Getting to Zero San Francisco Consortium Zero new HIV infections Zero HIV deaths Zero stigma and discrimination
Agenda 1. Welcome, Acknowledgements & Overview 2. In Memoriam 3. Policy & Legislative Update 4. GTZ-SF looking back to move forward 5. Panel & Community Discussion: Promoting Black/African-American Health Equity: Addressing Racism & Institutional Bias
Getting to Zero San Francisco: Multi-sector independent consortium, operating under principles of collective impact: “Long-term commitment of groups from different sectors to a common agenda to solve a specific social problem.” • Improve HIV outcomes 2014 for persons living with disease and at risk in San Francisco • Secure funding and broad city/private sector support for gaps • Create innovative programs • Exchange best practices with other cities
In Memoriam
Policy Update Courtney Mulhern-Pearson, MPH November 29, 2018 SAN FRANCISCO AIDS FOUNDATION //
Agenda 1 Proposition C – next steps and implementation 2 California’s End the HIV, HCV and STD Epidemics project SAN FRANCISCO AIDS FOUNDATION // 2
Update on Proposition C SAN FRANCISCO AIDS FOUNDATION //
An overview of proposition C SAN FRANCISCO AIDS FOUNDATION // 4
Proposition C – results and implementation • Proposition C passed in November with 61 percent of the vote – This is enough to meet the simple majority requirement but not enough to pass the two- thirds threshold – In August 2017, the CA Supreme Court ruled (5-2) that ballot measures that raise taxes for a specific purpose only require simple majority to pass when placed on the ballot via citizens’ initiative – June’s Prop C and Prop G were the first measures to be passed after this ruling and C is being challenged in court – San Francisco City Attorney Dennis Herrera will proactively file a validation lawsuit for November’s Proposition C – Mayor London Breed introduced an ordinance to allow this to happen – The city will begin collecting the tax starting in January but the City Controller has said SF cannot begin spending the funds until the legal issues are resolved – In the meantime, the collected money will sit in reserve – Advocates are continuing to work on implementation planning, including recommendations for the oversight committee SAN FRANCISCO AIDS FOUNDATION // 5
Prop C: Lessons Learned & Next Steps event on Dec 5 • Please join us for Prop C: Lessons Learned & Next Steps. • When: Wednesday, December 5th. Doors open at 5:30pm and program begins at 6pm. • Where: Glide, 330 Ellis St., Freedom Hall • What: A presentation and panel discussion about Prop C lessons learned, next steps, and how to stay involved. • RSVP and share the event on Facebook SAN FRANCISCO AIDS FOUNDATION // 6
End the Epidemics Project SAN FRANCISCO AIDS FOUNDATION //
Statewide End the Epidemics project • Over the past several months, 85 public health and community leaders from across the state have come together and formed a coalition—End the Epidemics: Californians Mobilizing to End HIV, HCV, and STDs • The ETE coalition is now ready to release a statement that urges Governor-elect Newsom and the CA Legislature to implement a statewide strategy to end the HIV, HCV, and STD epidemics • Governor-elect Newsom endorsed the idea of creating a statewide HIV and HCV strategy during the campaign SAN FRANCISCO AIDS FOUNDATION // 8
ETE Goals • The ETE coalition has identified six goals for the strategy: 1. Increase the number of people living with HIV, HCV, and STDs who are aware of their status; 2. Increase access to comprehensive HIV, HCV, and STD prevention services; 3. Ensure linkage to and retention in culturally competent, quality health care for everyone living with and vulnerable to HIV, HCV, and STDs; 4. Increase training and capacity building to strengthen and integrate the HIV, HCV and STD provider workforce; 5. Address social determinants of health that impact people living with at increased risk for HIV, HCV, and STDs; 6. Develop and track metrics to assess progress toward ending the HIV, HCV, and STD epidemics. SAN FRANCISCO AIDS FOUNDATION // 9
ETE – next steps • The End the Epidemics coalition has drafted community consensus statement which: – Outlines the need for a comprehensive strategy to address the HIV and HCV epidemics as well as the state’s alarming epidemic of STDs – Calls on Governor-elect Newsom and the California Legislature to launch this effort as soon as possible, by convening a high-level working group of key stakeholders to develop and implement a strategy to end the HIV, HCV, and STD epidemics • The statement will be circulated for organizational sign-on next week • SFAF will be collecting individual sign-ons – text SFAF to 52886 to receive updates SAN FRANCISCO AIDS FOUNDATION // 10
SAN FRANCISCO AIDS FOUNDATION //
Getting to Zero San Francisco Consortium: Looking back to move forward
Getting to Zero San Francisco Mission & Vision Mission Zero new HIV infections Zero HIV deaths Zero HIV stigma & discrimination Vision Become the first municipal jurisdiction in the United States to achieve the UNAIDS vision of “ Getting to Zero ”
Strategic priorities for San Francisco Getting to Zero Consortium Rapid ART Linkage- City-wide Reducing Adolescent start with engagement- coordinated HIV & Young treatment retention in PrEP stigma Adult hubs care program Committee for each initiative is developing action plan, metrics and milestones. Linkage to care Drug user Mental health/ Substance Primary care Treatment as and partner health use/Housing as HIV prevention HIV screening prevention services (LINCS) Syringe Health ed/risk STD testing & Prevention HIV testing access reduction treatment with positives 9
PrEP
PrEP Uptake Citywide
RAPID: Better treatment, better Dissemination of Rapid Protocol prevention Dissemination Rationale Expedited (same day) linkage and ART start: • Reduces HIV illness and death • Reduces transmission • Empowers patient for disclosure Started as pilot at ZSFG hospital, GTZ expanded RAPID citywide
RAPID Outcomes & Global Dissemination • RAPID citywide • Rapid protocol taken up outcomes: by many organizations, locations, including: – Time from first medical visit to ART start: 0 days! – US CDC – Time from HIV diagnosis – New York City, to viral suppression: 66 Philadelphia, Atlanta, and days (decreased 54% in others last 3 years) – Central America – Thailand – Netherlands – Uganda, Kenya
Retention & Re-engagement Other initiatives: • Intensive case management • Food security • Employment services • Frontline Organizing Group • Cell phone charging stations Expanded LINCS : L inkage I ntegration, N avigation, C omprehensive S ervices
Improvements in Viral Suppression 100% 90% Percent virally suppressed 77% 75% 80% 68% 65% 70% 60% 50% 40% 30% 20% 10% 0% 2012 2013 2014 2015
Where we are heading into 2019 Nearly 16,000 PLWH in 800 20000 Living HIV cases • SF New HIV diagnoses Number of New HIV Diagnoses/Deaths 700 New diagnoses • 14,446 14,654 14,912 15,129 15,345 15,534 15,755 15,888 15,962 15,978 15,975 15,952 decreased 52% last 5 600 15000 years but only 5% Number of Living Cases 532 533 523 between 2016-2017 471 500 462 Number of deaths is 458 • 424 level 394 400 10000 Survival is improving; • 315 65% of PLWH >50yrs 272 300 327 325 Late diagnoses declined 233 • 244 from 21% in 2012 to 265 261 256 254 246 200 5000 241 237 221 235 236 11% in 2016 178 159 Number of HIV-related • 100 133 125 106 104 103 101 99 deaths has decreased 84 77 78 by 56% from 178 in 0 0 2006 to 78 in 2017 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year 16
BUT, DISPARITIES REMAIN
New diagnoses by race/ethnicity in men 2017 • Rates highest in Black MSM and not declining in past year • Latino men also higher rates
New diagnoses in SF highlight disparities 2017 100% 86% 90% PWID now 80% make up 25% Trans women: 70% 60% of new small % but 60% diagnoses dis- 50% proportionate 40% 30% 14% 20% 12% 11% 8% 6% 10% 2% 0%
PrEP uptake for eligibles lags behind for African Americans San Francisco City Clinic, 2014-2017 60 Percent of MSM eligible for PrEP 50 49.2 47.5 50 43.2 40 37.4 36 34.2 31 27.9 30 24.5 22.6 21.2 20 11.8 11.4 9.2 8.4 10 0 African American Latino White Asian 2014 2015 2016 2017
Rates of viral suppression lowest in Rates of viral suppression homeless (32%) lower in cis- and transgender women, people of color, youth, PWID
Priorities for 2019 for all committees • Homeless/marginally housed • People who inject drugs • Integrating interventions for HIV with STI/HCV prevention and treatment • Racial and economic justice
African-Americans make up 5.4% of the SF population, 14% of PLWH, and 26% of Homeless PLWH PEOPLE LIVING WITH HIV HOMELESS LIVING WITH HIV African American African Other Other 14% American Asian Asian 4% 8% 10% 26% 3% Latinx 24% White Latinx 43% White 20% 48%
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