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San Francisco officials report progress on 'Getting to 0' HIV initiative but warn of persistent disparities
Summary
Health Department presenters told the commission the Getting to 0 consortium has driven steep declines in new HIV diagnoses and faster linkage-to-care, but officials cautioned that African American and Latino men and some women continue to experience higher rates and that retention in care remains a major gap.
San Francisco Department of Public Health officials briefed the Health Commission on the Getting to 0 initiative, saying the multi‑sector consortium is targeting three goals: zero new HIV infections, zero HIV‑related deaths and zero stigma.
"We could be the first jurisdiction to reach those goals," Susan Buckbinder of Bridge HIV told commissioners, presenting surveillance trends that show a sharper decline in new diagnoses in San Francisco than the national average. Buckbinder said the city has seen its steepest declines since 2012 and that efforts span public health units, clinical providers, community organizations and academic partners.
Tracy Packer, from Community Health Equity and Promotion, described four signature initiatives: a citywide, coordinated PrEP program; rapid access to antiretroviral therapy via treatment hubs (defined as access within five days of diagnosis); stronger linkage, engagement and retention programs; and stigma‑reduction efforts. "We define rapid as people having access to treatment within 5 days of their diagnosis," Packer said, describing newly funded 'RAPID' hubs and detailing a pharmacy‑delivered PrEP pilot and an emergency youth PrEP supply that has enrolled 10 patients aged 16 to 20.
Presenters highlighted measurable gains: faster linkage and treatment timelines, and higher rates of viral suppression in several clinic networks. Buckbinder and Packer emphasized, however, that the improvements are uneven: African American men and Latino men remain disproportionately affected, and African American women show notably high diagnosis rates relative to their population size. Commission materials showed that, while overall new diagnoses declined citywide, particular subgroups lag behind in early diagnosis and retention.
Commissioners pressed presenters on measurement and next steps. Commissioners asked whether stigma is being tracked; Buckbinder said stigma metrics are new and that a stigma‑metrics group is integrating stigma questions into community surveys so trends can be reported in future updates. On retention, presenters said it remains the primary shortfall; programs like intensive case management, medication lockers and a cell‑phone reminder pilot are being deployed to re‑engage people who fall out of care. Packer said the initiative is working regionally with Alameda, Marin and San Mateo counties to align testing and linkage practices.
The presenters said the consortium intends to report updated annual surveillance numbers later in the summer or early fall and welcomed commission input on additional metrics. The presentation concluded with requests from commissioners for further analyses (including flow or cascade analyses) to identify the specific steps in which people are lost from diagnosis to sustained viral suppression.
