San Francisco reports sharp drop in new HIV diagnoses; gaps remain among homeless and people of color

San Francisco Department of Public Health officials reported Tuesday that new HIV diagnoses declined 16% in 2016 to 223 — the lowest number the city has recorded — and that several care metrics have improved, though deep disparities persist.

"New HIV diagnosis have continued to decline," Susan Shearer, director of the HIV epidemiology section, told the commission, citing improved linkage to care, faster time to treatment and rising viral suppression. Shearer said 93 percent of people living with HIV in San Francisco are aware of their status, a rate substantially higher than the national average.

The presentation detailed measurable gains: linkage to care within one month rose (Shearer moved the indicator from three months to one), time from care to treatment dropped from 30 days to six, and diagnosis-to-viral-suppression time fell from roughly five months to about two and a half months. For people diagnosed in 2016, viral suppression rates in early follow-up rose to 77 percent; overall, 73 percent of people living with HIV in the city are virally suppressed.

However, Shearer and Tracy Packer, director of Community Health Equity and Promotion and a leader in the Getting to 0 initiative, emphasized uneven outcomes. "The proportion of viral suppression among people who are homeless at their last housing status check was 31 percent," Shearer said, and African Americans and Latinos continue to experience higher rates of new diagnosis when adjusted for population size.

Packer described targeted interventions funded under Getting to 0: four new community PrEP programs that began in February to reach African American, Latino and young communities; pharmacy-delivered PrEP; rapid linkage hubs under the RAPID initiative; and enhanced case-management programs (LINCS) for re-engagement and retention. She reported an increase in PrEP starts citywide, from about 4,700 in 2014 to 12,500 in 2016, and cited early evidence that navigation and intensive case management improve suppression among hard-to-reach groups.

Commissioners pressed for methods and context. Shearer explained the 93 percent awareness figure is derived from national HIV behavioral surveillance surveys that test participants who report negative or unknown status, allowing estimation of undiagnosed infection. Commissioners and presenters also discussed small-number volatility in subgroups (for example, Asian/Pacific Islander counts that can ‘‘bounce around’’ due to low absolute numbers) and the need to focus on populations that are slower to decline in new diagnoses.

Public-health partners including the San Francisco AIDS Foundation applauded the funding shifts; Joe Hollendoner, the foundation’s CEO, said expanded PrEP and syringe-access investments are helping reach young African American men. National partners from the Centers for Disease Control and Prevention attended and described their support for integrated screening and targeted grants.

The commission asked staff to follow up with disaggregated data where possible — including separating Pacific Islander data from broader Asian categories — and to return with metrics from targeted pilots (for example, a locker pilot for homeless clients and pharmacy-based PrEP outcomes). The department said it will continue quarterly reporting on progress and on strategies to close racial, gender and housing-status gaps.