. Susan Phillip said that chlamydia, gonorrhea and syphilis are rising and stressed the need to prioritize congenital syphilis prevention. She and City Clinic staff described a pilot that provides a 90-minute gonorrhea/chlamydia test at the point of care; in early evaluation, 92 percent of patients who tested positive received same-day treatment. City Clinic and public-health laboratory staff said they are exploring extending that rapid testing capability to jail health settings to reduce untreated infections among people who are released before conventional lab results return.

Commissioners asked about race/ethnicity breakdowns for STD trends, the relationship between incarceration and transmission, and jail-based screening and treatment capacity. Staff said race/ethnicity analyses are available and that jail screening is constrained when people are released before results come back; they described ongoing efforts to pilot point-of-care testing in jails and increase linkage to care.

The commission thanked staff for the comprehensive presentation and asked staff and network partners to return with follow-up data as interventions scale.